In his State of the Union Address earlier this year, President Trump announced the laudable goal of eliminating HIV transmission by the year 2030. Needle exchange programs (also called Syringe Exchange Programs or SEPs) are a public health approach in use since the 1980s with a proven record of reducing the spread of HIV, hepatitis, and other blood-borne infectious diseases. I have presented much of the data supporting needle exchange programs here and, more recently, here. Now, new research reported in the Journal of Acquired Immune Deficiency Syndrome adds even more strength to the argument in favor of needle exchange programs.
Because most of the averted cases would have received publicly funded health care, the study’s authors then translated averted cases into cost savings for the two cities.Using surveillance data of HIV diagnoses associated with intravenous drug use from Philadelphia and Baltimore, cities where needle exchange programs had been permitted since the early 1990s, their analysis concluded that more than 10,000 cases of HIV were averted in Philadelphia from the years 1993 to 2002, and nearly 1,900 cases were averted in Baltimore from 1995 to 2004.
The forecasts estimated an average of 1,059 HIV diagnoses in Philadelphia and 189 HIV diagnoses in Baltimore averted annually. Multiplying the lifetime costs of HIV treatment per person ($229,800) by the average number of diagnoses averted annually in both cities yields an estimated annual saving of $243.4 million for Philadelphia and $62.4 million for Baltimore. Considering diagnoses averted over the 10-year modeled period, the lifetime cost savings associated with averted HIV diagnoses stemming from policy change to support SEPs may be more than $2.4 billion and $624 million dollars for Philadelphia and Baltimore, respectively. Because SEPs are relatively inexpensive to operate, overall cost savings are substantial even when deducting program operational costs from the total amount.
Needle exchange programs have long been endorsed and encouraged by the Centers for Disease Control and Prevention, the Surgeon General of the United States, the World Health Organization, the American Public Health Association, and the American Medical Association. Nevertheless, needle exchange programs are legally permitted to operate in only 28 states and the District of Columbia. Drug paraphernalia laws make them illegal elsewhere.
Some critics argue that needle exchange programs “enable” or “endorse” intravenous drug use. Such moralizing is not appropriate in this context. Addiction is a behavioral disorder characterized by “compulsive use despite negative consequences.” Preventing organizations from providing an effective means of harm reduction to people with addiction who continue to use drugs is akin to denying insulin to diabetics who continue to make dangerous eating choices.
It is not unrealistic to set a 10-year goal for ending HIV transmission. Needle exchange programs are essential for that to happen.