Injecting drug users are at high risk for HIV because of the use of shared needles. Injection drug use is particularly high in Eastern Europe and Southeast Asia, two regions in which PEPFAR is increasingly active. Yet access to HIV prevention services is extremely limited for injecting drug users, leaving them at a higher risk of infection and impeding worldwide efforts to slow the spread of HIV. There is no evidence that syringe exchange programs increase the use of illicit drugs, but there is evidence that such programs reduce the transmission of HIV.
Congress overturned the 20-year ban on using federal funds to support domestic needle exchange programs in December 2009. This ban provided an excuse for PEPFAR’s lack of funding to such initiatives. Now that Congress has removed this obstacle, the United States should fund these programs wherever possible. This will allow for a more effective and humane response that will both save lives and help prevent the spread of HIV. And President Obama should make it clear to the State Department that PEPFAR funds can and should be used to fund syringe exchange programs in those countries that need such programs now that he has signed this important legislation.
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