OBAMA'S HIV FIX: SYRINGE EXCHANGE IS A MAJOR COMPONENT

What if we had a mechanism that stopped the spread of HIV that experts
had speculated would work even before the cause of AIDS had been
identified and that subsequent scientific enquiry confirmed was
effective? We do, that mechanism is syringe exchange. What if we had
national governments dating back to President Ronald Reagan that knew
what worked and yet fought against it, lied to the public, bullied
local governments and generally saw the spread of HIV as justified,
purely because the population that was affected was drug users, and
drug use is addressed in the United States by making it as dangerous
as possible?

What if men, women and children had been needlessly infected with HIV
purely to teach them the "evil of their ways?" And what if we knew
that the majority of these people were African American or Latino?
Sadly, this is an exact description of the political response to
syringe exchange and to the HIV epidemic among injection-drug users in
the United States.

A ban on syringe exchange has existed in the United States since 1988,
when Congress prohibited funding to support syringe exchange. In order
to overturn the ban, it had been incumbent on the surgeon general to
determine that syringe exchange prevents the spread of HIV and does
not increase drug use. Evidence to support these conditions has been
met repeatedly.

In 1998, under President Bill Clinton, Secretary of Health and Human
Services Donna Shalala certified scientific evidence in support of
syringe exchange as a valid public-health intervention, however
Clinton did not act to have the ban lifted. The irony is that because
of the ban, syringe-exchange research exists in abundance, and it is
irrefutable that it is an effective means to stop the spread of HIV.

Not only is syringe exchange effective in halting the transmission of
HIV, evidence from New York demonstrates that hepatitis C (HCV)
transmission rates among injection-drug users can also be
significantly lowered. The incidence of HCV infection among drug
injectors has begun to drop from 80 percent to below 40 percent among
newer injectors.

Harm-reduction services, such as syringe exchange, promote the
prevention of HCV, as well as make medical treatment and social
services more readily available to people who are living with HCV. The
maintenance of the ban on syringe exchange callously excludes drug
users from receiving essential prevention-and-intervention services
and carries a symbolic dimension that delegitimizes syringe exchange
and undermines public health advocacy efforts.

Regardless of how one might feel about drug users, syringe exchange is
effective, is essential and there is momentum for change.

During the recent presidential campaign, each of the Democratic
candidates endorsed removing the federal ban during their term in
office. One of the candidates was elected president, and another was
appointed secretary of state. President-elect Barack Obama's HIV
platform says he will "support legislation that would lift the ban on
federal funding for syringe exchange as a strategy to reduce HIV
transmission among injection-drug users and their partners and
children." On Jan. 6, 2009, Bronx Democratic Congressman Jose Serrano,
along with 28 sponsors, introduced into Congress a bill -- HR 179, the
Community AIDS and Hepatitis Prevention Act of 2009 -- to lift the
ban.

The time to act is now. We need to call and to write our congressional
members. We need to insist that the United States joins the rank of
syringe-exchange-enlightened countries such as Australia, Holland,
Canada, the U.K., Iran (yes, Iran), Moldova, and others. The damage
that has been wreaked over the last 20 years cannot be undone, but a
new direction can be forged. It is imperative that we participate in
cultivating a new course of action and participate in the righting of
wrongs.

Help lift the federal ban on the funding of syringe exchange.

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