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Study: Needle-exchange program leads to big drop in D.C. HIV infections

A needle obtained from a needle-exchange program in Seattle. (David Ryder/Reuters)

An earlier version of this article identified The Milken Institute School of Public Health by its old name, the School of Public Health and Health Services. That name still exists on some of the school's Web sites, but it is inaccurate.

The average monthly rate of new HIV infections among drug users in the nation’s capital dropped by about 70 percent after the District implemented a needle exchange program in 2008, according to a study that was released Thursday.

On average, new HIV cases arising as the result of drug users sharing needles dropped from about 19 new infections per month before needle exchanges became available to fewer than six after the program was implemented, the study’s authors said.

Overall, that amounted to 120 “averted” HIV infections over a two-year period.

The study will be published this month in the scientific journal AIDS and Behavior.

Monica Ruiz, an assistant research professor at the George Washington University’s Milken Institute School of Public Health , and two colleagues analyzed 12 years of data provided by the D.C. Department of Health to evaluate the change.

“This shows that policy change matters for HIV prevention,” Ruiz said Wednesday. AIDS prevention is often focused on changing individual behavior, she added. “But policy changes like this that help people to get the resources that they need to stay healthy and prevent infection — those are hugely important.”

The program cost $650,000 per year when it was implemented. But according to the study, it yielded a potential windfall for taxpayers, under the assumption that the city shoulders much of the burden of caring for new HIV and AIDS cases, many of which involve residents who are poor and African American.

In 2010, the Centers for Disease Control and Prevention estimated the average lifetime cost of care per HIV patient at $380,000.

“Therefore, averting an estimated 120 cases of HIV infection translates to an approximate cost savings of 45.6 million USD,” the study said.

The study analyzed data collected between 1998 and 2008, before the program was implemented, and compared it with data collected over a two-year period that ended in 2011.

Ruiz said the results serve as a case study in how congressional control over the District’s local budget and policymaking can affect something as specific as HIV transmission rates among local drug users.

From 1998 to 2007, the District was blocked by Congress from allocating local tax dollars for needle-exchange efforts.

“It was the only city in the U.S. prohibited from using municipal revenue to support syringe access,” the study says.

Congress altered the provision in 2007, and then-Mayor Adrian M. Fenty subsequently allocated money for a needle-exchange initiative.

Ruiz said in a phone interview that she hoped policymakers on Capitol Hill would heed her team’s findings and ensure that the city continues to be able to operate its needle-exchange program.

The rate of HIV transmission has continued to decline. According to the most recent statistics published by the D.C. Department of Health, an average of 2.5 new cases per month were attributed to intravenous drug use in 2013.

The District’s needle-exchange program is the only one in the Washington metropolitan area, Ruiz said. And while the analysis included HIV data for D.C. residents, it didn’t include residents of Virginia and Maryland, many of whom also have taken advantage of the District’s program, she said.

“We’ve had people in the needle-exchange registry who list their addresses as West Virginia. So people are coming from far away,” Ruiz said.

The research was supported by a grant from the National Institute on Drug Abuse and is part of a larger, ongoing project, led by Ruiz, to study the impact of policy changes on HIV transmission through intravenous drug use in the District.