For nearly 20 years, Congress has maintained a federal ban on the funding of syringe exchange programs. The reasons are essentially ideological -- proponents of the ban believe that syringe exchange condones and encourages drug use. They also reject the wealth of evidence in favor of syringe exchange, an extensive body of research indicating that syringe exchange programs successfully reduce risk of HIV infection among drug injectors. Research also indicates that syringe exchange programs do not result in increased drug use, and indeed assist drug users in getting into substance abuse treatment.
Some critics of syringe exchange have attempted to use hepatitis C as an argument for why syringe exchange programs do not work -- specifically, they cite research showing that syringe exchange program participation does not lower the incidence of new hepatitis C infections.
This argument is rather disingenuous -- even if these programs failed to prevent hepatitis C, their success in preventing HIV is enough to warrant political support and funding. And more recent research suggests that on a structural/community level, syringe access through syringe exchange programs correlates to declines in the prevalence of hepatitis C. Indeed, the Centers for Disease Control have documented a dramatic decline in the number of new hepatitis C infections over the past two decades, including a decline in the number of infections attributed to injection drug use. They attribute this decline in part to the adoption of risk reduction practices by drug injectors.
Another argument against the critics' interpretation of the research on hepatitis C and syringe exchange: in general, in any given community, only a relatively small portion of drug injectors are utilizing the local syringe exchange program(s). Part of this is due to resource constraints of the programs that lead to limited hours, location, and staffing -- resource constraints that can be directly attributed to the maintenance of the federal funding ban. However, the benefits of syringe exchange extend beyond people who directly participate -- in my experience, many people attending these programs obtain needles not only for themselves, but also for partners and friends who do not or cannot attend. Thus, clean syringes are distributed much more broadly in the community than actual numbers of participants would suggest. Indeed, that's why syringe exchange has a community-level effect on both HIV and hepatitis C rates -- it functions as both an individual-level intervention that includes one-on-one education and counseling, and as a community-level intervention that promotes dissemination of harm reduction information and strategies while increasing overall access to sterile syringes.
We still have much work to do in improving hepatitis C prevention for drug injectors -- syringe access is a necessary component, but we need to expand access while also exploring other strategies to reduce risks. Syringe exchange programs constitute the ideal environment to pilot and evaluate new strategies. Unfortunately, very little research funding has been directed towards developing successful interventions.
Syringe exchange programs are a cornerstone of hepatitis C prevention, but they also comprise a crucial point of contact and engagement with drug injectors that can facilitate access to a range of other services, including hepatitis C testing, hepatitis A and B vaccination, group education and support for people living with hepatitis C, and case management and referral to medical care, including hepatitis C treatment.
Hepatitis C advocates should support calls on Congress to remove the federal ban on syringe exchange funding. Indeed, many hepatitis C advocates are at the forefront of local and state struggles to establish new syringe exchange programs. These programs provide vital services and infrastructure for the fight against hepatitis C. Access to federal funding will strengthen our response to the hepatitis C epidemic among the group with the highest risk and prevalence of infection.
