Good News for HIV Prevention Policy: Syringe Access Update

By Scott Burris

In documenting how often public health law research does influence legislation, I’ve used syringe exchange programs as an example of evidence NOT guiding policy.  Despite the consensus in health research that increasing access to sterile syringes has helped reduce HIV, state drug paraphernalia laws, and pharmacy regulations remain a barrier, as does the lack of strong and stable funding for the programs that are working.  The case was just made again in an article in the Annals of Health Law. Rachel Hulkower and Leslie Wolf retell the story of the federal funding ban, going over the evidence yet again, and argue that state inaction would best be overcome with money: replacing the federal ban with a positive endorsement and real funding.  (As long as we are in an optimistic mood, I would add strings – no HIV funding for states that don’t remove legal barriers to syringe access.  This would balance the scales a bit for Congress’ past sin in requiring state recipients of HIV funds to provide for criminalization of exposure and transmission.)

But today I type to tell a happier story. This summer, the state of Nevada passed a statute authorizing syringe exchange and pharmacy sales.  There are now 16 jurisdictions whose laws explicitly authorize syringe exchange programs (CA, CO, CT, DC, DE, HI, MA, MD, ME, NJ, NM, NV, NY, RI, VT, WA) and the number of states that require a prescription for retail purchase without exception has dwindled to ONE (Chris Christie’s New Jersey – Delaware, the other hold out, changed its law this year.)  But the important thing is not the next halting steps in this slow trend, but the quality of Nevada’s legal contribution.  This is going to get a little bit wonky in parts, but let me just take you on a quick tour of this marvelous statute, which drew from a model created several years ago by the Canadian HIV/AIDS Legal Network.

After straightforward and unashamed recitals of its purposes, the law does everything right:

  • It allows any government agency, health program, medical facility or a person with a 501c3 fiscal sponsor to establish a program,
  • It requires staff training, safe disposal and good record-keeping, but does not impose requirements like one-for-one exchange that evidence suggests are harmful
  • It provides civil immunity for actions taken in good faith and without recklessness
  • Ensures the privacy of client records, and bars their use in criminal investigations or prosecutions; and it
  • Forbids discrimination in  the operation of the program “on the basis of race, color, religion, sex, sexual orientation, gender identity or expression, age, political affiliation, disability, national origin, residence, frequency of injection or controlled substance used.”

In short, the law treats HIV among IDUs as a health threat faced by people who have the same rights and needs and dignity as the rest of us, and treats syringe exchange as the effective, helpful and non-threatening intervention that evidence and experience show it to be. Thanks to Nevada’s governor, its legislators (including the sponsors listed below), the Harm Reduction Coalition and the Canadian HIV/AIDS Legal Network for a hopeful reminder that evidence-based policy can happen, even when drugs are concerned.

Note: The bill was sponsored in the Senate by Senators Parks, Spearman, Segerblom, Kihuen, Atkinson, Gustavson, Jones, Manendo, Smith and Woodhouse. Joint Sponsors in the Assembly were Assemblypersons Healey, Ohrenschall; Aizley, Daly, Dondero, Loop, Fiore, Hogan, Martin, Pierce, Spiegel and Swank

Temple University Center for Public Health Law Research

Temple University Center for Public Health Law Research

Based at the Temple University Beasley School of Law, the Center for Public Health Law Research supports the widespread adoption of scientific tools and methods for mapping and evaluating the impact of law on health. It works by developing and teaching public health law research and legal epidemiology methods (including legal mapping and policy surveillance); researching laws and policies that improve health, increase access to care, and create or remove barriers to health (e.g., laws or policies that create or remove inequity); and communicating and disseminating evidence to facilitate innovation.

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