Dear President Obama, It is Time to Put Out....the Approval for Federal Funding of Needle Exchange

After an outright declaration of support for the needle exchange (based on the overwhelming evidence) and sending out coy signals through the choice of health appointees who are supporters of needle exchange, I feel disappointed in your decision not to go ahead an remove the ban on federal funding for needle exchange for the 2009-2010 budget.

Do you think we just aren't ready for this commitment?

This non-action represents a dangerous uncertainty. The other side of the aisle-- or more precisely, the celebritextreme right pundits on Fox News-- is happy to jump on any hint of doubt. While I understand that polls and some backroom deals may be at play in your decision- this moment of reflection indicates that the OVERWHELMING evidence from IOM and other numerous studies that prove the benefit of needle exchange is not enough.

In fact, the evidence is sufficient for needle exchange to not be controversial in the science and health community.

This is truly unfortunate as in this next year, HIV prevention funding for Russia and Central Asia is due to be in the budget for the upcoming fiscal year. Eastern Europe and Central Asia have the unhappy honor of having the fastest growing HIV epidemic which is largely due to injecting drug risk behavior. Incorporating the intervention with the best track record for injecting drug users (IDUs) would benefit these countries immensely. It may be another 5 YEARS until the next round of USAID funding for these countries comes up--- at the cost of thousands of people newly infected with HIV (as well as Syphilis and Hepatitis C).

This sends the wrong message. Just as you repealed the global gag rule and supported stem cell research, you should let the science do the arguing for you and move ahead with removing the restriction on federally funded needle exchange.

Kaiser Network Update on Obama on Needle Exchange

HIV and Income

Hans Rosling, of Gapminder, did a great
presentation of the complicated picture of HIV.


Some key points:

(1) The poorest countries/poorest population quintiles aren't necessarily the ones with the highest HIV prevalence.
(2) Africa is a diverse continent, home to countries with different HIV epidemic stories. We see different epidemiological stories even within those countries.
(3) We need to think about and test other explanations of different HIV/STI epidemic stories e.g. number of partners and concurrency (vs serial monogamy).


Please see the presentation in full at the Hans Rosling TED presentation