Kaiser Family Foundation Study Examines Impact of California Law Authorizing Syringe-Exchange Programs
A new study released by the Kaiser Family Foundation examines the impact in six California communities of AB 136, a state law authorizing local governments to legalize syringe-exchange programs if they declare a public health emergency because of a high HIV infection rate. Five California communities -- Alameda, Los Angeles, Sacramento, Santa Barbara and Santa Clara counties -- have used the law to implement SEPs. San Diego considered implementing an SEP, but later reneged on the proposal. According to the study, " Syringe Exchange and AB 136: The Dynamics of Local Consideration in Six California Communities," California provides "an important window for assessing" the impact of the programs because of its high AIDS caseload and because injection drug use is the second largest risk factor for HIV in the state. Researchers interviewed "key stakeholders" -- including public health officers, law enforcement officials, SEP staff and SEP advocates -- in the six jurisdictions and conducted a statewide survey of local health officers in conjunction with the California Conference of Local Health Officers. The study examined seven key areas: status of SEPS before and after the passage of AB 136 in 1999; status of local declarations of emergency; effects of the law on views about SEPs; the perceived role of "various stakeholders" in the debate over whether to declare a local emergency; the role of the law in "facilitating or hindering" discussions about implementing SEPs; perceived benefits and limitations of the law; and perspective on the need for technical and other assistance in formulating a response to the law.
AB 136 "has played a limited, albeit important role in responding to the HIV epidemic" among injection drug users in California, according to the study. Respondents were "nearly unanimous" in the belief that the law "facilitated local consideration of syringe-exchange programs." However, they said that the law "did not settle ongoing debates in many communities" and did not "appear to change fundamental attitudes of support or opposition to SEPs generally." AB 136 did, however, "change the dynamics" of community discussions about SEPs by "generat[ing] new or renewed political support and advocacy to establish legal SEPs," and "improv[ing] opportunities for SEP funding." The law, which took effect in January 2000, also "increased legitimacy of SEPs" and "expanded collaboration between public health, SEP and other service providers." Only five of the six communities issued emergency declarations, but those that did "generally did so with strong support from a variety of stakeholders." Failure to win support from law enforcement groups and local officials were cited as two of the main reasons for failure to issue an emergency declaration.
Participants identified two major limitations of the law -- the need to declare and the "perceived need to renew a local emergency every 14 to 21 days," and the fact that the law does not "protect clients of AB 136-sanctioned SEPs from state laws prohibiting the possession of needles and syringes." Other concerns included a lack of resources and "increased politicization of program design due to government involvement." Survey participants also requested more technical assistance, including more information about SEPs in general, their status in other California communities and how to go about authorizing a local emergency declaration.
The study lists several recommendations made by survey respondents, including reconsideration of the clause that makes it necessary to continually renew the emergency declaration and of the law that penalizes people for having needles and syringes, even if they were obtained through an AB 136-authorized SEP. They also recommend improving education efforts and technical assistance with implementation. Overall, the study "indicates that AB 136 was both symbolically and practically significant," and the law "provided new opportunities for local communities to initiate and increase their dialogue about syringe access and to implement such programs," the study states. However, the law "did not settle the ongoing debate over syringe-exchange programs in many communities, indicating a need for continued dialogue and information sharing," it adds. "Taken together, the findings from this study offer important lessons to national, state and local policymakers, public health officials and communities considering options for reducing HIV infections in their communities," the report concludes (Collins et al., "Syringe Exchange and AB 136: The Dynamics of Local Consideration in Six California Communities" executive summary, February 2002). The full report is available online.