Each quarter, the Elton John AIDS Foundation (EJAF) shines a spotlight on an important issue, region, or population in the effort to end the HIV/AIDS epidemic and on the Foundation’s strategies and the innovative work of EJAF grantees in that field. For the first quarter of 2012, we are focusing attention on injection drug users, a highly stigmatized and under-served at-risk population, and the important role syringe exchange programs play in reducing HIV transmission and increasing access to care.
According to the U.S. Centers for Disease Control and Prevention (CDC), more than 4,000 people become newly infected with HIV every year in the U.S. because of unsafe injection drug use. This accounts for nearly one in 10 new HIV infections.
Furthermore, in a 2009 study of people who inject drugs in 20 cities, the CDC found that health risks continue to be high and engagement in health services remains low. A total of 9% of people injecting drugs were HIV-positive. Nearly half of those testing positive didn’t know that they were infected. More than one in three people had shared syringes during the previous year. Most had had unprotected sex, and most had NOT been tested for HIV during the past year. Only one in five had been reached by an HIV prevention program.
In a country as wealthy as the United States, these poor health statistics are entirely preventable, and thus remain entirely unacceptable.
One way to fix this is clear. Studies indicate that the rate of new HIV infections drops when people who inject drugs have ready access to clean syringes and condoms, and when people have increased access to annual HIV testing, linkage to health care, and successful HIV treatment, if required.
Beginning in the mid-1980’s, syringe exchange programs were organized by HIV and drug rehabilitation activists largely as an act of civil disobedience, breaking drug paraphernalia laws in order to help reduce the high HIV transmission rates among injection drug users. Funded mostly by nonprofit organizations and championed by key public health leaders, as evaluation studies documented the effectiveness of syringe exchange, partnerships developed between activists and health and police departments so that syringe exchange programs could operate without legal ramifications, although the activity is still considered by some to be controversial politically. The result of this work and concurrent HIV programming for drug users has been immense: just in the last decade CDC data shows that the United States cut HIV transmission in half among injection drug users.
Unfortunately, despite health care reform and a National HIV/AIDS Strategy, the U.S. government has been held back from funding this work. In 2011, conservative politicians in Congress once again banned federal funding of syringe exchange, blocking support for hundreds of health programs around the U.S. This goes against hard science and proven harm reduction strategies throughout the country. 
Syringe exchange reduces the risk of HIV and hepatitis C transmission by providing people with clean syringes in exchange for used ones. More than 200 syringe exchange programs in 32 U.S. states directly reach tens of thousands of drug users with health information, services, and pathways to recovery, while simultaneously reducing the number of contaminated needles discarded on community streets, playgrounds, and other public areas.
For many people struggling with addiction, an encounter with a syringe exchange outreach worker is often the first time someone has expressed concern for their health and well-being. Numerous scientific studies have incontrovertibly proven that syringe exchange reduces HIV transmission and doesn’t promote drug use. Syringe exchange programs are also a valuable link to additional social, medical, mental health, and drug treatment services.
From 2005 to the present, the Elton John AIDS Foundation (EJAF) has invested more than $3.2 million nationally in needle exchange and harm reduction services through the Syringe Access Fund, a grant-making partnership with AIDS United, the Irene Diamond Fund, The Open Society Foundations, and the Levi Strauss Foundation, and another $400,000 in syringe access research and advocacy initiatives. This includes a stepped-up investment in 2011 of $1.6 million over the next two years for front-line harm reduction programs through the Syringe Access Fund.
Our investment goes far. In 2011, EJAF funded approximately 50 organizations through the most recent grant cycle of the Syringe Access Fund, including The Lower East Side Harm Reduction Center in New York City, The Chicago Recovery Alliance, The AIDS Task Force of Greater Cleveland, Women with a Vision in New Orleans, Helping Individual Prostitutes Survive (HIPS) in Washington D.C., and Clean Needles Now in Los Angeles, among others. These small, community-based organizations reach more than 30,000 people at high risk for HIV infection and transmission, distributing more than 10 million syringes, and ensuring that people get the health information and services they need.
Ultimately, new injection-related HIV infections CAN be brought to zero in the United States. The extent of the problem is well defined. Programs already exist to reach people, and science has proven the effectiveness of this approach. We need to mobilize the will and resources, and we will make history. Please join us.
