30-07-2025
New Executive Order Could Thwart Efforts To End HIV
Harm reduction initiatives, like syringe services programs, can reduce HIV transmission among people ... More who inject drugs. A recent executive order threatens such programs. (Photo by)
A recent executive order could hinder public health efforts designed to prevent new HIV infections. The EO largely focuses on people experiencing housing insecurities. But it also calls into question the value of harm reduction programs developed to help people who inject drugs. Public health experts argue that such services, like needle exchange programs, are effective. Moreover, these experts fear that the proposed changes could hinder efforts to combat HIV.
The executive order, signed by President Trump on July 24, 2025, states that the secretary of Health and Human Services shall ensure that grants, 'for substance use disorder prevention, treatment, and recovery fund evidence-based programs and do not fund programs that fail to achieve adequate outcomes, including so-called 'harm reduction' or 'safe consumption' efforts that only facilitate illegal drug use and its attendant harm.'
Harm reduction strategies are evidence-based. They do not facilitate illegal drug use. They do save lives.
Harm Reduction Strategies
The idea behind harm reduction is simple. People engage in dangerous activities. Harm reduction strategies minimize the risks. Think about the seatbelts in your car. They reduce car crash fatalities and make driving safer.
Syringe services programs work in the same manner. By ensuring that people who inject drugs have access to clean needles, SSPs make the act of injecting drugs less dangerous. They reduce overdose deaths. They help people get into treatment programs. And they decrease the transmission of HIV.
Injection Drug Use And HIV
The link between injection drug use and HIV transmission was clearly and tragically evident in Indiana over a decade ago. During a one-year period, 181 new HIV infections were confirmed, mostly in Scott County. Almost 90% of those new infections occurred in people who injected drugs. In March 2015, then-governor Mike Pence declared a public health emergency and authorized a short-term needle exchange program to help quell the outbreak. Combined with other public health efforts, this clean needle initiative caused the outbreak to subside. A subsequent modelling study, however, indicated that an earlier response could have prevented even more infections.
The events that occurred in Scott County, Indiana easily could occur elsewhere. Indeed, researchers have identified 220 counties in the U.S. at risk for HIV or hepatitis C outbreaks among people who inject drugs. A vast majority of the identified counties are rural. Many of them are in Appalachia. Robust harm reduction programs in these areas are needed to help prevent future outbreaks.
Public Health Effects Of Executive Order
When asked about the new executive order, Erin Shoe, public health director at Cabarrus Health Alliance in North Carolina said, 'We know, from firsthand experience, that access to mental health and harm reduction programs and resources save lives. Cabarrus Health Alliance staff are reviewing and interpreting the executive order while we await further guidance from relevant federal agencies. We stand ready to navigate changes to harm reduction programs to ensure those who have needs can access resources in a timely and safe manner.'
According to Dr. Elyse Powell, executive director at North Carolina Harm Reduction Coalition, 'Harm reduction works. It's one of the best tools we have to stop the spread of HIV. People who engage in services are five times more likely to enter treatment and three times more likely to completely stop drug use.'
Erin Major, a PhD candidate in the Health Law, Policy & Management Department at Boston University expressed similar thoughts. 'It's been shown time and time again that harm reduction is effective in terms of reducing not only overdose deaths, but also disease spread. Needle exchange programs can be effective ways to reduce the transmission of HIV. And harm reduction programs can increase treatment engagement,' she said.
These experts also noted the financial benefits of harm reduction strategies. 'This approach isn't just dangerous, it's extremely expensive,' noted Dr. Powell. 'Hepatitis C costs over $25,000 to treat. HIV has lifetime health costs that can total over $420,000. Harm reduction prevents the spread of these illnesses for pennies on the dollar.' Ms. Major agreed, commenting that, 'Preventing an HIV outbreak is much more cost effective than treating people after an outbreak has occurred.'
About 32,000 new HIV infections occurred in the United States in 2022. Approximately 7% of those infections occurred in people who inject drugs. We know that harm reduction strategies like syringe services programs can reduce this number. We also know that these strategies are cost effective. This executive order, however, stands in contrast to the existing evidence. Dr. Powell from NCHRC put it best, commenting that, 'Cutting funding means we'll be fighting this epidemic without one of the best tools in our toolbox.' That shouldn't be acceptable. If we hope to end HIV as a public health emergency in this country, then we need to employ all our resources.
