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Future of Maine's Needle Exchange Programs in Doubt
11/25/2009 Reported By: Susan Sharon
AIDS activists around the country think they might have a shot at lifting a two decades-long ban on federal funding for needle exchange programs. Many of the nation's 200 such programs are facing severe budget cutbacks in their states. Several needle exchanges in California have recently been eliminated. In Maine, demand for clean needles has risen dramatically as injection drug use has grown. But none of Maine's four programs will qualify for the federal cash infusion if a particular amendment is approved by Congress
At the Eastern Maine AIDS Network in Bangor, Executive Director Patsy Murphy and her staff keep track of about 380 clients. About 100 are HIV/AIDS patients who get assistance with medical, legal and mental health needs. The rest are people who regularly use the needle exchange program where they can swap out dirty needles for clean ones as a way to reduce the transmission of HIV/AIDS and Hepatitis C.
"J.J.," who is HIV positive, declined to give his last name. He says he and his friends come here regularly and he says they've learned not to mix up their works. "We keep track of our needles. Like each of us -- like mine has a black mark on it and I keep mine in a certain place and they keep theirs in a certain place."
Clients are regularly tested for HIV. If they're interested in substance abuse treatment or other counseling services, they are referred to outside agencies. Many of them are homeless or couch surfing, so the program also offers personal care products and access to a food pantry. But using drugs on the premises is prohibited.
As an extra precaution, Murphy says exchangers are not even permitted to use the bathroom. "They could use our facilities to shoot drugs. That's not what we're about," she says.
When Murphy first took over three years ago, she says the program was only handing out about 300 clean needles a month. Now she hands out about 4,000. She says the average exchanger is male, between the ages of 25 and 29 and either unemployed or on disability. "Many of the folks were receiving prescription drugs from physicians who prescribed painkillers either through a workers' comp injury or some type of car accident and now they can't get a prescription for it and they purchase drugs on the street."
The needle exchange is one of four similar programs around the state. Andrew Bossie of the Maine AIDS Alliance says all four are facing funding challenges, which is why he and so many other AIDS activists support the lifting of a 20-year-old ban on federal funding. "Some programs are seeing triple or four times the volume of syringes that they're exchanging as they were a year ago. And clearly at this point, with the economic recession, but also the difficulty to fund things, we have not seen our resources keep track with the need has been out there."
Around the country, the general concensus is that needle exchange programs work. Several federal studies have concluded that needle exchange programs reduce transmission of HIV and Hepatitis C without increasing illicit drug use. President Barack Obama campaigned on that theme. And while his first budget did not include funding for needle exchange, some observers say all the signals coming from the White House are good. "We see needle exchange as a valuable tool as long as it's used within the context of a broader public health strategy," says Dr. Keith Humphreys, a senior policy advisor at the White House Office on National Drug Control Policy, more commonly known as the office of the drug czar. "That includes HIV testing, Hepatitis C testing, medical care, dental care and most of all treatment for addiction."
Humphreys declined to say whether his office would support the lifting of the ban. But he did say there would be a general departure from the previous administration, which he says focused the success of its drug policy strictly on the basis of drug useage. "The Obama administration is going to measure itself and hold itself accountable not just for drug use but also its consequences, and that includes HIV/AIDS," Humphreys says.
Such a position could conceivably pave the way for additional federal money for needle exchange -- with one catch. Bill McColl is the political director at AIDS Action in Washington D.C., who's been following the needle exchange debate in Congress. "They did accept an amendment that would ban the use of federal funding within 1,000 feet of schools, universities, parks, day care centers, video arcades -- I like that one because it's right out of 1980s -- and unfortunately what that means is that, in effect, it would restore the ban," McColl says.
That's because even in states as rural as Maine, all four of the needle exchange programs fall within those limits. Patsy Murphy of the Eastern Maine AIDS Network says her office in a small strip mall adjacent to a park and within walking distance of downtown Bangor has been in its location since 2002 and, for many reasons, she'd prefer not to move. "This is a local issue. We know our community best and we are in the best position to protect our neighborhoods and our children."
For some members of Congress, the idea of providing clean needles to drug users runs counter to the anti-drug message, "Just Say No." Indiana Rep. Mark Souder, for example, supports the ban. He could not be reached for comment for this story, but he told a congressional hearing on drug policy four years ago that, instead of providing addicts with clean needles, "We should break the bonds of their addiction once and for all."
Bill McColl of AIDS Action says that's a misguided position. He points out that the cost of syringe exchange to prevent one HIV infection is about $8,800. The lifetime cost of treating one HIV positive person for life is $730,000. Patsy Murphy says Representatives Chellie Pingree and Mike Michaud have been supportive of her position. But it's unclear where Maine's two senators stand.
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