(David Hadorn)
Source: Associated Press
Pubdate: Mon, 20 Apr 1998


WASHINGTON (AP) -- Programs that let drug addicts exchange used needles for
clean ones fight AIDS and do not encourage illegal drug use, the Clinton
administration declared today -- but it will not allow federal tax dollars
to fund the programs.

The administration hopes that a strong endorsement will encourage
communities to start their own needle exchanges. But AIDS activists have
said that federal money -- so far banned -- is key, and they see the
decision, announced today by Health and Human Services Secretary Donna
Shalala, as a defeat.

``We have concluded that needle exchange programs, as part of a
comprehensive HIV prevention program, will decrease the transmission of HIV
and will not encourage the use of illegal drugs,'' Shalala said today.

But she said the program should be designed -- and funded -- by local
communities. Asked why a program could not be locally designed but
federally funded, she said: ``We had to make a choice. It was a decision.
It was a decision to leave it to local communities.''

An administration official, speaking on condition of anonymity, said the
decision to endorse the programs was based on science, but the decision not
to fund them came after consultations with the White House.

Shalala is telling state and local officials that to start a needle
exchange, the programs must be part of a comprehensive HIV prevention
strategy that includes referring participants to drug treatment and
counseling.  Also, needles must be made available only on a replacement

AIDS activists were stunned by the decision, questioning how federal public
health officials could say that needle exchanges work but then decline to
fund them.

``It's like saying the world is not flat but not funding Columbus'
voyage,'' said Daniel Zingale of the activist group AIDS Action.

``It's politics rather than public science,'' added Winnie Stachelberg of
the Human Rights Campaign. ``Local communities have been scraping together
programs for the last several years, but it's clear federal funds are

Needle exchange programs are one of the hottest topics in the AIDS crisis.
Half of all people who catch HIV are infected by dirty needles, sex with
injecting drug users or are children of infected addicts --  totaling 33
people every day, AIDS experts say.

Numerous scientific studies and public health groups have declared that
needle exchanges reduce that risk, and 88 needle exchanges operate around
the country with private, state or local funding.

But Congress had banned letting communities use federal tax dollars to pay
for needle exchanges until Shalala certified that scientific studies proved
they both reduced spread of the HIV virus and did not encourage drug use.

After a months-long review by her top scientific advisers, Shalala this
morning decided that needle exchanges are scientifically backed.

The scientific review found that the needle exchanges that work best are
part of a larger anti-HIV program that pushes addicts toward drug

Indeed, one study of a needle exchange in the Bronx, N.Y., found that
providing clean needles to heroin addicts in addition to offering them
methadone treatment both lowered the risk of HIV infection and lowered
their overall drug use.

But whether to allow federal funding was a politically charged question
that administration officials debated heavily over the weekend. Ultimately,
Shalala decided that whether to fund a needle exchange was up to each

The decision came after Republicans in Congress had threatened to ban
federal funding of needle exchanges altogether if Shalala did decide to
attempt it. And President Clinton's own drug policy chief, Barry McCaffery,
has vigorously fought that attempt, saying it would send the wrong message
to children.

``Such a program would in reality use tax dollars and the authority of the
federal government to push drug paraphernalia into already drug-ravaged
inner cities. This is reckless and irresponsible,'' Sen. Chuck Grassley,
R-Iowa, said in a weekend statement.

Public health experts directly dispute that: ``Does needle exchange promote
drug use? A preponderance of evidence shows either no change or decreased
drug use,'' an NIH consensus conference concluded 14 months ago, saying the
ban on funding for these programs will lead to ``many thousands of
unnecessary deaths.''

Shalala last year agreed that science proved that needle exchanges were
effective in fighting HIV, but said at that time that she needed to review
further data on how they affect drug use.