Legislation is making its way through Congress that could lift the ban on federal funding for needle exchange programs. The programs, where injection drug users can receive clean syringes, is credited in San Francisco with helping to keep down HIV transmission rates among IDUs.

In San Francisco, syringe exchange programs have been protected from cuts even as the Department of Public Health's budget has been reduced by millions of dollars. Even with that stability, people are hopeful that lifting the ban could eventually help the programs.

"If the federal ban is lifted it gives jurisdictions much more flexibility in terms of how to spend federal dollars," and other money, as well, said Dr. Grant Colfax, the city's HIV prevention director.

But "ultimately, the best thing would be for the federal government to really invest" in syringe exchange intervention "which we know is effective and saves lives," said Colfax.

According to Dr. Susan Scheer, co-director of the San Francisco health departmentÕs HIV epidemiology section, in 2008 there were 434 people newly diagnosed with HIV. Ten percent of those people were men who have sex with men IDUs. There were 74 total new cases among all IDUs last year.

Scheer wrote in an e-mail that the last incidence consensus estimate in 2006 was that there were 144 IDU new infections that year, including those unaware of their infection, and those not yet reported.

"This incidence estimate is likely down in 2009," she wrote.

This year, San Francisco is providing $881,463 to three programs that primarily do needle exchange, as well as a couple of agencies that provide syringe access as part of their other work.

Colfax said it's "hard to speculate" on whether there could be a decrease in funding for syringe exchange programs in San Francisco "given the fiscal environment we're in" with the state, the federal government, and locally.

On Friday, July 24, the House of Representatives passed an appropriations bill to fund the departments of labor, health and human services, education, and related agencies by a vote of 264-153. That bill includes a provision that would lift the ban.

House Speaker Nancy Pelosi (D-San Francisco) cheered the bill's passage in a statement.

"Sound science is an essential component of good public health policy, and the scientific support for needle exchange could not be more clear," stated Pelosi. "The Centers for Disease Control [and Prevention], the National Institutes for Health, the World Health Organization, and former Surgeon General David Satcher have all confirmed the scientific evidence in support of needle exchange programs. These initiatives are an effective public health intervention that reduces the number of new HIV infections without increasing the use of illegal drugs."

Drew Hammill, a spokesman for Pelosi, wrote in an e-mail to the Bay Area Reporter that if the provision is enacted, the CDC and other federal agencies would be able to fund syringe exchange "as part of a comprehensive approach to effective HIV prevention."

Hammill also wrote that Pelosi would work with Representative David Obey (D-Wisconsin), who chairs the appropriations committee, "to maintain the lifting of the ban in this legislation as we work with the Senate to finalize this appropriations bill."

According to CQ Today, the Senate Appropriations Labor, Health and Human Services, Education and Related Agencies Subcommittee on Tuesday approved its fiscal year 2010 spending bill draft by voice vote. That bill doesn't include language lifting the ban.

The publication quoted committee Chair Tom Harkin (D-Iowa) as saying lifting the ban on the needle exchange funding because that is "a matter for conference."

Asked if the CDC would direct more money toward syringe exchange programs, Jennifer Horvath, a spokeswoman for the agency, said she couldn't comment since the bill is pending.

However, she said, "In general we have seen needle exchange programs as one of the many tools that communities have found effective in addressing the dual epidemics of substance abuse and HIV transmission."

"The thing to emphasize is that we need more than just needle exchange programs alone, that they need to be part of a comprehensive HIV prevention program," Horvath added.

Local programs

Colm Hegarty is executive director of Tenderloin Health, an agency based in one of San Francisco's poorest neighborhoods that provides access to clean syringes.

Hegarty said ultimately, "The impact is that it will allow federal funding to be appropriated for syringe exchange, which is a very positive step in preventing the spread of HIV and hepatitis C, and I think ultimately it will save lives, it will reduce crime and it will decrease the costs associated with HIV treatment and hepatitis C treatment."

Making federal funding available would help Tenderloin Health in that "it will allow us to integrate syringe exchange into the overall strategy for prevention intervention. It will definitely impact us," said Hegarty.

Each week, the agency exchanges 2,645 syringes, serving 109 clients. Along with clean syringes, the program provides alcohol pads and sterile water to IDUs, one-on-one harm reduction counseling, and HIV testing.

The program receives $68,945 from the city, as well as $12,500 a year from the Syringe Access Fund, which is a collaboration between the Tides Foundation, Levi Strauss Foundation, the Elton John AIDS Foundation, the Irene Diamond Fund, and the National AIDS Fund.

 Mark Cloutier, CEO of the San Francisco AIDS Foundation, said of lifting the ban that it would "probably be a couple years before the money flows, but this is progress ... What's promising about this is the possibility of opening up a broader conversation about harm reduction as an overall strategy to HIV prevention."

The foundation's syringe exchange budget is $825,845 a year. The city contributes $668,904 of that.

The foundation has 11 syringe exchange sites, where 12,000 clients visited in the 2008-09 fiscal year, though Cloutier said the number is difficult to measure because of client confidentiality.

On top of providing clean syringes, the foundation also provides HIV testing and vaccinations for hepatitis B, and most sites have a nurse who deals with wound care and can make referrals for substance abuse treatment.

Cloutier said that this year the foundation had spent all of the needle exchange funds from the city on syringes a couple months before June 30, when the budget cycle ended.

"We found some other monies and got some contributions to make up for that to get through the end of year, but there was an increased demand for clean syringes this year," said Cloutier.

Cloutier said that he didn't know if the increase was because there were more clients, or if clients had needed more needles, or a combination.

Peter Davidson is board chair for the Homeless Youth Alliance, which is based in the city's Haight-Ashbury neighborhood. Davidson said that while the city's funding for needle exchange programs hasn't changed, the alliance has lost about a quarter of the rest of its budget for providing drop-in services like getting something to eat and assistance with things like getting people into drug treatment programs.

The alliance has an annual budget of about $150,000 from the city for syringe exchange.

The group gives out an average of about 15,000 to 20,000 needles to 200 to 300 people a month, said Davidson.

He said unless more money is available, he didn't anticipate that ending the federal funding ban would help the alliance directly, but he said that lifting the ban could help organizations that receive large amounts of federal money and work with injection drug users.