Back HCV Prevention Injection Drug Use U.S. Government Releases New Guidance for Syringe Program Funding

U.S. Government Releases New Guidance for Syringe Program Funding


The U.S. Department of Health and Human Services (DHHS) has released new guidance regarding use of federal funds to pay for many aspects of syringe service programs aimed at reducing the risk of HIV and viral hepatitis transmission among people who inject drugs. The guidance follows a change in federal law that lifts the overall ban on syringe service funding, although the new rules do not allow programs to pay for needles or syringes themselves.

HIV and hepatitis B and C are efficiently transmitted via shared syringes and other equipment used for drug injection, and people who inject drugs therefore have high rates of infection. According to Mary Beth Levin of Georgetown University, 8% of new HIV infections -- or 11 per day -- are attributable to sharing drug injection equipment.

Providing sterile syringes has been shown to dramatically reduce the risk of transmission, and HIV and hepatitis C prevalence and incidence are lower in areas that implemented such programs early and fund them adequately.

As Richard Wolitski, acting director of the DHHS Office of HIV/AIDS and Infectious Disease Policy, explained in a recent blog post, in 2011 the Surgeon General determined that syringe service programs are an effective way of reducing HIV transmission among people who inject drugs. There is ample evidence that these programs promote entry into, and retention in, drug treatment and medical services, without increasing illegal drug use.

Unfortunately, Congress instituted a ban in the 1980s that prohibited federal funds from being used to support syringe programs. For more than 20 years these programs instead have been funded mainly by local health departments and private foundations. The ban was briefing rescinded in 2009, but soon reinstated.

But in late 2015 Congress passed a bipartisan omnibus budget bill for fiscal year 2017that effectively lifted the ban. The bill omitted language that previously prevented funding of syringe service programs, allowing federal money to be used to pay for operational components. The change came about in part due to a growing epidemic of prescription opioid and heroin use in many regions of the U.S. An outbreak of HIV and hepatitis C last year in rural Indiana heightened the concern.

"Federal funds can now be used to support a comprehensive set of services, but they cannot be used to purchase sterile needles or syringes for illegal drug injection," according to Wolitski.

The latest DHHS guidance clarifies the new rules. Local, state, tribal, and territorial health departments can request to use federal funds to start or expand syringe services programs. They must consult with the Centers for Disease Control and Prevention (CDC) and provide evidence that their jurisdiction is experiencing or at risk for significant increases in viral hepatitis or an HIV outbreak due to injection drug use.

After receiving a request, CDC will have 30 days to notify the department whether the evidence is sufficient to demonstrate a need for syringe service programs. If so, the department or other eligible HHS grant recipients may then apply to federal agencies for funding. Each funding agency (e.g., CDC, HRSA, SAMHSA) will provide specific guidance to potential grantees.

"The recent outbreak of HIV and hepatitis C virus (HCV) among persons who were injecting drugs in rural Indiana, and the steep rise nationally in new HCV infections, are powerful reminders that the hard-won gains of the past can be lost if we do not remain vigilant," Wolitski wrote. "The opioid epidemic is affecting many communities across the country, and these areas are vulnerable to future outbreaks of HIV and the continued spread of viral hepatitis if we do not work to ensure that robust [syringe service programs] and other critical prevention and treatment services are in place where they are needed."

"Expanding the reach of [syringe service programs] and the services that these programs provide is part of a comprehensive approach to addressing HIV and viral hepatitis among people who inject drugs that supports the goals of theupdated National HIV/AIDS Strategy and the Viral Hepatitis Action Plan to reduce the number of new HIV and viral hepatitis infections," he added.

The DHHS guidance is part of a larger effort announced last week by President Barack Obama to address the prescription opioid and heroin epidemic. Other components include increasing access to medication-assisted substance use treatment by allocating $94 million to community health centers and increasing the current patient limit for doctors prescribing buprenorphine, requiring Medicaid to pay for substance use treatment, allocating $100 million for states to purchase and distribute naloxone for overdose prevention.



Department of Health and Human Services. Implementation Guidance to Support Certain Components of Syringe Services Programs, 2016.

R Wolitski. HHS Releases Guidance for Syringe Services Programs. March 29, 2016.

White House. Obama Administration Announces Additional Actions to Address the Prescription Opioid Abuse and Heroin Epidemic. Fact sheet. March 29, 2016.

Centers for Disease Control and Prevention. Access to Sterile Syringes. Fact sheet. March 30, 2016.