Source: San Diego Union Tribune (CA)
Pubdate: Tue, 21 Apr 1998
Author: Sheryl Gay Stolberg - New York Times News Service


Ban to stay despite reports of reducing the spread of AIDS

WASHINGTON -- After a bitter internal debate, the Clinton administration
yesterday declined to lift a 9-year-old ban on federal funding for programs
to distribute clean needles to drug addicts, even as the government's top
scientists certified that such programs do not encourage drug abuse and can
save lives by reducing the spread of AIDS.

The decision, announced by Donna Shalala, the secretary of health and human
services, immediately was denounced by public-health experts and advocates
for people with AIDS, who had been told in recent days that the ban was
about to be lifted.

"At best this is hypocrisy," said Dr. Scott Hitt, chairman of the
President's Advisory Council on HIV and AIDS. "At worst, it's a lie. And no
matter what, it's immoral."

The decision came after a week of negotiations between Shalala's staff and
the White House, according to two administration officials familiar with
the talks. Shalala had been pressing to rescind the ban, with some
restrictions, and was prepared to defend that decision on Capitol Hill,
knowing it was bound to be controversial.

But the president's policy advisers feared Republicans might push through
legislation that would strip federal money from organizations that provide
free needles, even though the money was used for other purposes. Late
Sunday night, Clinton decided to instruct Shalala to announce that federal
funds would not be released, despite the scientific evidence that
needle-exchange programs help prevent the spread of HIV.

"Any Republican could have offered a resolution, and we almost certainly
would have lost," said one of the officials, both of whom spoke on
condition they not be identified. "We don't have the votes for this in an
election year."

To further complicate matters, Gen. Barry McCaffrey, the retired Army
officer who is the administration's director of national drug policy, has
been fighting to retain the ban.

Sandra Thurman, the White House director of national AIDS policy, has
argued strenuously that it should be lifted. But McCaffrey argued such a
move would send the wrong message to children -- a position that another
official said was "an important consideration" for Clinton.

The ban dates back to 1989, when Congress declared that no federal money
could be spent to support clean-needle programs until the government could
provide scientific evidence that such programs both reduced the spread of
HIV, the virus that causes AIDS, and did not encourage drug use.

The administration offered that scientific evidence yesterday for the first
time. With the evidence in hand, the administration was free to begin
drafting guidelines for how federal money could be spent for
needle-exchange programs. Although Shalala's staff had come up with such
guidelines, the president declined to endorse them, officials said.

In effect, the decision means state and local governments, which receive
block grants from Washington for AIDS prevention efforts, still are barred
from using that money for needle exchange.

As the debate has continued, needle-exchange programs have cropped up
across the United States. There are about 100 programs in 20 states, many
operating on a shoestring budget, with private or local funds.

In many states, including California, needle exchange remains illegal, but
law-enforcement officers look the other way and allow the programs to
continue. Public-health experts had been hoping a release of federal funds
would legitimize these programs.

"There are states that for years have hidden behind federal opposition to
needle exchange to justify their own inaction," said Dr. Peter Lurie, who
in 1993, while teaching at the University of California San Francisco,
published the first government-financed survey of the effectiveness of
needle-exchange programs. Yesterday's decision, he said, means state and
local officials will have to "push forward for needle exchange even in the
face of the federal government's cowardice."

Federal officials have estimated that every day 33 people become infected
with the AIDS virus as a result of intravenous drug use, a figure that
includes drug abusers themselves, as well as their partners and children.
Intravenous drug use is also responsible for most of the increase in AIDS,
particularly among the poor and minorities.

Dr. David Satcher, the surgeon general, said yesterday that 40 percent of
all new AIDS infections in the United States are either directly or
indirectly attributed to infection by contaminated needles; among women and
children, the figure is 75 percent.

The decision clearly made the government's top scientists uncomfortable. At
the press conference announcing it, Shalala was accompanied by a phalanx of
them, including Satcher and Dr. Harold Varmus, director of the National
Institutes of Health, as well as two institute directors and two officials
from the Centers for Disease Control and Prevention in Atlanta.

Most shifted uncomfortably in their seats as reporters peppered Shalala
with questions about the administration's decision, although none publicly
disagreed with it.

Shalala declined to discuss the internal debate between her office and the
White House -- or even her own recommendations to the president -but said
the administration hoped its pronouncement would spur state and local
governments to pay for the programs on their own. In defending the decision
not to release federal funds, she said studies show that needle-exchange
programs work best when they are carefully designed within local

"We are sending the message that the senior scientists of this government,
in conjunction with a number of scientists around the world," have
concluded that "these needle-exchange programs do in fact work in reducing
HIV transmission and do not encourage drug use," she said.

Indeed, while critics have complained that the programs promote drug abuse,
Varmus said yesterday that is clearly not the case. An extensive review of
the scientific literature, Varmus said, provided "increasingly strong
evidence" that needle-exchange programs can be an effective means of
bringing addicts in for treatment.

He cited a Baltimore study of nearly 3,000 addicts, which found that the
needle-exchange program dramatically reduced the sharing of tainted
needles, and that half the participants in the program entered treatment.

Copyright 1998 Union-Tribune Publishing Co.