Clean Needle Exchange?

I would like to address a question from my friend, Anneli..."Here is a Q: Vancouver has a safe injection site, and I have heard that they are safer and cleaner and may stop diseases from spreading as rapidly. Does the States support these sites? Is it good to support them? What do you think?"

• These are some quick stats for the USA (Policy Facts, June 2001):
  753,907 cases of AIDS (>200CD4 count—therefore this does not include HIV cases).
  25%-36% AIDS cases are related to Injection Drug Use (IDU)
  ~2.4 Americans use injection drugs
  Kaiser found that 66% of Americans are in support of clean needle exchange programs
  

Clean Needle Exchange Programs (NEP) or Safe Injection Facilities (SIF) offer a safe place to dispose of used and potentially infected needles used by injection drug users. Along with clean needle exchange these programs offered a combination of drug treatment referrals, Methadone Maintenance (I can address this later), peer education, HIV prevention (including testing) etc.

I did some literature research on this using PubMed and Google Scholar, two huge databases of journals. Some quick observations that I've made over the past few days: 1. Most if not all of the journal articles recommended instituting clean needle exchange programs. 2. Most of the articles referenced success as a decrease in HIV and Hep C. 3. The articles only briefly addressed any ethical implications resulting from condoning clean needle exchange programs and when they did the issues were dismissed very quickly as unreasonable.

The SIF that Anneli is referencing was cleared in 1998 by the Canadian federal government (http://www.city.vancouver.bc.ca/CTYCLERK/CCLERK/980421/a12.htm ), which waived its drug laws to allow pilot SIF in Vancouver. Follow up studies in 2003 showed (Beletsky,L. 2008).
- decrease in needle sharing
- decrease in reuse of syringes
- decrease in outdoor injecting (and a decrease injecting in public areas)
- increase clean water for injecting
- increase in filtering drugs before use
- Lastly they saw the SIF as a gateway for additional treatment and counseling

In the United States SIF have been in existence for a while (I couldn't come up with a specific date but I'm pretty sure it would be about the late '80s since the congress specifically addressed restricting funds for SIF in 1988) however they have been funded by private organizations and highly regulated (CDC, 2007). In 2001 there were 113 SIF in 80 cities and 38 states (currently I believe that Texas is the only state where SIF is prohibited). The approximate cost for one year of operation with of SIF is $169,000 the cost for the treatment of one case of HIV through their death is about $200,000. These are obviously very loose numbers depending on number of clients that visit the site but if 100 clients visit per day than that is about $9,400 per avoided HIV case (Policy Facts, June 2001).

So if it's cheaper than treating a case of AIDS and it seems to be an effective prevention tool against acquiring HIV we should do it! This is the thoughts of most researchers. On the other hand giving clean needles to injecting drug users seems like it would endorse and promote injecting drug use which is illegal and harmful to one's body. Are we as Christians to condone "sinning safely"? I don't pretend to have the answers here but I just want to show you that it is not a clean cut issue. Here is a statement from a Christian organization: "If [Jesus] knew there was a box of new needles in the corner, I can imagine him mentioning it. Not to promote the practice, but to save life until a time when the person may be looking for help out of addiction, and for reconciliation with God." (http://www.globalchange.com/ttaa/ttaa%2013.htm)

It should be noted that James Dobson, a leader in the Christian Right movement, deeply criticizes needle exchange programs (http://www.aidsmap.com/en/news/DBB3AF1A-ABAB-4D13-991F-99EC029491C5.asp ) But unfortunately I have only been able to find an indirect statement from Focus on the Family through another article that was written in 2000. "NEPs condone drug use, an `immoral' behavior"
(Gent, CE, 2000).

I struggle primarily with who should fund these programs. It is one thing for the government to allow the SIF to exist but it is another to fund them. The reason I struggle with this is because I realize that drug addicts are fully hooked and will get needles any way that they can. If there is a way to help them and prevent further damage to their bodies I find it hard to stand in the way. However, I understand and can sympathized with the sentiment of some who would prefer that their mandatory tax dollars go toward something other than funding needle exchange for injection drug users who are already breaking the law by using illegal drugs. While this is harsh I wouldn't put it past most people when given a chance to have a say in how their tax dollars are spent. The question I would pose to these people is: Would you rather fund the antiretroviral therapy for those who contract AIDS through IDU?

In conclusion it is hard to deny the public health advantage and the cost effectiveness of SIF. However, since there is still a lot of controversy surrounding the morality of the implementation of SIF, I would suggest that private funds should continue funding these sites until a time when either injection drugs are legalized or there the prevalence of HIV increases past 2% in the general population in a given area (this means that HIV has generalized throughout the population). The bottom line though is that Jesus' transforming power is probably one of the only ways that injecting drugs users can really stop using these highly addictive drugs. So to those Christians who are against SIF, if you aren't introducing these people to Jesus and His power to be released from drugs than you have little space to condemn researchers who clearly see that SIF are preventing HIV/AIDS.

References:
Beletsky,L.The law (and politics) of safe injection facilities in the United States. Am J Public Health. 2008 Feb;98(2):231-7. Epub 2008 Jan 2.
CDC.Syringe exchange programs--United States, 2005. MMWR Morb Mortal Wkly Rep. 2007 Nov 9;56(44):1164-7.
Policy Facts. June 2001. http://www.aidsaction.org/legislation/pdf/Policy_Facts-Needle_Exchange2.pdf

Gent, CE. Needle exchange policy adoption in American cities: Why not? Policy sciences. 33:2. 125.