The XX Factor

Coming Soon to a Red State Near You: Needle Exchange Programs

Used syringes at a needle exchange clinic in St. Johnsbury, Vermont, in 2014.

Spencer Platt/Getty Images

Needle exchange programs, once a no-go in conservative politics, are now opening across the country to prevent the spread of HIV amid a growing heroin crisis. Since Congress lifted the ban on federal funding for such programs in an omnibus spending bill that passed in January, state and local governments have mulled the possibility of opening centers where intravenous drug users can trade in their used needles for clean ones instead of sharing them with other users.

Congress has gone back and forth on needle exchanges over the years: It initially prohibited federal funding for needle exchanges in 1988, then lifted the ban in 2009 before reinstating it in 2012. As a result, many of the country’s approximately 200 needle exchange programs are underfunded, which means they can only serve a limited population during limited hours. Under the new policy, needle exchange programs are eligible for federal dollars if they’re situated in areas where drug-related instances of HIV and hepatitis transmission are likely to increase. In a transparent concession to conservative optics, the funds cannot be spent on the needles themselves.

In the few weeks since the policy shift, new clinics have been planned or considered in Louisville, central Oregon, Indiana, Florida’s Miami Dade County, California’s Orange County, and Ohio, where the rate of hepatitis C infection increased 400 percent between 2009 and 2013. A bill that would authorize needle exchanges in Utah is currently moving through the state legislature, and it’s likely to pass. In northern Kentucky, where the hepatitis C rate is more than 19 times higher than the general U.S. rate, the Grant County Fiscal Court approved a new needle exchange on Monday night.

The resurgent heroin epidemic has forced Republican politicians to admit, against their former stances, that needle exchanges are one of the best ways to prevent public-health emergencies among intravenous drug users and the rest of the population. Indiana saw its first exchange open last year after an HIV crisis in Scott County, which recorded 80 new cases of HIV in a matter of months, a devastating spike from its previous rate of five new infections per year. Governor Mike Pence okayed a temporary state-funded needle exchange program in the county in violation of Indiana state law. “I do not enter into this lightly,” he said at the time. “In response to a public health emergency, I’m prepared to make an exception to my long-standing opposition to needle exchange programs.”

Conservatives have long argued that tax dollars should go toward drug-abuse counseling and treatment instead of needle exchanges, a cornerstone of the harm-reduction approach to public health. Harm-reduction advocates contend that there are many ways to reduce the negative consequences of drug use that don’t depend on a drug user’s complete abstinence from the drug, which is a deeply personal decision and an unlikely outcome in many cases. Public health care providers can’t force a drug user into addiction therapy, but needle exchanges can reach people who might have otherwise avoided outreach efforts. They’re also demonstrably effective. In D.C., where 3 percent of the population was infected with HIV just a few years ago, lifting a Congressional ban on municipal funding for needle exchanges prevented 120 new HIV infections in two years, saving District taxpayers roughly $44 million. Now, the Centers for Disease Control and Prevention has called for more needle exchange programs in rural areas, which have seen the most alarming surges in intravenous drug use.

Most heroin users are men, but the new needle exchange programs will benefit women, too. In 2010, women accounted for 20 percent of new HIV infections, 84 percent through heterosexual sex. That could change soon: The fastest-growing demographics of U.S. heroin users are women and white people who are largely young and poor. And women who don’t inject drugs but have sex with men are still at higher risk of contracting HIV and hepatitis in communities beset by a heroin epidemic, because their partners may be sharing needles. Needle exchanges that prevent men from contracting HIV will also protect the women they have sex with. Now, with a boost in funding and a looming public-health crisis to avert, they may finally get the political backing they deserve.