Thesis
Needle exchange programs are an integral part of community health. These programs provide the necessary tools for the promotion of health and the prevention of new cases of HIV/AIDS and Viral Hepatitis in local communities.

Impact of Syringe and Needle Exchange Programs: A Valuable Harm Reduction Technique in the Battle Against the Future of Infectious Diseases in our Communities.
Introduction
Infectious disease remains a viable social and health concern in communities around the globe. Implementing ways to slow or halt the spread of diseases such as HIV and viral Hepatitis is at the forefront of local public health programs. The implementation of needle exchange programs (NEPs) in correlation with additional harm reduction programs, these diseases could be diminished significantly. Programs that emphasize minimizing the risk of infection to the community along with the collaboration of federal and state agencies including providing funding that coincides with education to citizens will aid in the elimination of many infectious diseases along with improving long-term health outcomes for the citizens of the community.
Congress has granted states and local communities the use of federal funding for the implementation of needle exchange programs, with limitations on how programs are to be executed and how the funding is appropriated. With these limitations, NEPs are still able to provide safe and sterile equipment to aid in decreasing infection rates while assisting individuals to connect with additional community services including infection testing and treatment, substance abuse counseling, overdose education and prevention.
Needle exchange programs have many benefits, one being the reduction in the spread of blood-borne diseases in injection drug users, with minimum cost to the community. Currently Globally, around 13 million people inject drugs, and 1.7 million of those are living with HIV (WHO 2018). People who use drugs are also affected by Hepatitis C. The estimated global prevalence of Hepatitis C in people who inject drugs is a staggering 67%. Worldwide there are approximately 2.2 million HIV/Hepatitis C co-infections of which more than half are people who inject drugs. In recent years the World Health Organization has found that HIV and Hepatitis rates among people who inject drugs (PWID) have decreased significantly, this correlates with the increased prevalence of NEPS and the lifting of the ban in early 2016.
Those opposing NEPs implementation in communities assert that the programs condone and promote substance abuse. Politicians have voiced mixed messages when it comes to needle exchange programs since the first federal funding ban for these programs in 1988. In 2009, President Obama signed a law that would lift the current funding ban after it had been in place for 21 years. Congress silently reinstated the full ban two years later, which remained in effect until the ban was lifted in January 2016 by Congress (Weinmeyer, 2016).
Purpose
The purpose of the research and results conveyed here is to inform the population of the benefits and future positive health outcomes due to the implementation of Needle Exchange Programs throughout our cities and states. The benefits will be compared to the risks of the program to convey the impact of these programs on the communities involved. ADD TO THIS

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The Problem
On average there are 13 million people globally that claim to be injection drug users. In August 2018 injection drug users account for approximately 9% of total HIV infections in the United States and have led to a 150% increase in acute cases of Hepatitis C infections (CDC 2018). Diseases can be spread with ease in a community with large numbers of injection drug users who do not know the hazards of reusing dirty needles or do not have access to clean needles and needle exchange programs (NEPS) can help reduce or eradicate new infections in our communities. Between the years 2001 and 2010, HCV-infected individuals accounted for a total of almost three million outpatient, inpatient, and emergency department visits in the USA (Davis, Daily, Kristjansson, Kelley, Zullig, Baus, Davidov, & Fisher 2017). Although HCV can be transmitted in several other ways, injection drug use remains the most significant risk factor for obtaining an infection. It is estimated there are over 10 million people who inject drugs (PWIDs) that attain Hepatitis infections globally (CDC 2018).
The treatment costs of HIV and Hepatitis C are overwhelming. Since the HIV/AIDS epidemic began, injection drug use has, directly and indirectly, accounted for more than one-third of HIV cases in the United States; amounting to over 354,000 people currently receiving treatment. The Journal of the American Medical Association (2008) credits syringe exchanges for helping decrease the incidence of HIV by 80% among PWID (Hall, Song, & Rhodes 2008). In 2014 in the United States 73% of Hepatitis C cases were directly related to injection drug use (CDC 2015). NEPs are also credited with a decrease to 67% 1n 2017 (WHO 2018)
Harm Reduction
Harm reduction programs attempt to reduce the negative social and physical outcomes of both legal and illegal behaviors. The basis behind needle exchange programs these programs is to decrease the rate of adverse events that result from substance abuse. The goal with harm reduction in these programs is to maintain safety while substance abusers engage in drug and alcohol use, not to prevent them from doing it altogether. Many of the harm reduction approaches we see commonly are used daily by the general population, things such as promoting hand washing, wearing seat belts in cars, crosswalk signs, wearing helmets while riding bikes, and the no smoking ads on television. It is an approach that acknowledges that people do and will use drugs, and so instead of preaching abstaining from drugs, the programs focus on limiting potential consequences.
Harm reduction strategies support the idea that there may be several ways to abuse drugs and alcohol and rather than push for abstinence they provide education and information about the methods that are safer than others. The thought of harm reduction stems from the idea that some people may not be willing to quit even when faced with adverse outcomes, but when these actions affect other individuals, it is our duty in the health field to provide alternative options for protecting the community.
Needle Exchange Programs
Needle exchange programs (NEPs) are a type of harm reduction program that provides clean, sterile needle and other necessary supplies to injection drug users to reduce the spread of diseases such as HIV and Hepatitis. According to the recommendations of The World Health Organization (WHO) in 2018, 200 sterile needles per drug user per year should be distributed to effectively halt the spread of infectious diseases and other skin infections.
Needle Exchange programs target the reduction in transmission of HIV along with other blood-borne infections/viruses that are shown to be caused by sharing injection materials. The programs not only provide sterile needles, but many of these exchange programs also work toward the reduction of other immediate dangers that injection drug users face. They offer education on safer injection practices, as well as minimizing the harms of other drugs. NEPs provide information on how to avoid and manage an overdose situation. They teach safe handling and disposal of used needles, along with referrals to HIV testing, treatment, and support services provided within the community.
Needle Exchange and Government View
Stigma?
Bans?
Congress?
Funding and Appropriation
Benefits of Needle Exchange Programs
Access to sterile needles can help save lives and save the community money. The Institute of Medicine has stated that: “the cost-effectiveness savings of needle exchange is estimated to range from $3,000 to $50,000 per HIV infection prevented.” (CDC 2005). The decrease in healthcare cost a needle exchange can provide are substantial. The average annual cost to care for a person who is living with HIV is $23,000; the estimated lifetime cost of treating one HIV infection is $379,668.5 Eliminating just one year’s worth of the 50,000 new HIV infections that occur annually would save nearly $19 billion in lifetime treatment costs (CDC 2017).
Care associated with hepatitis treatment was close to $6.5 billion in 2011, and that cost is expected to increase to $9.1 billion in 2024 (Davis et al. 2017).
Needle Exchange programs provide access to other health services for uninsured
and low-income populations that may not have access to traditional health insurance and priority health care. A study conducted in California found that 76% of needle exchange participants received all their medical and preventive services exclusively through NEP’s, including hepatitis prevention and mental health services. (Heinzerling, 2006).
Barriers to Needle Exchange Programs

Counter Arguments and Controversy
Recommendations for the Advancement of Needle Exchange Programs

Conclusion
Needle Exchange Programs help build a solid foundation for the prevention fight to protect the health and safety of communities from the transmission and further spread of blood-borne diseases. They are a vital component to the healthcare field in preventing the spread of diseases such as HIV/Aids and Hepatitis. Since the implementation of the NEPs in 1980, there has been an 80% decrease in new HIV infections from an estimated 130,000 cases in 1985 to less than 50,000 in 2010 (CDC, 2018). That demonstrates effectiveness which is hard to dispute and partnered with law enforcement in the communities the prevalence of these diseases would show
further, decrease.

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