Syringe Services Programs

Preventing HIV and Hepatitis Among People Who Inject Drugs and Their Partners

The U.S. Department of Health and Human Services (HHS) is committed to working with grantees and partners to reduce the spread of HIV and viral hepatitis in the United States. The nation is experiencing a growing epidemic of illegal opioid drug use, which has also led to an increase in unsafe injection practices that put people who inject drugs (PWID) at risk of HIV and viral hepatitis.

One means of preventing transmission of these blood-borne infections is through reducing the sharing of needles, syringes, and other drug injection equipment by PWID.  Syringe services programs (SSPs) that allow PWID to exchange used syringes for sterile ones have been demonstrated to be an effective component of a comprehensive approach to prevent HIV and viral hepatitis among PWID, while not increasing drug use.

HHS Implementation Guidance to Support Certain Component of Syringe Services Programs (2016)

In March 2016, HHS issued guidance (PDF 976 KB) for HHS-funded programs regarding the use of federal funds to implement or expand syringe services programs (SSPs) for people who inject drugs. The guidance is the result of the bipartisan budget agreement that was signed into law in December 2015 which revised a previous Congressional ban on the use of federal funds for such programs and now allows communities with a demonstrated need to use federal funds for the operational components of syringe services programs.

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 and how those funds can be used.  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.

Agency-Specific Guidance

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:

• The CDC Program Guidance for Implementing Certain Components of Syringe Services Programs, 2016 (PDF 341 KB) provides specific procedures for CDC-funded grantees. The CDC guidance details which SSP activities can be supported with CDC funds, which relevant CDC cooperative agreements can be used to support SSPs, and the process by which CDC-funded programs may request to direct resources to implement new or expand existing SSPs for PWID.
• Health Resources & Services Administration-Specific Implementation Guidance to Support Certain Components of Syringe Services Programs, 2016 (PDF 329 KB)
• The Substance Abuse and Mental Health Services Administration (SAMHSA) issued separate SSP guidances for its Substance Abuse Prevention and Treatment Block Grants and its Minority HIV/AIDS Initiative (MAI) Programs grants:
  • SAMHSA-specific Guidance for States Requesting Use of Substance Abuse Prevention and Treatment Block Grant Funds to Implement SSPs (PDF 80 KB)
  • SAMHSA-specific Guidance for Minority HIV/AIDS Initiative (MAI) Programs Implementing SSPs (PDF 78 KB)

Key Resources About Using Federal Funds to Support SSPs

• CDC Webinar on Obtaining Approval for Use of Federal Funds for SSPs
  On April 27, 2016, CDC hosted a webinar to walk participants through the process of requesting a determination of need for syringe services programs (SSPs) in consultation with CDC. Participants received practical information and tips for preparing these requests as well as responses to their questions. If interested in requesting a CDC determination of need for SSPs within a jurisdiction, these webinar resources may be helpful to HIV, viral hepatitis, injury, and/or substance abuse prevention, surveillance, and program staff within health departments:
  • Presentation (PPT - 910KB) (PDF - 616KB)
  • Transcript (PDF - 116KB)
  • Audio (MP4-64MB)
• Read this related blog post by HHS’s Dr. Richard Wolitski
• Download the HHS guidance (PDF 976 KB)
• Download the HRSA guidance (PDF 324 KB)
• Read letters CDC sent to prevention colleagues (PDF 110 KB) and grantees (PDF 193 KB) announcing the release of the HHS SSP guidance
• Review this White House fact sheet on the opioid epidemic in the U.S.
• Read a statement by CDC’s Dr. Jonathan Mermin

Take a Closer Look

Below are further resources about SSPs in general:

• CDC – HIV and Injection Drug Use in the United States
• CDC – Syringe Services Programs: Assessing Local Drug Use
• CDC – Developing, Implementing, and Monitoring Programs
• CDC – Syringe Service Programs for Persons Who Inject Drugs in Urban, Suburban, and Rural Areas — United States, 2013 (MMWR December 11, 2015)
• CDC – Vital Signs: HIV and Trends in Injection Drug Use
• HHS – Opioids: The Prescription Drug and Heroin Overdose Epidemic
• HRSA – AETC: Syringe Services Programs (Needle Exchange)