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HHS Releases Guidance for Syringe Services Programs

Rich Wolitski - headshot - March 2016

Richard J. Wolitski, Ph.D., Acting Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services

The United States is experiencing a growing opioid epidemic, which has made many communities vulnerable to outbreaks of HIV and viral hepatitis among people who inject drugs (PWID). To address this issue, Members of Congress worked together late last year on a broad, bipartisan basis to revise a longstanding ban on the use of federal funds for Syringe Services Programs (SSPs). President Obama signed the bipartisan budget agreement into law, which makes it possible for grantees to use federal funds to support operational components of SSPs under certain circumstances.

To support implementation of this change in law, the U.S. Department of Health and Human Services (HHS) has released new guidance [PDF 960 KB] for state, local, tribal, and territorial health departments that will allow them to request permission to use federal funds to support SSPs.

A large number of scientific studies have found that SSPs reduce HIV risk. In 2011, the U.S. Surgeon General determined that SSPs are an effective way of reducing HIV transmission among PWID and that there is ample evidence that SSPs promote entry to, and retention in, drug treatment and medical services, without increasing illegal drug use. Many national and community-based organizations worked for years to draw attention to the scientific evidence and to build support for SSPs. The change in the law would not have occurred without their sustained effort.

Requesting Use of Federal Funds

The HHS guidance describes how health departments can request to use federal funds to start or expand SSPs in order to prevent new HIV and viral hepatitis infections. Federal funds can now be used to support a comprehensive set of services, but they cannot be used to purchase sterile needles or syringes for illegal drug injection.

The guidance states that state, local, tribal, and territorial health departments must consult with the Centers for Disease Control and Prevention (CDC) and provide evidence that their jurisdiction is (1) experiencing, or (2) at risk for significant increases in viral hepatitis infections or an HIV outbreak due to injection drug use.

After receiving a request for determination of need, CDC will have 30 days to notify the requestor whether the evidence is sufficient to demonstrate a need for SSPs. When CDC finds there is sufficient evidence, state, local, tribal, and territorial health departments and other eligible HHS grant recipients may then apply to their respective federal agencies to direct funds to support approved SSP activities. Each funding agency will be providing specific SSP guidance to its grantees regarding which specific programs may apply and the application process for each agency.

Lessons Learned

The recent outbreak of HIV and hepatitis C virus (HCV) among persons who were injecting drugs in rural Indiana, and the steep rise nationally in new HCV infections, are powerful reminders that the hard-won gains of the past can be lost if we do not remain vigilant. The opioid epidemic is affecting many communities across the country, and these areas are vulnerable to future outbreaks of HIV and the continued spread of viral hepatitis if we do not work to ensure that robust SSPs and other critical prevention and treatment services are in place where they are needed. When the local opioid epidemic in Indiana fueled a dramatic increase in the number of new HIV cases, public health officials were able to halt the further spread of the virus by implementing a comprehensive response to identify and prevent new infections that included SSPs as a key component.

Expanding the reach of SSPs and the services that these programs provide is part of a comprehensive approach to addressing HIV and viral hepatitis among PWID that supports the goals of the updated National HIV/AIDS Strategy and the Viral Hepatitis Action Plan to reduce the number of new HIV and viral hepatitis infections. HHS is committed to supporting health departments and all of our partners in the field to conduct SSPs in a way that protects the lives and health of all those at risk for, and living with, HIV and viral hepatitis. In the weeks to come, HHS agencies will be offering additional information and technical assistance to federal grantees that may wish to use federal funds to support operational components of SSPs. Together, our actions will play an important role in preventing new infections among PWID.

View the SSP guidelines here [PDF 960 KB].

View The White House Fact Sheet: Obama Administration Announces Additional Actions to Address the Prescription Opioid Abuse and Heroin Epidemic here.