Even in counties that have SSPs, there are policies that create barriers to access. Cabell County has received attention for a recent HIV outbreak despite having an SSP. In Cabell County, the health department opened an SSP in 2015, but the county has reported a sharp rise in new HIV diagnoses among its residents. Since 2018, 80 people in the county have been diagnosed with HIV, and these diagnoses were primarily among people who inject drugs. Notably, Cabell County implemented a number of policy changes to its SSP starting in 2017, which have likely undermined the effectiveness of SSP services. Under these changes, first-time users of the SSP are only given 40 needles and the SSP expects to receive 40 back if the person wishes to continue with the program. The county also discontinued family members picking up syringes for individuals who use drugs, meaning that the individuals must come in themselves to pick up syringes. Additionally, and significantly, people who use the SSP must also be Cabell County residents and show proof of residency.
These kinds of policies exist or have been proposed in many other jurisdictions and are not effective in stopping the transmission of HIV through injection drug use. They are contrary to best practices that harm reduction advocates and health experts recommend. Best practices indicated that the following practices are counterproductive to effective SSPs: limiting the frequency of visits and number of syringes, enforcing a mandated exchange ratio (such as “one for one” exchange or providing new syringes only to those who return used ones), limiting program access to individuals who live within specified boundaries, requiring identifying documents, and requiring unnecessary data collection. These practices limit people who inject drugs from accessing SSPs.
The legalization and expansions of SSPs are critical to reducing the transmission of HIV and Hepatitis C and promoting health. But we also need to ensure that SSPs are not implementing policies that undermine this goal. More policy work is needed to eliminate barriers to people accessing SSPs. We must prioritize the needs of people who use drugs in health service delivery and ensure that people who use drugs have meaningful input into how SSPs operate.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.