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The Debate
www.avert.org
Though studies have shown their effectiveness and that NEPs do not cause problems for other segments of society,4 there are still many opponents of needle exchange. Since the beginning of the focus on the worldwide crack-cocaine epidemic in the mid-1980s, there has been a focus on “harm reduction” with regard to the drug problem. Harm reduction is a social policy that prioritizes the negative effects of drug use. Abstinence is seen as the most effective avoidance of such problems, but not the only solution. Within this approach, many societies have come to accept drug treatment programs and “zero tolerance” as the only socially acceptable ways of dealing with drug addiction.5 Since it is not practical to believe that the end of illicit drug use is near, many now think that instead of wiping out the problem, the risk involved with the behaviors should be reduced. It is as a result of “risk reduction” that the controversy over SEPs on moral grounds exists. Societies and governments fear that by providing sterile needles they would be “condoning” drug use and therefore non-users would be encouraged to take up the habit; opponents stand in staunch support of the “zero tolerance” policy. Nevertheless, it was found that NEPs did not lead to increased drug use, but instead the same level or even less usage: “’Harm reduction’ gathered increasing support as a public health framework of the AIDS era…an urgent switch from a preoccupation with reducing drug consumption…to an overarching aim of reducing drug-related harm.”3 Time and time again it has been found that NEPs do not encourage drug use among participants nor do they aid in the recruitment of first-time IDUs.4 In addition to the social perspective, treating a person with AIDS is a great financial burden, so there is “the potential that averting HIV infection through harm reduction measures will benefit non-participants and society by reducing health care costs.”8 With both social and economic benefits and costs considered, NEPs significantly and cost-effectively reduce needle sharing and HIV infection without negative consequences for society. New Jersey state legislator Joseph J. Roberts, Jr. was justified in stating that, “The experiences of other states that repealed prescription-only syringe sales or instituted syringe exchange programs further underscore how New Jersey could benefit from a more tolerant approach to syringe access. Statistical analyses...show that New Jersey’s infectious-disease rates would drop precipitously.”9
Different cities in the United States have adopted different types of needle exchange programs to accommodate each city’s unique resources and needs. Due to the fact that initial reports failed to allay societal concerns that NEPs were not “socially acceptable”, an evaluation of the advantages, disadvantages, and effectiveness of NEPs in four cities was done.10 The study evaluated syringe reuse, instead of sharing, because reuse is a good measure of whether the NEPs were increasing the availability of syringes. The NEPs, conducted in San Francisco, Chicago, Baltimore, and New Haven, were operated in different locations, either at fixed sites or a mobile van, and with different policies, such as one-to-one exchange or exchange limits per visit. Yet, all were found to successfully accomplish their goal. The results obtained provide striking support for the creation of new NEPs. In San Francisco, the percentage of users who reported using their syringes more than once fell by 21.1% while the percentage of users who reported using syringes only once rose significantly. Meanwhile, in Chicago, the percentage of participants who reported one-time use of syringes rose from 6.4% before the exchange to 74.2% after the program began. The study was done over the course of many months, and thus it was found that the changes were maintained overtime. The comparison of different types of sites and different methods provides convincing support that NEPs should continue to operate and that new NEPs should be established in other cities with IDU-HIV transmission problems.10
