ATTACKS by US congressional members on policies for individuals engaged in injection drug use have put available funding to combat HIV/AIDS in jeopardy.

Injection drug users, who fall into the category of the world's poorest, and most marginalized, are among those most susceptible to contracting HIV/AIDS. HIV/AIDS prevention strategies exist that have successfully contained the transmission of HIV/AIDS to and from people who inject drugs. These strategies are not only necessary to address the health of people engaging in dangerously unhealthy behaviors, they are also a vital tool in preventing HIV/AIDS from breaking out of these communities and spreading into the general population. While HIV/AIDS prevention strategies for people who inject drugs have not been a key intervention in Africa, they are absolutely essential in Eastern Europe, Asia, and parts of Latin America.

According to UNAIDS, there are 5 million new HIV/AIDS infections annually. Injection drug use accounts for 10% of all infections worldwide, and outside of Africa the figure is thought to be upwards of 30%. In many parts of the world, especially Eastern Europe, where HIV is spreading the fastest, injection drug use is driving the epidemic. In Russia, thought to have one of the fastest-growing AIDS epidemics in the world, 3 of 4 new infections is attributable to injection drug use. In Asia, injection drug use is the major mode of HIV transmission. It represents more than 80% of cases in Kazakhstan, 75% in Malaysia, 75% in Vietnam, and 50% in China. The International Committee of the Red Cross estimates that globally there are more than 10 million people who inject drugs and, of these, 2-3 million are estimated to be HIV-positive. According to the International Federation of the Red Cross and Red Crescent Societies, HIV can "rapidly spread through drug using populations and can stabilize at high prevalence rates" and that "in the absence of preventive measures the prevalence rate can rise up to 40 per cent or more within 1-2 years of introduction of HIV into a community." According to the World Health Organization (WHO), "[p]rovision of access to sterile injection equipment for injection drug users and the encouragement of its use are essential components of HIV/AIDS prevention programs, and should be seen as part of overall comprehensive strategies to reduce the demand for illicit drugs."

Affording harm reduction programs to injection drug users is a human rights obligation. Article 25 (1) of the 1948 Universal Declaration of Human Rights affirms "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health[horizontal ellipsis]" In the Declaration of Commitment, unanimously accepted at the 26th UN General Assembly Special Session on HIV/AIDS, 2001, states made specific commitments relevant to people who inject drugs, including "expanded access to essential commodities, including male and female condoms and sterile injecting equipment."

Harm reduction strategies for injection drug users are some of the most effective and well-documented strategies to help stem the spread of HIV/AIDS.

In 2002, the WHO commissioned a study of HIV prevalence in 103 cities in 24 countries. In 36 cities with needle exchange programs, HIV prevalence decreased by 18.6% annually, while in 67 cities without needle exchange programs, HIV prevalence increased by 8.1% annually. Harm reduction programs like needle and syringe exchange programs help connect drug users with the health system, help drug users to stop injecting and stop sharing equipment, and provide education about minimizing other high-risk behaviors. In 2004, the Global HIV Prevention Working Group, consisting of the world's leading experts in HIV prevention, concurred that harm reduction programs offer an ideal gateway for injection drug users, a marginalized population, to enter the health system to receive HIV-related medical services and drug treatment services.

Harm reduction programs do not increase drug use, negatively impact drug treatment, or increase the amount of injecting equipment on the street. According to the WHO, "[t]here is no convincing evidence of major unintended negative consequences of programs providing sterile injection equipment to injection drug users, such as initiation of injection among people who have not injected previously."

In addition, "[s]tudies in Australia, Canada, Sweden, the United Kingdom, and the United States have all shown that such programs-particularly in concert with other interventions-help reduce the sharing of injecting equipment and the transmission of HIV. There was no evidence that they increased either the number of injectors or the frequency of injecting drug use."

The mainstream US medical, nursing, and public health communities support needle exchange programs for injection drug users. Official resolutions in support of these programs have been issued by the American Nurses Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Medical Association, the American Public Health Association, the National Association of Boards of Pharmacy, the American Pharmaceutical Association, the American Society of Addiction Medicine, the Association of State and Territorial Health Officials, the Council of State and Territorial Epidemiologists, the Institute of Medicine, the Committee on HIV Prevention Strategies in the United States, the National Association of County and City Health Departments, and the National Association of State Controlled Substances Authorities. In addition, the US Conference of Mayors, representing more than 1050 mayors of cities with populations of at least 30,000, in 1997 called for an end to the federal ban on needle exchanges, based on studies that prove the effectiveness of needle exchange programs in preventing the spread of HIV/AIDS, and noting that needle exchange programs do not increase drug use.

Needle exchange, drug treatment, contraceptive services, and healthcare for mental and physical illness, both for Americans who inject drugs, and for people abroad who might receive assistance through our foreign aid programs, need the support of the US Congress and others. A human rights approach that is also the medically rational approach to the needs of people who inject drugs is the right path to take and will help make the United States a leader in preventing the spread of HIV/AIDS worldwide in this area.