The District of Columbia’s needle exchange program prevented 120 new cases of HIV infection among injection drug users and saved an estimated $44 million in health care costs over two years, according to a new study from a George Washington University professor.
The study, published in the scientific journal AIDS and Behavior, shows that the average number of new injection drug use (IDU)-related cases of HIV infections dropped from about 19 infections per month to fewer than six—a decrease of about 70 percent.
Monica Ruiz, an assistant research professor in the Milken Institute School of Public Health, attributes the decline to a change in legislation that allowed municipal revenue to fund a network of needle exchange programs in Washington, D.C. These social services allow injection drug users to obtain hypodermic needles and other health services at little or no cost. Clean injection needles reduce the risk of exposure to HIV and other blood infections, like Hepatitis C.
“It’s not easy to quit if you’re addicted,” said Dr. Ruiz who led the study. “And so, in the meantime, here are these programs that can help people stay as healthy as possible while they’re engaging in that behavior, and then link them to services that can help them once they are ready to quit.”
In 1998, Congress banned the use of federal funds for needle exchange programs, but it did allow states and cities to use locally generated revenues to support such programs. However, Congress, which has final say over the District’s budget, banned the city from using its own funds for needle exchange programs.
In December 2007, Congress passed legislation that lifted the so-called “D.C. ban.” Then-Mayor Adrian Fenty (D) allocated $650,000 to the Department of Health to support four community-based organizations to deliver syringes, condoms, HIV testing referrals and addiction treatment referrals to drug users in the District.
Dr. Ruiz and her colleagues examined how the policy affected the HIV epidemic in terms of actual new cases associated with injection drug use. The research team used surveillance data to determine the number of new IDU-related cases of HIV following the removal of the D.C. ban and the implementation of the needle exchange network. Next, the team used mathematical models to forecast how many cases of HIV would have occurred had the D.C. ban remained in place.
They found that if the D.C. ban had remained in place, an estimated 296 injection drug users would have become infected with HIV during the two-year study period. Once the District launched its needle exchange network, there were only 176 new cases of IDU-associated HIV.
“This study shows the real impact of policy change,” Dr. Ruiz said. “This hopefully will be more evidence to keep the D.C. ban out of legislation.”
The program cost $650,000 per year when implemented, but the researchers estimate that it saved the city $44.3 million in health care costs. Since people receiving HIV and AIDS care in the District are likely supported by the publicly funded D.C. health exchange, taxpayers are ultimately the ones reaping financial rewards from a reduction in HIV cases, Dr. Ruiz said.
The study also could help to inform a wider national debate among policymakers about whether to fund these types of programs. While some legislatures have argued that syringe exchange programs increase crime, encourage drug use and lure people into addiction, Dr. Ruiz said there is no evidence to confirm these myths.
“A lot of these beliefs are based on misinformation and just a dogmatic approach to addiction—not understanding addiction is a medical issue and not just a bad habit,” she said.
Dr. Ruiz noted that needle exchange programs often help people quit their addiction, as they are sometimes the only available sources of health care for drug users. Not only do these programs provide clean syringes, but they also offer referrals to HIV testing, condoms, counseling and other services.
“Injection drug users are disenfranchised from the mainstream of the health care infrastructure and often face stigma, bias and discrimination,” she said. “They continue to go back to needle exchange programs because they know they won’t be judged and know they can get access to services.”
While the results from the study were overwhelmingly positive, Dr. Ruiz said needle exchange programs are only “one step in the right direction” toward ending the HIV epidemic in the District. African American men who have sex with men remain the highest HIV-infected group in D.C.
Dr. Ruiz hopes that evidence from this study can be a model for reducing risk among other populations besides drug users.
“What we need to do is think of other ways we can change the District’s environment that will facilitate risk reduction and prevention for these other groups,” Dr. Ruiz said. “We might think about what other policies are in place that inhibit people from accessing the services that they need or that drive people toward behaviors that increase their risk.”