Advancing HIV and Hepatitis Prevention Advancing HIV and Hepatitis Prevention for Drug Usersfor Drug Users

Ending the Ban on Federal Funding for Ending the Ban on Federal Funding for Syringe Service Programs: new Syringe Service Programs: new

environments, new data, new messages, environments, new data, new messages, new messengersnew messengers

Why should anyone Why should anyone care?care?

• Here in the US, 8% of new HIV infections are due to IDU. Here in the US, 8% of new HIV infections are due to IDU. • That’s 11 people per day.That’s 11 people per day.• IDUs are twice as likely to be unaware of their HIV status IDUs are twice as likely to be unaware of their HIV status

than the general public. than the general public. • Outside of Sub-Saharan Africa, three out of ten new Outside of Sub-Saharan Africa, three out of ten new

infections are due to IDU.infections are due to IDU.• No $$ will go to SSPs outside the US until the ban has No $$ will go to SSPs outside the US until the ban has

been lifted.been lifted.• Here in the US, Hep C is the leading cause of death Here in the US, Hep C is the leading cause of death

among those living with HIV.among those living with HIV.• Hep C is the leading cause of liver transplants.Hep C is the leading cause of liver transplants.• The epidemic of prescription drug use and IDU.The epidemic of prescription drug use and IDU.• There are more deaths due to drug overdose than auto There are more deaths due to drug overdose than auto

accidents.accidents.• Health care is a right.Health care is a right.

o In 2009, Congress removed a 21-year prohibition on the In 2009, Congress removed a 21-year prohibition on the use of federal funds to support SSPs.use of federal funds to support SSPs.11 Two years later, Two years later, Congress re-imposed the ban on federal funding for Congress re-imposed the ban on federal funding for SSPs.SSPs.22

o While the ban was lifted, federal dollars were used to While the ban was lifted, federal dollars were used to support SSPs in California, Connecticut, Delaware, Illinois, support SSPs in California, Connecticut, Delaware, Illinois, Massachusetts, Minnesota, New Jersey, New Mexico, New Massachusetts, Minnesota, New Jersey, New Mexico, New York, Puerto Rico, Vermont, and Washington.York, Puerto Rico, Vermont, and Washington.33

o Funding came from CDC, HRSA, and SAMHSA. IHS was a Funding came from CDC, HRSA, and SAMHSA. IHS was a potential source which wasn’t tapped.potential source which wasn’t tapped.

o Seen as a “seal of approval”, lifting the ban opened doors Seen as a “seal of approval”, lifting the ban opened doors from other donors. from other donors.

o These dollars were used to: expand service hours, These dollars were used to: expand service hours, provide services in new locations, and provide additional provide services in new locations, and provide additional services such as case management and overdose services such as case management and overdose prevention services.prevention services.

A Brief History of the BanA Brief History of the Ban

Where are we now?Where are we now? This is the closest we have been This is the closest we have been

since the ban was reinstated in 2011.since the ban was reinstated in 2011. Big change: the House came up with Big change: the House came up with

the language.the language. House and Senate now have identical House and Senate now have identical

language for a partial lift. Unlike language for a partial lift. Unlike previous years, both are under previous years, both are under Republican control.Republican control.

What exactly?What exactly? Report languageReport language"Needle Exchange Programs.—The Committee maintains its support for federal, state and local efforts to address the abuse of

prescription painkillers and other opioids. The Committee is alarmed by trends in urban and rural communities which indicate a transition to injection drug use, and supports state and local efforts to mitigate the spread of related infections, such as Hepatitis and HIV/AIDS, and associated healthcare costs. The Committee believes the determination about whether to implement needle exchange programs remains a quintessentially local function, and therefore maintains its prohibition on the use of federal funds for the purchase of syringes or sterile needles as a title V general provision. The provision is modified, however, to allow existing programs in hard-hit communities to access federal funds for other program elements, including substance use counseling and referral to treatment, that support communities in their drive to end the cycle of dependency. Eligible programs must demonstrate a need or federal support based on actual cases of Hepatitis or HIV/AIDS or on conditions posing a significant risk for an outbreak."

Budget languageBudget languageSEC. 520. Notwithstanding any other provision of this Act, no funds appropriated in this Act shall be used to purchase sterile needles

or syringes for the hypodermic injection of any illegal drug: Provided, That such limitation does not apply to the use of funds for elements of a program other than making such purchases if the relevant State or local health department, in consultation with the Centers for Disease Control and Prevention, determines that the State or local jurisdiction, as applicable, is experiencing, or is at risk for, a significant increase in hepatitis infections or an HIV outbreak due to injection drug use, and such program is operating in accordance with State and local law.

So what?So what?So basically with this partial lift, federal dollars could go to all aspects of an SSP, except for the needles themselves. It's counter-

intuitive, but not a big deal since syringes are often the least expensive part of operating an SSP.  It is an improvement over how things stand now. Currently, federal dollars cannot be used for syringes, personnel, and housing the exchange (either a vehicle or a building). The other issue (which is just FYI) is working with the CDC to define "conditions posing a significant risk" and "hard-hit communities".

HOW DID WE GET HERE?HOW DID WE GET HERE?

NEW MESSAGES AND MESSENGERSNEW MESSAGES AND MESSENGERSoSSPs save lives by preventing the spread of HIV and viral hepatitis and SSPs save lives by preventing the spread of HIV and viral hepatitis and by serving as a bridge to other services, including treatment for by serving as a bridge to other services, including treatment for substance use disorder.substance use disorder.oBy reducing improperly disposed syringes, SSPs are good for By reducing improperly disposed syringes, SSPs are good for everyone: IDUs, first-responders, law enforcement, and general public everyone: IDUs, first-responders, law enforcement, and general public safety.safety.oSSPs address health disparities. SSPs address health disparities. oIn light of prescription drug misuse and its expansion into injection In light of prescription drug misuse and its expansion into injection drugs, the need for SSPs is greater than ever.drugs, the need for SSPs is greater than ever.oSSPs enjoy broad support from medical, legal, public health, faith, and SSPs enjoy broad support from medical, legal, public health, faith, and local communities. Feds are the outlier.local communities. Feds are the outlier.oIt’s a matter of local control. It’s a matter of local control. State and local decision makers should have State and local decision makers should have flexibility in the use of federal funds to address local health concernsflexibility in the use of federal funds to address local health concerns..oLifting the ban costs nothing and saves money.Lifting the ban costs nothing and saves money.

State, local, and faith-based organizations State, local, and faith-based organizations around the country already support SSPs around the country already support SSPs

The following organizations support SSPs: The following organizations support SSPs: oAmerican Medical Student AssociationAmerican Medical Student AssociationoAmerican Academy of Family PhysiciansAmerican Academy of Family PhysiciansoAmerican Academy of PediatricsAmerican Academy of PediatricsoAmerican Bar AssociationAmerican Bar AssociationoAmerican Medical AssociationAmerican Medical AssociationoAmerican Public Health AssociationAmerican Public Health AssociationoAmerican Society of Addiction MedicineAmerican Society of Addiction MedicineoInternational Red Cross-Red Crescent SocietyInternational Red Cross-Red Crescent SocietyoLatino Commission on AIDSLatino Commission on AIDSoNAACPNAACPoNational Academy of SciencesNational Academy of SciencesoNational Black Leadership Commission on AIDSNational Black Leadership Commission on AIDSoNational Black Police AssociationNational Black Police AssociationoNational Institute on Drug AbuseNational Institute on Drug AbuseoOffice of National Drug Control PolicyOffice of National Drug Control PolicyoPresidential Advisory Committee on AIDSPresidential Advisory Committee on AIDSoUS Conference of MayorsUS Conference of MayorsoWorld BankWorld BankoWorld Health OrganizationWorld Health Organization

SSPs also enjoy support from faith communities, including:

•Central Conference of American Rabbis•Episcopal Church•National Council on Jewish Women•Presbyterian Church of the United States•Society of Christian Ethics•Union for Reform Judaism•Unitarian Universalist Association•United Church of Christ•United Methodist Church, General Board of Church and Society•Regional AIDS Interfaith Network

State, local, and faith-based organizations State, local, and faith-based organizations around the country already support SSPs around the country already support SSPs

"Syringe decriminalization and "Syringe decriminalization and exchange is ...an issue of compassion exchange is ...an issue of compassion and justice... As people of faith, we and justice... As people of faith, we are called to be the embodiment of are called to be the embodiment of that compassion and instruments of that compassion and instruments of that justice in this world to offer an that justice in this world to offer an eternal hope. The hope that someone eternal hope. The hope that someone may live another day. The hope that may live another day. The hope that they may be reconciled with their they may be reconciled with their family. The hope that they can live a family. The hope that they can live a life free of disease. The hope that life free of disease. The hope that they might choose to find treatment. they might choose to find treatment. The hope that with that The hope that with that one more day, they might find their one more day, they might find their own hope for a future outside of their own hope for a future outside of their addiction."addiction." - Pastor James Sizemore, Lead Pastor, - Pastor James Sizemore, Lead Pastor, Catalyst Community Church, Fayetteville, Catalyst Community Church, Fayetteville, North CarolinaNorth Carolina

Note: since this map was developed, there are SSPs in Indiana, Kentucky, and West Virginia

There are already a number of programs:

Most funding (82%) for SSPs is public – Most funding (82%) for SSPs is public – Feds are the outlier when it comes to fundingFeds are the outlier when it comes to funding

Year of Operation 2012 2013

Total $$$ $19,431,912 $21,920,648City Gov $ $5,789,118 $6,504,086County Gov $ $1,538,358 $1,431,851State Gov $ $8,391,180 $10,059,565Foundation $ $1,966,688 $2,129,610Individual Donations $696,947 $611,269Out-of-pocket $ $50,525 $90,250NASEN $ $4,150 $2,100CBO Donation $ $28,740 $47,200Corporate Donation $ $68,300 $157,500Other $ $856,406 $887,218

The most important myth to The most important myth to dismantle: we can’t afford it.dismantle: we can’t afford it.

Lifting the ban costs NOTHING. It simply allows localities to spend Lifting the ban costs NOTHING. It simply allows localities to spend their federal dollars as they see fit. their federal dollars as they see fit. ((In this way, it is also a state rights issueIn this way, it is also a state rights issue.).)

Every dollar invested in SSPs Every dollar invested in SSPs results in results in

$7 in savings$7 in savings just by preventing new HIV just by preventing new HIV

infections.infections.11

Through Medicaid, Medicare, and Ryan White, the federal government is the biggest payer of HIV care. So not only are we saving federal dollars, we are saving entitlement (Medicaid and Medicare) and discretionary (RW) funds.

Local Data HelpsLocal Data Helpso Between 2001 and 2011, Illinois saw a drop of nearly Between 2001 and 2011, Illinois saw a drop of nearly

two-thirds in new HIV cases among IDUs, averting an two-thirds in new HIV cases among IDUs, averting an estimated $200 million in medical expenses.estimated $200 million in medical expenses.11

o In Massachusetts, there was a 54% decrease in new HIV In Massachusetts, there was a 54% decrease in new HIV diagnosis between 1999 and 2012, preventing 5,699 diagnosis between 1999 and 2012, preventing 5,699 infections and saving more than $2 billion in health care infections and saving more than $2 billion in health care costs.costs.22

o King County (Washington State) spent $1.1 million on King County (Washington State) spent $1.1 million on SSPs in 2008. If HIV was prevented among only 1% of SSPs in 2008. If HIV was prevented among only 1% of IDUs in King County, the resulting savings in HIV IDUs in King County, the resulting savings in HIV treatment costs will be $70 million.treatment costs will be $70 million.33

o Washington, DC was allowed to spend its own money on Washington, DC was allowed to spend its own money on SSPs in 2007. Within two years, 120 HIV infections were SSPs in 2007. Within two years, 120 HIV infections were averted, resulting in $45.6M in savings.averted, resulting in $45.6M in savings.44

o Miami, a city without legal SSPs, Miami, a city without legal SSPs, published study of the published study of the costs of bacterial infections relating to IDU at Jackson costs of bacterial infections relating to IDU at Jackson Memorial Hospital. The cost was $11.4M over 12 month Memorial Hospital. The cost was $11.4M over 12 month period.period.55

““I understand I understand that there will that there will be questions, be questions, but this is but this is common common sense.”sense.”

- Sister Maureen - Sister Maureen Joyce, CEO of Catholic Joyce, CEO of Catholic Charities, Albany, NYCharities, Albany, NY

Messages and Messengers: law enforcement, faith communities, and families.

It’s not just the needle, it’s about the people!It’s not just the needle, it’s about the people!SSPs provide a variety of services in addition to syringe exchangeSSPs provide a variety of services in addition to syringe exchange11

o Onsite medical careOnsite medical care 1 1

o Screening and counseling for HIV, Screening and counseling for HIV, hepatitis C, and STIs (injection drug users hepatitis C, and STIs (injection drug users are twice as likely as the general public are twice as likely as the general public not to know their HIV status)not to know their HIV status) 1,2 1,2

o Distribution of safer sex supplies, food, Distribution of safer sex supplies, food, and clothingand clothing 1 1

o Referrals to substance use treatment and Referrals to substance use treatment and support groupssupport groups 1 1

o Medications and resources to prevent Medications and resources to prevent death from drug overdosedeath from drug overdose 3 3

o Case managementCase management

Selected Services Offered by SSPs Nationwide

SSPs Make Communities Safer for EveryoneSSPs Make Communities Safer for Everyone

o SSPs distribute free sterile syringes SSPs distribute free sterile syringes to injection drug users (IDUs), which to injection drug users (IDUs), which reduces the likelihood that users will reduces the likelihood that users will share injecting equipment.share injecting equipment.11

o SSPs safely dispose of used SSPs safely dispose of used needles, a service not typically needles, a service not typically provided by distributors such as provided by distributors such as pharmacies.pharmacies.

o SSPs make neighborhoods safer by SSPs make neighborhoods safer by reducing needle-stick injuries.reducing needle-stick injuries.11

LOCAL EXAMPLESLOCAL EXAMPLESo In Baltimore, SSPs helped In Baltimore, SSPs helped

reduce the number of reduce the number of improperly discarded syringes improperly discarded syringes by almost 50%.by almost 50%. 1 1

o In Portland, Oregon, the In Portland, Oregon, the implementation of SSPs implementation of SSPs reduced the number of reduced the number of improperly discarded syringes improperly discarded syringes by two-thirds.by two-thirds.22

o In 2008 and 2009, Miami (which In 2008 and 2009, Miami (which had no SSPs) saw eight times had no SSPs) saw eight times more improperly disposed more improperly disposed syringes than San Francisco syringes than San Francisco (where SSPs are available) (where SSPs are available) despite the fact that San despite the fact that San Francisco is thought to have Francisco is thought to have twice as many IDUs.twice as many IDUs.33

SSPs Protect Those who Protect UsSSPs Protect Those who Protect Uso Needle stick injuries to law enforcement are a Needle stick injuries to law enforcement are a

common occurrence. In San Diego, nearly common occurrence. In San Diego, nearly 30% of officers have been stuck by a needle.30% of officers have been stuck by a needle.1 1

o Decriminalization of syringes (and SSPs) has Decriminalization of syringes (and SSPs) has been tied to reduced needle stick injuries. In been tied to reduced needle stick injuries. In South Carolina, where syringes are legal, South Carolina, where syringes are legal, officers have experienced needle stick officers have experienced needle stick injuries at half the rate of their counterparts injuries at half the rate of their counterparts in North Carolina, where syringes are illegal.in North Carolina, where syringes are illegal.22

o In Connecticut, police officer needle stick In Connecticut, police officer needle stick injuries were reduced by two-thirds after the injuries were reduced by two-thirds after the establishment of SSPs.establishment of SSPs.33

o ““In the cities that have adopted needle In the cities that have adopted needle services programs, there is a dramatic services programs, there is a dramatic reduction in needle sticks to firefighters who reduction in needle sticks to firefighters who crawl on their hands and knees through crawl on their hands and knees through smoke-filled rooms in search of victims.” - smoke-filled rooms in search of victims.” - Charles Aughenbaugh, Jr., President, New Jersey Deputy Fire Chiefs Charles Aughenbaugh, Jr., President, New Jersey Deputy Fire Chiefs Association, Retired Deputy Fire Chief, March 2011Association, Retired Deputy Fire Chief, March 2011

Messages and Messengers: Messages and Messengers: law enforcement, faith law enforcement, faith communities, and families.communities, and families.

““By restoring the ban on federal funding By restoring the ban on federal funding for syringe exchange, members of for syringe exchange, members of Congress undoubtedly believed they were Congress undoubtedly believed they were striking a blow against drug use. As striking a blow against drug use. As extensive experience has shown, nothing extensive experience has shown, nothing could be further from the truth. By could be further from the truth. By withholding funding for syringe exchange, withholding funding for syringe exchange, Congress has made our communities less Congress has made our communities less safe, made police officers and medical safe, made police officers and medical responders unsafe, undermined a vital responders unsafe, undermined a vital bridge to drug treatment, and hindered bridge to drug treatment, and hindered national efforts to address public health national efforts to address public health problems such as HIV and hepatitis C.”problems such as HIV and hepatitis C.”

- Chief James Pugel, Seattle Police Department- Chief James Pugel, Seattle Police Department

o In New York City, the growth of SSPs from 1990 to 2001 was associated with a 78% decrease in HIV prevalence among IDUs. 1

o During this time period, the same population saw a decrease in the prevalence of hepatitis C from 90% to 63% 2

o One study showed that within 6 months of using federally-funded SSPs, clients saw a 45% increase in employment.

o In addition, SSP clients were 25% more likely to have been successfully referred to mental health treatment and prescribed medication than other SAMHSA grantees.3

o In New Jersey, 22% of the state’s SSP clients have entered drug treatment.4

SSPs Bring Results

SSPs Do NOT lead to an increase SSPs Do NOT lead to an increase in crime or drug use.in crime or drug use.

o Neighborhoods in Baltimore with SSPs experienced an Neighborhoods in Baltimore with SSPs experienced an 11% decrease in break-ins and burglaries, while areas 11% decrease in break-ins and burglaries, while areas without SSPs saw an 8% increase in such crimes during without SSPs saw an 8% increase in such crimes during the same period.the same period.11

o In Seattle, IDUs who had used SSPs were more likely to In Seattle, IDUs who had used SSPs were more likely to report a significant decrease (>75%) in injection drug report a significant decrease (>75%) in injection drug use, to stop using injection drugs, and to remain in use, to stop using injection drugs, and to remain in treatment than IDUs who had never used SSPs.treatment than IDUs who had never used SSPs.22

o The same study in Seattle found that new users of the The same study in Seattle found that new users of the SSP were five times more likely to enter drug treatment SSP were five times more likely to enter drug treatment than individuals who never utilized the program.than individuals who never utilized the program.22

Local Examples

o Individuals using prescription drugs nonmedically may turn to injection as a more Individuals using prescription drugs nonmedically may turn to injection as a more efficient method of drug delivery.efficient method of drug delivery.1 1 Additionally, the high cost of prescription drugs and Additionally, the high cost of prescription drugs and crackdown on prescription drug use can cause IDUs to transition to heroin use.crackdown on prescription drug use can cause IDUs to transition to heroin use.22

o A recent report by the Substance Abuse and Mental Health Services Administration A recent report by the Substance Abuse and Mental Health Services Administration (SAMHSA) showed that those who reported prior use of nonmedical pain relievers were (SAMHSA) showed that those who reported prior use of nonmedical pain relievers were 19 times more likely 19 times more likely to have recently begun using heroin than those who had not to have recently begun using heroin than those who had not used nonmedical pain relievers. The report also showed that used nonmedical pain relievers. The report also showed that 79.5%79.5% of people who of people who recently began using heroin had previously used prescription drugs for nonmedical recently began using heroin had previously used prescription drugs for nonmedical purposes.purposes.33

o Heroin use has increased dramatically nationwide in the past several years. Whereas Heroin use has increased dramatically nationwide in the past several years. Whereas in 2007, SAMHSA reported there to be 373,000 recent heroin users in the US, in 2007, SAMHSA reported there to be 373,000 recent heroin users in the US, this this number jumped to 669,000 in 2012number jumped to 669,000 in 2012..44

o SSPs play an important role in addressing the needs of new IDUs. Other outlets for SSPs play an important role in addressing the needs of new IDUs. Other outlets for these individuals to feel safe accessing care and treatment are scarce.these individuals to feel safe accessing care and treatment are scarce.

o In response, SSPs have opened in Indiana, Kentucky and West Virginia,In response, SSPs have opened in Indiana, Kentucky and West Virginia,

Prescription drug misuse leads Prescription drug misuse leads to a new generation of IDU.to a new generation of IDU.

Kentucky Case StudyKentucky Case Studyo A recent study has found that 35.3% of nonmedical A recent study has found that 35.3% of nonmedical

prescription opioid users in rural Kentucky are now prescription opioid users in rural Kentucky are now injecting the drug.injecting the drug.11

o This value is higher than was previously reported among This value is higher than was previously reported among that population, demonstrating an increase in that population, demonstrating an increase in injectioninjection as as the method for nonmedical prescription opioid users to the method for nonmedical prescription opioid users to administer their drugs.administer their drugs.11

o Kentucky has some of the highest rates of hepatitis C in Kentucky has some of the highest rates of hepatitis C in the country. It also has a high number of heart valve the country. It also has a high number of heart valve transplants due to endocarditis due to IDU.transplants due to endocarditis due to IDU.

o Last year it was close to legalizing syringe exchange. The Last year it was close to legalizing syringe exchange. The outbreak in Indiana motivated passage this year.outbreak in Indiana motivated passage this year.

Re-invigorating our traditional allies – this is a health disparity issue.Re-invigorating our traditional allies – this is a health disparity issue.No matter how you slice it - HIV, AIDS, new infections, current infections, cumulative infections, No matter how you slice it - HIV, AIDS, new infections, current infections, cumulative infections, death rates, males, females – African-Americans and Latinos are disproportionately represented.death rates, males, females – African-Americans and Latinos are disproportionately represented.

The prevalence of HIV among Hispanic and The prevalence of HIV among Hispanic and African-American IDUs is nearly twice as African-American IDUs is nearly twice as

high as it is for Caucasians.high as it is for Caucasians.11

““As the Chairman of the As the Chairman of the National Black National Black Leadership Commission Leadership Commission on AIDS Inc., and the on AIDS Inc., and the resident of a state with a resident of a state with a sizeable Latino sizeable Latino community, I have community, I have personally witnessed personally witnessed these disproportionate these disproportionate and devastating results.”and devastating results.”Reverend Dr. W. James Favorite - Senior Pastor of Reverend Dr. W. James Favorite - Senior Pastor of the historical Beulah Baptist Institutional Church and the historical Beulah Baptist Institutional Church and Chair of the National Black Leadership Commission Chair of the National Black Leadership Commission on AIDS. on AIDS. 

Local data helpsLocal data helpsPopulation Percent of population2 Current HIV infections attributable to

injection drug use3

African-Americans in California 6.6% 33.7%African-Americans in Connecticut 11.3% 35.3%Latinos in Connecticut 14.7% 38.5%African-Americans in Florida 16.7% 55.1%African-Americans in Georgia 31.4% 80.7%African-Americans in Illinois 14.7% 67.4%African-Americans in Kentucky 8.2% 49.7%African-Americans in Maryland 30.1% 83.3%African-Americans in Massachusetts 8.1% 30.7%Latinos in Massachusetts 10.5% 35.9%African-Americans in New Jersey 14.7% 60.2%African-Americans in New York 17.5% 47.5%Latinos in New York 18.4% 38.7%African-Americans in North Carolina 22.0% 75.7%African-Americans in Ohio 12.5% 56.2%African-Americans in Pennsylvania 11.5% 51.7%Latinos in Pennsylvania 6.3% 23.5%African-Americans in Texas 12.5% 51.6%

African-Americans in Washington 4.0% 22.2%

Looking at Looking at newnew infections:infections:

African-African-Americans are Americans are 11X and 11X and Latinos are 5x Latinos are 5x more likely to more likely to acquire HIV via acquire HIV via IDU than their IDU than their Caucasian Caucasian counterparts.counterparts.CDC, MMWR, HIV Infection Among Injection-Drug CDC, MMWR, HIV Infection Among Injection-Drug Users --- 34 States, 2004—2007, Nov 22, 2009.Users --- 34 States, 2004—2007, Nov 22, 2009.

Now what?Now what? Current status: Current status:

Right now, the budget is in a CR (continuing resolution), meaning that things are on hold and operating as usual until Dec 11.

• Here is an update on what's happening: http://cqrcengage.com/aidsunited/app/document/9740255• Nice summary on the budget: http://www.cqrcengage.com/aidsunited/app/document/9464743

Our ask:Our ask: We are encouraged by recent Congressional action on this issue, and would like to express our appreciation for the We are encouraged by recent Congressional action on this issue, and would like to express our appreciation for the

modification to the syringe access funding rider that you included in the House FY 16 Labor, Health and Human Services, modification to the syringe access funding rider that you included in the House FY 16 Labor, Health and Human Services, Education and Related Agencies (LHHS) Appropriations bill. Bipartisan leadership in modifying the ban on federal funding Education and Related Agencies (LHHS) Appropriations bill. Bipartisan leadership in modifying the ban on federal funding for syringe access programs will help many individuals in our communities struggling with opioid use disorder access life-for syringe access programs will help many individuals in our communities struggling with opioid use disorder access life-saving programs to avert drug overdose; access medical and substance use disorder treatment and recovery services; saving programs to avert drug overdose; access medical and substance use disorder treatment and recovery services; and prevent life-threatening infections, including HIV and hepatitis C. It will also allow us to address this issue abroad and prevent life-threatening infections, including HIV and hepatitis C. It will also allow us to address this issue abroad where outside of Sub-Saharan Africa, three out of ten new HIV infections are because of injection drug use. where outside of Sub-Saharan Africa, three out of ten new HIV infections are because of injection drug use. Accordingly, Accordingly, we urge you to include this modified rider in any FY 16 Continuing Resolution, final FY 16 LHHS bill, and/or we urge you to include this modified rider in any FY 16 Continuing Resolution, final FY 16 LHHS bill, and/or FY 16 LHHS omnibus appropriations bill.FY 16 LHHS omnibus appropriations bill.

OrOr

No matter what the appropriations outcome is, we ask that any final appropriations bill or continuing resolution should No matter what the appropriations outcome is, we ask that any final appropriations bill or continuing resolution should contain the language allowing states or local jurisdictions to use federal funds for syringe exchange programs if they are contain the language allowing states or local jurisdictions to use federal funds for syringe exchange programs if they are experiencing or at risk for a significant increase in hepatitis infections or an HIV outbreak due to injection drug use. It experiencing or at risk for a significant increase in hepatitis infections or an HIV outbreak due to injection drug use. It would also allow us to address this issue abroad where we have already enjoyed bipartisan success fighting HIV.would also allow us to address this issue abroad where we have already enjoyed bipartisan success fighting HIV.

House ask: keep the new language they put forward (House was first) House ask: keep the new language they put forward (House was first) regardless if there is a CR, omnibus, or final LHHS bill. regardless if there is a CR, omnibus, or final LHHS bill.

If the member is a Democrat, ask that they let Lowey know of their support.If the member is a Democrat, ask that they let Lowey know of their support.If the member is a Republican, ask that they let Rogers know of their supportIf the member is a Republican, ask that they let Rogers know of their support

Approps subcmte on HealthApprops subcmte on Health

RepublicansRepublicansChairman Tom Cole (OK)Chairman Tom Cole (OK) Mike Simpson (ID)Mike Simpson (ID) Steve Womack (AR)Steve Womack (AR) Chuck Fleischmann (TN)Chuck Fleischmann (TN) Andy Harris, MD (MD)Andy Harris, MD (MD) Martha Roby (AL)Martha Roby (AL) Charlie Dent (PA)Charlie Dent (PA) Scott Rigell (VA)Scott Rigell (VA)

DemocratsDemocratsRanking Member Rosa DeLauro (CT) Ranking Member Rosa DeLauro (CT) Lucille Roybal-Allard (CA)Lucille Roybal-Allard (CA)Barbara Lee (CA)Barbara Lee (CA)Chaka Fattah (PA)Chaka Fattah (PA)

Full Approps CmteFull Approps Cmte

RepublicansRepublicansHarold Rogers* (KY), Rodney P. Frelinghuysen (NJ), Harold Rogers* (KY), Rodney P. Frelinghuysen (NJ), Robert B. Aderholt (AL), Kay Granger (TX), Michael Robert B. Aderholt (AL), Kay Granger (TX), Michael K. Simpson (ID), John Abney Culberson (TX) , Ander K. Simpson (ID), John Abney Culberson (TX) , Ander Crenshaw (FL), John R. Carter (TX), Ken Calvert Crenshaw (FL), John R. Carter (TX), Ken Calvert (CA), Tom Cole (OK), Mario Diaz-Balart (FL), Charles (CA), Tom Cole (OK), Mario Diaz-Balart (FL), Charles W. Dent (PA), Tom Graves (GA), Kevin Yoder (KS), W. Dent (PA), Tom Graves (GA), Kevin Yoder (KS), Steve Womack (AR), Alan Nunnelee (MI), Jeff Steve Womack (AR), Alan Nunnelee (MI), Jeff Fortenberry (NE), Tom Rooney (FL), Chuck Fortenberry (NE), Tom Rooney (FL), Chuck Fleischmann (TN), Jaime Herrera Beutler (WA), Fleischmann (TN), Jaime Herrera Beutler (WA), David Joyce (OH), David Valadao (CA), Andy Harris, David Joyce (OH), David Valadao (CA), Andy Harris, MD (MD), Martha Roby (AL), Mark Amodei (NV), MD (MD), Martha Roby (AL), Mark Amodei (NV), Chris Stewart (UT), Scott Rigell (VA), David Jolly Chris Stewart (UT), Scott Rigell (VA), David Jolly (FL), David Young (IA), Evan Jenkins (WV)(FL), David Young (IA), Evan Jenkins (WV)

DemocratsDemocratsNita M. Lowey* (NY), Marcy Kaptur (OH), Peter J. Nita M. Lowey* (NY), Marcy Kaptur (OH), Peter J. Visclosky (IN), José E. Serrano (NY), Rosa L. DeLauro Visclosky (IN), José E. Serrano (NY), Rosa L. DeLauro (CT), David E. Price (NC), Lucille Roybal-Allard (CA), (CT), David E. Price (NC), Lucille Roybal-Allard (CA), Sam Farr (CA), Chaka Fattah (PA), Sanford D. Sam Farr (CA), Chaka Fattah (PA), Sanford D. Bishop, Jr. (GA), Barbara Lee (CA), Adam B. Schiff Bishop, Jr. (GA), Barbara Lee (CA), Adam B. Schiff (CA), Michael M. Honda (CA), Betty McCollum (MN), (CA), Michael M. Honda (CA), Betty McCollum (MN), Tim Ryan (OH), Debbie Wasserman Schultz (FL), Tim Ryan (OH), Debbie Wasserman Schultz (FL), Henry Cuellar (TX), Chellie Pingree (ME), Mike Henry Cuellar (TX), Chellie Pingree (ME), Mike Quigley (IL), Steve Israel (NY), C.A. Dutch Quigley (IL), Steve Israel (NY), C.A. Dutch Ruppersberger (MD), Derek Kilmer, WA Ruppersberger (MD), Derek Kilmer, WA

Senate ask: keep the new language regardless if there is a CR, Senate ask: keep the new language regardless if there is a CR, omnibus, or final LHHS bill. omnibus, or final LHHS bill.

If the Senator is a Republican, ask that they inform Cochran and Blunt of their support.If the Senator is a Republican, ask that they inform Cochran and Blunt of their support.If the Senator is a Democrat, ask that they inform Mikulski and Murray of their support.If the Senator is a Democrat, ask that they inform Mikulski and Murray of their support.

Approps subcmte on Health:Approps subcmte on Health: DemocratDemocratRanking Member Patty Murray (WA)Ranking Member Patty Murray (WA)Richard Durbin (IL)Richard Durbin (IL)Jack Reed (RI)Jack Reed (RI)Barbara Mikulski (MD)Barbara Mikulski (MD)Jeanne Shaheen (NH)Jeanne Shaheen (NH)Jeff Merkley (OR)Jeff Merkley (OR)Brian Schatz (HI)Brian Schatz (HI)Tammy Baldwin (WI)Tammy Baldwin (WI) RepublicanRepublicanChairman Roy Blunt (MO)Chairman Roy Blunt (MO)Jerry Moran (KS)Jerry Moran (KS)Richard Shelby (AL)Richard Shelby (AL)Thad Cochran (MI)Thad Cochran (MI)Lamar Alexander (TN)Lamar Alexander (TN)Lindsey Graham (SC)Lindsey Graham (SC)Mark Kirk (IL)Mark Kirk (IL)Bill Cassidy (LA)Bill Cassidy (LA)Shelley Moore Capito (WV)Shelley Moore Capito (WV)James Lankford (OK)James Lankford (OK)

Full CommitteeFull Committee

Democratic MembersDemocratic Members

Vice Chairwoman Barbara Mikulski (MD), Vice Chairwoman Barbara Mikulski (MD), Patrick J. Leahy (VT), Patty Murray (WA), Patrick J. Leahy (VT), Patty Murray (WA), Dianne Feinstein (CA), Richard J. Durbin (IL), Dianne Feinstein (CA), Richard J. Durbin (IL), Jack Reed (RI), Jon Tester (MT), Tom Udall Jack Reed (RI), Jon Tester (MT), Tom Udall (NM), Jeanne Shaheen (NH), Jeff Merkley (NM), Jeanne Shaheen (NH), Jeff Merkley (OR), Chris Coons (DE), Brian Schatz (HI), (OR), Chris Coons (DE), Brian Schatz (HI), Tammy Baldwin (WI), Christopher Murphy Tammy Baldwin (WI), Christopher Murphy (CT)(CT)

Republican MembersRepublican Members

Chairman Thad Cochran(MS), Richard C. Chairman Thad Cochran(MS), Richard C. Shelby (AL), Jerry Moran (KS), Mitch Shelby (AL), Jerry Moran (KS), Mitch McConnell (KY), Lamar Alexander (TN), McConnell (KY), Lamar Alexander (TN), Susan Collins (ME), Lisa Murkowski (AK), Susan Collins (ME), Lisa Murkowski (AK), Lindsey Graham (SC), Mark Kirk (IL), Roy Lindsey Graham (SC), Mark Kirk (IL), Roy Blunt (MO), Jerry Moran (KS), John Hoeven Blunt (MO), Jerry Moran (KS), John Hoeven (ND), Shelly Moore Capito (WV), Bill Cassidy (ND), Shelly Moore Capito (WV), Bill Cassidy (LA), James Lankford (OK), Steve Davies (LA), James Lankford (OK), Steve Davies (MT), John Boozeman (AR)(MT), John Boozeman (AR)

You can’t wring your hands and roll-up your sleeves at the same time.You can’t wring your hands and roll-up your sleeves at the same time. - Pat Schroeder- Pat Schroeder

o Learn moreLearn more: visit : visit www.amfar.org/endthebanwww.amfar.org/endtheban. . Watch the ten-minute movie, “The Watch the ten-minute movie, “The Exchange,” as well as the shorts, Exchange,” as well as the shorts, “Dollars & Sense,” “Race & “Dollars & Sense,” “Race & Drugs,” and “Addiction & You.”Drugs,” and “Addiction & You.”

o Call/ write to your repCall/ write to your rep: : http://www.cqrcengage.com/aidsuhttp://www.cqrcengage.com/aidsunited/app/write-a-letter?nited/app/write-a-letter?0&engagementId=965170&engagementId=96517

o Get the word out:Get the word out: host a film host a film screening, post the links on screening, post the links on facebook, send a tweet, and share facebook, send a tweet, and share on listservs.on listservs.

o Call Call your representative in Congress your representative in Congress as an individual or as a group event.as an individual or as a group event.

o WriteWrite an op-ed, blog post, an op-ed, blog post, organizational sign-on, or letter to organizational sign-on, or letter to your representative in Congress.your representative in Congress.

o VisitVisit your congressional office, your congressional office, either in-state or in DC.either in-state or in DC.

o Work with your local SSPWork with your local SSP:: volunteer, donate, ask them to volunteer, donate, ask them to speak to your group (go to speak to your group (go to www.nasen.org www.nasen.org to find the SSP to find the SSP nearest you). Ask your nearest you). Ask your representative in Congress to visit representative in Congress to visit the local SSP and see it for the local SSP and see it for themselves. themselves.

o Not sure how? Not sure how? Go to Go to www.coalitionforsyringeaccess.orgwww.coalitionforsyringeaccess.org

Students with Senator Blumenthal (CT).

More options for taking action:More options for taking action:

Final Talking PointsFinal Talking Points This policy costs nothing: Lifting the ban does not involve additional dollars. It simply allows localities to

spend their federal prevention dollars as they see fit. It may be a source of additional federal dollars in the future if additional dollars are allocated to HIV prevention. It's cost effective: For every additional dollar invested, an average of $7 dollars in HIV treatment costs are saved. This does not include other associated costs such as viral hepatitis, secondary infections (e.g. endocarditis), injection related wounds, or drug overdose. Federal dollars open doors: Federal funding is often perceived by other donors as a "seal of approval", leading to new funding streams. Federal grantees can also receive extensive technical assistance at no cost. It's about local control: States and localities know how best to respond to the epidemics of HIV, viral hepatitis, and drug overdose.  It's about health disparities: African-Americans are 11x and Latinos are 5x more likely to contract HIV from an infected needle than their Caucasian counterparts. SSPs are a bridge to related services: HIV testing, viral hepatitis services, treatment for substance use disorder, and drug overdose prevention and response services. The changing demographics of injection drug users: Due to the crackdown on prescription drug use, many are transitioning to heroin use. This new generation of users is more likely to be young, female, and non-urban.,,,

 SSPs make neighborhoods safer for everyone: Because they provide a safe place to dispose of used needles, there are fewer injuries to civilians (kids playing in the park) and first responders alike.

Thank youThank youMary Beth Levin, MPHMary Beth Levin, MPHAssociate ProfessorAssociate ProfessorDepartment of Family Medicine and Community HealthDepartment of Family Medicine and Community HealthGeorgetown University School of MedicineGeorgetown University School of Medicinelevinmb@gmail.comlevinmb@gmail.com

Bill McCollBill McCollDirector of Health PolicyDirector of Health PolicyAIDS UnitedAIDS UnitedWMcColl@aidsunited.orgWMcColl@aidsunited.org