Source: Los Angeles Times (CA)
Contact:  213-237-4712
Pubdate: April 21, 1998
Author: Marlene Cimons, Elizabeth Shogren, Times Staff Writers


Administration agrees exchange program cuts AIDS spread, doesn't foster
illicit drug use, but will leave financing to state,   local groups.

WASHINGTON--The Clinton administration declared Monday that needle exchange
programs reduce the spread of AIDS and do not encourage illegal drug
use--but it will continue to oppose federal funding for this approach, a
decision that provoked anger on both sides of the long-raging debate.

Health and Human Services Secretary Donna Shalala said that, although the
administration has concluded that it is best to leave the funding of such
programs to state and local sources, she encouraged communities to include
needle exchanges as part of their AIDS prevention strategies.

But many AIDS service organizations were stunned by the administration's
announcement, given that half of all new HIV infections are linked to
needle-injected drug use, according to federal health officials.

"This is like acknowledging the world is not flat, then refusing to fund
Columbus' voyage," said Daniel Zingale, executive director of AIDS Action
Council, a Washington-based lobbying group. Congressional conservatives,
meanwhile, expressed chagrin over the administration's ringing endorsement
of needle exchange programs. Sen. John Ashcroft (R-Mo.) said that the
administration's expression of support "accepts and encourages drug use as
a way of life." He also expressed concern that "it opens the door" to
future federal funding of needle exchange programs.

Numerous studies have shown the efficacy of such programs but the subject
of government-backed needle exchanges has remained a politically volatile
one. Not only have conservatives adamantly opposed such programs but
President Clinton's own advisors have argued heatedly over whether to
support them. Barry R. McCaffrey, director of the White House office of
drug control policy, for example, has insisted that such programs send the
wrong message about drug use.

The administration's announcement Monday was reminiscent of Clinton's past
approaches to some hot-button issues--gays in the military, for
example--where he has attempted to strike a middle ground that pleased few.

Federal funding of needle exchange programs was banned by Congress in 1988
but the secretary of Health and Human Services has the authority to remove
the ban. Many public health officials, AIDS activists and others--including
Clinton's own AIDS advisory panel--have called on her repeatedly to do so.

Armed with new scientific findings by high-ranking administration health
officials showing that the programs help reduce HIV transmission, Shalala
was willing to defend funding the programs before lawmakers on Capitol
Hill, sources said.

But White House officials said they doubted they could win such a fight
with the GOP-controlled Congress and were afraid that the battle would
dampen state and local efforts to establish or sustain the programs.

Funding efforts "would have been voted down immediately and you would have
scared off the local people," White House advisor Rahm Emanuel said.
Ultimately, Clinton decided that it was not worth the fight with Congress,
sources said.

Referring to the politics surrounding the issue, Emanuel said: "You've got
to see three, four or five moves down the checkerboard." And Clinton, by
endorsing the concept that needle exchanges help reduce HIV transmission,
hopes to boost local efforts to fund needle exchanges, he said.

But AIDS activists predicted that it would have the opposite effect, saying
they feared local programs now will founder without federal help.

Monday's decision "has the potential to do damage to the funding that
exists today," said James Loyce Jr., chief executive officer of AIDS
Project/Los Angeles. "The funding is barely there now. The local
governments, such as [the city of] Los Angeles . . . that have taken
[needle exchanges] on have already taken a big risk--this will only
undermine the advocacy that's already been done on the local level."

Shalala noted that the use of needle exchange programs has increased
throughout the AIDS epidemic. Citing figures from the federal Centers for
Disease Control and Prevention, she said communities in 28 states and one
U.S. territory operate needle exchange programs supported by state, local
or private funds. In Los Angeles, three organizations run needle exchange
programs at multiple sites throughout the region. They are funded in part
by a $180,000 grant from the city, according to AIDS Project/Los Angeles.

Shalala said the administration decided "that the best course at this time"
is to leave the creation and funding of needle exchange programs to
communities and "to communicate what has been learned from the science so
that communities can construct the most successful programs possible to
reduce the transmission of HIV." She said the programs should be part of a
comprehensive HIV prevention strategy that includes referring participants
to drug treatment and counseling and that needles must be made available
only on a replacement basis.

Rep. Nancy Pelosi (D-San Francisco), a longtime advocate of needle exchange
programs, said the administration's stance "shows a lack of political will
in the midst of a public health emergency." And Rep. Henry A. Waxman (D-Los
Angeles) said: "It is unfortunate that fear of congressional backlash
sustains the funding freeze." But Rep. Gerald B. H. Solomon (R-N.Y.), in a
letter sent Monday to Clinton, condemned the administration's "seemingly
continued support for such programs" and urged administration support "in
pursuing a permanent ban on the use of federal tax dollars for needle
exchange programs."

Times staff writer Alissa J. Rubin contributed to this story.

* * *

Needle Swaps Los Angeles and San Francisco are among major cities that
offer legally sanctioned needle exchange programs. But many cities still
don't. Half of all new HIV infections are associated with needle

Miami St. Louis Newark, N.J. New Orleans

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