Syringe Exchange: A Moral Issue

By Benjamin Shepard, Ph.D., L.M.S.W., and Erica Poellot, M.S.S.W.

Winter 2009/2010
Introduction
When thinin! a"o#t $%& pre'ention, it i( #(e)#l to con(ider a )e* (tati(tic(. More than a
+#arter o) ,%DS ca(e( in the -.S. amon! people 1. and older are directly lined to the #(e
o) injection dr#!(. ,mon! *omen, /00 o) ,%DS ca(e( are d#e to injection dr#! #(e or (e1
*ith (omeone *ho contracted $%& thro#!h injectin!. %njection dr#! #(er( 2%D-(3 acco#nt
)or (ome .00 o) all people *ith ,%DS in the -.S. 4nce in)ected, %D-( ha'e the hi!he(t
illne(( and death rate( and pro!re(( to ,%DS )a(ter than any other !ro#p. %D-( acco#nt )or
500 o) people *ith the $6PE7L%89 :http;//***.the"ody.com/content/art<0=0.html:
hepatiti( > 'ir#( 2$>&3, and a third o) all people *ith $%& al(o ha'e $>&. ,nd m#ch o)
thi( tae( place amon! already at?ri( !ro#p(. :,)rican?,merican( and Latino( )ace
di(proportionately hi!h rate( o) $%& d#e to injection dr#! #(e,: note( the $6PE7L%89
:http;//***.the"ody.com/content/art<0/5.html: $arm 7ed#ction >oalition. :Per'a(i'e
(ti!ma to*ard( dr#! #(e amon! health care pro'ider( re(#lt( in #ne+#al treatment )or
people *ith a hi(tory o) dr#! injection, leadin! to (#"optimal care.:
When thinin! a"o#t $%& and a"o#t health in !eneral, *e m#(t al(o con(ider (ocial and
economic !ap(. 4ne in )i'e 8e* 6orer( li'e( in po'erty. %n the -.S. a( a *hole, the riche(t
10 o) the pop#lation control( more o) the nation@( *ealth than the "ottom 900 com"ined.
S#ch ine+#ality directly a))ect( the !eneral health and $%& ri( )actor( o) the poor. :We
carry o#r hi(tory in o#r "odie(: e1plained one doctor, re)lectin! on the e))ect( o) income
and (ocial i((#e( on health. Economic policy i( health policy. Ahi( i( partic#larly tr#e *ith
re!ard to $%& and $>&.
Ahe !reater pre'alence o) $%& amon! *omen and dr#! #(er( in ,)rican?,merican and
Latino comm#nitie( complicate( an already di))ic#lt (it#ation. Ao "e at all e))ecti'e, $%&
pre'ention e))ort( m#(t attempt to c#r" $%& (ti!ma, (e1i(m, homopho"ia, raci(m, and other
(ocial inj#(tice(, (#ch a( poor ed#cation and lac o) ho#(in!. ,ll o) the(e )actor( )#el hi!h?
ri( "eha'ior, *hich increa(e( the ri( o) $%& and $>& e1po(#re. Social (ti!ma,
di(crimination, the in'i(i"ility o) dr#! #(er( in p#"lic health policie(, and :a"(tinence?only:
approache( "a(ed on ideolo!y rather than e'idence all (er'e to limit acce(( to $%&
pre'ention (er'ice( and +#ality health care. B#t there are option( o#t there.
Syringe Exchange
Ahe (in!le mo(t e))ecti'e mean( o) $%& pre'ention amon! %D-( i( (yrin!e e1chan!e. Ahi(
harm red#ction approach o))er( tool( to protect the health and *ell?"ein! o) dr#! #(er( and
their (e1#al partner(, lo'ed one(, and comm#nitie(. Syrin!e e1chan!e pro!ram( 2SEP(3
pro'ide tool(, re(o#rce(, and ed#cation to a((i(t people *ho inject dr#!( "y helpin! them
learn a"o#t and #(e (a)er injection and (a)er (e1 practice(. Ahey ha'e had a tremendo#(
impact on the $%& epidemic, and the ann#al incidence o) ne* $%& in)ection( amon! %D-(
ha( dropped ro#!hly B00 (ince the late 19B0(.
De(pite their remara"le e))ecti'ene(( in red#cin! $%&, SEP( are not a( *ide(pread a( they
(ho#ld "e, and (i!ni)icant !ap( and challen!e( remain. Sti!ma, comm#nity oppo(ition, and
(e'erely limited )#ndin! (o#rce(, ha'e *ored to pre'ent SEP( )rom meetin! the !ro*in!
need( o) their comm#nitie(. 8ational (t#die( ha'e )o#nd that area( *ith hi!h rate( o) $%&
in)ection o)ten do not o))er le!al acce(( to (terile (yrin!e(. E'en in (tate( *here (yrin!e
e1chan!e i( openly a'aila"le, re!#lation( can "e onero#(. Camie Da'aro, E1ec#ti'e Director
o) the Wa(hin!ton $ei!ht( >orner Project, noted pro'ider( m#(t j#mp thro#!h a n#m"er o)
hoop( to !et (#ch pro!ram( o)) the !ro#nd; :, lot o) *or !oe( into !ettin! a (yrin!e
e1chan!e pro!ram (tarted. ,nd % )o#nd that thro#!h doin! that, *ho % *a( a( an acti'i(t and
my *or really chan!ed.: Many (#ch pro!ram( are )orced to con)ront a con(tant on(la#!ht
o) +#e(tion( and concern( "y tho(e *ho 'ie* dr#! #(e in term( o) morality rather than
p#"lic health.
Faith-Based Barriers
>ompo#ndin! thi(, comm#nitie( o) )aith ha'e not con(i(tently em"raced $%& pre'ention
amon! %D-(. &ery )e* ha'e (tepped )or*ard to (#pport (yrin!e e1chan!e or common(en(e
$%& pre'ention. Dor e1ample, on a recent trip to ,)rica, the Pope reiterated hi(
lon!(tandin! oppo(ition to condom #(e, e'en to )i!ht $%&. Eay and "i(e1#al men, %D-(,
and other !ro#p( at hi!h ri( o) $%& in)ection are o)ten not repre(ented amon! reli!io#(
comm#nitie(. MoraliFin! $%& in)ection and dr#! #(e ha( (i!ni)icantly re(tricted the
dialo!#e aro#nd $%& and %D-(, *ith ne!ati'e e))ect( on p#"lic health policy and )#ndin!
)or SEP(.
While (yrin!e e1chan!e ha( lon! "een reco!niFed "y the p#"lic health comm#nity a( a
'al#a"le and e))ecti'e tool in $%& pre'ention, comm#nitie( o) )aith ha'e hi(torically "een
am"i'alent a"o#t (#pportin! it. :7eli!io#( tradition( had a parado1ical impact on the (ocial
re(pon(e to the epidemic; "oth a (o#rce o) (ti!ma and the "a(i( o) enormo#( concern and
compa((ion,: *rite( (ociolo!i(t S#(an M. >ham"rG. :Some reli!io#( leader( #(ed ,%DS a(
an o"ject le((on ill#(tratin! moral decline. 4ther( preached compa((ion and empha(iFed the
o"li!ation to care )or the (ic and dyin!.: Eenerally (peain!, oppo(ition to (yrin!e
e1chan!e ha( "een rooted in the "elie) that (#pportin! (yrin!e e1chan!e i( an endor(ement
o) dr#! #(e. De(pite the )act that it ha( "een (ho*n that (yrin!e e1chan!e doe( not
enco#ra!e or increa(e dr#! #(e, the condemnation o) dr#! #(e ha( "een a primary "arrier to
it( acceptance.
Faith-Based Efforts
6et there are e1ample( o) )aith?"a(ed e))ort( to (#pport the(e pro!ram(. Dor e1ample,
>itiWide $arm 7ed#ction "e!an operation( in 199= *ith the (#pport o) La 7e(#rrection
-nited Methodi(t >h#rch, pro'idin! (er'ice( in area( o) -pper Manhattan and the Bron1
that )e* (er'ice pro'ider( had reached o#t to. St. ,nn@( >orner o) $arm 7ed#ction in the
Bron1 *a( )o#nded *ith a (imilar mi((ion. C#d(on Memorial >h#rch in Manhattan ha( lon!
)acilitated and (#pported harm red#ction trainin! and practice(. 4ther reli!io#( !ro#p(,
incl#din! the Epi(copal >h#rch, Pre("yterian >h#rch -S,, Ahe -nited >h#rch o) >hri(t,
the -nitarian -ni'er(ali(t ,((ociation, and the -nion )or 7e)orm C#dai(m ha'e come o#t in
(#pport o) harm red#ction and SEP(. Some con!re!ation( ha'e e'en "le((ed condom( and
(yrin!e( in the hope( o) c#r"in! the (pread o) the 'ir#(. 4ther( ha'e )acilitated harm
red#ction o#treach.
Ahe $%& *or o) reli!io#( !ro#p( ha( it( root( in a holi(tic concern )or pre'enti'e health
care, re(pect )or the di!nity o) tho(e a))ected, and a )#ndamental "elie) that each per(on ha(
an e((ential *orth. $o#(e( o) *or(hip )ir(t o))ered care and treatment )or people *ith $%&
and their )amilie(, and !rad#ally (hi)ted into (e1#al health e))ort( to addre(( $%& and other
SA%(. E'ent#ally, they "e!an $%& pre'ention e))ort( )or hi!h ri(?pop#lation(, incl#din!
%D-(.
>h#rche( in hard?hit comm#nitie( ha'e "een compelled to con)ront their o*n theolo!ie(.
Dor many year(, traditional morali(m had a ne!ati'e impact on $%& pre'ention and care.
Dather Errol $ar'ey, )ormerly o) Manhattan@( St. ,#!#(tine >h#rch, e1plained; :Ahere i(
more a*arene(( )or the i((#e no*. 8ot (#re i) the needle e1chan!e i((#e i( pa((G no*. Many
leader( in the "lac ch#rch are (till learnin!. % *o#ld lie to thin that thi( ha( chan!ed/i(
chan!in!. Ao tae a (tand in endor(in! needle e1chan!e i( a "i! j#mp.:
>atholic >haritie( in San Dranci(co too o'er an $%& ho#(in! pro!ram that had r#n into
)inancial tro#"le(. Ahe pro!ram pro'ided ho#(in!, (er'ice(, and (ta"ility )or people in need.
B#t they *ere #na"le to (#pport harm red#ction e))ort( (#ch a( pro'idin! condom(. Ahe
re(#lt *a( #ne'en, *hich typi)ie( the >atholic >h#rch@( re(pon(e. While many (a* harm
red#ction in term( o) permi((i'ene((, other( (a* it a( part o) a theolo!y o) care, "le((in!
(yrin!e( and condom( a( part o) comprehen(i'e o#treach.
Personal Responses
7e'erend Stacey Latimer i( the Do#nder/>E4 o) Lo'e ,li'e %nternational %nc., a )aith?
"a(ed nonpro)it committed to empo*erin! tho(e a))ected "y $%& and other heath pro"lem(
that pla!#e the "lac comm#nity. :$%& ha( "ecome the teacher,: he e1plain(. :%t ha( ca#(ed
#( to ha'e to deal *ith i((#e( *e ha'e not *anted to deal *ith incl#din! dr#! #(e. 4#r o*n
theolo!ie( ha'e paralyFed #(. Eod ha( rai(ed #p nonpro)it( *hich ha'e ta#!ht the ch#rch
theolo!y o) h#man compa((ion. 8o one can one loo at *ho they are a( (eparate )rom o#r
(tr#!!le(.: Ei'en thi(, Latimer ha( "een a"le to em"race harm red#ction. :Dr#! #(er( are a
people *ho are a part o) #(. When one i( (#))erin!, *hen one i( h#rt, *e are all h#rt.
Leader( don@t *ant to tal a"o#t dr#! #(e "eca#(e they don@t *ant to tal a"o#t their o*n
dr#! #(e. When % tal to yo# % ha'e to tal a"o#t me. $elp them (ee *ho they are and *here
there are hole( in the )ence that they are tryin! to "#ild #p and yo# do it thro#!h lo'e.:
Dather $ar'ey (a* the ,%DS "attle a( part o) a lar!er (tr#!!le )or (ocial j#(tice, and in a
"i"lical conte1t (imilar to lepro(y. :$o* are *e to treat people *ho ha'e "een a))licted "y a
terri"le di(ea(e,: he a((. :People moraliFe ,%DS, and the ch#rch needed to (tep #p and
tae leader(hip on thi( i((#e.: So $ar'ey 'ie*ed harm red#ction e))ort( *ithin a (imilar
h#mani(t 'ie*. :8eedle e1chan!e o))ered #( a *ay to (ay that dr#! addict( are people and
they ha'e an illne(( that merit( concern and lo'e. 8eedle e1chan!e *a( a reality. -ntil *e
!et people in Hdr#!I treatment then thi( i( a *ay to tae care o) them.:
%n 199., Dather 7o"ert ,rpin *rote a "oo o) letter( entitled Wonder)#lly, Dear)#lly Made,
a"o#t hi( e1perience o) li'in! *ith $%& a( an openly !ay prie(t. :,%DS i( a (icne((, a
di(ea(e ?? not a moral j#d!ment, not Eod@( *rath,: he *rote to hi( con!re!ation; :Aell
Htho(e *ith ,%DSI that they are lo'ed, not "y Eod, "#t "y yo#. Beca#(e the only hand( Eod
ha( to to#ch them *ith are yo#r hand(. ,nd the only heart Eod ha( to lo'e them *ith i(
yo#r heart.: ,rpin *o#ld die the )ollo*in! year, "#t not *itho#t plantin! a (eed o) tolerance
that (pread. When Eene'a Bell@( (on died o) ,%DS in the early 1990(, (he *rote a"o#t her
e1perience in My 7o(e; ,n ,)rican ,merican Mother@( Story o) ,%DS. Ceremiah Wri!ht o)
Arinity -nited >h#rch o) >hri(t in >hica!o re)lected on her e1perience; :H7Ieadin! her
(tory may a*aen #( to the tr#e meanin! o) Ce(#(@ *ord(; @%na(m#ch a( yo# ha'e done it to
the lea(t o) the(e my little one( yo# ha'e done it #nto me.@ %t i( certainly my prayer that the
latter *ill "e the ca(e.: Many ?? "#t not all ?? )aith comm#nitie( ha'e taen hi( *ord( to
heart.
Conclusion
,( the(e (torie( atte(t, the re(pon(e o) )aith comm#nitie( to $%& and (yrin!e e1chan!e ha(
"een mi1ed and complicated. Bo" ,rpin noted that the >atholic >h#rch *a( homopho"ic
and tolerated him only "eca#(e o) hi( illne((. ,( the c#rrent Pope@( (peech in ,)rica
(#!!e(t(, hard?line theolo!y (till o)ten tr#mp( e'idence?"a(ed $%& pre'ention. 6et, on the
!ro#nd, people )rom a *ide ran!e o) per(pecti'e( ha'e learned )rom their e1perience o)
copin! *ith $%&. ,( thi( article *a( "ein! completed, >atholic >haritie( 8e* 6or
anno#nced that )or the )ir(t time it *o#ld (#pport SEP( in 8e* 6or State. :% #nder(tand
there *ill "e +#e(tion(, "#t thi( i( common (en(e,: (aid Si(ter Ma#reen Coyce, >E4 o)
>atholic >haritie(. Many ha'e t#rned a*ay )rom hard?and?)a(t po(ition( to (#pport any
pro!ram they can )ind, incl#din! (yrin!e e1chan!e, that *ill c#r" the epidemic. 6et,
morali(m die( hard, and contin#e( to impede p#"lic health e))ort(. n
A long-time supporter of ACT UP, Benjamin Shepard is an assistant professor at New York
Cit College of Te!hnolog" #ri!a Poellot is $e%elopment &anager at the 'arm (edu!tion
Coalition"
Ahi( article *a( pro'ided "y ,>7%, and EM$>. %t i( a part o) the
p#"lication A!hie%e. 6o# can )ind thi( article online "y typin! thi( addre(( into yo#r We"
"ro*(er;
http;//***.the"ody.com/content/art=</B..html
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