Source: Newsday (NY)
Pubdate: 24 Mar 1998
Author: Robert Dawidoff
Note: Robert Dawidoff is a professor of American history at Claremont
Graduate University.


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

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

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.