Washington D.C., USA, 22-27 July 2012www.aids2012.org

Addressing the NSEP Shortfall in the USA:

Local Problems, Local Solutions

Paola Barahona, MPH

Project Director

DC Appleseed Center for Law and Justice

pbarahona@dcappleseed.org

paola.barahona@gmail.com

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Syringe Exchange in Congress’s Backyard

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Congressional Budget Oversight

• DC budget is passed annually by Congress as an Appropriations Act

• DC Code: “no amount may be obligated or expended by any officer or employee of the District of Columbia government unless such amount has been approved by Congress, and then only according to such Act.”

• Community Calls for Budget Autonomy

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Beginnings of Syringe Access in DC

• 1980s – ACT UP• 1992 – Government Agency• 1994 Legislation allowed SEP by a community-

based organization• 1996 Whitman-Walker Clinic begins an SEP

under a DC government contract

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Federal Ban

• From 1988 to 2009 the Labor, Health and Human Services, Education, and Related Services bill included language banning the use of federal funds for syringe exchange program services.

• 1988 language included exemption criteria:– SEP proven effective in reducing HIV

transmission– SEP proven not to increase drug use

Washington D.C., USA, 22-27 July 2012www.aids2012.org

1998 Surgeon General Review

• Scientific literature review• Found criteria were met• The Clinton administration, however, did not

exercise the waiver, finding the issue politically divisive

• Maintain ban on use of federal dollars• Leave to local jurisdictions to decide if want to

use local or state dollars for needle exchange to fight their local epidemic

Washington D.C., USA, 22-27 July 2012www.aids2012.org

FY 1999 Tiahrt Amendment

• Prohibited DC from spending any of its money on SEP

• Additionally, any entity receiving federal or local funds could not operate SEP.

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Creation of PreventionWorks!

• October 1998: Staff of WWC DC NEP laid off and hired by newly-incorporated organization to continue the SEP

• Not authorized to conduct SEP until December 1998

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Some Obstacles

• Funding – all private• Collaboration with other CBOs• Government officials wouldn’t speak out publicly

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FY 2000

• Tiahrt tries to continue his restriction• President Clinton vetoes the omnibus

appropriations bill twice – due in part to the restrictive DC SEP language

• Compromise:– continues local funding ban– requires any entity that runs an SEP and

receives federal or local funds to account for those funds separately and only use private funds for SEP

Washington D.C., USA, 22-27 July 2012www.aids2012.org

2000 Surgeon General Literature Review

• Report issued by Surgeon General and senior scientists, unanimously agreed

• Conclusions on effects of SEPs:– “a decrease in new HIV seroconversions;– An increase in the numbers of injection drug users

referred to and retained in substance abuse treatment; and

– Well documented opportunities for multiple prevention services and referral and entry into medical care.”

– Also concluded that SEPs do not increase use of illegal drugs – and may in fact decrease injection frequency

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Success brings more Restriction in DC

• FY 2001 Congress adds restrictions on SEP in DC– No SEP could operate within 1,000 feet of any

school– If an SEP operated near a DC Housing

project, the District had to submit a monthly report on illegal drug activity in that are

Washington D.C., USA, 22-27 July 2012www.aids2012.org

FY 2002

• Chairman Joe Knollenberg (R-MI) of the DC Subcommittee continues the local funding prohibition, but deletes the other restrictions

• The Senate Subcommittee, under the leadership of Sen. Mary Landrieu (D-LA), passes a bill that does not include the local funding prohibition.

• In Conference, the House version becomes law

Washington D.C., USA, 22-27 July 2012www.aids2012.org

2007

• Chairman Jose Serrano (D-NY) does not include local funding ban in DC appropriation bill.

• On the House floor, Rep. Mark Souder (R-IN) offers an amendment to overturn Serrano– The amendment is defeated by a vote of 208-

216• President Bush signs FY 2008 appropriations bill

allowing DC to spend local funds on SEP

Washington D.C., USA, 22-27 July 2012www.aids2012.org

2008 DC NEX

• Mayor Adrian Fenty announces proposal to spend $650,000 of DC funds on SEPS

• January 2008 Press Conference – Mayor awards DC government $300,000 contract to PW to expand its SEP

Washington D.C., USA, 22-27 July 2012www.aids2012.org

2008 DC NEX - continued

• March 2008 a Request for Applications was released for new SEPs in DC

• April 2008: 3 additional programs were awarded funding for SEP– Family and Medical Counseling Service– HIPS– Bread for the City

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Recent Updates – Federal Ban

• FY 2010 Consolidated Appropriations Act removed the federal funding ban

• The FY 2012 Consolidated Appropriations Act again prohibited the use of federal funds to support SEP

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Update - DC NEX

• PreventionWorks closed February 2011• Three organizations continue to operate SEP

with local funding– Family and Medical Counseling Service– HIPS– Bread for the City