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Addressing the NSEP Shortfall in the USA: Local Problems, Local Solutions. Paola Barahona, MPH Project Director DC Appleseed Center for Law and Justice pbarahona@dcappleseed.org paola.barahona@gmail.com. Syringe Exchange in Congress’s Backyard. Congressional Budget Oversight. - PowerPoint PPT Presentation
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Washington D.C., USA, 22-27 July 2012www.aids2012.org
Addressing the NSEP Shortfall in the USA:
Local Problems, Local Solutions
Paola Barahona, MPHProject Director
DC Appleseed Center for Law and Justicepbarahona@dcappleseed.orgpaola.barahona@gmail.com
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Syringe Exchange in Congress’s Backyard
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Congressional Budget Oversight• DC budget is passed annually by Congress as
an Appropriations Act• DC Code: “no amount may be obligated or
expended by any officer or employee of the District of Columbia government unless such amount has been approved by Congress, and then only according to such Act.”
• Community Calls for Budget Autonomy
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Beginnings of Syringe Access in DC
• 1980s – ACT UP• 1992 – Government Agency• 1994 Legislation allowed SEP by a community-
based organization• 1996 Whitman-Walker Clinic begins an SEP
under a DC government contract
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Federal Ban• From 1988 to 2009 the Labor, Health and
Human Services, Education, and Related Services bill included language banning the use of federal funds for syringe exchange program services.
• 1988 language included exemption criteria:– SEP proven effective in reducing HIV
transmission– SEP proven not to increase drug use
Washington D.C., USA, 22-27 July 2012www.aids2012.org
1998 Surgeon General Review• Scientific literature review• Found criteria were met• The Clinton administration, however, did not
exercise the waiver, finding the issue politically divisive
• Maintain ban on use of federal dollars• Leave to local jurisdictions to decide if want to
use local or state dollars for needle exchange to fight their local epidemic
Washington D.C., USA, 22-27 July 2012www.aids2012.org
FY 1999 Tiahrt Amendment• Prohibited DC from spending any of its money
on SEP• Additionally, any entity receiving federal or local
funds could not operate SEP.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Creation of PreventionWorks!• October 1998: Staff of WWC DC NEP laid off
and hired by newly-incorporated organization to continue the SEP
• Not authorized to conduct SEP until December 1998
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Some Obstacles• Funding – all private• Collaboration with other CBOs• Government officials wouldn’t speak out publicly
Washington D.C., USA, 22-27 July 2012www.aids2012.org
FY 2000• Tiahrt tries to continue his restriction• President Clinton vetoes the omnibus
appropriations bill twice – due in part to the restrictive DC SEP language
• Compromise:– continues local funding ban– requires any entity that runs an SEP and
receives federal or local funds to account for those funds separately and only use private funds for SEP
Washington D.C., USA, 22-27 July 2012www.aids2012.org
2000 Surgeon General Literature Review
• Report issued by Surgeon General and senior scientists, unanimously agreed
• Conclusions on effects of SEPs:– “a decrease in new HIV seroconversions;– An increase in the numbers of injection drug users
referred to and retained in substance abuse treatment; and
– Well documented opportunities for multiple prevention services and referral and entry into medical care.”
– Also concluded that SEPs do not increase use of illegal drugs – and may in fact decrease injection frequency
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Success brings more Restriction in DC
• FY 2001 Congress adds restrictions on SEP in DC– No SEP could operate within 1,000 feet of any
school– If an SEP operated near a DC Housing
project, the District had to submit a monthly report on illegal drug activity in that are
Washington D.C., USA, 22-27 July 2012www.aids2012.org
FY 2002• Chairman Joe Knollenberg (R-MI) of the DC
Subcommittee continues the local funding prohibition, but deletes the other restrictions
• The Senate Subcommittee, under the leadership of Sen. Mary Landrieu (D-LA), passes a bill that does not include the local funding prohibition.
• In Conference, the House version becomes law
Washington D.C., USA, 22-27 July 2012www.aids2012.org
2007• Chairman Jose Serrano (D-NY) does not include
local funding ban in DC appropriation bill.• On the House floor, Rep. Mark Souder (R-IN)
offers an amendment to overturn Serrano– The amendment is defeated by a vote of 208-
216• President Bush signs FY 2008 appropriations bill
allowing DC to spend local funds on SEP
Washington D.C., USA, 22-27 July 2012www.aids2012.org
2008 DC NEX• Mayor Adrian Fenty announces proposal to
spend $650,000 of DC funds on SEPS• January 2008 Press Conference – Mayor
awards DC government $300,000 contract to PW to expand its SEP
Washington D.C., USA, 22-27 July 2012www.aids2012.org
2008 DC NEX - continued• March 2008 a Request for Applications was
released for new SEPs in DC• April 2008: 3 additional programs were awarded
funding for SEP– Family and Medical Counseling Service– HIPS– Bread for the City
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Recent Updates – Federal Ban• FY 2010 Consolidated Appropriations Act
removed the federal funding ban• The FY 2012 Consolidated Appropriations Act
again prohibited the use of federal funds to support SEP
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Update - DC NEX• PreventionWorks closed February 2011• Three organizations continue to operate SEP
with local funding– Family and Medical Counseling Service– HIPS– Bread for the City
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