New York City Mayor Bloomberg Backs Needle Exchange, But Where's the Money? 3/21/03

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In a move that caught health workers and harm reduction advocates by surprise, New York City Mayor Michael Bloomberg (R) announced on March 13 that he supports needle exchange programs (NEPs) in the city to help reduce the spread of HIV/AIDS and other infectious diseases. But with both the city and the state of New York in deep financial crisis, it remains unclear whether Bloomberg's comments will result in any expansion of the city's existing NEPs. Even as Bloomberg embraced needle exchanges, his Health Commissioner, Dr. Thomas Frieden, was wrangling with city council members over proposed cuts in funding for groups that operate those and other AIDS prevention-related programs.

Bloomberg's comments came as he addressed a national HIV/AIDS conference at the midtown Manhattan Sheraton Hotel and Towers. During his speech, Bloomberg announced that the city will reorganize its programs to deliver HIV/AIDS services and that the city will support needle exchange programs. Bloomberg's commitment marks a sharp contrast with his predecessor, Rudolph Giuliani, who ignored NEPs despite their proven record of effectiveness.

Noting that more than 100,000 New York City residents are HIV positive, with half of them diagnosed with AIDS, Bloomberg called the situation "unacceptable" and vowed "to do better." Bloomberg said his administration will try to make the city a national model for meeting the Centers for Disease Control and Prevention's goal of reducing US HIV infections by 50% by 2005, and that NEPs will be part of that push.

"These programs have been operating in New York City for over 10 years," said Bloomberg. "The sky has not fallen. Drug use and drug-related crime have not gone up. In fact, they've gone down."

Harm reductionists and AIDS workers welcomed Bloomberg's remarks, but wondered aloud whether his words would be backed up with hard cash. "After years of struggling to have needle exchange recognized in the city, one of the centers of HIV and intravenous drug use in the US, it is very gratifying to have the mayor acknowledge that it works," said Allan Clear, executive director of the New York-based Harm Reduction Coalition (http://www.harmreduction.org). "We have been working on the mayor with a coalition of NEPs, and that is partially why this happened," Clear told DRCNet. "We've been showing people what we are able to do in New York City, and this is one of the fruits of our work."

But lack of government funding raises serious questions, said Clear. "The budget crises in the state and here in the city make the future unclear. We are pushing for a meeting with the mayor so we can discuss this further."

Dr. Don Des Jarlais of Beth Israel Medical Center has tracked HIV among injection drug users since the 1980s. "We have tested injectors for HIV all over the city over time, and the rates of infection have dropped by at least half since these programs became legal, so the mayor's comments are a very positive sign," he told DRCNet. "At a time when NEPs are under some political and financial pressure, this is an important source of public support."

Des Jarlais was also worried about the future of NEPs given the city's and the state's perilous financial situation. "The financial crisis certainly isn't going to help," said Des Jarlais. "We will have to see how that plays out. But having the mayor take this stand at this time is very reassuring."

Nine NEPs currently operate in New York City, and they have played a critical role in stemming HIV/AIDS infections, said Des Jarlais. "NEPs have been absolutely critical," he said. "The mayor cited data we provided showing that NEPs cut the rate of new infections by more than half, and that is very impressive. There would be tens of thousands more people with HIV/AIDS in New York City if not for syringe exchanges."

Daliah Heller is the executive director of Citiwide Harm Reduction, a needle exchange operating in the Bronx and Manhattan. Heller's program is part of a coalition of HIV organizations that have been working with the city on needle exchange since Mayor Bloomberg came into office. "Needle exchange is the most successful prevention strategy in the history of the epidemic. When injectors use these programs, they don't just protect themselves. They protect their families and their communities."

"These programs don't just fight HIV. They are a crucial bridge to drug treatment and health care," added Amu Ptah, the Harm Reduction Coalition's national policy director. "For eleven years these programs have been working with the people that everyone else has shut out or forgotten about. They've gotten thousands of people into drug treatment, housing, family services and AIDS care. The majority of drug related HIV and hepatitis is happening in communities of color, and it's hitting women worst of all. These infections are preventable, and they always were preventable. Allowing deadly viruses to spread is an attack on our communities."

But even as Bloomberg praised NEPs and harm reductionists praised the mayor, Health Commissioner Frieden was warning of layoffs and health clinic closings, leaving in doubt whether NEPs could expect any new support and even raising questions about whether they could expect support at current levels. Between state cutbacks and Bloomberg's demands that city agencies retrench to help close a looming budget gap in the city, the situation is grim, Frieden told the city council in a Tuesday session.

"Proposals currently being considered in Albany to reduce the state's matching funds for public health activities, coming on top of the cuts we have already sustained, would have a devastating effect on the department's ability to protect the public health," he said. Frieden warned that many programs could be eliminated, including HIV testing, and that dozens of HIV/AIDS prevention groups would be forced to seek funding from other sources.

Of particular concern to council members was $5 million in HIV/AIDS assistance from the state, a sum that Frieden said would now not be available. At least one member, Councilwoman Christine Quinn of Manhattan, chair of the Health Committee, accused the Bloomberg administration of cutting the funds.

But Frieden insisted that he had few options. "I would respectfully ask the Council to tell me where you'd like me to cut," he said. "If you want me to put back $12, $13 million in programs. Should I stop issuing birth and death certificates? Should I not investigate severe acute respiratory syndrome? Should I close a TB clinic somewhere? Should I stop treating STDs? Should I stop doing HIV prevention? I'm all ears."

So, New York's mayor now supports NEPs, but there's no money. "I guess that means we have some moral support," said HRC's Clear.

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