In his 2010 budget, President Obama failed to deliver on his commitment to end the ban on federal funding of needle exchange services--an action he promised to take before and after the election and one that would help protect the health and save the lives of tens of thousands of injection drug users--in the U.S. and around the world.
Every year since 1988, Congress has tucked the ban into the Labor HHS appropriations bill with a provision stating that "no funds appropriated in this Act shall be used to carry out any program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug."
These words have meant that communities across the U.S. are limited in how they can fight HIV among some of their most vulnerable residents. Technically, they do not apply to any funding not covered by the Labor HHS bill. However, bureaucrats administering U.S. foreign assistance have felt constrained by this language and have cautiously decided to apply it to all foreign assistance. The harm caused by these words goes beyond HIV as well, as needle exchange programs are also an important tool in fighting viral hepatitis.
Given President Obama's strong support for needle exchange programs and the Administration's commitment to invigorating the federal response to the HIV/AIDS epidemic, we hoped that the President would seize this first opportunity for lifting federal restrictions on this lifesaving prevention strategy by removing this provision from his FY10 budget request to Congress. Sadly, it remains. Denying people at risk for HIV a proven prevention intervention is a denial of their basic human rights and it was certainly a surprise to find it still in the budget.
The President has repeatedly expressed his support for lifting the ban, pledging during the campaign, the transition, and after the inauguration to take action on this issue. Within 24 hours of his inauguration, the White House website stated clearly: "The President also supports lifting the federal ban on needle exchange, which could dramatically reduce rates of [HIV] infection among drug users."
While we are disappointed by the inaction on needle exchange funding in the President's budget, the prospects of lifting the federal ban have not been defeated. We and our allies on this issue will continue working with the Administration and Congress to remove the obstacles to the implementation of needle exchange programs in communities devastated by HIV.
The President must now move past simply being clear in his support for ending the federal ban and insist that Congress not include the restriction in the appropriations legislation they send him. The Administration must also work with Congress to pass the Community AIDS and Hepatitis Prevention Act , and direct HHS and State to remove all non-legislative barriers for funding of needle exchange.
While there is a lot the Obama Administration needs to do, they alone are not responsible for paving the way for federal support of needle exchange programs. We know the importance of scaling up these programs in the US and elsewhere and we must now reach out to Members of Congress to ensure that they also allow science to guide their judgment on this issue. They, too, have an important role to play in lifting the ban and we must see to it that they act with due haste.
