Annals of Health Law
ACHIEVING AN AIDS-FREE GENERATION
SEPs provide IDUs with a place to bring dirty and potentially infectious
injection equipment to exchange for clean, sterile replacements.63 The weight
of public health research consistently shows that programs facilitating dirty-for-clean exchanges successfully curb the infection rate of blood-borne viral
illnesses in IDUs. The programs also create opportunities for addiction
treatment by offering recovery services, such as counseling, referral to
treatment centers, and connection with other medical resources in
conjunction with a syringe exchange.64
interventions “have the greatest beneficial impact when delivered together.” WORLD HEALTH
ORG. ET AL., supra note 47, at 7. The WHO’s position is consistent with the scientific data.
Studies show that SEPs are “an effective way to link some hard-to-reach IDUs with important
public health services, including TB and STD screening and treatment. Through their referrals
to substance abuse treatment, SEPs can help IDUs stop using drugs. Studies also show that
SEPs do not encourage drug use among SEP participants or the recruitment of first-time drug
users.” Syringe Exchange Programs, CTRS. FOR DISEASE CONTROL & PREVENTION (Dec.
2005), http://www.cdc.gov/idu/facts/aed_idu_syr.pdf. Safe injection facilities offer services
similar to SEPs but also allow IDUs to inject at the facility. Studies show safe injection
facilities are “associated with use of drug treatment, health care, and social welfare services”
and “more rapid entry into detoxification programs” and result in less public injection and
litter in the neighborhood. Semaan et al., supra note 41, at 100, 102.
63. V. Guardino et al., Syringe Exchange Programs—United States, 2008, 59 MORBIDITY
& MORTALITY WKLY. REP. 1488, 1488 (2010) (defining SEPs); C. A. McKnight et al., Update:
Syringe Exchange Programs—United States, 2002, 54 MORBIDITY & MORTALITY WKLY. REP.
673, 673 (2005). Operations take place out of stores, mobile units, and in health clinics.
Syringe Exchange Programs, supra note 16.
64. SEPs can reduce HIV transmission by 33–42% in some settings. For this reason, SEPs
are included in the “comprehensive package for the prevention, treatment and care of HIV
among IDUs.” WORLD HEALTH ORG. ET AL., supra note 47, at 6. “An impressive body of
evidence suggests powerful effects from needle exchange programs . . . . Studies show
reduction in risk behavior as high as 80%, with estimates of a 30% or greater reduction of HIV
in IDUs.” CTRS. FOR DISEASE CONTROL & PREVENTION, supra note 62 (quoting the 1997
National Institutes of Health Consensus Panel on HIV Prevention); Carol Strike et al.,
Guidelines for Better Harm Reduction: Evaluating Implementation of Best Practice
Recommendations for Needle and Syringe Programs (NSPs), 22 INTERNAT’L J. DRUG POL’Y
34, 34 (2011) (“Three decades of international evidence demonstrates that needle and syringe
programs (NSPs) reduce needle sharing, HIV incidence and prevalence, and are cost effective
when compared with the costs of treating individuals with HIV/AIDs.”) (citations omitted).
See Ricky N. Bluthenthal et al., Higher Syringe Coverage is Associated with Lower Odds of
HIV Risk and Does Not Increase Unsafe Syringe Disposal Among Syringe Exchange Program
Clients, 89 DRUG & ALCOHOL DEPENDENCE 214, 219 (2007) (finding a “strong associat[ion]”
between the percentage of an individual’s syringes obtained from an SEP and lower HIV risk);
Bluthenthal et al., supra note 21, at 1136 (describing programs that improve access to sterile
needles and syringes as “among the most effective methods for preventing the spread of
HIV . . . among injection drug users”); Margaret MacDonald et al., Effectiveness of Needle
and Syringe Programmes for Preventing HIV Transmission, 14 INT’L J. DRUG POL’Y 353
(2003); Alan Neaigus et al., Greater Drug Injecting Risk for HIV, HBV, and HCV Infection in
a City Where Syringe Exchange and Pharmacy Syringe Distribution are Illegal, 85 J. URBAN
HEALTH 309, 310 (2008) (reporting that most of the prior studies have found SEPs reduce the
risk of infection); J.M. Raboud et al., The Impact of Needle-Exchange Programs on the Spread