Web Special Article: World AIDS Day and Needle Exchange

By: Brad Forenza, MSSW

December 1, 2012 marks the 24^th annual observance of World AIDS Day; while the United States has come a long way in caring for our friends and neighbors living with HIV/AIDS (some now refer to it as a treatable illness as opposed to a terminal disease), there are still more innovations to be made in social work practice and intervention research with this population. This includes more education and outreach about viral transmissions, but also advocating for concrete—albeit politically divisive—interventions like needle exchange, which enables injection drug users to trade dirty needles for clean ones. This article focuses on the formation and implementation of New Jersey’s needle exchange pilot, the last state to implement such a program.

Needle Exchange Formation (1996 – 2006)

When New Jersey enacted the Bloodborne Disease Harm Reduction Act, it did so to safeguard injection drug users (IDUs) against the transmission of potentially terminal viruses like HIV/AIDS. Despite altruistic intentions, the Act was met with alarm. Its polarity may be attributed to the social construction of IDUs: politically weak and socially undesirable addicts. The majority of policies that pertain to IDUs (chief among them: rigid mandatory minimum laws) sustain the image of a group that is inherently deviant, abhorrent, and immoral. Needle exchange programs demonstrate compassion for IDUs and their overall well being.

Before needle exchange became New Jersey law, it was estimated that 50% of all new HIV/AIDS cases diagnosed in the state could be attributed to injection drug use; in 2006, the state ranked first in the nation with respect to the spread of HIV/AIDS via contaminated needles. Additionally, the state’s two largest cities (Newark and Jersey City) were among the nation’s top five metropolitan residences of infected IDUs (Assembly Bill Comments, 2006). While other states—even traditionally conservative ones—had implemented variations of needle exchange years earlier, as of 2006, New Jersey had not. In the late 1990s, then-Governor Christie Whitman (a Republican) rejected calls to address the issue:

“We outlaw drug use because of what it does to people... there are bad things that happen when you use intravenous drugs, and I cannot bring myself to sanction that by having government give out clean needles.” (Statement by Christie Whitman to the National Press Club; cited in News Briefs, 1996)

Four years after Whitman’s statement, a report from the United States Department of Health and Human Services (2000) became the authoritative, empirically based voice on needle exchange. The report confirmed that the presence of needle exchange yielded two major benefits: (1) it decreased the incidence of new HIV cases, and (2) it increased the numbers of IDUs referred to, and retained in, drug treatment. The report also demonstrated that the presence of needle exchange did not increase a community’s incidence of drug use.

In response to the DHHS report, the Drug Policy Alliance, a national interest group that lobbies for alternatives to the War on Drugs, created the Campaign for a Healthier New Jersey. The Campaign lobbied the city councils of Atlantic City and Camden to legalize needle exchange. Both councils approved a permissive measure, but the legality of implementation was challenged under a directive from then-Governor James McGreevey (a Democrat), with whom the courts ultimately sided:

"It is abundantly clear that the Ordinance permits what is expressly forbidden by (state law)... the distribution of hypodermic syringes by a municipality to persons not authorized to possess them, namely intravenous users of illegal drugs.” (Statement by Superior Court Judge Valerie Armstrong; citied in Livio, 2004)

The summer of 2004 brought an abrupt end to the tenure of Governor McGreevey. In the waning days of his administration, he allowed needle exchange to flourish under a temporary executive order. Fifteen months later, Democrat Jon Corzine was sworn into the Governorship. Based on prior record, Corzine was assumed to be a friend to progressive causes like needle exchange. As such, when an allied bill made its way through the state legislature, among those offering support was Eddy Bresnitz, Corzine’s State Epidemiologist:

"We should not be delaying another minute in putting life-saving tools such as syringe exchange programs in the hands of communities desperate to stop the transmission of bloodborne diseases… syringe exchange programs not only prevent the transmission of bloodborne diseases but also help drug addicts get into treatment.'' (Testimony of the State Epidemiologist; cited in Smith, Needle Access Bill Advances, 2006)

The bill that Corzine signed into law on December 19, 2006, made New Jersey the last state in the nation to adopt a needle exchange policy (Division of Addictions, 2008). It was not the vast, comprehensive bill that supporters once envisioned; instead, the Governor’s signature allowed the State Department of Health and Senior Services to adopt regulations permitting only six municipalities to apply for, and implement, local needle exchange programs. The bill would also appropriate $10 million for drug treatment.

Needle Exchange Implementation (2007 – Present)

Since a municipality’s eligibility to implement depended on its per-capita incidence of HIV/AIDS attributed to injection drug use, eligibility was effectively restricted to 12 cities, though only six would receive final authorization. Atlantic City and Camden were the first two approved for needle exchange. They implemented their programs on November 27, 2007, and January 5, 2008, respectively. Paterson, Newark, and Jersey City (the state’s three largest municipalities) soon followed. In concurrence with the original Act, a sixth municipality is still eligible to receive authorization.

After receiving authorization, municipalities themselves were responsible for financing and administering the local programs. This lack of uniformity, in spite of a clear policy outcome (to reduce the harm associated with injection drug use), is evidence of experimental implementation. To compound adversity, a 1988 ban (since overturned) prevented nonprofits from using federal money to implement needle exchange. As such, each municipality relied heavily on private and philanthropic donations to fund its program.

A USA Today article (Kaczmarek, 2008) highlighted the variance of New Jersey’s implementation model: in addition to staggered hours, poor funding, and low manpower, the programs also suffered from lack of consumer awareness. Of the consumers who were aware, many believed that participation would eventually become actionable by law enforcement. By 2010, however, almost 4,500 IDUs participated in one of New Jersey’s five needle exchange programs:

“It’s a lot better than making the trip to Philadelphia to get needles… or getting them on the street illegally.” (Camden Consumer; cited in Kaczmarek, 2008)

“If you look at the number of people served (at our facility), which is over 500… and then you consider how many times a day they shoot up… that is thousands of times we have prevented the spread of deadly infections.” (Director of a needle exchange designee; cited in Mandell, 2009)

“All of Broadway was an active spot for injection drug use, but we don’t see that anymore… it’s not just preventing the spread of HIV… it’s helping to wean them off drugs.” (Paterson Mayor Joey Torres; cited in New Jersey Department of Health and Senior Services, 2010)

The mayor’s assertion speaks to the second component of the Act: drug treatment. While the Act appropriated no money to the micro-implementing localities, it did extend $10 million to establish the Needle Exchange Treatment Initiative (NETI). According to the Division of Addictions (2008), transportation is offered from harm reduction sites to NETI facilities, in an effort to increase treatment possibilities. Since enactment, more than 20% of IDUs participating in one of the five programs are assumed to have received drug treatment through NETI.

Needle Exchange and World AIDS Day

New Jersey’s needle exchange program is still in its early stages; it is too soon to tell if bloodborne diseases like HIV/AIDS have, in fact, decreased as a result of the five existing sites. Preliminary data suggests, however, that needle exchange was not the harbinger for increased drug use it was once assumed to be. Finally, the New Jersey Department of Health and Senior Services (2010) confirms that, with respect to “street sweeps,” the number of used needles left in public space has decreased in cities with needle exchange pilot programs.

On November 3, 2009, incumbent Governor Jon Corzine (a Democrat) was defeated in his bid for re-election by challenger Chris Christie (a Republican). In an outgoing report to the incoming gubernatorial administration, Corzine’s Commissioner of Health and Senior Services cautioned that, to be optimally effective at reducing the incidence of bloodborne disease, needle exchange would require centralized resources like (1) a secure funding stream, (2) coordinated outreach with law enforcement, and (3) a greater scope of program availability and oversight. Since taking office, however, Christie has continued the pilot program structure. In a break from his political base, Christie also enacted a law permitting syringe sales without a prescription.

Nationally, in 2009, President Obama fulfilled a campaign promise to lift a 21-year ban on federal funding for needle exchange programs. Also in 2009, congress approved the implementation of needle exchange in the District of Columbia. These trends—in concert with 50 permissive state laws—suggest that public officials recognize the value of needle exchange as a way to combat once fatal diseases like HIV/AIDS. As we enter the 25^th year of World AIDS Day, let us not forget the value of such innovative programs, which enable us to celebrate our friends and neighbors living with the disease much longer than experts once anticipated. And let us work to ensure the solvency and sustainability of likeminded programs.

Bibliography

Assembly Bill Comments. (2006). The Bloodborne Disease Harm Reduction Act. 211^th Legislature, A3256.

Division of Addictions. (2008). New Jersey Department of Human Services Division of Addictions: biannual report. Retrieved from: http://www.state.nj.us/humanservices/das/treatment/neti/NETI%20Bi-Annual%20Report%20Oct%2008.pdf (December 3, 2010).

Kaczmarek, Joseph. (2008, February 26). Needle exchange program struggles in New Jersey. USA Today.

Livio, Susan. (2004, September 2). Judge throws out Atlantic City’s anti-AIDS Needle Exchange. The Star Ledger.

Mandell, Meredith. (2009, March 12). Praise for drug program. The Record.

New Jersey Department of Health and Senior Services. (2010). New Jersey Syringe Access Program demonstration project: interim report. Retrieved from: http://www.state.nj.us/health/aids/documents/nj_sep_evaluation.pdf (November 22, 2010).

News Briefs [organizationally published article]. (1996, February 20). Whitman rejects panel’s suggestions about needle exchange. Retrieved from:

http://www.ndsn.org/march96/harmred.html

Smith, Philip. (2006, October 19). Harm reduction: New Jersey needle exchange, needle access bill advances. Stop the Drug War. Retrieved from:

http://stopthedrugwar.org/chronicle/2006/oct/19/harm_reduction_new_jersey_needle

U.S. Department of Health and Human Services. (2000). Evidence-based findings on the efficacy of syringe exchange programs: an analysis of the scientific research completed since April 1998. Retreved from:

http://www.dogwoodcenter.org/references/Satcher00.html

Brad Forenza is an Adjunct Instructor and Doctoral Candidate at Rutgers University. His research foci include social policy, civil society, and youth development. He is a graduate of Ithaca College (B.S.) and Columbia University (M.S.S.W). Brad started his career as an intern in the Office of (former) United States Senator Hillary Rodham Clinton. For six subsequent years, he was Senior Aide and Speechwriter to a member of the New Jersey Legislature. His career in public service is accentuated by: (1) direct social work practice at several youth & family development agencies, and (2) applied research/program evaluation for clients in the human services.