Annals of Health Law
ACHIEVING AN AIDS-FREE GENERATION
However, IDUs inject drugs an estimated 1,000 times per year per person.52
To comply with CDC recommendations, an average individual would need
to obtain 1,000 sterile syringes and needles each year. However, sterile
syringes and needles are not available in the quantities needed to actually
reduce risk.53 State and federal laws limiting or prohibiting the distribution
of syringes and needles prevent IDUs from receiving sterile equipment.54
They also perpetuate the negative perception of IDUs as criminals rather than
persons with medical needs.55 Many states criminalize the possession of
hypodermic syringes and needles,56 limit distribution by pharmacists and
2005), http://www.cdc.gov/idu/facts/aed_idu_syr.pdf. The recommendations include using
only new, sterile equipment; avoiding needle sharing; and purchasing syringes from a “reliable
source.” Id. Several other government agencies and prevention organizations recommend
using sterile equipment to reduce the risk of HIV transmission in IDUs. See Access to Sterile
Syringes, supra note 15. For example, the Institute of Medicine of the National Academy of
Sciences published recommendations that for “injection drug users who cannot or will not stop
injecting drugs, the once-only use of sterile needles and syringes remains the safest, most
effective approach for limiting HIV transmission.” Jennifer McNeely et al., Sterile Syringe
Access and Disposal Among Injection Drug Users Newly Enrolled in Methadone Maintenance
Treatment: A Cross-Sectional Survey, 3 HARM REDUCTION J. 8, 8 (2006) (quoting J. Normand
et al., executive summary of PREVENTING HIV TRANSMISSION: THE ROLE OF S TERILE NEEDLES
AND BLEACH 2 (J. Normand et al. eds., 1995)). This approach, often referred to as “harm
reduction,” recognizes the reality of drug use and addiction and seeks to minimize harms when
the underlying drug using behavior continues. See Canadian Paediatric Soc’y, Harm
Reduction: An Approach to Reducing Risky Health Behaviours In Adolescents, 13
PAEDIATRICS & CHILD HEALTH 53, 53 (2008) (describing history of harm reduction concept).
Addiction “is a chronic, relapsing disease, characterized by compulsive drug-seeking and use
and by molecular changes in the brain.” Semaan et al., supra note 41, at 102.
52. P. Lurie et al., A Sterile Syringe for Every Drug User Injection: How Many Injections
Take Place Annually, and How Might Pharmacists Contribute to Syringe Distribution?, 18 J.
ACQUIRED IMMUNE DEFICIENCY SYNDROMES & HUMAN RETROVIROLOGY S45 (1998); see also
David Vlahov & Benjamin Junge, The Role of Needle Exchange Programs in HIV Prevention,
113 PUB. HEALTH REPS. 75 (1998); Access to Sterile Syringes, supra note 15.
53. Semaan et al., supra note 41, at 104; see also Larry Gostin et al., Prevention of
HIV/AIDS and Other Blood-Borne Diseases Among Injection Drug Users: A National Survey
on the Regulation of Syringes and Needles, 277 J. AM. MED. ASS’N 53 (1997). Forty-seven
states and Washington, D. C. limit the availability of syringes and needles to zero when the
known use of these items is illegal injecting drug use. Id. at 54–55. Eight states have further
limited the sale of syringes and needles in pharmacies by requiring a doctor’s prescription. Id.
at 56. See also discussion infra Part II. A.
54. Access to Sterile Syringes, supra note 15.
55. INT’L FED’N OF RED CROSS & RED CRESCENT SOCIETIES, supra note 9, at 7. Stigma
creates a barrier to successful treatment and prevention for IDUs, both within the IDU
population and the greater community. Simmonds & Coomber, supra note 47, at 121. A
community may view an IDU with HIV as more “blameworthy” than an individual who
contracts HIV by more “innocent” means. Id. at 122.
56. Access to Sterile Syringes, supra note 15; see, e.g., ALA. CODE § 13A-12-260 (2012).
The term “drug paraphernalia” includes “[h]ypodermic syringes, needles and other objects
used, intended for use, or designed for use in parenterally injecting controlled substances into
the human body.” Id. § 13A-12-260(a)(11). The Alabama code prohibits the possession, use,