Fighting HIV/AIDS or Enabling Addicts?

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Baltimore has been named in different outlets as the “Heroin Capital” in the United States. Around 60,000 people are drug addicts, which is around 3% of the population. The drug problem in Baltimore is worse than other cites because of drug culture rooted in families and over several generations. There is a very strong relationship between intravenous drug use (IDU) and HIV/AIDS. 61% of new AIDS cases were among IDUs; some people describe this phenomenon as the “Twin Epidemic”. In an attempt to use the concept of Harm Reduction as a strategy to reduce the prevalence of HIV/AIDS and other blood borne pathogens, The Baltimore Syringe Exchange Program was created in 1994. Since then, they have exchanged nearly half a million needles each year making the percentages of HIV diagnoses attributed to Injection drug use fall from 53% to almost 16% in 2010.

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Despite the huge success of this program, it is still surrounded with huge controversy for multiple reasons. All the reasons surround a single themed question; are we fighting AIDS? Or enabling addicts? It is argued that this program enables addicts and increases crime rates by providing the necessary equipment for them in terms of distribution of needles rather than exchange. The new bill passed by the General Assembly, expanded the needle exchange program by not limiting the amount of needles provided to one person. Many critics of this program argue that distributing needles into the community will enable drug addicts rather than fight AIDS.  But the numbers tell us otherwise, as mentioned before. This program helped cause a significant reduction in HIV rated among drug users and offers other services such as counseling and advocacy. It falls within the cores of public health practice that promotes health and reduces/prevents harm.Screen Shot 2015-03-06 at 3.31.08 PM

Courtesy of Maryland Department of Health and Mental Hygiene. Baltimore City HIV/AIDS Epidemiologic Profile: Fourth Quarter 2007.

Observing the success of this program in Baltimore and other cities nation-wide, it is time to advocate for a much bigger expansion and scope of this program. Also, it is time to show the Federal government its success and remove the ban on federal spending for these types of programs to ensure it’s sustained and durable success.

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6 Responses to “Fighting HIV/AIDS or Enabling Addicts?”

  1. rebecca7w Says:

    I find it interesting that the IDU rate for the NEP sites also fall over the course of the program alongside the HIV incidence rate, as compared to the non-NEP sites; this has been previously noted elsewhere as well (http://onlinelibrary.wiley.com/doi/10.1111/j.1748-720X.1995.tb01383.x/abstract), and counters the argument that needle exchange programs encourage IDU. A recent parallel to this conundrum would be the use of HPV vaccine in school-aged children, with some postulating that the vaccine “enables” sexual promiscuity, which has not been found to be based in evidence or fact (http://time.com/3701507/hpv-vaccine-sti/).

  2. jaminaddae Says:

    I have been contemplating this very same issue ever since i heard about this needle exchange program, thank you for writing such an informative piece on it. This is a sensitive issue that borders on morality for most people, however we should not fail to appreciate the bigger picture. Needles on their own do not create addicts in society, and addiction is a medical/psychiatric problem that requires medical treatment. These people are not going to stop injecting drugs on their own or disappear from society. As long as they keep using needles for injecting drugs, why not do it in a safe manner (which will not only prevent HIV but HCV as well). Needle exchange is not the solution to eliminating the drug problem in our community but it is a sure effective way in preventing HIV/HCV

  3. meghanoconnell2015 Says:

    I agree with jaminaddae and think this is a progressive step forward in decreasing rates of HIV. It would be interesting to see the amount of money invested in the program and compare it to trends of public spending on HIV in Baltimore since the program was initiated. Have we saved money and if so how much? It is sometimes unfortunate that policy depends so heavily on money and cost-effectiveness, but this could be one approach to sell it in other contexts. Nice post, very interesting!

  4. sghrjn Says:

    I think cost-effectiveness of the needle exchange program (NEP) has been studied extensively (also in Baltimore) and Hopkins played an important role (ex. http://goo.gl/rsg4XY). It is already well known that NEP does not increase injection drug usage (http://goo.gl/HlFscT). I think reinstatement of federal funding ban is more driven by emotional, ethical and religious reasons. On the other hand, current endemic of HIV in Baltimore is not driven by IDUs (proportion of IDUs among newly-diagnosed HIV patients was below 10%), but by MSMs (55%). Considering this epidemiologic transition, I am not sure whether we should emphasize more on enabling federal funding on NEP (because some private funding are available now).

  5. alsabah87 Says:

    Great post! I very much agree that federal government needs to expand the Baltimore Syringe Exchange Program because as research shows us, the reduction in HIV/AIDS is significant. I’ve personally noticed how drug addiction is a very important topic in Baltimore during my time here. It has been my impression that different intoxicating substances are central to the way of life among impoverished communities, and based on the numbers published from the literature above, those same communities struggling with heroine addiction are also plagued with high rates of HIV/AIDS infections.

    I wonder if we can explore alternative intervention programs if the struggle, in this case, is with the amount of funding? Perhaps other possible alternatives can be intervention strategies more focused on education as a prevention mechanism by spreading awareness within these communities? Most importantly, people need to realize that HIV/AIDS is not merely due to unprotected sex, but that intravenous drug users inevitably are at risk of infection because of the exchange of needles between multiple addicts. This is the link that federal governments and the general public must always keep in mind. Thanks for sharing!

  6. kamillegardner1384 Says:

    This is an interesting program that I had not previously heard of, and I think it is a great initiative aimed at reducing HIV/AIDS transmission and mitigating some of the health consequences that drug use often entails. This is a very interesting debate that you have posed in your blog post between whether or not the syringe program is helping one problem but enhancing another. However, similar arguments have been made for planning interventions, and I think many in the public health community would agree that contraceptive availability doesn’t necessarily mean increased sexual behavior, but rather safer sex practices. So for this reason, I would certainly agree that this program is needed to address HIV/AIDS and heroine use in Baltimore community. However, I think this program should be coupled with another program that is aimed at reducing drug addiction, such as detox clinics and other addiction recovery programs and services.

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