Pediatricians should advocate for needle exchange programs to reduce the rate of HIV infection among young drug users, the American Academy of Pediatrics said February 2 in a revised policy statement on reducing HIV related to drug injection. The position is a step forward from the group's previous policy statement on the issue, crafted in 1994, that said only that needle exchanges should be "encouraged and expanded."
"Pediatricians should advocate for unencumbered access to sterile syringes and improved knowledge about decontamination of injection equipment," the policy statement now reads. "Physicians should be knowledgeable about their states' statutes regarding possession of syringes and needles and available mechanisms for procurement. These programs should be encouraged, expanded, and linked to drug treatment and other HIV-1 risk-reduction education. It is important that these programs be conducted within the context of continuing research to document effectiveness and clarify factors that seem Pediatricians should speak out in support of needle exchange programs to reduce the spread of HIV among injection drug users," the American Academy of Pediatrics says in a toughened policy statement.
The new, more aggressively pro-needle exchange policy is part of a comprehensive set of positions on dealing with HIV infection among youth. In addition to "engaging youth in care," the pediatricians also called for "frank discussion" within families about ways of avoiding drug use, including alcohol and tobacco use and for advocacy for "youth-friendly substance-abuse treatment facilities that are able to accommodate all youth, including those who are uninsured, underinsured, and undocumented."
"If we can help young people avoid a chronic illness that we have no cure for, I would hope people would embrace that idea," said the lead author, Dr. Lisa Henry-Reid of Chicago's John H. Stroger Jr. Hospital.
Congress has barred the federal funding of needle exchange programs, and the Bush administration has demonstrated an intolerance for even the words "harm reduction," but the evidence that the programs work to reduce the rate of HIV infection among drug users is compelling. The federal Centers for Disease Control and Prevention says the programs can reduce the spread of disease without increasing drug use.
The American Academy of Pediatrics minced few words in its assessment of the utility of needle exchange programs, based on a review of the scientific literature. "Syringe-exchange programs reduce the risk of HIV-1 acquisition from use of shared needles," the group declared flatly. "Syringe-exchange programs do not lead to an increase in injection drug use," the report's authors wrote. "The number of studies that have demonstrated benefits from needle-exchange programs, particularly those conducted within the context of comprehensive drug treatment, is now sufficient to support efforts to make such programs more widely available."
But while around 200 needle exchange programs are now operating in 36 states and the District of Columbia, they remain highly contentious. They draw opposition from social conservatives who view them as "enabling" or "aiding and abetting" illicit drug use and from NIMBY-style activists who fear they will draw or concentrate "undesirable elements" to their communities.