Implications of the Lifting of the Federal Ban on Syringe Exchange Texas Department of State Health Services HIV/STD Confe...
Epidemiological Context <ul><li>Approximately one million injection drug users in the U.S. </li></ul><ul><li>Sustained dec...
National Syringe Access Landscape <ul><li>Diversity of programs, practice and policies </li></ul><ul><li>Legal and regulat...
Syringe Access Categories <ul><li>Pharmacy sale without prescription </li></ul><ul><li>Syringe exchange </li></ul><ul><li>...
Measuring the impact of pharmacy sale <ul><li>New York State since 2001 </li></ul><ul><li>Documented shift in source of mo...
State of Syringe Exchange in the U.S. <ul><li>186 known programs operating in 36 states, the District of Columbia, Puerto ...
State of Syringe Access in the U.S. <ul><li>14 states have no known SEP. </li></ul><ul><li>Six states have no legal method...
Funding Issues <ul><li>61% of syringe exchange programs receive some public funding (state/city/county). </li></ul><ul><li...
Current Federal Policy <ul><li>The 21 year-old ban on the use of federal funds for syringe exchange programs was lifted in...
Next Steps <ul><li>National Efforts </li></ul><ul><li>HHS Interim Guidance </li></ul><ul><li>NASTAD Survey </li></ul><ul><...
Best Practices for Expanding Syringe Access at the State or City Level <ul><li>Seek the endorsement of the state or city o...
Visions for the Future <ul><li>Ubiquitous syringe access </li></ul><ul><li>Comprehensive drug user health initiatives </li...
Acknowledgements <ul><li>Sincere thanks to Daniel Raymond, Harm Reduction Coalition, Dave Purchase, North American Syringe...
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Implications of the Lifting of Federal Ban on Syringe Access

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Implications of the Lifting of Federal Ban on Syringe Access

  1. 1. Implications of the Lifting of the Federal Ban on Syringe Exchange Texas Department of State Health Services HIV/STD Conference May 25, 2010
  2. 2. Epidemiological Context <ul><li>Approximately one million injection drug users in the U.S. </li></ul><ul><li>Sustained declines in HIV incidence: </li></ul><ul><li>7,160 estimated new infections in 2006 (includes Puerto Rico but not MSM/IDU) </li></ul><ul><li>Evidence for parallel but more modest decline in HCV incidence (though overall prevalence remains very high </li></ul>
  3. 3. National Syringe Access Landscape <ul><li>Diversity of programs, practice and policies </li></ul><ul><li>Legal and regulatory patchwork </li></ul><ul><li>Public health vs. paraphernalia laws, stigma and community concerns </li></ul><ul><li>Mixed environment evolved in the context for the federal funding ban </li></ul><ul><li>Syringe access often remains outside of HIV and hepatitis policy and planning processes </li></ul>
  4. 4. Syringe Access Categories <ul><li>Pharmacy sale without prescription </li></ul><ul><li>Syringe exchange </li></ul><ul><li>Physician prescription </li></ul>
  5. 5. Measuring the impact of pharmacy sale <ul><li>New York State since 2001 </li></ul><ul><li>Documented shift in source of most recent syringe sales </li></ul><ul><li>Broad participation from pharmacies (over 3,000) </li></ul><ul><li>Estimated syringe sales now match number of syringes distributed by syringe exchange programs </li></ul><ul><li>Average syringes sold per pharmacy: 67.1 per month (2006) </li></ul><ul><li>Data from New York City shows that sexual transmission may now be a more significant contributor to HIV prevalence among people who inject in New York City than unsafe injection practices </li></ul>
  6. 6. State of Syringe Exchange in the U.S. <ul><li>186 known programs operating in 36 states, the District of Columbia, Puerto Rico and the Indian Nations. </li></ul><ul><li>Broad diversity in size, service delivery, models and settings, organization type, data collection methods, program philosophy and operational constraints. </li></ul>
  7. 7. State of Syringe Access in the U.S. <ul><li>14 states have no known SEP. </li></ul><ul><li>Six states have no legal method for people to acquire sterile syringes. </li></ul><ul><li>26 states legally allow for syringe exchange programs. </li></ul><ul><li>31 states allow pharmacy sale of syringes to people who use injection drugs. </li></ul><ul><li>16 states allow both. </li></ul><ul><li>Five states have cities that allow for SEPs though SEPs are not authorized statewide. </li></ul>
  8. 8. Funding Issues <ul><li>61% of syringe exchange programs receive some public funding (state/city/county). </li></ul><ul><li>Total SEP budget in 2007 (70% reporting) $19.6 million ($14.4 million in public funding). </li></ul><ul><li>Few private/foundation funding sources </li></ul><ul><ul><li>Syringe Access Fund: over 250 grants totaling $6.5 million since 2004 </li></ul></ul><ul><li>56% of programs report lack of resources/lack of funding </li></ul>
  9. 9. Current Federal Policy <ul><li>The 21 year-old ban on the use of federal funds for syringe exchange programs was lifted in December 2009 when President Obama signed the Omnibus Departments of Labor, Health and Human Services, and Related Agency Appropriations Bill, 2010 into law without this restriction. </li></ul>
  10. 10. Next Steps <ul><li>National Efforts </li></ul><ul><li>HHS Interim Guidance </li></ul><ul><li>NASTAD Survey </li></ul><ul><li>HHS Consultation </li></ul><ul><li>HHS Syringe Access Guidance </li></ul><ul><li>Harm Reduction Coalition CBA </li></ul><ul><li>Local Efforts </li></ul>
  11. 11. Best Practices for Expanding Syringe Access at the State or City Level <ul><li>Seek the endorsement of the state or city officials; </li></ul><ul><li>Ensure that paraphernalia laws exempt possession of syringes; </li></ul><ul><li>Involve and educate law enforcement; </li></ul><ul><li>Include the affected population in the delivery of syringe access efforts; </li></ul><ul><li>Provide other health services; </li></ul><ul><li>Make regulations appropriate to allow pharmacy sales of syringes and; </li></ul><ul><li>Ensure there are appropriate and accessible disposal systems. </li></ul>
  12. 12. Visions for the Future <ul><li>Ubiquitous syringe access </li></ul><ul><li>Comprehensive drug user health initiatives </li></ul><ul><li>Destigmatization and legitimation leading to removal of political, legal, funding barriers </li></ul><ul><li>Reframing debates on syringe exchange, harm reduction, IDUs and drug policy </li></ul>
  13. 13. Acknowledgements <ul><li>Sincere thanks to Daniel Raymond, Harm Reduction Coalition, Dave Purchase, North American Syringe Exchange Network (NASEN) and Shannon Wyss, National AIDS Fund. </li></ul><ul><li>THANK YOU! </li></ul><ul><li>Please contact Natalie Cramer at [email_address] with questions. </li></ul>
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