Injecting Reason: Human Rights and HIV Prevention for Injection Drug Users

California: A Case Study

Questions & Answers

What is this report about?

This report documents police harassment and other forms of government interference with needle exchange programs and other initiatives that provide sterile syringes to injection drug users. Sterile syringe programs are designed to protect injection drug users from infectious diseases until such time as they can or will stop using drugs. In California, where needle exchange is legal in a number of counties, Human Rights Watch documented cases of police stopping and arresting program clients for possession of sterile and used syringes. Human Rights Watch also examined the public health impact of restricting needle exchange and of prohibiting nonprescription sale of syringes in pharmacies.

How serious are these abuses?

Sterile syringe programs are the key to preventing explosive HIV/AIDS and hepatitis C epidemics among injection drug users, their sex partners, their children, and untold others. The sharing of injection equipment accounts for as many as half of new HIV infections in the United States. Interfering with sterile syringe programs leads drug users to reuse and share syringes, and engage in other high-risk injection practices. Not only does this create a public health crisis, but it also violates drug users’ human right to take steps to protect their health without fear of punishment or discrimination.

Doesn’t giving sterile syringes to drug users encourage drug use?

Every government-funded study to research the issue has concluded that sterile syringe programs do not increase drug use. In a 2000 review of existing evidence, then-U.S. Surgeon General David Satcher declared that “there is conclusive evidence that syringe exchange programs, as part of a comprehensive HIV/AIDS strategy, are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs.” Opposition to sterile syringe programs cannot be justified on scientific or public health grounds.

Don’t injection drug users need treatment, not sterile syringes?

Medical treatment for narcotics addiction can be an effective way to address injection drug use. However, over 80 percent of people who need addiction treatment in the United States do not have access to it. Sterile syringe programs allow injection drug users to protect themselves from fatal diseases until such time as they can obtain treatment. These programs also function as a gateway into treatment programs by providing injection drug users with referrals to treatment providers. In 2002, the Centers for Disease Control and Prevention recommended that “for injection drug users who cannot or will not stop using drugs, using sterile needles and syringes only once remains the safest, most effective approach for limiting HIV transmission.”

Why focus on California?

California is home to almost one eighth of reported AIDS cases in the United States. Injection drug use is becoming an increasingly significant cause of HIV transmission in the state. Yet California is one of two states to have convicted a lay needle exchange volunteer of a syringe law violation, and one of five states to prohibit the nonprescription sale of syringes in pharmacies. Because needle exchange programs must be authorized by local jurisdictions in California, fourteen of the state’s thirty-seven needle exchange programs operate illegally.

(Last updated on September 9, 2003 )

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