(David Hadorn) Source: Associated Press Pubdate: Mon, 20 Apr 1998 U.S. WON'T FUND NEEDLE EXCHANGES 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 basis. 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 needed.'' 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 treatment. 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 community. 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.