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Posts Tagged ‘Needle exchange’

The needle exchange ban never applied to US-funded international AIDS programs, but the previous administration essentially acted as if it did. Now that the ban has officially hit the legislative dustbin, Eric Goosby, MD, the U.S. global AIDS coordinator, has signaled an readiness to move forward in providing PEPFAR support for needle exchange programs in countries hard hit by the HIV/AIDS epidemic. But the wheels of bureaucracy may move slowly.

Here’s the statement Dr. Goosby gave to Housing Works, which posted this comprehensive blog on what the end of the ban means in practice domestically and globally.  Click the link above to read the full blog or read below for Goosby’s statement: 
 
“I’ve been involved in working with injection drug users for a long time, and my view is that the evidence strongly supports the value of needle and syringe programs as part of a comprehensive prevention portfolio,” Goosby said in a statement to the Update. “PEPFAR is currently working with agencies across the U.S. Government to determine the best way forward in supporting this comprehensive package.”

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Lawmakers have finalized the fiscal year 2010 budget for foreign assistance, setting funding for key programs to fight global HIV and TB and reaching a landmark deal to revise the needle-exchange ban.

The agreement—expected to pass the House before the end of this week and the Senate before the end of next week—includes some modest increases for bilateral HIV and TB, as well as for the Global Fund to Fight AIDS, Tuberculosis and Malaria. But the funding levels still fall far short of what’s needed to combat these twin epidemics and of what was authorized in the Lantos-Hyde Act passed by Congress last summer.

The deal, for example, would allocate $5.359 billion for global AIDS, $1.05 billion for the Global Fund, and $225 million for TB. It also includes a slight boost for NIH. The gloal AIDS figure does not include bilateral HIV/AIDS funds for USAID or the CDC’s Global AIDS Program; with those pots of money tallied, the total US bilateral AIDS funding for 2010 stands at $5.828 billion. (See chart below for more details on how this comparies to last year, etc.)

The real headline, though, is this: Key congressional negotiators agreed to ease the ban on federal funding for needle exchange programs. This is a long-overdue move that will remove an unnecessary and harmful barrier to effective HIV prevention efforts. It’s also a big surprise.

Earlier this year, the House approved lifting the ban, but included so many restrictions as to make federal funding for such programs essentially unfeasible (i.e., not near any schools, parks, arcades, etc.). The Senate voted to keep the ban in place.

The new agreement revises the ban so it would only prohibit the use of federal funds for needle exchange programs in a location “that local public health or law enforcement agencies determine to be inappropriate.”

Here’s the chart, which lays out the approved spending levels for FY2009, the funding levels authorized in the PEPFAR II, the President’s request for FY2010, and last night’s Congressional agreement.

Dollars in millions

  FY09 PEPFAR II Obama FY 10 Final
Global AIDS $5.159bil $6.5bil $5.259bil $5.359bil
Global Fund $600 $2bil $600 $1.05 bil
Tuberculosis $163 $650 $173 $225
NIH $30.566 N/A $30.758 $31.008

 

Notes:  The reauthorization bill did not contain specified year by year funding levels with the exception of the Global Fund which was authorized at $2 billion.   The amounts listed under PEPFAR II for bilateral Global AIDS and TB are extrapolated from the overall five-year funding levels authorized in the bill. In addition, as noted above, the global AIDS figure does not include money directed to USAID or CDC for their bilateral HIV programs.

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In case lawmakers need an extra nudge as they consider lifting the ban on federal funding for needle exchange programs, here are two fresh facts on the effectiveness of this tool in reducing the spread of HIV:

*In India, needle exchange programs have contributed to a dramatic reduction in HIV seroprevalence among injection drug users—cutting the rate from 81% to 58% over a three-year period.

*In Brazil, syringe exchange policies have led to a 62% reduction in HIV infections among injection drug users.

This data comes from a new report, “Syringe exchange programs around the world: The global context,” out this week from the Gay Men’s Health Crisis. The report says that as of 2008, there were at least 77 countries worldwide that had introduced syringe exchange programs (SEPs) to curb the spread of HIV/AIDS.

The news of how effective SEPs can be in reducing HIV infection is no surprise to those who of us advocating for evidence-based global health policies. But it comes as Congress considers overturning its ban using federal money to support needle exchange programs. A House committee approved a measure lifting the ban, albeit with so many restrictions as to make it essentially useless. A Senate panel voted to leave the ban in place. That means a full-blown congressional fight on this hot topic is in the offing.

As we’ve written here before, the ban technically only applies to domestic programs, but PEPFAR officials have extended it to international programs, so this has major implications for global HIV prevention efforts. Dr. Eric Goosby, the US Global AIDS coordinator, has strongly signaled the administration’s desire to see the ban overturned and says a move to do so in the international context is in the works. But the White House seems to be waiting for Congress to make a more definitive move on this first. Given that, this report adds some important new points to the debate.

Here’s more from the GMHC’s news release and a link to the full report.

“The newly released report highlighted five policy lessons from the review of global SEPs: (1) the importance of government sponsorship and regulatory oversight of community-organized SEPs; (2) how legal regimes can inhibit the success of SEPs in reducing HIV infection rates; (3) the ways in which successful SEPs interact flexibly with IDUs, such as by providing mobile services, syringe vending machines, or even drug rehabilitation services; (4) how countries can use SEPs to promote rehabilitation and reduce the incidence of drug use; and (5) the ways in which SEPs have thrived even in countries with strong social and religious mores opposing drug use.”

http://www.gmhc.org/policy/2009/gmhc_intl_seps.pdf

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First, a quick update on needle exchange: The Senate Appropriations subcommittee on labor, health and education programs approved a spending bill this week that leaves in place the funding ban on needle exchange programs. This means a fight in conference over the fate of that provision, since the House approved language lifting the ban, albeit with lots of restrictions on where needle exchange programs can be located. As we’ve written here before, the ban technically only applies to domestic programs, but PEPFAR officials have extended it to international programs, so this has major implications for global HIV prevention efforts.

Now, for those who didn’t get enough HIV/AIDS science or policy news at the IAS conference in Cape Town (or those who didn’t get to go in the first place), Aidsmap.com has launched an online discussion forum to further delve into questions raised at the conference. Among the topics up for debate: the implications of calls for earlier initiation of antiretroviral treatment. Click here to check out the Aidsmap forums–and make sure to cross-post comments here, so the discussion can be wide-ranging.

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This is an update to our post earlier this morning on two key HIV policy votes in the House today.

So much for a new era of evidence-based AIDS policy in a Congress controlled by Democrats. In today’s vote on HIV/AIDS research, lawmakers agreed (by voice vote) to strip out funding for three HIV research grants, apparently because they involved examining the role of substance abuse and sexual behavior in HIV transmission. Never mind that physician-scientists say understanding the risk factors posed by prostitution and illicit drug use are vital to controlling the HIV/AIDS epidemic.

In a second pivotal House vote today, HIV/AIDS advocates won, sort of, when an amendment to reinstate the ban on federal funding for needle exchange programs was narrowly defeated.

It was only “sort of” a win because the language that was preserved by today’s vote is pretty muddy to begin with. Instead of a clear repeal of the ban, as Rep. David Obey, D-Wis., originally proposed, the langauge was significantly watered down to say that no needle exchange programs could be funded within 1,000 feet of certain locations, such as schools, arcades, etc.

Obey inserted that weaker language, even as he reportedly acknowledged that it is probably unworkable. He has said he would work toward an alternative as this bill moves forward.

Both these provisions were included in a massive spending bill to fund domestic health, labor, and education programs. The fight will likely now move to the Senate and then a conference committee, where the two chambers will work out any differences in their competing versions of the spending bill.

Advocates will be working to restore the HIV research money and  press for a full repeal of the needle-exchange ban.

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The House of Representatives will take up two pivotal HIV/AIDS-related amendments today as it debates a massive spending bill for domestic labor, health and education programs. Although the policy decisions at stake today are part of a domestic funding bill, they have implications for global AIDS. 

The first is a proposal by Rep. Darrell Issa, R-CA, to rescind funding for three peer-reviewed grants that focus on HIV/AIDS  prevention. Issa says they are an example of wasteful spending. The three grants ar focus on : substance abuse and HIV risk among Thai women;  HIV prevention for hospitalized Russian alcoholics; and venue-based HIV and alcohol use risk reduction among female sex workers in China. More information is included below in an action alert being circulated by health advocates.

The second amendment, from Rep. Mark Souder, R-Ind., would reinstate the ban on federal funding for needle exchange programs. As we’ve written in earlier posts on this subject, Rep. David Obey, D-Wis., moved to overturn the ban in subcommittee. He inserted a watered-down version in full committee but has pledged to work toward full repeal. Souder’s proposal would cut those efforts short and put back in place a ban that physicians and other AIDS advocates have long criticized as an unnecessary hurdle to effective HIV prevention efforts.

(more…)

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One step forward, half a step back. That’s where advocates of evidence-based treatment of HIV/AIDS seem to have landed Friday in their efforts to overturn the two-decades-old ban on federal funding for needle exchange programs.

Last week, Rep. David Obey, D-Wis., chairman of the House Appropriations Committee, successfully moved to nix the needle-exchange ban when a subcommittee took up the FY2010 spending bill for health and labor programs. But when the full committee took up the bill late Friday, Obey offered an amended version that would bar needle exchange programs from operating within 1,000 feet of certain organizations, such as schools and arcades. His move seriously watered down the provision, potentially make it difficult to find a legal location for a syringe exchange program.  But Obey reportedly acknowledged that this would be unworkable and said he would try to find an alternative approach as this bill moves forward.

Obey’s move was likley an attempt to pre-empt Republican efforts to fully reinstate the ban; an amendmend to do just that was voted down after Obey’s substitute provision was accepted. (more…)

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