Injecting Advice

Guide to Developing and Managing Syringe Access Programs

Guest writer Emily Winkelstein. Written on . Posted in .

In late 2009, harm reduction advocates and drug users in the United State achieved a major victory – the lifting of the federal ban on funding for syringe exchange. The ban, which had been in place for some 20 years, meant that zero federal dollars could be spent on syringe access – forcing syringe access programs (SAPs) to piecemeal together different private and local sources of funding in order to implement one of the simplest and most effective forms of HIV prevention available for drug users. But the federal ban did more than just deny access to money from the country’s largest (and wealthiest) public health, substance use and disease control agencies: it also placed moral and political veils over the issue of drug use and sent a message attempting to delegitimize syringe access programs altogether. Advocates and activists, drug users and their allies, were forced to fight harder for every dollar (and every syringe) while HIV and hepatitis C continued to spread needlessly.

Despite the combined effects of the federal funding ban, the country’s well-known “war on drugs” ideology and the pervasive stigma associated with drugs, people who use drugs and their allies have a long and proud history of providing syringe access services throughout the U.S. From underground programs operating outside the law to small and large non-profit organizations to services run by city and state government health departments, SAPs sprang up across the country as a major component in the landscape of prevention services for drug users.

Following the success of our campaign to lift the federal ban, the Harm Reduction Coalition (HRC) quickly moved to develop pragmatic and comprehensive guidance on developing and managing syringe access programs based on expertise and lessons learned over the years. While there have been similar manuals developed by other health organizations and syringe access providers throughout North America and the rest of the world, HRC began receiving an increased number of requests for technical assistance after the ban was lifted and felt a responsibility to create a document that represented HRC’s perspective on SAP development. We wanted to create a document that would be honest and straightforward in its approach, providing concrete practice suggestions while still encouraging the creativity and flexibility that makes SAPs most successful. HRC also recognized that the U.S. Centers for Disease Control and Prevention (CDC) would be putting forth their own program guidance, and we hoped to have as much influence on that process as possible.

The result

HRC SAP CoverThe result is our Guide to Developing and Managing Syringe Access Programs now available in both hard copy or as a downloadable PDF. The manual walks the reader through the process of starting a SAP including: Planning and Design, Operational Issues, Organizational Issues, External Issues and Population-Specific Considerations. There is also an extensive appendix with additional information and links to resources. Although the guide is written with a particular attention to the needs of U.S.-based SAPs, we hope the manual can serve as a valuable resource on a global scale. The entire guide can be viewed, downloaded and ordered on HRC’s website.

As we write in the manual, “An SAP is more than a social service or public health intervention. It is a creative social justice project that has the potential to challenge your world-view and take you to new and exciting places.” HRC is anxious to see where it takes you. We welcome your comments and feedback.

In late 2009, harm reduction advocates and drug users in the United State achieved a major victory – the lifting of the federal ban on funding for syringe exchange. The ban, which had been in place for some 20 years, meant that zero federal dollars could be spent on syringe access – forcing syringe access programs (SAPs) to piecemeal together different private and local sources of funding in order to implement one of the simplest and most effective forms of HIV prevention available for drug users.· But the federal ban did more than just deny access to money from the country’s largest (and wealthiest) public health, substance use and disease control agencies: it also placed moral and political veils over the issue of drug use and sent a message attempting to delegitimize syringe access programs altogether. Advocates and activists, drug users and their allies, were forced to fight harder for every dollar (and every syringe) while HIV and hepatitis C continued to spread needlessly.

Despite the combined effects of the federal funding ban, the country’s well-known “war on drugs” ideology and the pervasive stigma associated with drugs, people who use drugs and their allies have a long and proud history of providing syringe access services throughout the U.S. From underground programs operating outside the law to small and large non-profit organizations to services run by city and state government health departments, SAPs sprang up across the country as a major component in the landscape of prevention services for drug users.·

Following the success of our campaign to lift the federal ban, the Harm Reduction Coalition (HRC) quickly moved to develop pragmatic and comprehensive guidance on developing and managing syringe access programs based on expertise and lessons learned over the years. While there have been similar manuals developed by other health organizations and syringe access providers throughout North America and the rest of the world, HRC began receiving an increased number of requests for technical assistance after the ban was lifted and felt a responsibility to create a document that represented HRC’s perspective on SAP development. We wanted to create a document that would be honest and straightforward in its approach, providing concrete practice suggestions while still encouraging the creativity and flexibility that makes SAPs most successful. HRC also recognized that the U.S. Centers for Disease Control and Prevention (CDC) would be putting forth their own program guidance, and we hoped to have as much influence on that process as possible.

As we write in the manual, “An SAP is more than a social service or public health intervention. It is a creative social justice project that has the potential to challenge your world-view and take you to new and exciting places.” HRC is anxious to see where it takes you. We welcome your comments and feedback.

Resource developed by: Harm Reduction Coalition

Guest Writer: Emily Winkelstein

Emily Winkelstein is a radical social worker and harm reductionist. She has been working in the field of harm reduction and public health for nearly 15 years. She spent five years working as Program Manager for a research study and drop-in center aimed at younger injection drug users where she also conducted peer-delivered syringe exchange. Emily is currently working for the Harm Reduction Coalition as Publications Coordinator.

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