Annals of Health Law
ACHIEVING AN AIDS-FREE GENERATION
doctors,57 and inhibit the operation of SEPs.58 Stigmatizing and criminalizing
IDUs may prevent them from seeking or receiving medical services.59
Substance abuse behaviors make IDUs a unique at-risk population because
HIV prevention measures necessarily include treatment for the chronic
illness of addiction.60 To the extent that the punitive approach to IDUs fails
to address mental health and addiction treatment, it fails to significantly
reduce IDU activity and resulting HIV transmissions.
The most effective prevention strategies take a comprehensive approach
to drug addiction and HIV prevention.61 SEPs seek to change risky
behavior—using unclean syringes and needles—while also addressing
substance abuse, thereby taking a more inclusive approach to the issues of
drug addiction and HIV prevention and treatment.62 Among other services,
delivery and sale of “drug paraphernalia.” Id. § 13A-12-260(c)–(e).
57. Access to Sterile Syringes, supra note 15; see, e.g., CAL. BUS. & PROF. CODE § 4145
(2011). “[ A] pharmacist may furnish or sell 10 or fewer hypodermic needles or syringes at any
one time to a person 18 years of age or older . . . .” Id. § 4145(a)(2).
58. Alexis N. Martinez et al., The Impact of Legalizing Syringe Exchange Programs on
Arrests Among Injection Drug Users in California, 84 J. URBAN HEALTH 423, 424 (2007);
Access to Sterile Syringes, supra note 15. Law enforcement plays an influential role in the
success or failure of a syringe exchange program. Martinez et al., supra, at 432. “Police
crackdowns” and “heightened street-level police intervention” are associated with decreased
syringe exchange participation. Without agreements with police, SEP activity may be viewed
as a reason to “crackdown,” resulting in lower participation. Id.
59. Simmonds & Coomber, supra note 47, at 121.
60. Definition of Addiction, AM. SOC’Y OF ADDICTION MED. (Apr. 19, 2011),
http://www.asam.org/for-the-public/definition-of-addiction. “ A particularly pathological
aspect of the way that persons with addiction pursue substance use or external rewards is that
preoccupation with, obsession with and/or pursuit of rewards (e.g., alcohol and other drug use)
persist despite the accumulation of adverse consequences. These manifestations can occur
compulsively or impulsively, as a reflection of impaired control.” Id.
61. Access to Sterile Syringes, supra note 15. An effective comprehensive approach
requires a combination of substance abuse treatment and prevention to address the injecting
drug use, HIV treatment services, and access to sterile syringes and needles. DEP’T OF HEALTH
& HUMAN SERVS., IMPLEMENTATION GUIDANCE FOR SYRINGE SERVICES PROGRAMS 1 (2010),
available at http://www.cdc.gov/hiv/resources/guidelines/PDF/SSP-guidanceacc.pdf. The
prohibition of SEPs is unique to the United States, and such programs implemented in other
countries are effective in reducing needle-sharing behaviors, rates of HIV transmission, and
improving access to substance abuse treatment and prevention services. COMM. ON THE
PREVENTION OF HIV INFECTION AMONG INJECTING DRUG USERS IN HIGH-RISK COUNTRIES,
supra note 20; Lawrence O. Gostin & Zita Lazzarini, Prevention of HIV/AIDS Among
Injection Drug Users: The Theory and Science of Public Health and Criminal Justice
Approaches to Disease Prevention, 46 EMORY L.J. 587, 676–80 (1997).
62. DEP’T OF HEALTH & HUMAN SERVS., supra note 61. “The term SSP is inclusive of
syringe access, disposal, and needle exchange programs, as well as referral and linkage to HIV
prevention services, substance abuse treatment, and medical and mental health care.” Id. The
WHO, UNODC, UNAIDS TECHNICAL GUIDE FOR COUN TRIES TO SET TARGETS FOR UNIVERSAL
ACCESS TO HIV PREVENTION, TREATMEN T AND CARE FOR INJECTING DRUG USERS recommends
a comprehensive package for prevention, treatment and care of HIV among IDUs because the