Concessions to moderates would make it difficult for urban clinics to obtain federal money.
When the House of Representatives last week passed legislation lifting a 21-year-old prohibition on federal funding for needle exchange programs, some ban critics cheered the move as a long step toward curbing the spread of blood-borne diseases like HIV. Yet the proposal moving through Congress, according to many health and human rights advocates, has been diluted to the point that it won’t help the same urban areas most afflicted by those illnesses.
“It’s too restrictive,” said Allan Clear, executive director of the Harm Reduction Coalition, an advocacy group. “You couldn’t open a program in Washington, D.C. — or most any urban area — with these restrictions.”
That’s because the House bill, while repealing the ban on federal money for needle exchanges, also prohibits such programs from operating within 1,000 feet of schools, daycare centers and other areas where children are likely to congregate. The sponsor of the 1,000-foot stipulation, House Appropriations Chairman David Obey (D-Wis.), included the restriction, not because he supports it, but to appease conservative critics who might have killed the entire provision otherwise. Yet needle exchange supporters argue that the geographic restraints are so expansive that they’ll neuter most benefits that would come with allowing federal funding of clean-needle programs.
“As a practical matter, you won’t be able to have needle exchange in the city,” said Rebecca Schleifer, advocate for the health and human rights division at Human Rights Watch. “There are schools and daycare centers everywhere.” The restrictions, she added, make the bill “meaningless as a practical matter, even if it’s important as a symbolic matter.”
The debate over needle exchange programs cuts largely along party lines, with Democrats touting the health benefits associated with providing access to clean syringes and Republicans blasting the thought of the taxpayers abetting illegal drug use. On the House floor before last week’s vote, Obey cited “overwhelming evidence that we can help stop the spread of AIDS by allowing needle exchange programs.” Rep. Todd Tiahrt (R-Kan.) countered with the argument that drug users are “dependent on a lifestyle that only leads to destruction, and … I personally don’t want to be part of that destruction.”
A long list of public health organizations — including the National Institute of Medicine, the Centers for Disease Control and Prevention, the World Health Organization and the American Public Health Association — have sided with Obey. A 2004 WHO report, for example, found that the evidence to support the effectiveness of needle exchange programs to reduce the spread of HIV “must be regarded as overwhelming.”
On the campaign trail, President Obama had run on a platform of repealing the ban on federal funding for needle exchange programs, which has been in effect since 1988. But since taking the White House, the signals from Obama have been more mixed. The administration, for example, fought a United Nations resolution endorsing “harm reduction” measures, including needle exchange, as a way to mitigate the damaging health effects associated with illegal drug use. The U.S. representative to the U.N. said at the time that the administration supports needle exchange, but not some of the other programs falling under harm reduction’s umbrella, including safe injection facilities. Yet when the White House unveiled its 2010 budget blueprint a few weeks later, the ban on federal needle exchange funding remained.
The White House did not return a call for comment.
House Democrats picked up the issue where the administration didn’t, with Obey trumpeting his repeal of the funding ban as part of the funding bill for the Labor and Health and Human Services Departments. But to ensure that the repeal survived the process, Obey watered it down. Aside from schools and daycare centers, the bill also prohibits needle exchanges within 1,000 feet of universities, pools, parks, video arcades “or an event sponsored by any such entity.”
“In an urban environment, that really is a restriction on almost anywhere,” said William McColl, political director for AIDS Action. If the bill is enacted as it stands, he added, “it would preclude the use of needle exchange in the areas that need it most.”
The proposal, which doesn’t earmark any funding for needle exchange programs, passed the House last Friday by a vote of 264 to 153. The Senate’s version of the Labor-HHS funding bill, which passed the Senate Appropriations Committee Thursday, retains the needle-funding ban. Needle exchange supporters on and off Capitol Hill are hoping to remove the geographic restrictions when the two chambers meet to hash out the differences between the two bills — a process that won’t arrive until September, at the earliest.
In the eyes of needle exchange opponents, the longer the wait the better. David Evans, special advisor to the Drug Free America Foundation, argued that federal funding for needle exchange programs would “set the tone” that illegal drug use is OK. Furthermore, Evans said, drug users are much more likely to die from something like overdose than they are to die of HIV/AIDS “Giving people needles is not going to address the overdose problem,” Evans said. “It’s just going to encourage it, frankly.”
Evans cited a 2001 study which found that needle users in Baltimore were more likely to contract HIV from sexual activity than from dirty needles. The argument over needle exchange on Capitol Hill, he added, “is really a debate on the studies.”
Health and human rights advocates are hopeful that the Obama administration will put its weight behind lifting the needle-funding ban. As some indication that it’s leaning in that direction, the White House nominated former Seattle police chief Gil Kerlikowske to be the country’s point-man on drug policy. Despite his law-enforcement background, Kerlikowske has a long history of treating drug addiction as an illness to be treated rather than a crime to be punished. Indeed, in a written response to lawmakers during his confirmation process, Kerlikowske trumpeted the virtues of needle exchange programs to fight needle-borne illnesses.
“Needle exchange programs have been proven to reduce the transmission of blood borne diseases,” he wrote. “A number of studies conducted in the U.S. have shown needle exchange programs do not increase drug use.”
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