Natalie Davies examines an effort to increase regulations on needle exchange programmes in West Virginia, at a time when the state was experiencing an outbreak of HIV related to injecting drug use.

In early April 2021, the Republican party-led legislature in West Virginia (an eastern state in the US) approved a bill to ‘regulate’ needle exchange programmes. The bill contained requirements that could make it more difficult for services to provide harm reduction resources and for people who inject drugs to access those harm reduction services:

  • There would be a limit to the number of providers able to give sterile syringes to people who inject drugs.
  • Providers would need to acquire licences for operating, and would also need to offer other healthcare services, such as referral to treatment.
  • Providers would need to stamp their name on any injecting equipment they distribute so that the source of injecting-related litter could be identified.
  • People wanting to access sterile injecting equipment would be required to show an identification card.

Elected members of the House voted 67-32 to send this bill to the governor at a time when the state was experiencing an outbreak of HIV related to injecting drug use. Reporter Julia Lurie said:

“The stakes couldn’t be higher: Kanawha County, which includes Charleston, is currently experiencing an HIV outbreak that the Centers for Disease Control and Prevention considers ‘the most concerning in the United States.’ Last year, 35 new HIV cases were reported among Charleston’s intravenous drug users. That was just one fewer case than all of New York City had in 2019, at 150 times the population. At a recent city council meeting, a CDC representative warned that the HIV diagnoses that had been reported were likely ‘the tip of the iceberg.’”

Needle and syringe programmes are one of the main interventions for reducing injecting-related transmission of HIV, hepatitis C, and other blood-borne viruses, and work by providing people who inject drugs with sterile injecting equipment and advice.

The UK’s health advisory body, the National Institute for Health and Clinical Excellence (NICE), recommends high-coverage (and if need be, 24-hour) needle exchange to combat HIV and hepatitis C. The aim, they say, is for every person who injects drugs to have more sterile injecting equipment than they need for every single injection.

Philadelphia and Baltimore, two cities that were struggling to combat HIV, implemented needle and syringe programmes in 1992 and 1994 (respectively), both of which had a major impact. A study published in the Journal of Acquired Immune Deficiency Syndromes estimated that 10,592 HIV diagnoses were averted in Philadelphia over the decade, and 1,891 HIV diagnoses were averted in Baltimore over a similar time span. The evidence strongly suggested that this reduction was because of a reduction in injecting-related risk through access to needle and syringe programmes.

In another study, published in the International Journal of Drug Policy, the same group of researchers interviewed 29 key stakeholders in three US cities (Baltimore and Philadelphia as above, plus Washington DC), asking them about the historical, social, political, and scientific context during the policy change process. For Baltimore and Philadelphia, research evidence played a consistent role in driving policy change. In contrast, research evidence played only a minor role in the decision in Washington DC, where some policymakers were perceived to be unwilling to consider its relevance.

A recurring theme in all three cities was the idea of ‘data free zones’, which stakeholders defined as the presence of people opposed to needle and syringe programmes claiming they were detrimental to society, but with no empirical evidence to support this.

“…There was so much evidence… So much scientific evidence about the effectiveness of needle exchange for HIV prevention. I can’t say there was any rational basis for the [needle exchange ban]”.

Study participants, who were primarily supporters of needle and syringe programmes, interpreted the arguments of opponents as being rooted in fears that needle and syringe programmes would increase drug use and undermine the ‘War on Drugs’. One participant said, “You have to realize that, for some […], there are not any facts that are going to win them on policy”.

by Natalie Davies

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