hesp

AMSA Health EquityAMSA Health Equity
Scholars ProgramScholars Program
Webinar December 16 2015Webinar December 16 2015

Why should anyoneWhy should anyone
care?care?
• Here in the US, 8% of new HIV infections are due to IDU.Here in the US, 8% of new HIV infections are due to IDU.
• That’s 11 people per day.That’s 11 people per day.
• IDUs are twice as likely to be unaware of their HIV statusIDUs are twice as likely to be unaware of their HIV status
as the general public.as the general public.
• Outside of Sub-Saharan Africa, three out of ten newOutside of Sub-Saharan Africa, three out of ten new
infections are due to IDU.infections are due to IDU.
• No $$ will go to SSPs outside the US until the ban hasNo $$ will go to SSPs outside the US until the ban has
been lifted.been lifted.
• Here in the US, Hep C is the leading cause of deathHere in the US, Hep C is the leading cause of death
among those living with HIV.among those living with HIV.
• Hep C is the leading cause of liver transplants.Hep C is the leading cause of liver transplants.
• The epidemic of prescription drug use and IDU.The epidemic of prescription drug use and IDU.
• There are more deaths due to drug overdose than autoThere are more deaths due to drug overdose than auto
accidents.accidents.
• Health care is a right.Health care is a right.

It’s not about the needle, it’s about the people…
SSPs make neighborhoods safer for everyone. They also
protect the sexual partners and children of IDUs.
Reggie once injected drugs, contracting HIV and
hepatitis C, which were both transmitted to his
wife. His youngest son contracted hepatitis C
perinatally.
Zee has never injected drugs. The father of her
children did use needles. She found out she was
positive when she gave birth to their daughter.

Because they have
been able to access
care, both Reggie and
Zee have been living
with HIV for more
than twenty years.
Reggie is working and
raising his kids.
Zee is working and has
realized a moment she
never thought she
would live long enough
to experience: the birth
of her first grandchild.
Update: Zee passed
away in January, 2015.
It’s not about the needle, it’s about the people…

Re-invigorating our traditional allies – this is a health disparity issue.Re-invigorating our traditional allies – this is a health disparity issue.
No matter how you slice it - HIV, AIDS, new infections, current infections, cumulativeNo matter how you slice it - HIV, AIDS, new infections, current infections, cumulative
infections, death rates, males, females – African-Americans and Latinos areinfections, death rates, males, females – African-Americans and Latinos are
disproportionately represented.disproportionately represented.

The prevalence of HIV among Hispanic andThe prevalence of HIV among Hispanic and
African-American IDUs is nearly twice as high as itAfrican-American IDUs is nearly twice as high as it
is for Caucasians.is for Caucasians.11
““As the Chairman of theAs the Chairman of the
National BlackNational Black
Leadership CommissionLeadership Commission
on AIDS Inc., and theon AIDS Inc., and the
resident of a state with aresident of a state with a
sizeable Latinosizeable Latino
community, I havecommunity, I have
personally witnessedpersonally witnessed
these disproportionatethese disproportionate
and devastating results.”and devastating results.”
Reverend Dr. W. James Favorite - Senior Pastor ofReverend Dr. W. James Favorite - Senior Pastor of
the historical Beulah Baptist Institutional Church andthe historical Beulah Baptist Institutional Church and
Chair of the National Black Leadership CommissionChair of the National Black Leadership Commission
on AIDS.on AIDS.

Local data helpsLocal data helps
Population Percent of population2 Current HIV infections attributable to
injection drug use3
African-Americans in California 6.6% 33.7%
African-Americans in Connecticut 11.3% 35.3%
Latinos in Connecticut 14.7% 38.5%
African-Americans in Florida 16.7% 55.1%
African-Americans in Georgia 31.4% 80.7%
African-Americans in Illinois 14.7% 67.4%
African-Americans in Kentucky 8.2% 49.7%
African-Americans in Maryland 30.1% 83.3%
African-Americans in
Massachusetts 8.1% 30.7%
Latinos in Massachusetts 10.5% 35.9%
African-Americans in New Jersey 14.7% 60.2%
African-Americans in New York 17.5% 47.5%
Latinos in New York 18.4% 38.7%
African-Americans in North
Carolina 22.0% 75.7%
African-Americans in Ohio 12.5% 56.2%
African-Americans in
Pennsylvania 11.5% 51.7%
Latinos in Pennsylvania 6.3% 23.5%
African-Americans in Texas 12.5% 51.6%
African-Americans in Washington 4.0% 22.2%

Looking atLooking at newnew
infections:infections:
African-African-
Americans areAmericans are
11X and11X and
Latinos are 5xLatinos are 5x
more likely tomore likely to
acquire HIV viaacquire HIV via
IDU than theirIDU than their
CaucasianCaucasian
counterparts.counterparts.
CDC, MMWR, HIV Infection Among Injection-CDC, MMWR, HIV Infection Among Injection-
Drug Users --- 34 States, 2004—2007, Nov 22,Drug Users --- 34 States, 2004—2007, Nov 22,
2009.2009.

• OTC access varies by state
• Full range of SSP services are not available
• Not equitably distributed (like food deserts)
• Not required to stock syringes
• Pharmacy has discretion about whom to serve; more
likely to refuse service to people of color
• False choice: we need both

What is harm reduction?
Harm reduction is a set of
practical strategies that
reduce negative
consequences of drug use,
incorporating a spectrum of
strategies from safer use, to
managed use to abstinence.
Harm reduction strategies
meet drug users "where
they're at," addressing
conditions of use along with
the use itself.
-Harm Reduction Coalition, NY,
USA

Is a practical strategy that attempts to
reduce negative consequences of
drug use and other activities.
Accepts that some will engage in
dangerous activities, but does not
attempt to minimize the harm or
dangers involved.
Focuses on the individual and their
health and wellness needs.
Places individuals in the greater social
context.
Places a value on drug users having a
voice in the creation of programs and
policies designed to serve them.
From www.preventionworksdc.org, Jan. 24, 2011

Harm reduction is NOT
Harm reduction is NOT “whatever happens,
happens.”
Harm reduction is NOT “anything goes”
Harm reduction is NOT simply “meeting the client
where the client is at” (it’s helping them to change
behavior)
Harm reduction is NOT “Helping a person who has
gotten off drugs to start using again.”
Harm reduction is NOT condoning, endorsing, or
encouraging drug use.
Harm reduction is NOT Legalization

Harm reduction is not unique to drug use

There is more to harm reduction
than preventing HIV and viral hep.
Prevention of injection-related
wounds
Prevention of secondary
infections (endocarditis, cotton
fever)
Safer injection technique
Alternatives to injecting
Overdose prevention and
response
Immunization
STI testing
Safer sex supplies
Case management
Addiction treatment
Employment assistance

SSPs help reduce health disparities among
IDUs by increasing access to health services
Syringe Services Programs: Myth vs. Fact
SSPs represent a critical
tool for minimizing HIV
risks and addressing health
disparities by reaching the
IDU community with vital
syringe and health
services.1
Source: Medline Reports Chicago2
1
amfAR, Federal Funding for Syringe Services Programs: Saving Money, Promoting
Public Safety, and Improving Public Health. Available at:
http://www.amfar.org/uploadedFiles/_amfarorg/Articles/On_The_Hill/2013/issue
-brief-federal-funding-for-syringe-service-programs.pdf
2
Available at: http://news.medill.northwestern.edu/chicago/news.aspx?id=86315
HIV impacts all injection drug users equally,
regardless of race or ethnicity

Access to
buprenorphine/Suboxone

Yes
•Reduces HIV
•Reduces viral hepatitis
•Reduces drug use
•Reduces improperly disposed syringes
•Saves money and lives
•Most people like SSPs
•Feds are the outlier.

o In 2009, Congress removed a 21-year prohibition on theIn 2009, Congress removed a 21-year prohibition on the
use of federal funds to support SSPs.use of federal funds to support SSPs.11
Two years later,Two years later,
Congress re-imposed the ban on federal funding forCongress re-imposed the ban on federal funding for
SSPs.SSPs.22
o While the ban was lifted, federal dollars were used toWhile the ban was lifted, federal dollars were used to
support SSPs in California, Connecticut, Delaware,support SSPs in California, Connecticut, Delaware,
Illinois, Massachusetts, Minnesota, New Jersey, NewIllinois, Massachusetts, Minnesota, New Jersey, New
Mexico, New York, Puerto Rico, Vermont, andMexico, New York, Puerto Rico, Vermont, and
Washington.Washington.33
o Funding came from CDC, HRSA, and SAMHSA. IHS was aFunding came from CDC, HRSA, and SAMHSA. IHS was a
potential source which wasn’t tapped.potential source which wasn’t tapped.
o Seen as a “seal of approval”, lifting the ban opened doorsSeen as a “seal of approval”, lifting the ban opened doors
from other donors.from other donors.
o These dollars were used to: expand service hours,These dollars were used to: expand service hours,
provide services in new locations, and provide additionalprovide services in new locations, and provide additional
services such as case management and overdoseservices such as case management and overdose
prevention services.prevention services.
A Brief History of the BanA Brief History of the Ban

Where are we now?Where are we now?
 This is the closest we have beenThis is the closest we have been
since the ban was reinstated in 2011.since the ban was reinstated in 2011.
 Big change: the House came up withBig change: the House came up with
the language.the language.
 House and Senate now have identicalHouse and Senate now have identical
language for a partial lift. Unlikelanguage for a partial lift. Unlike
previous years, both are underprevious years, both are under
Republican control.Republican control.

What exactly?What exactly?
 Report languageReport language
"Needle Exchange Programs.—The Committee maintains its support for federal, state and local efforts to address the abuse of
prescription painkillers and other opioids. The Committee is alarmed by trends in urban and rural communities which
indicate a transition to injection drug use, and supports state and local efforts to mitigate the spread of related
infections, such as Hepatitis and HIV/AIDS, and associated healthcare costs. The Committee believes the determination
about whether to implement needle exchange programs remains a quintessentially local function, and therefore
maintains its prohibition on the use of federal funds for the purchase of syringes or sterile needles as a title V general
provision. The provision is modified, however, to allow existing programs in hard-hit communities to access federal
funds for other program elements, including substance use counseling and referral to treatment, that support
communities in their drive to end the cycle of dependency. Eligible programs must demonstrate a need or federal
support based on actual cases of Hepatitis or HIV/AIDS or on conditions posing a significant risk for an outbreak."
 Budget languageBudget language
SEC. 520. Notwithstanding any other provision of this Act, no funds appropriated in this Act shall be used to purchase sterile
needles or syringes for the hypodermic injection of any illegal drug: Provided, That such limitation does not apply to the
use of funds for elements of a program other than making such purchases if the relevant State or local health
department, in consultation with the Centers for Disease Control and Prevention, determines that the State or local
jurisdiction, as applicable, is experiencing, or is at risk for, a significant increase in hepatitis infections or an HIV
outbreak due to injection drug use, and such program is operating in accordance with State and local law.
 So what?So what?
So basically with this partial lift, federal dollars could go to all aspects of an SSP, except for the needles themselves. It's
counter-intuitive, but not a big deal since syringes are often the least expensive part of operating an SSP. It is an
improvement over how things stand now. Currently, federal dollars cannot be used for syringes, personnel, and housing
the exchange (either a vehicle or a building). The other issue (which is just FYI) is working with the CDC to define
"conditions posing a significant risk" and "hard-hit communities".

HOW DID WE GET HERE?HOW DID WE GET HERE?
NEW MESSAGES AND MESSENGERSNEW MESSAGES AND MESSENGERS
oSSPs save lives by preventing the spread of HIV and viral hepatitisSSPs save lives by preventing the spread of HIV and viral hepatitis
and by serving as a bridge to other services, including treatment forand by serving as a bridge to other services, including treatment for
substance use disorder.substance use disorder.
oBy reducing improperly disposed syringes, SSPs are good forBy reducing improperly disposed syringes, SSPs are good for
everyone: IDUs, first-responders, law enforcement, and general publiceveryone: IDUs, first-responders, law enforcement, and general public
safety.safety.
oSSPs address health disparities.SSPs address health disparities.
oIn light of prescription drug misuse and its expansion into injectionIn light of prescription drug misuse and its expansion into injection
drugs, the need for SSPs is greater than ever.drugs, the need for SSPs is greater than ever.
oSSPs enjoy broad support from medical, legal, public health, faith,SSPs enjoy broad support from medical, legal, public health, faith,
and local communities. Feds are the outlier.and local communities. Feds are the outlier.
oIt’s a matter of local control.It’s a matter of local control. State and local decision makers should haveState and local decision makers should have
flexibility in the use of federal funds to address local health concernsflexibility in the use of federal funds to address local health concerns..
oLifting the ban costs nothing and saves money.Lifting the ban costs nothing and saves money.

State, local, and faith-based organizationsState, local, and faith-based organizations
around the country already support SSPsaround the country already support SSPs
The following organizations supportThe following organizations support
SSPs:SSPs:
oAmerican Medical Student AssociationAmerican Medical Student Association
oAmerican Academy of Family PhysiciansAmerican Academy of Family Physicians
oAmerican Academy of PediatricsAmerican Academy of Pediatrics
oAmerican Bar AssociationAmerican Bar Association
oAmerican Medical AssociationAmerican Medical Association
oAmerican Public Health AssociationAmerican Public Health Association
oAmerican Society of Addiction MedicineAmerican Society of Addiction Medicine
oInternational Red Cross-Red CrescentInternational Red Cross-Red Crescent
SocietySociety
oLatino Commission on AIDSLatino Commission on AIDS
oNAACPNAACP
oNational Academy of SciencesNational Academy of Sciences
oNational Black Leadership Commission onNational Black Leadership Commission on
AIDSAIDS
oNational Black Police AssociationNational Black Police Association
oNational Institute on Drug AbuseNational Institute on Drug Abuse
oOffice of National Drug Control PolicyOffice of National Drug Control Policy
oPresidential Advisory Committee on AIDSPresidential Advisory Committee on AIDS
oUS Conference of MayorsUS Conference of Mayors
oWorld BankWorld Bank
oWorld Health OrganizationWorld Health Organization
SSPs also enjoy support from faith
communities, including:
•Central Conference of American Rabbis
•Episcopal Church
•National Council on Jewish Women
•Presbyterian Church of the United
States
•Society of Christian Ethics
•Union for Reform Judaism
•Unitarian Universalist Association
•United Church of Christ
•United Methodist Church, General
Board of Church and Society
•Regional AIDS Interfaith Network

State, local, and faith-based organizations around theState, local, and faith-based organizations around the
country already support SSPscountry already support SSPs
 "Syringe decriminalization and"Syringe decriminalization and
exchange is ...an issue ofexchange is ...an issue of
compassion and justice... As peoplecompassion and justice... As people
of faith, we are called to be theof faith, we are called to be the
embodiment of that compassion andembodiment of that compassion and
instruments of that justice in thisinstruments of that justice in this
world to offer an eternal hope. Theworld to offer an eternal hope. The
hope that someone may live anotherhope that someone may live another
day. The hope that they may beday. The hope that they may be
reconciled with their family. The hopereconciled with their family. The hope
that they can live a life free ofthat they can live a life free of
disease. The hope that they mightdisease. The hope that they might
choose to find treatment. The hopechoose to find treatment. The hope
that with that one more day, theythat with that one more day, they
might find their own hope for amight find their own hope for a
future outside of their addiction."future outside of their addiction."
- Pastor James Sizemore, Lead Pastor,- Pastor James Sizemore, Lead Pastor,
Catalyst Community Church, Fayetteville,Catalyst Community Church, Fayetteville,
North CarolinaNorth Carolina

Note: since this map was developed, there are SSPs in Indiana, Kentucky, and West Virginia
There are already a number of programs:

Most funding (82%) for SSPs is public –Most funding (82%) for SSPs is public –
Feds are the outlier when it comes to fundingFeds are the outlier when it comes to funding
Year of Operation
2012 2013
Total $$$ $19,431,912 $21,920,648
City Gov $ $5,789,118 $6,504,086
County Gov $ $1,538,358 $1,431,851
State Gov $ $8,391,180 $10,059,565
Foundation $ $1,966,688 $2,129,610
Individual Donations $696,947 $611,269
Out-of-pocket $ $50,525 $90,250
NASEN $ $4,150 $2,100
CBO Donation $ $28,740 $47,200
Corporate Donation $ $68,300 $157,500
Other $ $856,406 $887,218

The most important myth to dismantle:The most important myth to dismantle:
we can’t afford it.we can’t afford it.
Lifting the ban costs NOTHING. It simply allows localities to spendLifting the ban costs NOTHING. It simply allows localities to spend
their federal dollars as they see fit.their federal dollars as they see fit. ((In this way, it is also a state rights issueIn this way, it is also a state rights issue.).)
Every dollar invested in SSPsEvery dollar invested in SSPs
results inresults in
$7 in savings$7 in savings
just by preventing new HIVjust by preventing new HIV
infections.infections.11
Through Medicaid, Medicare, and Ryan White, the federal government is the
biggest payer of HIV care. So not only are we saving federal dollars, we are
saving entitlement (Medicaid and Medicare) and discretionary (RW) funds.

Local Data HelpsLocal Data Helps
o Between 2001 and 2011, Illinois saw a drop of nearlyBetween 2001 and 2011, Illinois saw a drop of nearly
two-thirds in new HIV cases among IDUs, averting antwo-thirds in new HIV cases among IDUs, averting an
estimated $200 million in medical expenses.estimated $200 million in medical expenses.11
o In Massachusetts, there was a 54% decrease in new HIVIn Massachusetts, there was a 54% decrease in new HIV
diagnosis between 1999 and 2012, preventing 5,699diagnosis between 1999 and 2012, preventing 5,699
infections and saving more than $2 billion in health careinfections and saving more than $2 billion in health care
costs.costs.22
o King County (Washington State) spent $1.1 million onKing County (Washington State) spent $1.1 million on
SSPs in 2008. If HIV was prevented among only 1% ofSSPs in 2008. If HIV was prevented among only 1% of
IDUs in King County, the resulting savings in HIVIDUs in King County, the resulting savings in HIV
treatment costs will be $70 million.treatment costs will be $70 million.33
o Washington, DC was allowed to spend its own money onWashington, DC was allowed to spend its own money on
SSPs in 2007. Within two years, 120 HIV infections wereSSPs in 2007. Within two years, 120 HIV infections were
averted, resulting in $45.6M in savings.averted, resulting in $45.6M in savings.44
o Miami, a city without legal SSPs,Miami, a city without legal SSPs, published study of thepublished study of the
costs of bacterial infections relating to IDU at Jacksoncosts of bacterial infections relating to IDU at Jackson
Memorial Hospital. The cost was $11.4M over 12 monthMemorial Hospital. The cost was $11.4M over 12 month
period.period.55

““I understandI understand
that there willthat there will
be questions,be questions,
but this isbut this is
commoncommon
sense.”sense.”
- Sister Maureen- Sister Maureen
Joyce, CEO of CatholicJoyce, CEO of Catholic
Charities, Albany, NYCharities, Albany, NY
Messages and Messengers:
law enforcement, faith communities, and families.

It’s not just the needle, it’sIt’s not just the needle, it’s
about the people!about the people!
SSPs provide a variety of services inSSPs provide a variety of services in
addition to syringe exchangeaddition to syringe exchange11
o Onsite medical careOnsite medical care11
o Screening and counseling for HIV,Screening and counseling for HIV,
hepatitis C, and STIs (injection drughepatitis C, and STIs (injection drug
users are twice as likely as the generalusers are twice as likely as the general
public not to know their HIV status)public not to know their HIV status) 1,21,2
o Distribution of safer sex supplies, food,Distribution of safer sex supplies, food,
and clothingand clothing11
o Referrals to substance use treatment andReferrals to substance use treatment and
support groupssupport groups11
o Medications and resources to preventMedications and resources to prevent
death from drug overdosedeath from drug overdose33
o Case managementCase management
Selected Services Offered by
SSPs Nationwide

SSPs Make Communities Safer for EveryoneSSPs Make Communities Safer for Everyone
o SSPs distribute free sterile syringesSSPs distribute free sterile syringes
to injection drug users (IDUs), whichto injection drug users (IDUs), which
reduces the likelihood that users willreduces the likelihood that users will
share injecting equipment.share injecting equipment.11
o SSPs safely dispose of usedSSPs safely dispose of used
needles, a service not typicallyneedles, a service not typically
provided by distributors such asprovided by distributors such as
pharmacies.pharmacies.
o SSPs make neighborhoods safer bySSPs make neighborhoods safer by
reducing needle-stick injuries.reducing needle-stick injuries.11

LOCAL EXAMPLESLOCAL EXAMPLES
o In Baltimore, SSPs helpedIn Baltimore, SSPs helped
reduce the number ofreduce the number of
improperly discarded syringesimproperly discarded syringes
by almost 50%.by almost 50%.11
o In Portland, Oregon, theIn Portland, Oregon, the
implementation of SSPsimplementation of SSPs
reduced the number ofreduced the number of
improperly discarded syringesimproperly discarded syringes
by two-thirds.by two-thirds.22
o In 2008 and 2009, Miami (whichIn 2008 and 2009, Miami (which
had no SSPs) saw eight timeshad no SSPs) saw eight times
more improperly disposedmore improperly disposed
syringes than San Franciscosyringes than San Francisco
(where SSPs are available)(where SSPs are available)
despite the fact that Sandespite the fact that San
Francisco is thought to haveFrancisco is thought to have
twice as many IDUs.twice as many IDUs.33

Messages and Messengers:Messages and Messengers:
law enforcement, faith communities, andlaw enforcement, faith communities, and
families.families.
““By restoring the ban on federal fundingBy restoring the ban on federal funding
for syringe exchange, members offor syringe exchange, members of
Congress undoubtedly believed they wereCongress undoubtedly believed they were
striking a blow against drug use. Asstriking a blow against drug use. As
extensive experience has shown, nothingextensive experience has shown, nothing
could be further from the truth. Bycould be further from the truth. By
withholding funding for syringe exchange,withholding funding for syringe exchange,
Congress has made our communities lessCongress has made our communities less
safe, made police officers and medicalsafe, made police officers and medical
responders unsafe, undermined a vitalresponders unsafe, undermined a vital
bridge to drug treatment, and hinderedbridge to drug treatment, and hindered
national efforts to address public healthnational efforts to address public health
problems such as HIV and hepatitis C.”problems such as HIV and hepatitis C.”
- Chief James Pugel, Seattle Police Department- Chief James Pugel, Seattle Police Department

o In New York City, the growth of SSPs from 1990
to 2001 was associated with a 78% decrease in
HIV prevalence among IDUs.1
o During this time period, the same population
saw a decrease in the prevalence of hepatitis C
from 90% to 63% 2
o One study showed that within 6 months of using
federally-funded SSPs, clients saw a 45%
increase in employment.
o In addition, SSP clients were 25% more likely to
have been successfully referred to mental health
treatment and prescribed medication than other
SAMHSA grantees.3
o In New Jersey, 22% of the state’s SSP clients
have entered drug treatment.4
SSPs Bring Results

SSPs Do NOT lead to an increaseSSPs Do NOT lead to an increase
in crime or drug use.in crime or drug use.
o Neighborhoods in Baltimore with SSPs experienced anNeighborhoods in Baltimore with SSPs experienced an
11% decrease in break-ins and burglaries, while areas11% decrease in break-ins and burglaries, while areas
without SSPs saw an 8% increase in such crimes duringwithout SSPs saw an 8% increase in such crimes during
the same period.the same period.11
o In Seattle, IDUs who had used SSPs were more likely toIn Seattle, IDUs who had used SSPs were more likely to
report a significant decrease (>75%) in injection drugreport a significant decrease (>75%) in injection drug
use, to stop using injection drugs, and to remain inuse, to stop using injection drugs, and to remain in
treatment than IDUs who had never used SSPs.treatment than IDUs who had never used SSPs.22
o The same study in Seattle found that new users of theThe same study in Seattle found that new users of the
SSP were five times more likely to enter drug treatmentSSP were five times more likely to enter drug treatment
than individuals who never utilized the program.than individuals who never utilized the program.22
Local Examples

Now what?Now what?
 Current status:Current status:
Right now, the budget is in a CR (continuing resolution), meaning that things are
on hold and operating as usual until Dec 11.
• Here is an update on what's happening: http://cqrcengage.com/aidsunited/app/document/9740255
• Nice summary on the budget: http://www.cqrcengage.com/aidsunited/app/document/9464743
 Our ask:Our ask:
 We are encouraged by recent Congressional action on this issue, and would like to express our appreciation for theWe are encouraged by recent Congressional action on this issue, and would like to express our appreciation for the
modification to the syringe access funding rider that you included in the House FY 16 Labor, Health and Humanmodification to the syringe access funding rider that you included in the House FY 16 Labor, Health and Human
Services, Education and Related Agencies (LHHS) Appropriations bill. Bipartisan leadership in modifying the ban onServices, Education and Related Agencies (LHHS) Appropriations bill. Bipartisan leadership in modifying the ban on
federal funding for syringe access programs will help many individuals in our communities struggling with opioid usefederal funding for syringe access programs will help many individuals in our communities struggling with opioid use
disorder access life-saving programs to avert drug overdose; access medical and substance use disorder treatment anddisorder access life-saving programs to avert drug overdose; access medical and substance use disorder treatment and
recovery services; and prevent life-threatening infections, including HIV and hepatitis C. It will also allow us to addressrecovery services; and prevent life-threatening infections, including HIV and hepatitis C. It will also allow us to address
this issue abroad where outside of Sub-Saharan Africa, three out of ten new HIV infections are because of injection drugthis issue abroad where outside of Sub-Saharan Africa, three out of ten new HIV infections are because of injection drug
use.use. Accordingly, we urge you to include this modified rider in any FY 16 Continuing Resolution, final FY 16Accordingly, we urge you to include this modified rider in any FY 16 Continuing Resolution, final FY 16
LHHS bill, and/or FY 16 LHHS omnibus appropriations bill.LHHS bill, and/or FY 16 LHHS omnibus appropriations bill.
 OrOr
 No matter what the appropriations outcome is, we ask that any final appropriations bill or continuing resolution shouldNo matter what the appropriations outcome is, we ask that any final appropriations bill or continuing resolution should
contain the language allowing states or local jurisdictions to use federal funds for syringe exchange programs if they arecontain the language allowing states or local jurisdictions to use federal funds for syringe exchange programs if they are
experiencing or at risk for a significant increase in hepatitis infections or an HIV outbreak due to injection drug use. Itexperiencing or at risk for a significant increase in hepatitis infections or an HIV outbreak due to injection drug use. It
would also allow us to address this issue abroad where we have already enjoyed bipartisan success fighting HIV.would also allow us to address this issue abroad where we have already enjoyed bipartisan success fighting HIV.

House ask: keep the new language they put forward (House was first)House ask: keep the new language they put forward (House was first)
regardless if there is a CR, omnibus, or final LHHS bill.regardless if there is a CR, omnibus, or final LHHS bill.
If the member is a Democrat, ask that they let Lowey know of their support.If the member is a Democrat, ask that they let Lowey know of their support.
If the member is a Republican, ask that they let Rogers know of their supportIf the member is a Republican, ask that they let Rogers know of their support
Approps subcmte on HealthApprops subcmte on Health
RepublicansRepublicans
Chairman Tom Cole (OK)Chairman Tom Cole (OK)
Mike Simpson (ID)Mike Simpson (ID)
Steve Womack (AR)Steve Womack (AR)
Chuck Fleischmann (TN)Chuck Fleischmann (TN)
Andy Harris, MD (MD)Andy Harris, MD (MD)
Martha Roby (AL)Martha Roby (AL)
Charlie Dent (PA)Charlie Dent (PA)
Scott Rigell (VA)Scott Rigell (VA)
DemocratsDemocrats
Ranking Member Rosa DeLauro (CT)Ranking Member Rosa DeLauro (CT)
Lucille Roybal-Allard (CA)Lucille Roybal-Allard (CA)
Barbara Lee (CA)Barbara Lee (CA)
Chaka Fattah (PA)Chaka Fattah (PA)
Full Approps CmteFull Approps Cmte
RepublicansRepublicans
Harold Rogers* (KY), Rodney P. FrelinghuysenHarold Rogers* (KY), Rodney P. Frelinghuysen
(NJ), Robert B. Aderholt (AL), Kay Granger (TX),(NJ), Robert B. Aderholt (AL), Kay Granger (TX),
Michael K. Simpson (ID), John Abney CulbersonMichael K. Simpson (ID), John Abney Culberson
(TX) , Ander Crenshaw (FL), John R. Carter (TX),(TX) , Ander Crenshaw (FL), John R. Carter (TX),
Ken Calvert (CA), Tom Cole (OK), Mario Diaz-Ken Calvert (CA), Tom Cole (OK), Mario Diaz-
Balart (FL), Charles W. Dent (PA), Tom GravesBalart (FL), Charles W. Dent (PA), Tom Graves
(GA), Kevin Yoder (KS), Steve Womack (AR), Alan(GA), Kevin Yoder (KS), Steve Womack (AR), Alan
Nunnelee (MI), Jeff Fortenberry (NE), TomNunnelee (MI), Jeff Fortenberry (NE), Tom
Rooney (FL), Chuck Fleischmann (TN), JaimeRooney (FL), Chuck Fleischmann (TN), Jaime
Herrera Beutler (WA), David Joyce (OH), DavidHerrera Beutler (WA), David Joyce (OH), David
Valadao (CA), Andy Harris, MD (MD), MarthaValadao (CA), Andy Harris, MD (MD), Martha
Roby (AL), Mark Amodei (NV), Chris StewartRoby (AL), Mark Amodei (NV), Chris Stewart
(UT), Scott Rigell (VA), David Jolly (FL), David(UT), Scott Rigell (VA), David Jolly (FL), David
Young (IA), Evan Jenkins (WV)Young (IA), Evan Jenkins (WV)
DemocratsDemocrats
Nita M. Lowey* (NY), Marcy Kaptur (OH), Peter J.Nita M. Lowey* (NY), Marcy Kaptur (OH), Peter J.
Visclosky (IN), José E. Serrano (NY), Rosa L.Visclosky (IN), José E. Serrano (NY), Rosa L.
DeLauro (CT), David E. Price (NC), Lucille Roybal-DeLauro (CT), David E. Price (NC), Lucille Roybal-
Allard (CA), Sam Farr (CA), Chaka Fattah (PA),Allard (CA), Sam Farr (CA), Chaka Fattah (PA),
Sanford D. Bishop, Jr. (GA), Barbara Lee (CA),Sanford D. Bishop, Jr. (GA), Barbara Lee (CA),
Adam B. Schiff (CA), Michael M. Honda (CA),Adam B. Schiff (CA), Michael M. Honda (CA),
Betty McCollum (MN), Tim Ryan (OH), DebbieBetty McCollum (MN), Tim Ryan (OH), Debbie
Wasserman Schultz (FL), Henry Cuellar (TX),Wasserman Schultz (FL), Henry Cuellar (TX),
Chellie Pingree (ME), Mike Quigley (IL), SteveChellie Pingree (ME), Mike Quigley (IL), Steve
Israel (NY), C.A. Dutch Ruppersberger (MD),Israel (NY), C.A. Dutch Ruppersberger (MD),
Derek Kilmer, WADerek Kilmer, WA

Senate ask: keep the new language regardless if there is a CR,Senate ask: keep the new language regardless if there is a CR,
omnibus, or final LHHS bill.omnibus, or final LHHS bill.
If the Senator is a Republican, ask that they inform Cochran and Blunt of their support.If the Senator is a Republican, ask that they inform Cochran and Blunt of their support.
If the Senator is a Democrat, ask that they inform Mikulski and Murray of their support.If the Senator is a Democrat, ask that they inform Mikulski and Murray of their support.
Approps subcmte on Health:Approps subcmte on Health:
DemocratDemocrat
Ranking Member Patty Murray (WA)Ranking Member Patty Murray (WA)
Richard Durbin (IL)Richard Durbin (IL)
Jack Reed (RI)Jack Reed (RI)
Barbara Mikulski (MD)Barbara Mikulski (MD)
Jeanne Shaheen (NH)Jeanne Shaheen (NH)
Jeff Merkley (OR)Jeff Merkley (OR)
Brian Schatz (HI)Brian Schatz (HI)
Tammy Baldwin (WI)Tammy Baldwin (WI)
RepublicanRepublican
Chairman Roy Blunt (MO)Chairman Roy Blunt (MO)
Jerry Moran (KS)Jerry Moran (KS)
Richard Shelby (AL)Richard Shelby (AL)
Thad Cochran (MI)Thad Cochran (MI)
Lamar Alexander (TN)Lamar Alexander (TN)
Lindsey Graham (SC)Lindsey Graham (SC)
Mark Kirk (IL)Mark Kirk (IL)
Bill Cassidy (LA)Bill Cassidy (LA)
Shelley Moore Capito (WV)Shelley Moore Capito (WV)
James Lankford (OK)James Lankford (OK)
Full CommitteeFull Committee
Democratic MembersDemocratic Members
Vice Chairwoman Barbara Mikulski (MD),Vice Chairwoman Barbara Mikulski (MD),
Patrick J. Leahy (VT), Patty Murray (WA),Patrick J. Leahy (VT), Patty Murray (WA),
Dianne Feinstein (CA), Richard J. DurbinDianne Feinstein (CA), Richard J. Durbin
(IL), Jack Reed (RI), Jon Tester (MT), Tom(IL), Jack Reed (RI), Jon Tester (MT), Tom
Udall (NM), Jeanne Shaheen (NH), JeffUdall (NM), Jeanne Shaheen (NH), Jeff
Merkley (OR), Chris Coons (DE), BrianMerkley (OR), Chris Coons (DE), Brian
Schatz (HI), Tammy Baldwin (WI),Schatz (HI), Tammy Baldwin (WI),
Christopher Murphy (CT)Christopher Murphy (CT)
Republican MembersRepublican Members
Chairman Thad Cochran(MS), Richard C.Chairman Thad Cochran(MS), Richard C.
Shelby (AL), Jerry Moran (KS), MitchShelby (AL), Jerry Moran (KS), Mitch
McConnell (KY), Lamar Alexander (TN),McConnell (KY), Lamar Alexander (TN),
Susan Collins (ME), Lisa Murkowski (AK),Susan Collins (ME), Lisa Murkowski (AK),
Lindsey Graham (SC), Mark Kirk (IL), RoyLindsey Graham (SC), Mark Kirk (IL), Roy
Blunt (MO), Jerry Moran (KS), JohnBlunt (MO), Jerry Moran (KS), John
Hoeven (ND), Shelly Moore Capito (WV),Hoeven (ND), Shelly Moore Capito (WV),
Bill Cassidy (LA), James Lankford (OK),Bill Cassidy (LA), James Lankford (OK),
Steve Davies (MT), John Boozeman (AR)Steve Davies (MT), John Boozeman (AR)

Final Talking PointsFinal Talking Points
 This policy costs nothing: Lifting the ban does not involve additional dollars. It simply allows
localities to spend their federal prevention dollars as they see fit. It may be a source of additional
federal dollars in the future if additional dollars are allocated to HIV prevention.
It's cost effective: For every additional dollar invested, an average of $7 dollars in HIV treatment
costs are saved. This does not include other associated costs such as viral hepatitis, secondary
infections (e.g. endocarditis), injection related wounds, or drug overdose.
Federal dollars open doors: Federal funding is often perceived by other donors as a "seal of
approval", leading to new funding streams. Federal grantees can also receive extensive technical
assistance at no cost.
It's about local control: States and localities know how best to respond to the epidemics of HIV,
viral hepatitis, and drug overdose.
It's about health disparities: African-Americans are 11x and Latinos are 5x more likely to contract
HIV from an infected needle than their Caucasian counterparts.
SSPs are a bridge to related services: HIV testing, viral hepatitis services, treatment for substance
use disorder, and drug overdose prevention and response services.
The changing demographics of injection drug users: Due to the crackdown on prescription drug use,
many are transitioning to heroin use. This new generation of users is more likely to be young,
female, and non-urban.,,,
SSPs make neighborhoods safer for everyone: Because they provide a safe place to dispose of used
needles, there are fewer injuries to civilians (kids playing in the park) and first responders alike.

You can’t wring your hands and roll-You can’t wring your hands and roll-
up your sleeves at the same time.up your sleeves at the same time.
- Pat Schroeder- Pat Schroedero Learn moreLearn more: visit: visit
www.amfar.org/endthebanwww.amfar.org/endtheban. Watch. Watch
the ten-minute movie, “Thethe ten-minute movie, “The
Exchange,” as well as the shorts,Exchange,” as well as the shorts,
“Dollars & Sense,” “Race & Drugs,”“Dollars & Sense,” “Race & Drugs,”
and “Addiction & You.”and “Addiction & You.”
o Call/ write to your repCall/ write to your rep:: http://http://
www.cqrcengage.com/aidsunited/app/write-a-letter?0&engagemenwww.cqrcengage.com/aidsunited/app/write-a-letter?0&engagement
o Get the word out:Get the word out: host a filmhost a film
screening, post the links onscreening, post the links on
facebook, send a tweet, and sharefacebook, send a tweet, and share
on listservs.on listservs.

o CallCall your representative in Congressyour representative in Congress
as an individual or as a group event.as an individual or as a group event.
o WriteWrite an op-ed, blog post,an op-ed, blog post,
organizational sign-on, or letter toorganizational sign-on, or letter to
your representative in Congress.your representative in Congress.
o VisitVisit your congressional office,your congressional office,
either in-state or in DC.either in-state or in DC.
o Work with your local SSPWork with your local SSP::
volunteer, donate, ask them tovolunteer, donate, ask them to
speak to your group (go tospeak to your group (go to
www.nasen.orgwww.nasen.org to find the SSPto find the SSP
nearest you). Ask yournearest you). Ask your
representative in Congress to visitrepresentative in Congress to visit
the local SSP and see it forthe local SSP and see it for
themselves.themselves.
o Not sure how?Not sure how? Go toGo to
www.coalitionforsyringeaccess.orgwww.coalitionforsyringeaccess.org
Students with Senator Blumenthal (CT).
More options for taking action:More options for taking action:

Students making a differenceTwo quick events
Lunchtime BBL
Multiple student orgs sponsoring
Showed “The Exchange”
Passed around the petition
Inspired students to go lobbying
Showed the three remaining films (10 min)
Call-in on the Hill
Hill visit (ex: Senator Markey)
Hill visits:
DC office best
Conference call with the DC office
Local office with letter from you
- Ask them to visit local SSP
Always write thank you notes!

Repeal HIV Discrimination Acthttps://www.congress.gov/bill/114th-congress/senate-bill/2336?q={%22search%22%3A[%22repeal+hiv+discrimination+act
%22]}&resultIndex=1

Clean Needles Save
LivesA CONVERSATION ABOUT NEEDLE EXCHANGE
MIRIAM MCQUADE AND KYLE BARBOUR
CO-FOUNDERS OF OC NEEDLE EXCHANGE PROGRAM

Naloxone
• Incredibly safe opiate overdose
reversal drug
• Supplied by many NEPs and
community organizations
• California law (AB 635) facilitates
this and provides liability
protection
• Easier than setting up a NEP, but
newer

Medical student op-edMedical student op-ed

Page two has a nice call to
action:

Protesters display placards while demonstrating during an address by House
majority leader Eric Cantor at the John F. Kennedy School of Government at
Harvard University, in Cambridge, Mass., Monday, March 11, 2013. The
demonstrators called attention to what they describe as Cantor's opposition to
funding syringe exchange programs for people with HIV and AIDS. (AP
Photo/Steven Senne)
Facing protesters who challenged him to support
federal funding for a syringe exchange program,
Cantor said the recent spending cuts require certain
"tradeoffs."

Students making a difference
 2011 Medical students published research
showing that Miami has 8X more publicly
discarded syringes than SF but only half the
IDU population.
 Students launch Florida Needle Exchange
Initiative
 2013 Bill introduced for five year pilot
program in Miami.
 Garnered support from FL Medical
Association, FL Nurse Practitioner Network,
FL Academy of Family Physicians, FL
Chapter of American Academy of
Pediatrics, and medical societies of Miami-
Dade, Palm Beach, Lee, and Hillsborough
Counties
 2014 Differing versions pass in House and
Senate. No time to pass amended bill.
 Published study of costs of hospitalizations
relating to IDU at Jackson Memorial
Hospital. The cost is $11.4M over 12 month
period. It would be great to replicate this
study at a site with a syringe exchange.
 2015 bill is reintroduced.

So what?
Document the problem (also
provides baseline data)
Wound care info
Hoya clinic
Wound care kits (as pictured,
but with antibiotic ointment,
gauze, and one-pager instead
of bleach and bottle).
Utilization review of the
components of the wound care
kits.
Bake sale/bottled water drive.

Que mas?
How: volunteer days,
service-learning,
internship, student
orientations, special
projects
How: outreach, testing,
kit assemblage, planting
flowers, writing grants,
OD KAP study, COPC f/u,
info for transgender
clients, mapping pts.

Humility is requisiteHumility is requisite
to serviceto service
• No Columbus-ing – do your homeworkNo Columbus-ing – do your homework
• Do you have to be in charge?Do you have to be in charge?
• Should you be in charge?Should you be in charge?

This could be you!
Ask questions:
HIV testing, OD rates,
testing in the ED
Lead by example: practice
what you preach.
Get tested
Carry condoms
Keep Narcan on-hand.
Prescribe
Suboxone/buprenorphine
Prescribe Narcan

Sometimes…Sometimes…
The most qualifiedThe most qualified
person is the oneperson is the one
who happens to bewho happens to be
there.there.

 What is the role of the serviceWhat is the role of the service
provider? (a.k.a. YOU)provider? (a.k.a. YOU)
 You have credibilityYou have credibility
 You can speak on behalf of thoseYou can speak on behalf of those
who cannot speak for themselveswho cannot speak for themselves

Why do I Advocate?Why do I Advocate?

 You cant’ wring your handsYou cant’ wring your hands
and roll-up your sleeves atand roll-up your sleeves at
the same time…the same time…
 Pat SchroederPat Schroeder

Advocacy Opportunities
Three Branches of GovernmentThree Branches of Government

United States Senate
Overview:
Together with the House of Representatives, makes up the
U.S. Congress
Several exclusive powers not granted to the House,
including confirming appointments of Cabinet secretaries,
federal judges, other federal executive officials
Each state = 2 U.S. senators,
regardless of population
Staggered six-year terms
2 U.S. senators
2 U.S. senators

U.S. House of Representatives
Overview:
Together with the Senate, makes up the U.S. Congress
Each state = representation in proportion to its
population
Each state is entitled to at least one representative
435 voting representatives
Two-year terms
Several exclusive powers:
Initiate revenue bills
Elect President in case of Electoral College deadlock
Impeach officials

Advocacy in Action:
How to Advocate at the Federal Level

Advocacy!
Advocacy!
Advocacy!
Advocacy!
Advocacy!
Advocacy!
Advocacy!

We could review theWe could review the
previous chart, or weprevious chart, or we
can watch this:can watch this:
https://www.youtube.com/wahttps://www.youtube.com/wa
tch?v=tyeJ55o3El0tch?v=tyeJ55o3El0

But wait, there’s more…But wait, there’s more…
There’s funding!There’s funding!
Entitlement vs. DiscretionaryEntitlement vs. Discretionary

How to find out what isHow to find out what is
going on?going on?
Visit websites on the issue.Visit websites on the issue.
Visit www.thomas.govVisit www.thomas.gov

Knowledge is powerKnowledge is power
•Know the bill (number, status,Know the bill (number, status,
etc)etc)
•Know your member of congress.Know your member of congress.
•Know the local relevance.Know the local relevance.
•Know the economics.Know the economics.
•Know your data.Know your data.
•Let them know how to get inLet them know how to get in
touch with you.touch with you.
•KNOW YOUR ASK!KNOW YOUR ASK!
•Have your one-pager.Have your one-pager.
“All politics is local.”
Tip O’Neill

Know your ask:Know your ask:
be specific!be specific!
• Has the bill been introduced on this side ofHas the bill been introduced on this side of
Congress?Congress?
• Has the member co-signed the bill?Has the member co-signed the bill?
• Is the member on the relevant committee?Is the member on the relevant committee?
• Is the bill in cmte or on the floor for a vote?Is the bill in cmte or on the floor for a vote?
• Has the bill passed and this is about fullyHas the bill passed and this is about fully
funding?funding?

How to do itHow to do it
• Tell your story: why areTell your story: why are
you personally there.you personally there.
• Name the bill and give theName the bill and give the
status.status.
• Make your ask.Make your ask.
• Explain your ask with aExplain your ask with a
combination of personalcombination of personal
anecdote backed by data.anecdote backed by data.
• Talk about the economics:Talk about the economics:
how much will it cost,how much will it cost,
where is the money comingwhere is the money coming
from, is it cost effective.from, is it cost effective.
• f/uf/u

ObstaclesObstacles
 If you don’t know something –If you don’t know something –
 ““You’re talking to the wrong person”You’re talking to the wrong person”
 ““I’ve heard a lot of different stats”I’ve heard a lot of different stats”
 ““There are a lot of competingThere are a lot of competing
interests and limited funding”interests and limited funding”
 ““This is not a priority”This is not a priority”

Why Your Hill Visits Matter
Scenario 1: Agreeable staffer Scenario 2: Contentious staffer
• Don’t underestimate the power of a
thank you for future advocacy and
relationship-building
• You never know where you might find
common ground, especially on
pediatric issues: don’t doom the visit
before it begins
• Your federal legislator may support
Title X funding and gun violence
prevention legislation, but how many
other issues does he/she support, and
where will yours fall in the priority list?
• Raising the profile of your issue as a
constituent and as part of the public
health community is important: your
vote counts (and children’s votes don’t)
• Pitch yourself as a resource: how else
can you help advance the issue in
Washington? Testimony? Press event
participation? Writing in the media?
• More often than not with pediatric
issues, opposition is benign neglect:
unless you’re out beating the drum
about your cause, others will take
priority
• Are there other obstacles stopping the
issue from progressing? What are they
and how can you help?
• Speak from your expertise: adolescent
health is nonpartisan; ask questions,
don’t give up

It’s not just visitsIt’s not just visits
Letters and phone callsLetters and phone calls
matter too!matter too!

AdvocacyAdvocacy
 When you go fromWhen you go from
preaching to the choirpreaching to the choir
to expanding theto expanding the
congregationcongregation

Examples of advocacyExamples of advocacy

Raising Awareness?!?!?!Raising Awareness?!?!?!
Guilt isn’t helpfulGuilt isn’t helpful

After you present the problem…After you present the problem…

Present the solutionPresent the solution

Be clear about the solutionBe clear about the solution

So what? What do you want?So what? What do you want?

An expert:An expert:
 Is someone who hasIs someone who has
made every possiblemade every possible
mistake in a givenmistake in a given
situationsituation

Learn from those who wentLearn from those who went
before youbefore you

Plan for the futurePlan for the future

If a program collapses in yourIf a program collapses in your
absence, that is not true leadership.absence, that is not true leadership.
Ensure your own obsolescence: writeEnsure your own obsolescence: write
things down. (Don’t count on verbalthings down. (Don’t count on verbal
communication.)communication.)
Do onto others…Do onto others…
Noah’s Arc PrincipleNoah’s Arc Principle
Co-sponsor as much as possibleCo-sponsor as much as possible
Communicate and be responsiveCommunicate and be responsive

True leadershipTrue leadership

Have fun, darn it!!!Have fun, darn it!!!

Thank youThank you
Mary Beth Levin, MPHMary Beth Levin, MPH
Associate ProfessorAssociate Professor
Department of Family Medicine andDepartment of Family Medicine and
Community HealthCommunity Health
Georgetown University School of MedicineGeorgetown University School of Medicine
levinmb@gmail.comlevinmb@gmail.com

hesp

More Related Content

What's hot

Viewers also liked

Similar to hesp

More from Mary Beth Levin

hesp

Editor's Notes