In 1988, Congress passed an omnibus bill that included a federal funding ban on needle exchange programs. This ban continued despite scientific reports demonstrating the effectiveness of such programs in preventing HIV and hepatitis infections among intravenous drug users. President Obama repealed the ban in 2009 only to have Congress reinstate it in 2012. About 200 programs across the U.S. exist through a combination of local, state, and private funding.

A recent HIV outbreak in Indiana has highlighted the need for needle exchange. Last year, rural Scott County experienced a sudden increase in HIV infections that reached a peak of 184 new cases. Republican Governor Mike Pence, a vocal opponent of needle exchange, declared a state of emergency and approved a temporary program to combat the outbreak. Health officials criticized the response, pointing to the Governor's delay in waiting until the spread of HIV had reached epidemic proportions and his eventual legislation that limited needle exchange to treating emergencies rather than preventing outbreaks.

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