HIV/AIDS policy in North Carolina simply isn’t working.
Despite the strictest eligibility requirement in the country, hundreds of people have waited years for life-saving drugs in our state. Thousands more aren’t even eligible for the waiting list, because they make more than 125 percent of the federal poverty line — a little more than $12,000 per year. This is the worst eligibility level in the country, a far cry from the 300 percent deemed reasonable by our neighbors in South Carolina, Virginia, Tennessee and Georgia.
Both the N.C. Senate and House of Representatives have proposed raising the eligibility level to 250 percent of the poverty line in their 2007 budgets. But neither included additional funding to support the increase, leaving the state at the mercy of legislators in Washington (the program uses a mix of federal and state funds). And while these efforts should be applauded, they don’t address prevention and the growing number of infections each year.
Rather than paying for costly drugs once people are sick, the state should be doing more to prevent infections. Funding for the HIV Prevention Branch of the N.C. Division of Public Health is a meager $1.5 million annually. To meet the growing need for their education, testing, counseling and outreach programs, they need just $3.3 million in additional funds. Clearly, with a budget of more than $19 billion, legislators should be doing more.
Unquestionably both the drug-assistance program and the state’s HIV Prevention Branch need more funding. But one key tool for preventing the spread of the disease — legalizing needle-exchange programs — would cost nothing.
Twenty-five percent of the people infected with HIV/AIDS in North Carolina list injection-drug use as a risk factor in their having contracted the disease. Numerous studies, conducted by groups such as the National Institutes of Health and American Medical Association, have shown that needle-exchange programs slow the spread of HIV and don’t increase drug use.
Yet North Carolina law prohibits needle-exchange programs, despite the overwhelming research demonstrating their effectiveness. Meanwhile, programs operating illegally in Buncombe and Guilford counties have significantly reduced the number of HIV infections among injection-drug users.
The Needle Exchange Program of Asheville should be particularly commended for its work and courage. Compared with other N.C. counties containing significant urban areas, Buncombe has had far fewer new cases of HIV. In 2004 (the most recent statistics available), Mecklenburg, Wake, Durham, Guilford, Forsyth, New Hanover and Cumberland counties were all in the highest fifth of the state’s 100 counties in terms of new infections; Buncombe was in the lower half, which is great for a county that has a large metropolitan area. And according to the N.C. HIV Prevention Branch, Western North Carolina’s 19 counties reported less than 3 percent of the new HIV cases statewide that year.
Public-health advocates working to save lives and prevent the spread of deadly disease should not have to hide in the shadows. Refusing to accept this scientifically proven method for preventing the spread of HIV is as shortsighted and dangerous as any policy in our state.
At least 28 other states have legalized needle-exchange programs. If North Carolina lawmakers want to save the lives of hundreds of people while saving the state millions in treatment costs, they’ll make North Carolina the 29th.
[Brian Elderbroom is associate director of the Common Sense Foundation, a Raleigh-based nonprofit working to ensure that public policy in North Carolina addresses the needs of “those who are systematically denied access to power.”]