Brown University News Bureau

The Brown University Op-Ed Service
Tracie Sweeney, Editor
Distributed April 1998
Copyright ©1998 by Josiah D. Rich and Laura Dokson

Making syringes easier to acquire would stem RI's high AIDS rate

By Josiah D. Rich, M.D., M.P.H, and Laura Dokson
Josiah D. Rich is an assistant professor of medicine at Brown University. Laura Dokson is a senior at Brown University from Atlanta, Ga.

"Under current Rhode Island law, an individual can be imprisoned for up to five years for possession of a single syringe. These laws, originally designed to discourage injection drug use, have failed here and elsewhere"

Rhode Island has a growing epidemic that can be stemmed. The state is fourth in the nation in injection drug use as a cause of AIDS. More than half of the AIDS cases and most of the pediatric and heterosexually-acquired HIV in this state are directly related to injection drug use.

Legislation now before the general assembly (S98-2477 and H98-7555) could reverse this deadly trend. Re-use and sharing of syringes spreads HIV among injection drug users. When syringes are difficult to get, they are re-used. It is no coincidence that Rhode Island, which maintains one of the strictest prohibitions on syringe possession, also leads the nation in the re-use of syringes - addicts in Rhode Island use each syringe, on average, more than 20 times.

Syringes are scarce among injection drug users (and thus re-used) because of laws making the possession of a syringe without a prescription a felony. Under current Rhode Island law, an individual can be imprisoned for up to five years for possession of a single syringe. These laws, originally designed to discourage injection drug use, have failed here and elsewhere - there are an estimated 10,000 injection drug users in Rhode Island. In fact these laws inadvertently encourage the spread of HIV and AIDS in our state. In other regions of the United States and other nations where injection drug users have access to sterile syringes, there are much lower rates of HIV transmission through drug use.

Relaxing the laws regarding syringe purchase and possession may draw criticism from some, but the reaction may be based more on unsubstantiated fear than fact. We are fortunate in that we have the opportunity to see what happened in Connecticut, where, in 1992, it became legal to purchase and possess syringes without a prescription. Syringe sharing among HIV-infected drug injectors decreased from 71 percent to 29 percent without evidence of increased drug use or publicly discarded syringes. Noting these findings and others, the American Medical Association and the National Academy of Science both support changing laws to allow legal access to sterile syringes for injection drug users. In addition, the Centers for Disease Control and Prevention and many other federal agencies recommend that those who inject drugs use only sterile syringes obtained from a reliable source.

In terms of human tragedy and suffering, the cost of maintaining these laws and continuing the spread of HIV is tremendous. Medical care for HIV-infected individuals, a cost predominantly borne by us as taxpayers, exceeds $100,000 per person. To save lives and prevent the spread of this deadly and costly disease, Rhode Island must repeal these laws and provide injection drug users with legal access to sterile syringes.

Repealing the syringe laws must be just one part of a comprehensive strategy to prevent HIV associated with injection drug use. The strategy must also include getting drug users into drug treatment and aggressively supporting programs that discourage people from injecting drugs. In the meantime, however, for those who cannot stop injecting drugs, we need to ensure they will not get HIV, and not spread HIV to others. In an epidemic, if we can stop a single injection drug user from getting infected with HIV, there's a good chance we can stop the spread of HIV to that user's injecting partners, sexual partners, their children, and all of their partners' partners.

Providing legal access to sterile syringes would be the single most effective intervention to prevent further spread of HIV in Rhode Island. Bills S98-2477 and H98-7555 would go a long way toward that end by removing the felony for the possession of a syringe. Please contact your state senators, representatives and Gov. Lincoln Almond and tell them this issue is critically important. Providence recently became one of the 50 U.S. cities with the highest AIDS rates. We cannot afford to continue costly laws that facilitate the spread of HIV to Rhode Islanders.