Access to Sterile Syringes for Injecting Drug Users in New York City: Politics and Perception (1984–2010)

Abstract

In the United States, political and social environments have shaped public health response to injecting drug use, and New York City represents a salient example. The history of “harm reduction” in New York City is characterized within changing historical periods and in relation to the actions of stakeholders. The expansion is traced over four periods: (i) 1984–1989: emergence, activism, and science; (ii) 1990–1994 reckoning: syringe exchange legislation and consolidation; (iii) 1995–1999: bureaucratization, opposition, and challenges to institutional control; and (iv) 2000–2010 revitalization: expansion of syringe access and harm reduction. It is clear from this review that the leadership of activism and the work of advocates catalyzed syringe access policy and practice. Without this “push,” it is unlikely that New York City would have experienced the dramatic decline in HIV infection among drug injectors in the 1990s. Second, successful arguments for expanding syringe access in New York City were based on the high HIV/AIDS infection rates. Thus, program developments were advocated as HIV prevention interventions, rather than as expanded services for addressing broader health and social issues of injecting drug use.

Keywords :

• syringe exchange
• needle exchange
• injection drug use
• HIV/AIDS
• New York City
• structural barriers
• zero tolerance
• continuum of care

THE AUTHORS

Daliah Heller, Ph.D., MPH, is the Assistant Commissioner for the Bureau of Alcohol and Drug Use Prevention, Care, and Treatment at the Department of Health and Mental Hygiene in New York City. In this role, she is responsible for the development and oversight of programs, policies, initiatives, and studies addressing the prevalence, and the health and social consequences, of substance use in New York City. Prior to joining the Department, Dr Heller managed the expansion and delivery of services as the Executive Director of a leading harm reduction program in the United States.

Denise Paone, Ed.D., is the Director of Research in the Bureau of Alcohol and Drug Use Prevention, Care, and Treatment at the Department of Health and Mental Hygiene in New York City. She is currently conducting studies of drug-related morbidity and mortality in New York City. Dr Paone has conducted drug-related studies for the past 20 years. She has published numerous articles on evaluations of syringe exchange programs, injection drug use, and women and drugs.

Notes

2 Reporting an historical process, which is still ongoing, can be and is problematic particularly when the targeted process is politicalized and the authors are government employees. As you, the reader, review the four intervention periods in NYC which are being documented and analyzed and which are generalizable to other contexts, conditions and dimensions, consider and relate the selected parameters, graphically, to: (1) time, (2) activities carried out as well as (3) those which weren't, (4) endogenous and exogenous individual as well as systemic/structural barriers and “bridges”/facilitators and their (5) sources of power and influence to needed changes, from (6) micro to macro levels within your own context(s) and conditions. Editor's note