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Current State of Syringe Exchange Programs in the US: Crisis and Opportunity
Abstract
Background: Syringe exchange programs began in the US in the late 1980s and there are presently approximately 180 active syringe exchange programs (SEPs). During this time period, HIV incidence among IDUs declined by 80%. The ban on federal funding for syringe exchange was recently removed, but programs may be facing severe budget cuts due to fiscal problems among state and local governments.
Methods: A survey of executive directors of US syringe exchange programs participating in the North American Syringe Exchange Network (NASEN) was conducted in Spring, 2009. The questionnaire asked about program operations in 2008 and was emailed with follow-up telephone interviews. Similar surveys have been conducted since 1994, and a survey is currently being conducted for 2009 program operations. Data from the current survey will be included.
Results: 123 of 180 programs provided data for 2008. SEPs were active in 98 cities in 30 states. 29.1 million syringes were exchanged, and total SEP budgets totaled 16.8 (79%) was from local and state governments. SEPs provided many services in addition to basic syringe exchange: 98% provided male condoms, 87% HIV testing, 65% HCV testing, 55% STI screening, 49% HBV vaccination, and 89% referrals to substance abuse treatment.
Conclusions: US SEPs have become multi-service organizations heavily dependent upon state/local government funding. The 2008 data provides a baseline and the 2009 data will provide a first assessment of state/local budget reductions and how SEPs expect to use any federal funds that become available.
... Union the hill has become much less steep over the years, with "consensus replacing controversy" [2]. In 2018, there were 335 needle and syringe programmes in the USA, organised by a rather well-developed grassroots harm reduction movement [3][4][5]. The result of the federal government changing its position on needle and syringe programmes, leading to a partial repeal of the ban on federal funding for this service, is a recent increase in needle and syringe programmes in the USA. ...
... For example, the numbers of needles and syringes exchanged have been rising in recent years (Table 1) and complex issues, such as collaborating with pharmacies and reinforcing the network of HR programmes by their involvement in the programmes, have been opened. 4 Additional innovative interventions, including the distribution of gelatine capsules intended primarily for people who use pervitin as an oral alternative to riskier injecting practices, have also been developed [60,61]. The situation in Slovakia was somewhat different. ...
... In this respect, the Health 3 Note, for example, the initiation of the first study in the Czech Republic to use the Rapid Assessment and Response (WHO) methodology conducted in 1995 [59]. 4 As part of the IGA NR9447 project, a proposal for more intensive cooperation with pharmacies on harm reduction interventions was drafted; it is 5 This is in contradiction of the integrative approach to such services as recommended by the key EU documents cited in the introductory section above. estimated that pharmacies sold 1.5 million syringes to PWID in 2009 [27,28]. ...
Background
The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central Europe following the fall of the Iron Curtain. The associated social and economic transformation had significant consequences for drug policies in the region. A large number of emerging services have been dependent on funding from a wide range of national and/or local funding programmes, which continue to be unstable, and closely associated with political decisions and insufficient institution building. A sharp distinction is made between health and social services, often without regard to client input. The main objective of the paper is to identify the causes of the funding problems currently faced by HR services in the context of their history of institution building which represents a major threat to the future of HR services in the region.
Methods
Qualitative content analysis of documents was conducted in the development of two case studies of the Czech and Slovak Republics. The body of documentation under study comprised policy documents, including National Drug Strategies, Action Plans, ministerial documents, and official budgets and financial schedules, as well as documents from the grey literature and expert opinions.
Results
The insufficient investments in finalising the process of the institution building of HR services have resulted in a direct threat to their sustainability. An unbalanced inclination to the institutionalisation of HR within the domain of social services has led to a misperception of their integrity, as well as to their funding and long-term sustainability being endangered. In addition, this tendency has had a negative impact on the process of the institutionalisation of HR within the system of healthcare.
Conclusion
The case study revealed a lack of systemic grounding of HR services as interdisciplinary health-social services. The aftermath of the financial crisis in 2008 fully revealed the limitations of the funding system established ad hoc in the 1990s, which remains present until today, together with all its weak points. The entire situation is responsible for the dangerous erosion of the interpretation of the concept of harm reduction, which is supported by various stereotypes and false, or ideological, interpretations of the concept.
... Initially,harm reduction advocates faced an uphill battle but in the European Union the hill has become much less steep over the years, with "consensus replacing controversy" [2]. In 2018, there were 335needle and syringe programmes in the USA, organised by a rather well-developed grassroots harm reduction movement [3,4,5]. The result of the federal government changing its position on needle and syringe programmes,leading to a partial repeal of the ban on federal funding for this service, is a recent increase in needle and syringe programmes in the USA. ...
... While compromised by numerous major shortcomings, this initiative, the highlights of which were supported by the Bulletin of the Ministry of Health [57]published ve years earlier, was promising in terms of the further development, strengthening, and stabilisation of the health component of HR services within the Slovak healthcare system. It should be noted that the key argument used to support the negative position was the senseless (although symbolic and essential with a view to the subject matter of this paper) requirement that the HR programmes should restrict their activities to the domain of social interventions only [4] and give up the ambition of conducting public health interventions. On the other hand, nancial support from the OSF in the years 1998-2005 made it possible to establish a small network of services in the largest Slovak cities which continued to be maintained and developed until this source of funding was disengaged. ...
BACKGROUND: The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central Europe following the fall of the Iron Curtain. The associated social and economic transformationhad significant consequences for drug policies in the region. A large number of the emerging services have been dependent on funding from a wide range of national and/or local funding programmes, which continue to be unstable,and closelyassociated with political decisions and insufficient institution building. A sharp distinction is made between health and social services, often without regard to client input.The main objectiveof the paper is to identify the causes of the funding problems currently faced by HR services in the context of their history of institution buildingwhich represents a major threatto the future of HR services in the region.
METHODS: Qualitative content analysis of documents was conducted in the development of two case studies of the Czech and Slovak Republics. The body of documentation under study comprised policy documents, including National Drug Strategies, Action Plans, ministerial documents, and official budgets and financial schedules, as well as documents from the grey literature and expert opinions.
RESULTS: The insufficient investments in finalising the process of the institution building of HR services has resulted in a direct threat to their sustainability. An unbalanced inclination to the institutionalisation of HR within the domain of social services has led to a misperception of their integrity, as well as to their funding and long-term sustainability being endangered. In addition, this tendency has had a negative impact on the process of the institutionalisation of HR within the system of healthcare.
CONCLUSION:The case study revealed a lack of systemic grounding of HR services as interdisciplinary health-social services. The aftermath of the financial crisis in 2008 fully revealed the limitations of the funding system established ad hoc in the 1990s,which remains present until today, togetherwith all its weak points. The entire situation is responsible for the dangerous erosion of the interpretation of the concept of harm reduction, which is supported by various stereotypes and false, or ideological, interpretations of the concept.
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