Advances in medicine since the discovery of AIDS in 1981 have given us the technology to contain, if not eradicate, this deadly disease. Yet HIV, the virus that causes AIDS, continues to spread. There are 34 million people living with HIV or AIDS worldwide, 1.1 million of them in the United States. Every 9.5 minutes, someone is infected with HIV in the United States. Every year, approximately 50,000 new infections occur.
According to the Centers for Disease Control and Prevention, this number has been stable since the mid 1990s. That’s one way of looking at it. But why hasn’t the number decreased? The statistics could lead one to say that government is not doing enough, or that the policies in place aren’t working. It could also be that the people who are affected or at risk are ignoring HIV-prevention messages or failing to adopt healthy behaviors to fight against this epidemic, which, according to the U.S. Department of Health and Human Services, has claimed almost 636,000 lives in the United States alone.
CDC data show that injection drug users represented 8 percent of new HIV infections nationwide in 2010 and 16 percent of those living with HIV in 2009. According to the National HIV Behavioral Surveillance study, New York City has the largest population of injection drug users in the country, with estimates of 40,000 to 120,000. To date, 85,000 cases of HIV have been related to injection drug use in New York City.
According to the New York State Department of Health, in 1992, more than half of new HIV infections — 52 percent — were due to injection drug use. That year, the state implemented the Syringe Exchange Program to reduce HIV infection through contaminated syringes. The program, which provides injection drugs users with clean syringes and needles, permits community-based groups, not-for-profit organizations and government entities to posses and provide hypodermic needles and syringes without a prescription with the purpose of reducing HIV transmission.
Since its implementation, statewide rates of HIV infection by use of contaminated needles have dropped: to just over 5 percent in 2009. The state health department expanded the program in 2000 to prevent other blood-borne disease, including hepatitis B and hepatitis C. There are 21 program sites: 14 are in New York City, and there’s one each in Nassau County (Hempstead) and Suffolk (Wyandanch). Statewide, the program has enrolled 150,000 injection drug users.
Yet syringe exchange programs have been a matter of heated debate in the United States, more so because of our country’s “zero tolerance” attitude toward drug use. Federal policy prohibits the use of federal funds for syringe exchange programs, though state and city health departments are free to use their own money to operate such programs. Additional funding is required to reach more people, but the federal policy starves the program of the resources it needs.
Despite the encouraging results of New York’s syringe exchange program, it is difficult to replicate in much of the United States. Where similar programs are allowed, laws forbidding the possession of drug paraphernalia make their implementation difficult. This disconnect between public health and the legal system needs to be changed.
Our country might be far from ending illegal drug use, but the end of the AIDS epidemic should be in our sights. We can get even closer by decriminalizing syringes and expanding access to funding for these community-based life-saving programs.
Trushar Patel, a dentist from India, is a student in the Master of Public Health Program at Long Island University, Brooklyn.