Source: Newsday (NY) Pubdate: 24 Mar 1998 Contact: http://www.newsday.com Author: Robert Dawidoff Note: Robert Dawidoff is a professor of American history at Claremont Graduate University. NEEDLE EXCHANGES CAN SAVE LIVES IMAGINE IF YOU were the nation's top public health official and you could save thousands of lives and curb the spread of AIDS with your signature. That is the opportunity facing Secretary of Health and Human Services Donna Shallala. On April 1, she can authorize federal support for needle exchange programs for intravenous drug users and thereby significantly reduce the transmission of HIV. Intravenous drug users habitually share their hypodermic needles, exposing each other as well as their sexual partners and their offspring to the deadly disease. In an exchange program, addicts turn in their used dirty needles for clean ones. April 1 date is significant because federal legislation prohibiting federal support of needle exchange expires on March 31. If these programs can be shown to reduce the spread of AIDS without encouraging drug use, then HHS may proceed with the exchange. Needle exchange has been shown to meet these conditions. So what are public health officials waiting for? They must seize this chance to save American lives. Needle exchange is nobody's ideal solution to the problems of AIDS transmission or intravenous drug use. But there is no doubt that it works. According to studies of five New York City needle exchange programs, the HIV-infection rate was cut by two-thirds. The urgency and effectiveness of needle exchange have been endorsed by the president's own advisory council on AIDS, the American Medical Association, the National Academy of Sciences, the American Public Health Association, the National Commission on AIDS, the U.S. Conference of Mayors and the American Bar Asssociation, to name a few. Between 650,000 and 900,000 people in the United States are infected with HIV, and more than a million Americans inject illegal drugs. New medical therapies have reduced AIDS deaths significantly but have no impact on the rate of infection. There is a scientific consensus that clean needles and safer sex significantly reduce the rates. But the focus of public response has been on treatment, not prevention, as if these were competitive goals. The habitual sharing of needles spreads AIDS among users, their sexual partners and their babies. A large proportion of the estimated 6,000 cases of pediatric AIDS can be traced to shared needles. One third of all AIDS cases and more than half of those involving women result from injections of drugs or having sex with people who do. Fighting drug use is hard enough. When you add AIDS and its transmission, however, the public health system is overwhelmed. Needle exchange programs safely dispose of used needles. Most programs refer clients to HIV testing and counseling and drug treatment programs. A 1997 study, published in The Lancet (a British medical journal), estimated that needle exchange programs might have prevented between 4,400 and 9,700 HIV infections, which would have saved as much as half a billion dollars in health care expenditures. The same study estimated that needle exchange might prevent 11,300 more cases among drug injectors, their sexual partners and their children. It isn't hard to figure out why the government is not preparing the public to support needle exchange. Officials seem to have confused saving American lives with saving their own skins. It may well be that the political consequences of instituting needle exchange will be as contentious as the administration apparently fears. But politics as usual will not stop the AIDS plague. Courageous, professional and mature decisions about public health will. Surely we have learned something from the deadly results of government inaction during the first decade of the AIDS epidemic. An informed public must make it politically dangerous for the administration not to act on April 1 to save lives. Otherwise a missed opportunity will become a fatal April Fool's joke. Copyright 1998, Newsday Inc.