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May 2005 NORA Coalition Discusses Harm Reduction On Monday, May 9, the National Organizations Responding to AIDS (NORA) coalition, for which AIDS Action serves as the convener, held its monthly meeting, which featured an update on harm reduction and syringe exchange. The guest speakers were from Prevention Works!, which describes itself as “a health education program [based in Washington, DC] that uses harm reduction techniques to address the health care needs of people who use injection drugs.” Paola Barahona, executive director and Charles Sessoms, community liaison, represented PreventionWorks! at the meeting. The mission of PreventionWorks! is to prevent transmission of HIV and hepatitis within the injection drug user community. The organization’s staff accomplishes its mission through services to current drug users, including outreach and education, HIV counseling and testing, referrals to other medical and social services, and syringe exchange. Each year, the organization serves over 3,000 people in Washington D.C. through 15,000 contacts with clients and provides 400,000 syringes. Charles Sessoms opened the meeting by giving coalition members an introduction to the concept of harm reduction. According to Mr. Sessoms, harm reduction is “a set of principles, or philosophy, used in the implementation of strategies reducing the harm associated with something.” In the United States, harm reduction is most commonly associated with syringe exchange (or needle exchange—Mr. Sessoms noted that the two terms are often used interchangeably) programs, and is fairly controversial. Continuing, he said that in other countries, such as Canada, Australia, and the Netherlands, harm reduction is part of a broader social philosophy that emphasizes government-supported access to health care, housing, and education. All of these programs together form a “continuum of care” for people who use drugs and/or have other related health problems. In the United States, such a continuum of care does not exist, according to Mr. Sessoms. Therefore, drug users continue to be stigmatized and programs that attempt to help them--like syringe exchanges—continue to receive little public support. After Mr. Sessoms concluded his introduction, Paola Barahona provided an overview of the history of PreventionWorks! as a case study of a typical syringe exchange program. As a preface to her overview, she provided an historical context for syringe exchange. As explained by Ms Barahona, the first U.S. syringe exchange programs specifically targeted toward preventing HIV began during the mid-1980s. In response, the federal government imposed a 1988 ban on the use of federal funds to support such programs. The ban stipulated that federal funding would not be provided for syringe exchange programs until it could be shown that they reduced rates of HIV transmission and did not increase rates of drug use. However, the ban did not extend to local and state funding. A decade later, in 1998, the Surgeon General released a report stating that syringe exchange did in fact reduce rates of HIV transmission and did not increase rates of drug use. Despite the report’s finding and some talk of lifting the federal ban at that point, it stayed in place, Ms. Barahona reported. And to this day, it remains illegal for federal funds to be used to support syringe exchange. According to Ms. Barahona, PreventionWorks! was shaped both by the general history of syringe exchange in the U.S., and the specific factors that impacted the development of this form of harm reduction in D.C. The program that is now PreventionWorks! began in 1996 as an initiative of the Whitman Walker Clinic, a D.C.-based AIDS service organization and an AIDS Action member. However, in 1998, Congress passed an amendment to the D.C. appropriations bill which stipulated that no public funding of any kind could be used to support syringe exchange programs in the city, and threatened to terminate all of the public funding for organizations that supported syringe exchange.* As a result, PreventionWorks! chose to spin off into an independent organization, which it remains today. Following the presentation from PreventionWorks!, members of the coalition engaged in discussion about the role of syringe exchange in the prevention of HIV transmission and within the larger continuum of public health. Among the issues of great concern to NORA members were 1) getting federal officials to recognize and support scientific research into syringe exchange, which has consistently shown that it works, and 2) how to raise awareness that drug use is not simply a criminal offense; it’s often an indicator of a medical illness. * Congress has oversight over funding for the budget for the city of Washington D.C. Each year, funding is allocated via one of the annual appropriations bills. Under this system, Members of Congress are able to attach amendments, or “riders,” to the D.C. appropriations bill that require the D.C. government to do certain things. The ban on public funding for syringe exchange programs was enacted in 1998 via one of these riders.
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