President Bush last week signed a $555 billion fiscal year 2008 omnibus spending bill (HR 2764) that effectively lifts a ban on city funding for needle-exchange programs in Washington, D.C., the New York Times reports. Since 1999, the district has been the only U.S. city barred by federal law from using local funds for needle-exchange programs. A report released last month by district health officials found that injection drug use was the second most common cause of HIV transmission in the city (Urbina, New York Times, 12/27/07).

Mayor Adrian Fenty in a recent statement said the city plans to include needle exchanges in a larger program to reduce the spread of HIV/AIDS. About $1 million in city funds will be allocated for needle-exchange programs in 2008. District City Council member Jim Graham said a city-funded needle-exchange program will have a significant impact on the city's high rate of HIV/AIDS. He added, "This program will save lives" (Manning, AP/Google.com, 12/27/07).

Rep. Jose Serrano (D-N.Y.), chair of the House Subcommittee on Financial Services and General Government, said, "For too long, Congress has unfairly imposed on the citizens of D.C. by trying out their social experiments there." He added, "The ban on needle exchanges was one of the most egregious of these impositions, especially because the consensus is clear that these programs save lives" (New York Times, 12/27/07).

Omnibus Provisions
The omnibus bill signed by Bush, which combined 11 unfinished spending measures, will fund the Department of State, USAID, and other global health and international aid programs. It also affects the Millennium Challenge Corporation, which aims to encourage economic and political reforms in developing countries. The measure provides $6.5 billion for U.S. and global health activities, including emergency spending, which is $1.4 billion more than was allocated in 2007 and $796 million more than Bush's request, according to the House Appropriations Committee.

Five billion dollars in foreign operations spending will go to the President's Emergency Plan for AIDS Relief -- at least $1.2 billion more than the program received last year. The measure also includes a provision that would allow overseas HIV/AIDS programs relief from abstinence-education mandates. By law, at least one-third of HIV prevention funds that focus countries receive through PEPFAR must be used for abstinence-until-marriage programs.

Under the bill, the Global Fund to Fight AIDS, Tuberculosis and Malaria will receive about $841 million. The amount includes $546 million in the State-Foreign Operations section and $295 million in the Labor-HHS-Education section of the bill. Bush had requested $300 million for the Global Fund, all of which was allocated in the Labor-HHS bill.

In addition, the measure provides $1.8 billion for global health and child survival programs, including $347 million for HIV/AIDS programs. Funding for maternal and child health programs will increase by $101 million, and malaria and TB funding will increase by $101 million and $72 million, respectively. The measure will reduce funding for MCC to $1.54 billion -- about half of Bush's requested $3 billion. A proposal to change the way MCC funding is dispersed was dropped.

The measure also will increase funding for AIDS Drug Assistance Programs -- federal- and state-funded programs that provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals -- by $19 million to $809 million (Kaiser Daily HIV/AIDS Report, 12/19/07).

Related Editorials

• New York Times: Congress and Bush have "done the right thing" by lifting the ban against city funding for needle-exchange programs in the district, but an "even broader more damaging law" that prohibits federal funds for such programs in the U.S. and abroad "must also be rescinded," a Times editorial says. According to the Times, the "most important medical and public health organizations" in the U.S. endorsed needle-exchange programs more than 10 years ago, and the programs have proven to be "highly successful" worldwide. The law prohibiting the use of federal funds for these "crucial" programs has "hobbled" HIV/AIDS prevention efforts in the U.S. and abroad. Health organizations that use U.S. tax dollars "should be encouraged rather than blocked from developing" needle-exchange programs, the editorial says, concluding, "Eliminating the federal ban would save many thousands of lives every year" (New York Times, 12/28/07).

• Pittsburgh Post-Gazette: The "change in the law" regarding funding for needle-exchange programs in the district "owes more to a change in the leadership of Congress" than to the "grim facts" about the city's HIV/AIDS rate, a Post-Gazette editorial says. Because "Democrats were prepared to face reality at the intersection of compassion and common sense," Bush was "sent a budget bill that allowed the district to use its own funds for needle-exchange programs," the editorial says, adding that to "his credit," Bush signed the bill into law. "The Democratic-controlled Congress can't claim a long list of great achievements since taking up the reins of power, but little things can make a big difference," the Post-Gazette says, concluding, "This was one. A blow was struck for good sense in a matter of life and death" (Pittsburgh Post-Gazette, 12/31/07).

NPR's "Morning Edition" on Thursday reported on needle exchange programs in the district (Inskeep, "Morning Edition," NPR, 12/27/2007). Audio and a partial transcript of the segment are available online.

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