Showing posts with label needle exchange. Show all posts

Monday, October 11, 2010

Terminating harm reduction hope in CALI.

Very disappointing news from Stopthedrugwar.org. This man just condemned countless more people to die unnecessarily from Hep C - and to infect others until they do. I think he's pandering to the conservative communities who don't want to allow needle sales - they don't really seem to care much if a bunch more addicts die...until the one that gets Hep C or HIV from a dirty needle ends up being their kid.

I'd love to set up a needle exchange program in Phoenix. Since Sheriff Joe doesn't run the county health department he really shouldn't get the final word on that. The legislature and Governor will need to support it, though. I'm not sure what it would take to win them over. It won't be easy.

Schwarzenegger also vetoed a bill that the legislature passed unanimously that would have prohibited the shackling of pregnant prisoners - particularly during labor - even those in on non-violent offenses. I don't understand that one at all, except that he has absolutely no concept of what a woman goes through. How are we a threat to public safety when giving birth?

There are far too many ignorant people in power in this nation today.

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California Governor Vetoes Needle Access Bill

By psmith

Created 2010/10/06 - 8:27pm

by Phillip Smith [1], October 06, 2010, 08:27pm, (Issue #652 [2])

California Gov. Schwarzenegger could have made syringe sales to adults legal throughout the state in a bid to reduce the transmission of HIV and Hep C. Instead, he chose to extend a program leaving it up to cities and counties.

Gov. Arnold Schwarzenegger (R) last Thursday vetoed a bill that would have allowed pharmacies all over California sell syringes to adults without a prescription. The bill was touted by health experts as a key step in reducing the transmission of HIV/AIDS, hepatitis, and other blood-borne diseases.

mobile needle exchange/clinic site, Fresno

The state Department of Public Health estimates that approximately 3,000 California residents contract hepatitis C through syringe sharing every year and another 750 cases of HIV are caused by syringe sharing. Sharing dirty needles is the leading cause of new hepatitis C infections in the state and the second leading cause of new HIV infections.

"When I signed legislation my first year in office allowing for a pilot program to allow the sale of syringes through participating counties and registered pharmacies, I was seeking to balance the competing public health, law enforcement and local control issues that this issue requires," the governor wrote in his veto message [8]. "I believe this balance was achieved and SB 1029 [9] would remove the ability of local officials to best determine policies in their jurisdiction. Some counties have not sought to implement this pilot program, citing competing priorities, lack of pharmacy interest and law enforcement opposition. I respect these local decisions and while I appreciate the author’s hard work and dedication to this issue, I cannot sign this bill," Schwarzenegger wrote.

Instead, Schwarzenegger signed AB 1701 [10], which extends the existing Disease Prevention Demonstration Project for another eight years. That gives cities and counties the option of opting out of the program and not allowing syringe sales without a prescription.

The veto angered SB 1029 author Sen. Leland Yee (D-San Francisco), who in a statement last Friday said Schwarzenegger apparently "was not interested in an effective public health measure that would reduce health care costs to taxpayers. Not only did he ignore the recommendation of doctors and other health experts, but he ignored the fact that HIV-AIDS and hepatitis do not recognize county borders. Such epidemics are certain to continue without implementing these comprehensive strategies."

SB 1029's approach "has been evaluated extensively throughout the world and has been found to significantly reduce rates of HIV and hepatitis without contributing to any increase in drug use, drug injection, crime or unsafe discard of syringes," Yee continued. "In fact, there is not one credible study that refutes these findings. The governor’s veto is a moral and fiscal dilemma."

The veto was "tragic and infuriating," said Laura Thomas of the Drug Policy Alliance [11], which supported Yee's bill. "It is an irrational attachment to drug war hysteria, at the expense of human life and fiscal responsibility to the California taxpayer," she said. "Nothing would have worked better and cost less in reducing the spread of HIV and hepatitis C than SB 1029."

Source URL: http://stopthedrugwar.org/chronicle/2010/oct/06/california_governor_vetoes_needl

Monday, September 20, 2010

Syringe Exchange: For all the right reasons.

Cleveland has Ohio's only legal syringe exchange program

Updated: Monday, September 20, 2010, 12:09 PM

Emmanuel Romero, The Cleveland Plain Dealer

Clients of the Free Medical Clinic of Greater Cleveland can exchange one used syringe for one clean syringe.

CLEVELAND, Ohio -- The Free Medical Clinic of Greater Cleveland runs Ohio's only legal syringe exchange program.

Drug addicts, sex workers and white-collar professionals stop by The Free Clinic or its mobile van and exchange one used syringe for one clean one.

The premise is simple, say program advocates: By taking used syringes off the street, it decreases the chance someone in the community might be pricked by a needle tainted with blood-borne pathogens such as hepatitis C or HIV. The program also helps ensure that people in the community are less likely to have sexual contact with someone who shares dirty needles.

HIV prevention efforts nationwide received attention in mid-July when the Obama administration announced a national strategy to reduce the annual number of new HIV infections in the United States by 25 percent over the next five years.

President Barack Obama called for a coordinated national response to address the epidemic. The strategy he proposed would include intensifying HIV prevention efforts in communities where HIV is most heavily concentrated, expanding targeted efforts to prevent infection, and educating all Americans about the threat of HIV and how to prevent it, according to the executive summary of the National HIV/AIDS Strategy for the United States.

The strategy also calls for scientifically proven approaches to reducing HIV transmission, including syringe exchange programs, which while once banned from federal funding, are now eligible.

Cleveland first allowed syringe exchanges in 1995. At that time, more than 17 percent of new HIV infections were associated with intravenous drug use. Last year, that number had fallen to 3.4 percent, according to the Cleveland Department of Public Health.

By comparison, the Office of National AIDS Policy says the national rate of new HIV infections associated with intravenous drug use is 12 percent.

No one is claiming the syringe exchange alone is to credit for the decline. But the city's HIV surveillance report says that Cleveland's below average numbers, in combination with other HIV prevention efforts, may be associated to the exchange program.

"While we do not have direct evidence that needle exchange caused this decrease, the association appears to have timeliness, consistency and biological plausibility," David Bruckman, a biostatistician for the city's health department, said by email.

The syringe exchange -- which also helps addicts access services they either didn't know about or were too hesitant to look for, such as HIV and hepatitis testing, safer sex education and rehabilitation programs -- has strong support from public health officials and people in recovery.

"It's one of those public health interventions I really believe to be a no-brainer," said health department Director Matt Carroll, referring to the lower rates of HIV infections associated with intravenous drug use as reported by his department.

"If it wasn't for the needle exchange, I would have caught HIV," says Roy Vonderau Jr., a self-employed upholsterer and former client of the program who has been sober nine-and-a-half years.

Supporters also see syringe exchange programs as a financially sound way to tackle HIV.

"The health impact and costs that we incur as a result of HIV, hepatitis and other diseases transmitted through the use of shared or dirty needles is enormous," says Martin Flask, director of public safety for Cleveland.
According to the AIDS Taskforce of Greater Cleveland, the average lifetime cost of care without drug discounts for one HIV positive patient is $618,900. Syringes cost less than $1 each.

But critics of such programs have prevented them from becoming widespread. The government first banned federal funding for syringe exchange programs in 1988, an action fueled by widely held fears that such programs increased drug-related crime and implied the government supported drug use. Those fears did not pan out in Cleveland.

"I don't have any evidence to suggest any correlation at all between the needle exchange program and crime," says Flask, a former commander of police when the program started.

Advocates who credit the program for the decline in infections among intravenous drug users want to bring similar programs to other parts of Ohio. The AIDS Taskforce is advising city officials and advocacy groups, including people in Columbus and Cincinnati, that are interested in organizing syringe exchange programs.

"We need to make sure we have more talks and figure out -- is [Columbus] ready to support something like that?" says Peggy Anderson, president and CEO of the Columbus AIDS Task Force. The city and police department need to be on board to help ensure a successful program, she said.

David Merriman, project coordinator of the Office of HIV/AIDS Services for the Cleveland Department of Public Health, also has reached out and connected people from STOP AIDS Cincinnati to The Free Clinic.
"The biggest thing we learned was what they did before they even started a syringe exchange," says Adam Reilly, MSM outreach educator at STOP AIDS. Knowing which city officials to talk to and what data to collect are two important steps.

For the last year, Reilly's group has been conducting surveys with drug users and Cincinnati police to gauge their thoughts on a syringe exchange program.

Members of STOP AIDS, Cincinnati's public health department and Cincinnati police plan to present this data to Cincinnati's health commissioner in September, says Reilly, who believes that state law remains the biggest barrier to starting syringe exchange programs.

Under current Ohio laws, a syringe exchange program can only operate if a city's health department issues an emergency order, but that doesn't protect participants from state prosecution. With support from the MAC AIDS Fund, a charity affiliated with MAC Cosmetics, the AIDS Taskforce is working with state policymakers to amend laws that prohibit the possession of syringes by drug addicts or the distribution of syringes to drug addicts.

In 2009, then-state representative Tyrone Yates of Cincinnati sponsored House Bill 274, which would have allowed drug addicts to carry syringes from an exchange program for the purpose of preventing disease transmission. The bill died after Yates accepted a municipal judicial appointment in January.

Despite that setback, legislators have been willing to talk about proposing new bills, said Chris Krueger, syringe exchange policy coordinator for the AIDS Taskforce, though he declined to identify which legislators were talking to the AIDS Taskforce.

In December 2009, Congress passed and Obama signed an appropriations bill that included language to lift the two-decades-old ban on federal funding for syringe exchange programs. That was a big move on the national level, Krueger says.

In July, the Department of Health and Human Services released written guidance on using HIV prevention funds for syringe exchange programs. The guidance allows money from two existing national grants -- neither of which currently funds The Free Clinic -- to be used for syringe exchange programs. The move does not promise additional federal money.

"The budget environment is very tight right now," says Jennifer Kates, vice president and director of global health policy and HIV for the Kaiser Family Foundation, a non-profit, non-partisan foundation.

The Free Clinic's syringe exchange program is primarily funded by the George Gund Foundation and the AIDS Funding Collaborative. While the Free Clinic receives federal funds for HIV prevention, none of these funds are currently used for the syringe exchange. It is unclear when they can apply for federal grants that can be used for the program.

The program is only reaching about a third of the population it needs to, says Chico Lewis, outreach coordinator for The Free Clinic's syringe exchange program, who bases his assertion on his experience working as a resident assistant at Matt Talbot Inn, a residential treatment facility. Lewis said several clients there have told him they were not aware the syringe exchange program existed.

As for critics who feel Lewis is only supporting drug addiction, and ask why he works with the syringe exchange program, his answer comes quick and easy: "I'm saving lives."

Saturday, September 11, 2010

Youth on Fire: Heroin and Hep C everywhere.

I read this last night and wept. This thing is going after our kids with a vengeance. It's already bigger than AIDS. What's it going to take for us to step up the to fight with everything we've got? How will kids get help while they still have hope if they're too afraid of arrest?

We can't just keep throwing addicts into prison and leaving them to die there, but in America, chains and cages for our people seem to be all we're willing to invest our resources in. How is that either good public health policy or justice?

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Hepatitis C Spikes Among Young Heroin Users

By Martha Bebinger

WBUR

Sep. 9, 2010, 6:27 AM

BOSTON — Heroin, a drug that claims nearly two lives in Massachusetts every day, killed a young woman in Cambridge late last month. She had just turned 18 when she overdosed alone in a bathroom.

“It was a real tragedy, it always is,” says Michael May, the outreach coordinator at Youth on Fire, a teen drop-in center in Cambridge. “She was really young, had been using for a long time and was a pretty key fixture in the community around here.”

May worked with the girl he can’t name and worries that the epidemic he fights every day is gaining steam.
“This summer has been very intense for heroin use in this area,” May says. “And we’ve been getting a lot of kids who, rather than a slow progression into injection drug use, have kind of jumped right into it.”

Needle Use On The Rise

This signals trouble for diseases transmitted through needles, which are also on the rise. The Department of Public Health says infection rates for Hepatitis C in 15- to 25-year-olds have almost doubled since 2002. But there’s no money in this year’s budget for Hep C prevention or to treat new patients.

Hepatitis C is passed through blood in needles, on cotton and on other equipment drug users share. It is 10 times more infectious through a needle stick than HIV. If untreated, Hep C inflames, scars and can ruin your liver.

Dan Church, an epidemiologist at the Department of Public Health, says a spike in Hep C among young heroin users is an urgent matter.

“It’s very alarming to see these numbers of cases with a disease that we really have not seen in this age group for quite some time.” So I think it’s very important that we start thinking about how we can prevent Hepatitis C and provide them education so they will not continue to transmit this disease unknowingly to other people,” Church says.

That is happening. Heroin users and counselors say Hep C is everywhere.

“Once I found out about Hep C, it was just like, yeah, everyone has Hep C,” says Gabe, a 23-year-old who fears arrest if he gives his last name. He started shooting heroin nine years ago but says he only uses occasionally these days.

Gabe does not have Hep C. He tries to keep a few clean needles on him as he moves between Boston and his other home base, Chicago, hopping freight trains, but it doesn’t always work out.

“I’ve definitely gone back and grabbed my old needles off the ground; I don’t know if someone used them, or somebody else’s got dropped there,” Gabe says.

“I generally kept them hidden in one spot but sometimes, you know…”

In Cambridge, and in the the state’s three other needle exchange programs, counselors work Hep C into their prevention talks even though state funding was eliminated this year. May, from Youth on Fire, has a list of precautions he urges users to take. But he knows they may not stick to them in the heat of the moment.

“If somebody’s in a hurry, if they’re sick, it’s just now, now, now,” May says, “and then after they get well is when the rational thinking comes back into play.”

What’s also scary, May says, is that many users aren’t too worried about Hep C.

Johnny, a 24-year-old who also won’t give his last name because he worries about being apprehended by police, sleeps in the woods and hangs out at “Youth on Fire” during the day. He has Hep C.

“It just makes you tired, that’s it. I mean, people can live with it for the rest of their lives right and not die,” he says.

Johnny may be able to manage Hep C with a good diet, rest and no drugs or alcohol. But even if he gets worse, he says he won’t seek treatment because “I heard it makes people really sick and it can kill you.”

Treating Hep C

Hepatitis C is difficult to treat. The drugs won’t kill but they can make patients feel like they have the flu on and off for six months to a year and are only effective in 30 to 40 percent of cases. But on the medical side, things may be looking up.

“We’re really on the dawn of a new era of treatment for Hep C,” says John Ward, director of the division of viral hepatitis at the Centers for Disease Control. “The drugs we have now aren’t specific for the virus.”
Ward says new drugs that are specific to Hep C could be on the market next year.

“When those [new drugs] come on, it will probably double the likelihood of being cleared of this virus and having to go through about half the weeks of treatment,” Ward says.

Ward is understandably excited about better treatment options. In addition to the new wave of young people infected with Hep C, one in 30 Baby Boomers have it, according to the CDC. They could have been infected through a blood transfusion if it occurred before 1992 or in a non-licensed tattoo parlor, but the main way people get Hep C is through intravenous drug use. Cynthia Jorgesen, who runs education and training programs at the CDC, says many people don’t want to recall a past that might have included Hep C.

“Because of that association with negative connotations,” she says, “a lot of people don’t assume they’re at risk because they’re not ‘one of those people.’ ”

Baby Boomers And Hep C

Sixty-five to 75 percent of Baby Boomers who have Hep C don’t know it. Ward says that’s because “they call Hep C the silent epidemic. You can live for decades and don’t know you are infected. The liver doesn’t complain much until it is very, very ill. So you don’t get sick often until it’s too late to help the liver.”

The CDC says death rates are expected to triple in the next 10 to 20 years if the Boomers don’t find out they have Hep C before they get seriously ill.

Most health insurance plans cover a Hep C screening if there’s reason to think you need one. The Department of Public Health is hoping word about Hep C will spread faster than the virus until there’s money again for prevention and new treatment.

Sunday, August 22, 2010

Harm Reductionists denied "medical necessity" defense for needle exchange.

These two courageous activists trying to stop the spread of Hep C and HIV in the community through an unauthorized needle exchange program have already been hit with sanctions by employers and licensing boards, and are now facing up to a year in jail. I believe their trial has been set for February 2011. This is actually an update - see the previous post on this story for more background

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URL: http://www.mapinc.org/drugnews/v10/n368/a11.html
Newshawk: Syringe Exchange Facts www.drugwarfacts.org/cms/node/66
Votes: 1
Webpage: http://mapinc.org/url/8LwY8ths
Pubdate: Tue, 18 May 2010
Source: Modesto Bee, The (CA)
Copyright: 2010 The Modesto Bee
Contact: letters@modbee.com
Website: http://www.modbee.com/
Details: http://www.mapinc.org/media/271
Author: Merrill Balassone
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)

RULING HURTS IN MODESTO NEEDLE EXCHANGE CASE

A judge ruled Monday that two people arrested for handing out clean syringes to drug users and collecting dirty ones will be barred from telling a jury they did so to help prevent a public health emergency.

Kristy Tribuzio, 36, and Brian Robinson, 38, face up to a year in jail after undercover officers said they caught the two operating an unauthorized needle exchange in a south Modesto park in April 2009.

Stanislaus County Superior Court Judge Ricardo Cordova said the pair had other options that were legal, such as lobbying local officials to change the law. In September 2008, the county Board of Supervisors voted against legalizing needle exchange programs over the recommendation of county health officials.

"Frankly, this is a political decision with which the defendants disagreed," Cordova said.

Tribuzio called Cordova's decision "insulting."

"This doesn't have anything to do with politics," she said. "It's a public health issue."

During a nearly two-hour hearing, Tribuzio and Robinson's defense team argued their clients were acting out of medical necessity: that conducting a needle exchange program was a justified act aimed at saving lives and preventing such diseases as HIV and hepatitis C among drug users.

Nearly two dozen needle exchange activists from Oakland, Sacramento, Fresno and Modesto were in court for the ruling.

Tribuzio's attorney, Alonzo Gradford, likened the rate of new hepatitis C cases in Stanislaus County -- nearly 12 per week -- to a ticking bomb.

"People are dying every day as a result of dirty needles," Gradford said. "That's an imminent emergency."

Prosecutor Merrill Hoult said the defendants knew what they were doing was illegal and operated the needle exchange as an act of civil disobedience.

"We have a systematic breaking of the law," Hoult said. "Needle exchanges may have been legal in other counties, but it's illegal here."

In California, there are more than 40 needle exchange programs, but the Central Valley has just three, according to the state Department of Public Health. Fresno County approved a needle exchange pilot program in December 2008.

Robinson's attorney, Ruben Villalobos, described the scene in Mono Park on a recent afternoon. He said he and an investigator found four dirty needles left in the park, nicknamed "Needle Park" and "Heroin Park."

"If we were in another county, what Mr. Robinson did would be perfectly legal," Villalobos said. "We as a society have decided you can't do it."

Tribuzio and Robinson will be back in court Aug. 2 for the setting of their trial date.

Wednesday, August 11, 2010

Harm Reduction, the Vienna Declaration, and the US War on Drugs

A note of much-needed Hope.

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HIV and the U.S.-led war on drugs

By Evan Wood
Los Angeles Times
(As printed in the Denver Post)

Posted: 07/30/2010

Last week, thousands of scientists, physicians and activists fighting the HIV and AIDS pandemic around the world gathered in Vienna to discuss the latest breakthroughs — and frustrations.

There were reports on several landmark studies describing the crucial role that treatments can play in reducing the infectiousness of HIV-positive individuals. And there was encouraging news from Africa, where a study found that an intra-vaginal anti-viral gel could reduce the risk of HIV infection among women who used it by 40 percent.

But there was also sobering news at the 18th International AIDS Conference, including stark evidence of how the HIV epidemic is raging unchecked among some populations of illicit drug users.

Vienna was selected to host the biannual meeting of HIV experts because it is the gateway to one of the world's most rapidly growing HIV epidemics: that among heroin users in Eastern Europe. Outside sub-Saharan Africa, about one in three new HIV infections stems from injecting illegal drugs, and in some parts of Eastern Europe and Central Asia, 70 percent of those who inject illicit drugs are infected with the virus.

In response to these alarming statistics, this year's conference endorsed as its official statement the Vienna Declaration, a document I helped draft to draw widespread attention to how the U.S.-led war on drugs has played a central role in driving the HIV epidemic around the world.

Writing in the medical journal the Lancet, where the Vienna Declaration was also published, Michel Sidibe, the executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS) and other prominent scientific leaders stated the situation succinctly: "The war on drugs has failed."

Criminalizing drug abuse drives addicts deeper underground and into the kinds of unsafe practices such as needle-sharing that spread infection. We have seen clearly that countries with the most draconian drug laws also have the highest rates of HIV infection among users.

In Russia, for example, where one in 100 adults is now estimated to be HIV-infected, a fierce drug war has outlawed basic harm reduction tools, such as methadone maintenance treatment. Methadone is on the World Health Organization's list of essential medicines, but Russian physicians cannot even openly discuss the need to prescribe the treatment without fear of reprisals.

The mass incarceration of drug users is particularly alarming, given the spread of HIV in prisons. A Pew Trusts analysis of U.S. Department of Justice data noted that one in nine black males age 20 to 34 is in prison, many of them as a result of drug law enforcement.

Given the link between prisons and HIV, it is not surprising that in places such as Washington more than 80 percent of HIV cases identified between 2001 and 2006 were among blacks.

Beyond HIV and AIDS, the declaration also notes that the war on drugs is ineffective.

"National and international drug surveillance systems have demonstrated a general pattern of falling drug prices and increasing drug purity — despite massive investments in drug law enforcement." In just a few short weeks since being made public, the Vienna Declaration has been endorsed by more than 13,600 individuals, including five Nobel laureates and various other global leaders in science, medicine and public health.

There also have been signs that the world may be heading toward more reasoned drug policies. Just before the Vienna conference, the Obama administration announced overdue and welcome steps to help fight the HIV epidemic among drug users. Most important, given the strong support for syringe exchange programs from the U.S. Institute of Medicine and WHO, the administration has reversed a longtime ban on funding clean syringe programs.

But there is still much that needs to be done. The Vienna Declaration calls for governments to "implement and evaluate a science-based public health approach to address the individual and community harms stemming from illicit drug use."

Not surprisingly, considering that strident special-interest groups have long misled U.S. voters into believing that the drug war is an essential crime-reduction tool, most government delegations at AIDS 2010, including the U.S. government delegation, remained largely silent on the Vienna Declaration.

Decades of worldwide drug-related violence have made clear that drug prohibition enriches organized crime and causes bloodshed. But the devastating public health consequences of the drug war have been less recognized, and government acknowledgement of the link between the war on drugs and the HIV epidemic is urgently needed. The next International AIDS Conference will be in Washington in 2012. Before that meeting, governments around the world will be asked to state a formal position regarding the declaration.

In the meantime, the declaration also asks for several noncontroversial steps, including that governments "undertake a transparent review of the effectiveness of current drug policies." Given the international public health emergency presented by HIV among drug users and the estimated $2.5 trillion in tax dollars wasted on the drug war over the last 40 years, the U.S. should move forward with this simple call.

——— ABOUT THE WRITER Evan Wood, a physician and associate professor of medicine at the University of British Columbia, directs the Urban Health Research Initiative at the BC Centre for Excellence in HIV/AIDS. He wrote this for the Los Angeles Times.

Friday, July 2, 2010

Victorian Harm Reduction: prison needle exchange.

Prisoners should have needle exchange

Sydney Morning Herald
June 22, 2010

AAP

Needle exchange programs should be introduced in Victoria's prisons to reduce the transmission of blood-borne viruses, the Australian Medical Association's Victorian president says.

Dr Harry Hemley said needle exchange programs in the wider community had significantly reduced the spread of Hepatitis C and other blood-borne viruses.

About 35 per cent of prisoners tested positive to Hepatitis C but intravenous drug users in prisons were still denied access to safe injecting equipment, Dr Hemley said.

"Prisoners deserve the same rights to access and quality of health care as the wider community, this includes access to a needle exchange program while in detention," Dr Hemley said in a statement on Tuesday.

"Illicit intravenous drug use is harmful and risky but unfortunately is common in Victorian prisons," he said.

"What we need to focus on, from a health perspective, is reducing the risks to detainees, prison staff and the public by reducing the spread of blood-borne viruses through sharing contaminated injecting equipment.

"Most prisoners will join the wider community on release, so reducing the spread of blood borne viruses in prisons will also impact on transmission in the wider population."

Dr Hemley said detoxification facilities should also be available to prisoners to manage substance abuse problems.

Wednesday, June 30, 2010

Harm Reduction in Prison: Under the Skin

We need to be organizing more programs like this here, too. Pretty cool that they went around interviewing the prisoners instead of letting all the "experts" speak for them...

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Under the Skin: A People’s Case for Prison Needle and Syringe Programs

What do people in prison have to say about the Canadian government’s unwillingness to permit the distribution of clean needles in prison?

Between 2008 and 2009, interviews were conducted in person and over the phone in British Columbia, Alberta, Manitoba, Ontario, Quebec, New Brunswick and Nova Scotia, resulting in sworn affidavits or testimonials from 50 individuals who have used drugs or shared needles in a federal prison. The hope is that their stories will strengthen the case for change, which governments continue to ignore even as a growing body of evidence highlights the need.

The Legal Network is not alone in calling on the federal government to implement needle and syringe programs in Canada’s prison. Our position is supported by the Canadian Medical Association, the Ontario Medical Associations, the World Health Organization, UNAIDS, the UN Office on Drugs and Crime, the Correctional Investigator of Canada and the Canadian Human Rights Commission. Furthermore, a 2006 review of the scientific evidence by the Public Health Agency of Canada concluded that prison-based needle and syringe programs have largely positive outcomes for the health of people in prison.

www.aidslaw.ca/
undertheskin

Published On	2010-02-02
Author	Canadian HIV/AIDS Legal Network
Topics	Prisons, Drug Policy and Harm Reduction
Document Type	Reports
Language	English
Doc Id	1594

Sunday, May 23, 2010

Harm Reduction debate in Australia

This recent news clip is from the Aussies, who are at least having a public dialogue about Hep C harm reduction interventions:

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Needle exchange 'would prevent hep C transmissions'

ABC.net.au

Updated Wed May 19, 2010 7:50am AEST

Drug reform groups and the ACT Greens are pushing for a needle exchange program to be set-up at the prison. (AAP : Julian Smith)

The ACT Greens and drug reform groups have seized on a possible hepatitis C transmission in Canberra's jail to renew their push for a needle exchange program.

There are high levels of hepatitis C in the Alexander Maconochie Centre.

Eighty-two detainees were tested in the last survey and Health Minister Katy Gallagher says 65 per cent of them had the virus.

She says there is evidence one detainee contracted the virus while in the jail.

"So this is our first case where there is evidence to support transmission of hepatitis C whilst in custody," she said.

ACT Health says the man is considering legal action.

"I've heard that there is a view that if there was a needle exchange program this may not have occurred," she said.

She says a needle exchange would bring health benefits but it would also create serious industrial problems.

But Greens MLA Amanda Bresnan says only a needle exchange will prevent transmissions.
"We can't bury our head in the sand about this. We should be providing safety to prisons and prison guards," she said.

Bill Bush from Family and Friends for Drug Law Reform says the Government has a responsibility to introduce an exchange program.

He says the Government is using the discomfort of prison officers as a fig leaf instead of engaging in dialogue.

Opposition corrections spokesman Jeremy Hanson says the possible transmission is one of a long list of failures at the prison.

"We have prisoners now being infected with hep C, we have prisoners protesting on the roof, we have guards taking weapons home - we have a whole range of problems in this jail," he said.

"I think it makes an absolute mockery of [Corrections Minister] Simon Corbell's management of this facility."

The Government says it will review the idea of a needle exchange program later this year.

Wednesday, May 19, 2010

ACT-UP is Alive and Well...

This article seemed relevant both because people with Hep C are often coinfected with HIV, and because ACT UP has a lot to teach the Hep C advocacy community about the urgency of finding a cure. Too often the State justifies under-investing in hepatitis patients because it's a disease that may still take anther 20-30 years to kill, and even then, they remind us, only about 15-20% of patients who have chronic hepatitis will develop serious liver damage, including cirrhosis and liver cancers.

The scale of Hep C infection far exceeds that of HIV, however, so even if HIV was more deadly and acted more quickly, at our present levels of investment in prevention and treatment, HEP C will kill far more. And the number of people infected by Hep C has already far exceeded those with HIV. As an illustration, for the month of April, 2010, the AZ Department of Corrections had custody of 183 prisoners they had identified as HIV+. That same month, the identified Hep C+ prisoner population was 6,096.

Think on that for a moment. About 50-70% of people with Hep C don't even know they have it, too.

The absolute numbers of new Hep C infections have come down across the country since 1992 (at which time it became possible to screen blood products for the virus, drastically reducing infections caused by transfusions and dialysis), deaths from advanced liver disease have still been rising, due overwhelmingly to hepatitis. In fact, unless there is dramatic intervention in the infectiousness and destructiveness of the virus, the mortality rate from liver disease is expected to double by the year 2020.

Those of us who have Hep C or love someone with it are tired of being told to "wait and see". We will work cooperatively with our partners as much as possible to leverage resources and get public support behind fighting this illness, but the State must remain ever mindful that every passing day without treatment brings those we love closer to what may be a terrible fate...and introduces thousands more to the possibility of the same. We saw the same thing happen with the AID epidemic, because the lives of most of those affected were so devalued by society. We would never have come as far as we have with AIDS research and resources for patients had it not been for people Acting Up.

We know what "wait and see" brings, and it is not an acceptable response to this epidemic. We aren't waiting any more.

Happy World Hepatitis Day, by the way.

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POZ Magazine

February 3, 2010

ACT UP’s Latest Act

by Trenton Straube

After almost 20 years, AIDS activist group ACT UP is making news again. But what are their targets in 2010, and who is joining their fight?

Can HIV history repeat itself? The AIDS Coalition to Unleash Power (ACT UP) experienced its headline-grabbing heyday two decades ago. But in the past several months, the group has once again garnered media attention in efforts to shake up the status quo.

Members of a Philadelphia chapter helped shut down the U.S. Capitol Rotunda in July while protesting for HIV/AIDS issues. An ACT UP chapter formed in Wisconsin to take on a local AIDS service organization (ASO). Another started up in San Diego to salvage the county’s HIV/AIDS services from massive budget cuts. And as if on cue, religious conservatives got in a kerfuffle over a Harvard University exhibit titled ACT UP New York: Activism, Art, and the AIDS Crisis, 1987–1993.

POZ wondered whether this flurry signals underlying shifts in the culture—and in the HIV community—that could herald the return of ACT UP. We spoke with recent headliners for some insight.

But first, a quick history lesson. ACT UP launched in 1987 as a social movement to confront the government, big pharma and general public for ignoring the AIDS crisis. It consisted of autonomous chapters that sprung up across the globe. They conveyed their messages through politically charged posters and slogans such as “Silence = Death.”

Most famously (or infamously), they staged nonviolent acts of civil disobedience—such as chaining themselves to the balcony of the New York Stock Exchange in 1989—that forced the world to take note of the AIDS epidemic. And it worked.

“Every single thing that people with AIDS have today is because of ACT UP—every med, every legal protection, insurance, housing protection, their representation of people with AIDS in public, safe sex itself,” says Sarah Schulman, a journalist and former member who is posting a collection of interviews with ACT UP New York members on actuporalhistory.org.

It’s ironic that one of the movement’s biggest successes—advocating for the introduction of protease inhibitors, first available in the mid-’90s—helped usher in its near extinction. By the late ’90s, it seemed, the battle had been won. Local and federal AIDS groups were up and running. Meds were available. And once fewer people were dying, fewer people were protesting. With a few notable exceptions, the movement became defunct.

Or maybe it just went into hibernation, waiting to be reawakened.

Such was the case last summer in Madison, Wisconsin. A group of about 10 activists (some HIV positive, some not) wanted to challenge a local ASO called AIDS Network to improve the quality and variety of care it offered. Aware of ACT UP’s history and name recognition, they decided to form a chapter.

The group spearheaded old-school protests outside the network and posted the ASO’s financial documents online. The tactics garnered attention.

But did they get results? In fact, AIDS Network has increased its client reassessment rate, opened a part-time food pantry and started a mental health service. “Our clients always received great care,” the network’s executive director Karen Dotson tells POZ. “I’m very proud of what we’ve done in the last year and a half that I’ve been here.”

But she says the recent improvements were in the works before ACT UP Wisconsin started acting up. She questions the activists’ mission: “Are they a diverse group? Are they focused on people living with HIV/AIDS? Or are they just concerned with critiquing AIDS Network?”

“This is not about me,” counters ACT UP Wisconsin’s Bob Bowers. “It’s not about Madison or AIDS Network. This is about the bigger picture. For us to take a stand here, we’ve seen a ripple effect across the United States. Friends in Key West [Florida] are cheering us on. They’re wanting to form chapters in Arizona and California.”

Bowers’ fellow activists describe the bigger picture as a scenario all-too-often playing out across the nation. Many of today’s AIDS organizations are stuck in an ’80s mentality of only offering prevention and helping clients “from diagnosis to death,” says Greg Milward, a chapter member. ACT UP can nudge these ASOs out of the past, pressuring them to offer integrative services such as dental care and programs for mental health and substance abuse.

In many cases ASO clients are so grateful for any services, especially in the midst of a great recession, that they don’t dare question or complain, adds Della Haugen, also a chapter member. And if they do feel mistreated, they don’t speak out because they fear being penalized. ACT UP can empower them and give them a voice.

“We feel it’s important to have the ACT UP chapter because so much accountability needs to be out there,” Haugen says. “Even if the issues with the local ASO are resolved, there are other issues to bring up.” Indeed, the group has also met with U.S. Congressman Dave Obey (D–Wisconsin) regarding lifting restrictions on needle-exchange programs.

Activists certainly have their work cut out for them. But the main challenge, as Bowers sees it, is that “there’s an incredible sense of complacency within the HIV/AIDS community because they think that this work is being done.”

Mike Tidmus would agree and disagree with that statement. The San Diego blogger has no illusions about California’s inability to get the AIDS-related work done. He’s well aware that the state’s budget has imploded. In Wisconsin, the focus is on redirecting funds. In California, it’s on salvaging them.

Tidmus launched an ACT UP chapter last summer in hopes of doing just that. He also envisioned the group fighting HIV/AIDS stigma in the gay community as well as working to make medical marijuana, which is legal there, cheaper for people with an AIDS diagnosis.

But only about eight people showed up for the first ACT UP meeting, and there was even less interest in holding a protest. “I tried to light a fire to get people to show up for an annual [state AIDS office meeting], and it sort of fizzled,” he recalls.

“There’s a lot of apathy,” Tidmus says. “People who might have been involved in the ’80s or ’90s are on [HIV meds] now, so it’s not the big deal it was before.” In other words, to paraphrase ACT UP founder Larry Kramer: If there’s no outrage, there’s no ACT UP.

But notable exceptions come to mind. ACT UP Philadelphia has been meeting most every Monday night since 1988. Part of its longevity, says member Jose de Marco, is that its members “are people of color, a mixture of straight, gay, homeless, substance users—we reflect AIDS in this country.”

The Philly chapter takes up causes important to its members, such as local housing issues and global AIDS programs. In addition, de Marco notes that, despite using social networking sites such as Facebook to get messages out, ACT UP Philly still believes in taking it to the streets, to corporate boardrooms and even to the U.S. Capitol.

So when its members learned last fall that the state of Pennsylvania had failed to use more than $11 million in available federal funds and had to send the money back to Washington, they knew how to channel their outrage.

They staged an in-your-face direct action at a state AIDS funding meeting. They promoted it, filmed it and posted the clips online. They made headlines—just like they did back in the ’80s.

Monday, May 17, 2010

Harm Reduction: Taking it to the Streets

I stumbled across this story below on a progressive blog this morning (via an awesome California blogspot for the "Off the Streets Project", a harm reduction effort in Modesto, Stanislaus County), and it set me off on a seven-hour writing tirade. You get spared most of it, though, so you have enough energy left to read about these folks.

Among other things, this group promotes needle exchange programs, which are outlawed in their city. A couple of activists went out and distributed free syringes anyway, and got arrested for it. Looks like the sheriff alrady had it in for them because of some like-minded blogger pissing him off. These folks haven't just been blogging and committing civil disobedience, though - they've also been going into neighborhoods and engaging people and literally cleaning up the streets to get rid of dirty needles. In the process they help build connections between community members and raise awareness about combating infectious, bloodborne diseases like Hep C.

I hope we're doing a lot of that here. I feel so out of touch with the streets - I used to work them, doing outreach, back in Michigan.

Anyway, read on and then come back up here and check them out at the source. That's how we started to get a grip on HIV: with good old-fashioned community-building and harm reduction methods, even though it meant dragging some sheriffs and lawmakers kicking and screaming into the real world. It's hard to believe that in 2010 there's still so much hysteria from some people over things like needle exchange and condom distribution...but then, look at some of the nonsense that comes out of Maricopa County and the State House. If there are still whole communities in Cali afraid of needle exchange in the streets, then I guess pushing harm reduction in the prisons and jails here may be a little more difficult than we originally thought...

Even the progressive blogger below was afraid to identify themselves. What's in store for us, I wonder? Anyway, our hats are off to these folks...

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Modesto Harm Reduction Activists Still Facing Jail

By Anonymous

In Modesto, two harm reduction activists, Brian Robinson and Kristy Tribuzio (the “Mono Park 2”), are facing significant sentences from a local court. And this for offering a voluntary service, a syringe exchange program (SEP) that elsewhere in California and in most industrial countries is taken for granted. Indeed, the nation’s drug czar, Gil Kerlikowske, has stated at a Congressional hearing that “needle exchange programs have been proven to reduce the transmission of blood-borne diseases.”

Modesto (pop. 209,000) is in Stanislaus County, where the economic slowdown has helped fuel substance abuse. According to the National Insurance Crime Bureau (NICB), Modesto has a higher rate of auto thefts than any other metropolitan area in America, a fact that contrasts strikingly with the image that the city fathers would like to project. And U.S. Attorney McGregor Scott referred to the Modesto area as “ground zero” for the meth problem nationwide.

In April 2009, Robinson and Tribuzio were arrested. Immediately after the arrest, Tribuzio not only lost her job with drug services in Stanislaus County but also her credentials to work as a substitute teacher. Furthermore, she was unable to continue in her education master’s program. Such multidimensional attacks on her right to work raise issues of proportionality.

Rationale of SEPs

In the health world, most people take it for granted that injecting drug users (IDUs) should have access to sterile injecting equipment. Contrary to the views of the apparatchiks in Modesto, SEPs do not encourage drug use. An IDU who is determined to inject will do so, with “dirties” or even with sharpened ballpoints.

Needle sharing brings with it the transmission of HIV and Hepatitis B and C, all of which are potentially lethal illnesses that are known to ravage vulnerable populations. Unlike gays, IDUs are an especially difficult population with which to make contact. A number of them are homeless.

The focus on using one-off needles is a continual reminder to IDUs to take care of their health. Often, the SEP clients collect needles for their circle of acquaintances. That helps avoid “dirties” littering parks and streets. Contrary to stereotypes, IDUs are not folks that just want to die. The SEP is an excellent mode to facilitate users making first contact with, for example, detox/rehab units, maintenance (with methadone) programs, a wide range of information or testing for HIV or HEP B or C.

Fresno SEP

In 1999, the California legislature legalized SEPs giving each county leeway as to implementation. Before it became acceptable to the powers that be in Fresno (on December 16, 2008), it had taken 14 years of underground activity on the streets and painstaking organizing.

In Fresno, the SEP makes basic medical treatment available. An M.D., Marc Lasher, a specialist in the field of substance abuse, is always in attendance with helpers. This facility takes place inside a bus that he drives to a discreet location in a cul-de-sac where the SEP takes place.

Dr. Lasher notes that “this is the standard of care established by the surgeon general, the CDC [Centers for Disease Control] and NIDA [National Institute on Drug Abuse] — that when a health provider comes across an IDU and that person is not willing to go into detox or rehab, then the health personnel should provide them with access to syringes to prevent them causing further harm to themselves or to other people.”

Fresno’s SEP distributes approximately 360,000 clean, one-way needles annually, most in exchange for those brought in by the users themselves who carefully collect their own and those around them.

The police in Fresno have not been afraid to arrest people for this voluntary work. For instance, Jean Rodrigues, one of the founders of the Fresno SEP, was arrested [when?] for the contents of her car (needles and paraphernalia). She took the rap so that other volunteers would not have to experience the multiple impacts of a trial. Fortunately, the DA dropped all the charges.

Dr. Lasher assured me that “getting organized and legalized didn’t happen overnight.” It entailed the painstaking work of persuasion: “We started meeting with the Board of Supervisors individually. We put together five or six doctors as a team and went and talked to them individually.”

The Fresno SEP is financed by a private foundation but currently has a two-month shortfall in its budget. One month is almost covered by the generally impoverished IDUs themselves who are all asked to make a donation, however small.

What Went Wrong in Modesto?

So how did it happen that the Modesto SEP was targeted? The answer lies both in the complicated local politics and, arguably, Robinson’s decision to distribute flyers announcing the service instead of using word-of-mouth.

Before the April 2009 busts, there had been a report by the Stanislaus County Civil Grand Jury in 2008 (see www.stancounty.com/bos/agenda/2008/20080715/Corr01.pdf starting on page 22) that supported an SEP. A number of significant institutions in the county supported that recommendation including the Health Department. However, the Board of Supervisors, the DA and the sheriff were unanimously against it.

Especially curious in the Modesto story is the role of a self-styled libertarian blogger, “Robert” (http://thehive.modbee.com/node/16466). It seems that prior to the events described here, Robert was involved in an altercation with the sheriff although what part this has played is unclear. From the chronology, it appears that Robert’s blog played a key role in the sheriff’s decision to make arrests, although the blog contains only his own prejudices and those of his supporters.

Robert’s main objection in Modesto was that needles were given away for none in exchange. Dallas Blanchard, who runs the Fresno SEP, explains that issue as follows: “The police may seize the user’s needles. What should I do? Give somebody none and then have him share a dirty needle?”

Current Situation: February Hearing

The situation for the Mono Park 2 is critical. On February 1, there will be a hearing at which a judge will decide whether the defense will be permitted to advance the legal argument of medical necessity. Before the November 9 hearing, they had not expected charges to be dropped. However, Tribuzio says they had thought there might be “some sort of reasonable alternative, such as an infraction with a fine.” Yet, the deal on the table from DA Birgit Fladager was harsh. Tribuzio notes that it included “a stay away order from an area in which 65+ needles had recently (November 8) been cleaned up in just a two-block radius.”

On November 9, the DA rejected any compromise and offered Robinson as the organizer of the activity a jail term of 30 days and Tribuzio probation for three years. If they contest the case, both could receive up to one year in jail on paraphernalia charges.

A Rollback Pattern Emerging?

The events in Modesto might be mistaken for provincialism and mediocrity. However, there are indications that this arrest is part of a wider rollback attempt.

An article, “Panic in Needle Park: Return of the Fearmongers,” in the January 6 Counterpunch (www.counterpunch.org/papa01062010.html) suggests that there is an ongoing attempt to turn this issue into a political football rather than a health issue. Anthony Papa’s article describes how three significant figures — John Gilbride (DEA), Bridget Brennan (special narcotics prosecutor of New York City) and Peter Vallone, Jr. (D-Queens, NYC City Council) — attacked a two-year-old pamphlet by the N.Y. Department of Health that explained New York’s harm reduction policies. Unusual for the GOP, Mayor Michael Bloomberg defended the pamphlet.

Other SEPs in rural areas of California have already been closed. The combination of California’s insolvency and provincial prejudice may prove lethal. One possible danger if the Modesto rollback succeeds is that it will make supervisory boards even more reluctant to back SEPs.

Tribuzio sees part of the problem in the power given to counties to make decisions for which they are ill-equipped: “I think that one of the biggest problems is that California law is inconsistent. It forces very important public health decisions to be left up to the politics and law enforcement influence of individual communities that are not equipped with the resources and education to be able to make the necessary decisions.”

Health issues getting turned into political footballs is a backward trend to note. And all this is taking place with the AIDS movement in a state of structural weakness. On the other hand, the federal government announced in November of last year that its longstanding ban (since 1999) on SEPs would be lifted. Let us hope that science holds sway here rather than the dogma and stereotypes backed by political calculation.

ackground Reading
Details on the Mono Park 2 (through October 2009):

http://stopthedrugwar.org/chronicle/605/mono_park_2_modesto_needle_exchange_arrest

Brian Robinson’s blog: http://offthestreetsproject.blogspot.com//

Needle exchange programs: http://en.wikipedia.org/wiki/Needle_exchange

The author of this article has chosen to remain anonymous.

February 1st, 2010

Friday, March 12, 2010

Harm Reduction Coalition: Principles

This site (HRC) is a useful resource for those interested in harm reduction strategies to reducing the spread of Hep C and other bloodborne diseases.
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Principles of Harm Reduction

Harm reduction is a set of practical strategies that reduce negative consequences of drug use, incorporating a spectrum of strategies from safer use, to managed use to abstinence. Harm reduction strategies meet drug users "where they're at," addressing conditions of use along with the use itself.

Because harm reduction demands that interventions and policies designed to serve drug users reflect specific individual and community needs, there is no universal definition of or formula for implementing harm reduction. However, HRC considers the following principles central to harm reduction practice.

* Accepts, for better and for worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.

* Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.

* Establishes quality of individual and community life and well-being--not necessarily cessation of all drug use--as the criteria for successful interventions and policies.

* Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.

* Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.

* Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.

* Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people's vulnerability to and capacity for effectively dealing with drug-related harm.

* Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.