The Final Report Summaries listed below were selected from hundreds of reports submitted to Professor Coplin at the Maxwell School of Syracuse University. These summaries illustrate the range of societal problems and policies that students prepared based on all the work required for the course. The reports have been edited for grammar and word selection, but the basic content has not been changed. To some extent and in varying degrees these summaries may be viewed as exemplars of final summary papers, but we expect that each year the level of accomplishment will improve. They are provided to future students so they can understand the variety of topics and the kind of research that is required to produce outstanding work in PAF 101. The students who have authored these papers along with the high school and name of the teachers are provided in the text that follows the list.
TO: Nick Pirro
Onondaga County Executive
From: Ryan Gerecht, EMT-D
Policy: Implement a Syringe Exchange Program in Onondaga County
Problem
The Onondaga County Health Assessment published in 1998 reports that the total
number of AIDS cases reported each year among residents of Onondaga County
has consistently increased from 108 in 1990 to 755 in 1997. Of these cases
the Health Department estimates that nearly 40% are a result of intravenous
drug users sharing contaminated syringes. Sharing contaminated or "dirty" syringes
results in the transmission of HIV through small drops of blood and body
fluid that remain inside the catheter of the syringe after injection. To
date the Centers for Disease Control and Prevention reports that there is
no cure for the disease resulting in a 100% mortality rate for those infected.
Proposed Policy
Since 1992, free and anonymous syringe exchange programs (SEPs) have been legal
in the state of New York. Since that time seven New York cities or
boroughs have established at least one SEP, each with great success. I
propose that the Onondaga County Health Department establish a SEP that would
provide sterile syringes and other necessary sterile injection accessories,
in accordance with the already established New York State Department of Health
guidelines governing SEPs.
Feasibility
The biggest obstacle against implementation of this policy is the initial cost
of setting up the program. The NYS Health Department and the NYS AIDS Institute
require that the organization setting up the SEP finance the initial program
setup. In addition, the SEP must receive state authorization prior to obtaining
the state and federal funds allocated for SEP operations. Setup costs include
acquiring a building, initial acquisition of syringes and accessories, initial
purchase of office supplies, and the initial hiring of SEP staff. Upon
inspection and approval by the AIDS Institute and the state health commissioner,
state and federal funds cover all of the aforementioned costs accept building
maintenance and utility costs. Despite this obstacle SEPs have proven to
be extremely cost-effective. It has been shown by the Centers for Disease
Control and Prevention that the cost per HIV infection prevented by SEPs
is between $4000 and $12000 which is considerably less than the estimated
$190,000 spent in the medical costs of treating a single person infected
with HIV. Despite the benefits of this policy, the financial
pressure on the county budget would create substantial, if not overwhelming,
political opposition to the policy.
Benchmarks
National researchers at both the Centers for Disease Control and the University
of California have shown SEP's to reduce HIV infection rates by nearly 50%.
In addition, researchers at the Chemical Dependency Institute of Beth Israel
Medical Center in New York City have recently reported that the rate of HIV
infection in New York State among intravenous drug users enrolled in syringe
exchange programs has also been reduced by 50%. Based on these statistics
and the fact that the HIV virus has an incubation period of 2 months to 10
years or longer, I would set benchmarks at 5, 10, and 15 years from the date
of SEP opening. Assuming implementation of this policy in 2005, the percentage
of HIV infections that are a result of IV drug use will decrease to 28% in
2012, 14% in 2017, and 7% in 2022. This 7% annual HIV infection rate as a
result of IV drug use is consistent with the data reported by the directors
of other New York State SEPs such as Steven Price of AIDS Rochester.