Syringe access landscape, 2010 for USCA


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Syringe access in the US: an overview of policy and programs following the lifting of the federal funding ban. Presented at the US Conference on AIDS, 9/13/10

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  • As we enter into the third decade of syringe exchange in the United States, we face new challenges and new opportunities. The innovation and research that has occurred over the past 20 years can guide our future work. But syringe exchange remains a political issue, and requires on-going and creative strategies for political engagement, advocacy, and action.
  • Syringe access landscape, 2010 for USCA

    1. 1. Charting the Syringe Access Landscape in 2010 Daniel Raymond Policy Director Harm Reduction Coalition [email_address] (212) 213-6376 x29
    2. 2. Current Federal Policy <ul><li>Blanket prohibition on use of federal funds to distribute syringes since 1988 </li></ul><ul><li>Labor/HHS Appropriations </li></ul><ul><li>Authorizing bills </li></ul><ul><li>Congress eased federal funding ban in December 2009 </li></ul><ul><li>Where are we now? What comes next? </li></ul>
    3. 3. Charting the landscape <ul><li>Diversity of programs, practices, policies </li></ul><ul><li>Legal and regulatory patchwork </li></ul><ul><li>Public health vs. paraphernalia laws, stigma, community concerns (NIMBY, safe disposal) </li></ul><ul><li>Mixed environment evolved in the context of federal funding ban: local and community-driven innovation and experimentation </li></ul><ul><li>Syringe access often remains outside of HIV and hepatitis policy and planning processes & structures at federal, state & local levels </li></ul>
    4. 4. Epidemiological context <ul><li>~ 1 million injection drug users in the U.S. </li></ul><ul><li>Sustained declines in HIV incidence: 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 (but overall prevalence remains very high) </li></ul>
    5. 5. Syringe access categories <ul><li>Pharmacy sale w/out prescription </li></ul><ul><li>Syringe exchange </li></ul><ul><li>Physician prescription </li></ul><ul><li>Other models outside of U.S. include vending machines*, supervised injection facilities </li></ul><ul><li>* used in Puerto Rico </li></ul>
    6. 6. Pharmacy sale and syringe access <ul><li>“ Clearly legal” in nearly half of all states; “clearly illegal” in six states </li></ul><ul><li>One in four states have passed laws to increase syringe access since 1987 </li></ul><ul><li>Subject to discretion, limitations, rules (e.g. record keeping, ID requirement) </li></ul><ul><li>Effective implementation engages pharmacists & staff, law enforcement, injection drug users </li></ul>
    7. 7. 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 (supplements syringe exchange) </li></ul><ul><li>Broad participation from pharmacies (over 3,000) </li></ul><ul><li>Estimated syringe sales now match numbers of syringes distributed by syringe exchange programs </li></ul><ul><li>Average syringes sold per pharmacy: 67.1 per month in 2006 </li></ul>
    8. 8. Syringe Exchange Landscape <ul><li>184 known programs operating in 36 States, the Indian Nations, Washington DC, and Puerto Rico </li></ul><ul><li>Broad diversity in size, service delivery models and settings, organizational type, data collection methods, program philosophy, and operational constraints (legal/political) </li></ul>
    9. 10. Funding issues <ul><li>61% of syringe exchange programs receive some public funding (city/county/state) </li></ul><ul><li>Total SEP budget in 2008 (67% reporting): $21.2 million (including $16.8 million in public funding) </li></ul><ul><li>Few private/foundation funding sources (Syringe Access Fund: 250 grants totaling $6.5 million since 2004) </li></ul><ul><li>67% of programs report lack of resources/lack of funding </li></ul>
    10. 11. Federal Funding Ban in Appropriations Bills – old language <ul><li>Labor/HHS/Education Appropriations: </li></ul><ul><li>SEC. 505. Notwithstanding any other provision of this Act, no funds appropriated in this Act shall be used to carry out any program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug. </li></ul>
    11. 12. Federal Funding in Appropriations Bills – new language <ul><li>Labor/HHS/Education Approps. FY 2010: </li></ul><ul><li>“ None of the funds contained in this Act may be used to distribute any needle or syringe for the purpose of preventing the spread of blood borne pathogens in any location that has been determined by the local public health or local law enforcement authorities to be inappropriate for such distribution.” </li></ul>
    12. 13. HHS interim guidance 7/7/10 <ul><li>Applies to CDC HIV prevention cooperative agreements to health departments, some SAMHSA programs </li></ul><ul><li>Requires annual certification of compliance with Congressional language by state AIDS director or SAMHSA grantee official </li></ul>
    13. 14. HHS interim guidance cont'd <ul><li>Funded grantees must, in turn, have documentation that local law enforcement and local public health authorities have agreed upon the location for the operation of the SSPs. </li></ul><ul><li>Copies of this documentation must be made available upon request by HHS and others, as appropriate (e.g. the Office of Inspector General, and the Government Accountability Office). </li></ul>
    14. 15. CDC guidance development <ul><li>Developing guidance on SSPs for health departments </li></ul><ul><li>Atlanta consultation August 30-31, 2010 </li></ul><ul><li>Further input through regional webinars </li></ul>
    15. 16. Concerns <ul><li>Law enforcement language, process remains a barrier in some jurisdictions </li></ul><ul><li>Uncertainty around future monitoring & evaluation/data collection requirements </li></ul><ul><li>Desire to preserve fragile local/state funding (vs. shift to federal) </li></ul>
    16. 17. Contexts <ul><li>State budget cuts already hitting programs </li></ul><ul><li>Flat CDC HIV prevention budget means little room to redirect funds to syringe exchange </li></ul><ul><li>Uncertain political environment requires strategies to defend against reinstatement of full funding ban </li></ul>
    17. 18. Opportunities <ul><li>Strengthen role of syringe access in implementation plans of National HIV/AIDS Strategy </li></ul><ul><li>Encourage federal leadership and support for changing state/local policies that restrict syringe access </li></ul><ul><li>Integrate syringe access into other federally funded programs & services </li></ul>
    18. 19. Visions for the Future <ul><li>Ubiquitous syringe access – anyone who provides services to any IDUs also provides syringes </li></ul><ul><li>Comprehensive drug user health initiatives link HIV, viral hepatitis, STDs, overdose, addiction, mental health, and primary care with education, social services, housing…. </li></ul><ul><li>Destigmatization & legitimation leading to removal of political, legal, funding barriers </li></ul><ul><li>Reframing debates on syringe exchange, harm reduction, IDUs, and drug policy for a shifting political environment </li></ul>