Pubdate: Sun, 27 Feb 2005
Source: Washington Post (DC)
Page: B06
Copyright: 2005 The Washington Post Company
Bookmark: (Needle Exchange)


THE BUSH administration is quietly extending a policy that undermines the 
global battle against AIDS. It is being pushed in this direction by 
Congress, notably by Rep. Mark Edward Souder (R-Ind.). But some 
administration officials zealously defend this policy error, claiming 
scientific evidence that doesn't exist.

The administration's error is to oppose the distribution of uncontaminated 
needles to drug addicts.

A large body of scientific evidence suggests that the free provision of 
clean needles curbs the spread of AIDS among drug users without increasing 
rates of addiction.

Given that addicts are at the center of many of the AIDS epidemics in 
Eastern Europe and Asia, ignoring this science could cost millions of lives.

In Russia, as of 2004, 80 percent of all HIV cases involved drug injectors, 
and many of these infections occurred because addicts share contaminated 

In Malaysia, China, Vietnam and Ukraine, drug injectors also account for 
more than half of all HIV cases.

Once a critical mass of drug users carries the virus, the epidemic spreads 
via unprotected sex to non-drug users.

The administration claims that the evidence for the effectiveness of needle 
exchange is shaky.

An official who requested anonymity directed us to a number of researchers 
who have allegedly cast doubt on the pro-exchange consensus. One of them is 
Steffanie A. Strathdee of the University of California at San Diego; when 
we contacted her, she responded that her research "supports the expansion 
of needle exchange programs, not the opposite." Another researcher cited by 
the administration is Martin T. Schechter of the University of British 
Columbia; he wrote us that "Our research here in Vancouver has been 
repeatedly used to cast doubt on needle exchange programs. I believe this 
is a clear misinterpretation of the facts." Yet a third researcher cited by 
the administration is Julie Bruneau at the University of Montreal; she told 
us that "in the vast majority of cases needle exchange programs drive HIV 
incidence lower." We asked Dr. Bruneau whether she favored needle exchanges 
in countries such as Russia or Thailand. "Yes, sure," she responded.

The Bush administration attempted to bolster its case by providing us with 
three scientific articles.

One, which has yet to be published in a peer-reviewed journal, was produced 
by an author unknown to leading experts in this field who is affiliated 
with a group called the Children's AIDS Fund. This group is more renowned 
for its ties to the Bush administration than for its public health rigor: 
As the Post's David Brown has reported, it recently received an 
administration grant despite the fact that an expert panel had deemed its 
application "not suitable for funding." The two other articles supplied by 
the administration had been published in the American Journal of Public 
Health. Although each raised questions about the certainty with which 
needle-exchange advocates state their case, neither opposed such programs.

Evidence that the administration does not cite leaves little doubt about 
the case for needle exchange.

A study of 81 cities published in 1997 in the Lancet, a medical journal, 
found that in cities without needle-exchange programs, HIV infection rates 
among injection drug users rose by nearly 6 percent per year; by contrast, 
cities that had introduced free-needle programs witnessed a decrease in 
infection rates of about the same magnitude. Elias A. Zerhouni, the 
director of the National Institutes of Health, wrote last year that 
exchange programs "can be an effective component of a comprehensive 
community-based HIV prevention effort," and a World Health Organization 
technical paper agreed that the provision of clean needles and syringes 
should be "a fundamental component of any comprehensive and effective 
HIV-prevention programme." Addressing legitimate methodological questions 
about the research favoring needle exchange, the WHO reasonably concluded 
that incomplete scientific evidence does not confer the freedom to ignore 
the knowledge we do have.

Respecting science does not appear to be the administration's priority, 
however. Not only is it refusing to spend federal dollars on needle 
exchange, but the administration also is waging a campaign to persuade the 
United Nations to toe its misguided line. The U.N. Office on Drugs and 
Crime, which is heavily reliant on U.S. funding, has been made to expunge 
references to needle exchange from its literature, and the administration 
is expected to continue its pressure on the United Nations at a meeting 
that starts March 7. The State Department's new leadership needs to end 
this bullying flat-earthism. It won't help President Bush's current effort 
to relaunch his image among allies.

And it's almost certain to kill people. 
- ---
MAP posted-by: Richard Lake