Two dominant concerns of recent decades, the spread of the HIV virus and intravenous drug abuse, have generated various responses. Efforts are made to combat both in social, scientific, and political arenas, as both concerns are perceived as going to issues of behavior modification; the drug addict, it is felt, requires physical and psychological treatment, while the spread of AIDS through either unprotected sex and/or syringes is also typically viewed as much as a social issue as a medical one. Then, the two factors are inextricably linked, as the presence of HIV from sexual activity is often transmitted through needle sharing. These realities in place, it was believed that providing clean needles would reduce risks of all infection, and some efforts have been directed accordingly. Thus far, needle exchange programs demonstrate consistent levels of success in decreasing spreads of infection. There remains, however, public and political opposition to such programs so strong, the perception that clean needles will encourage drug abuse and risky behavior is permitted to block governmental funding at state and federal levels. Much of this opposition, as will be seen, is based on moral ideologies. Nonetheless, and given the evidence thus far, needle exchange programs are a potently effective means of reducing disease, lowering fatality rates, and ultimately a responsibility the society must accept and expand if it is to serve the welfare of the people.
That the public is widely disinclined to support needle exchange, a fact translating into the legislation necessary to fund it, may be seen as deriving from several perceptions. Perhaps the most influential is that the state’s providing of clean needles to addicts stands as something of a subsidy to a criminal and unhealthy element of the society. To give needles is in a sense to validate usage. In the process, opposition holds, the society is sending out a dangerously mixed message: it reviles drug abuse and renders it illegal, but it will supply the tools needed for it. Another objection takes the form of “trust,” in that it is felt that providing clean needles in no way safeguards their remaining clean, particularly given the carelessness of addicts. Added to this is the more legitimate concern that, with funding for social welfare limited, money is diverted to such programs that would be better spent in offering real treatment (Wilson, Kolander, 2011, p. 86). In general terms and based upon the reluctance of state agencies to create exchange programs, these are significant obstacles.
The actual impact of needle exchange opposition is such that representative pressure brought about a reversal of policy by President Obama in 2009. While campaigning, Obama vowed to overturn the existing ban on funding exchanges, yet his 2009 budget proposal reinforced it. White House spokespeople at the time asserted that the commitment to support would emerge in time, but the reality of simple political necessity appears to have dominated. Conservative forces in the Congress made it very clear that they would oppose any such measures and Democrats, fearful of being perceived as too liberal, conceded (Svalavitz, 2009). In fairness to Obama, he stands in a line of leaders who have simultaneously expressed support for needle exchange but who were facing powerful opposition. President Clinton maneuvered the same course in 1998, and rescinded support only when he was persuaded that needle exchange was “sending the wrong message” from the government (Svalavitz, 2009). The relatively brief history of needle exchange, then, has been marked by ambiguity at the highest levels, which in turn reflects public opinion as divided, if not predominantly opposed.
These political and, consequently, social and economic realities in place, it is then necessary to examine precisely what effects needle exchange has been proven to generate. Strikingly, consistent success is documented, and Hawaii stands as strong evidence of the benefits of the programs. In 1990, it was the first state to authorize and fund syringe exchange. The programs are continued in the state because the results have been so positive, and confirmed by studies regularly made: “Most cities that responded early in the epidemic by implementing comprehensive syringe exchange programs have kept infection rates among drug injectors below five percent” (HSDOH, 2013). This ratio becomes more important when compared to infection rates elsewhere, as in New York and Miami, which remain at between 40-50 percent in such cities where exchange programs were either begun later or not at all. It is as well worth noting that Hawaii’s needle exchange agenda reflects a commitment to use the programs as a means of encouraging addicts to seek treatment, and the programs operate within a network enabling such a process (HSDOH, 2013). When the dirty needles are traded in for clean, the drug user is introduced to counseling and recovery options, as well as free HIV testing. Then, widespread research from the Center for Disease Control fully corroborates the success of all exchange programs, with reductions of infection spreading as high as 80 percent (CDC, 2013). It very much appears that, no matter the source of investigation, needle exchange decreases risk significantly and lowers transmission rates of disease.
Given this impressive array of evidence, it becomes all the more apparent that the primary obstacle facing the efforts is that of public opinion as hostile to them. As noted, there is an inherent dichotomy in the public mind in regard to the issue, as exchange equates to many to condoning drug abuse. Addiction is not treated, but prolonged, and this clearly conveys some measure of societal approval (Wilson, Kolander, 2011, p. 86). An example of just how vehemently large numbers of people feel regarding the immorality of needle exchange may be seen in the recent battle in Texas. The state has an estimated 70,000 HIV cases, and it has been determined that seven percent are created by needle sharing. Consequently, a bill to initiate pilot exchange programs was introduced, authorizing seven large counties to develop needle exchange. It was defeated in the state House, and at least partially due to powerful conservative manipulation of the media, and social media. The facts supporting the effectiveness of the programs elsewhere were eclipsed by a single message, as in conservative leader Michael Sullivan’s Internet statement warning Texans of the impending legislation. His
message essentially stated that the House was about to “give free needles to drug users”, and this triggered a sufficiently negative public response (AP, 2013). The statement evidently plays to that sense in the public that permission and/or endorsement is being given for an illegal and immoral habit, and one moreover funded by tax dollars.
Morality aside, it is reasonable that opposition to needle exchange would be concerned with promoting drug addiction. In plain terms, supplying for free one instrument within the practice appears to be an inducement, and this blatantly violates society’s obligation to care for its own well-being. With regard to the argument that needle exchange encourages experimentation with drugs and creates new users, however, no real evidence of any kind supports this. The American Foundation for AIDS Research sponsored a vast and independent study, and the effectiveness of exchange programs was seen as reducing the spread of HIV by 30 percent. At the same time, there was as well a significant increase in the number of drug users who, upon entering the needle exchange programs, then pursued addiction treatment. More to the point, there was no indication of new drug users as arising from the programs studied (Fan, Conner, & Villareal, 2011, p. 195). It seems difficult for strident opposition to accept, but all indications are that addiction is likely to be lessened with the emergence of needle exchange, rather than the contrary.
Linked to this is the important fact that such programs present one of the few means for the society to interact with a largely hidden population. With this interaction comes a wide array of opportunities to alter the user’s state of life, as well as offer vital health services apart from substance abuse (CDC, 2013).
The contrast between evidence supporting exchange programs and opposition to them leads to an inescapable conclusion: the public is so unwilling to abet drug usage as it perceives the agendas of the programs, it is expressing a potent antipathy based on moral values. Drugs are illegal and immoral, and actual benefits are immaterial, if the public’s action is immorally supportive of drug use. Likely connected to this is the lingering perception of AIDS as a disease based on immoral practices, either in terms of sexual conduct or drug. This inevitably translates to governmental response which, as noted, is contradictory. There is such resistance to needle exchange, it seems, that even its strongest adherents acknowledge that, in office, the pressure may dictate. For example, when asked in 2007 if she would support the programs while campaigning for office. Hillary Clinton conceded that political factors would play a large role in any decisions made (Svalavitz, 2009). The consistently positive example of Hawaii, corroborated by national research equally consistent, is as yet insufficient to surmount this ideological obstacle. Consequently, for further progress to be made in terms of society’s assisting in the reduction of infection spread through needle sharing, the society must confront and accept the reality that addressing a problem in an efficient way does not equate to condoning the root of the problem.
It is as futile to attack a society’s perceptions as it is demand that they change to accord with established fact. In this matter, society’s antipathy top drug abuse is so strong, remedial efforts to reduce the disease and death created by a component of that abuse are dismissed. It seems that, in the arena of needle sharing and needle exchange, it is ideas of morality that dominate, the success of existing programs notwithstanding. The irony here, of course, lies in the fact that true morality is served when fewer people suffer, but convention remains a force to potent to overcome, at least on a national level. Nonetheless, the greater reality remains that needle exchange programs are a consistently effective means of reducing disease, lowering fatality rates, and ultimately a responsibility the society must accept and widely implement if it is to serve the welfare of the people.
Associated Press (AP). (2013). “Texas House Strikes Down Pilot Drug Needle Exchange.” Retrieved from http://www.mywesttexas.com/statenation/article_10a79204-b487-11e2-9de4-001a4bcf887a.html
Center for Disease Control. (2005). Syringe Exchange Programs. Retrieved from http://www.cdc.gov/idu/facts/aed_idu_syr.pdf
Fan, H., Conner, R., & Villareal, L. (2011). AIDS: Science and Society. Sudbury: Jones &Bartlett Learning.
Hawii State Department of Health (HSDOH). (2013). STD/AIDS Prevention Brach: Reducing Harm Related to Injection Drug Use. Retrieved from
Svalavitz, M. (2009). “Why Obama Isn’t Funding Needle-Exchange Programs.” Time Magazine. Retrieved from http://www.time.com/time/nation/article/0,8599,1898073,00.html