Source: Dallas Morning News Contact: http://www.dallasnews.com Pubdate: Wed, 22 Apr 1998 Needle Exchange AIDS PREVENTION EFFORTS SHOULD INCLUDE SYRINGE PROGRAMS Oh, those radicals at the American Medical Association. They endorse needle exchange programs as one element of a comprehensive AIDS prevention strategy. They also support less controversial measures such as expanded drug treatment programs and improved care for HIV-positive infants and children. Their position isn't radical; it's common sense. AIDS endangers drug users and non-users alike. About 40 percent of HIV infections now occur among intravenous drug addicts - who have used dirty needles - and their intimate companions. Nevertheless, the Clinton White House, fearing a conservative backlash, refuses to allow any federal money to support needle exchange programs. Health and Human Services Secretary Donna Shalala reaffirmed the administration's position Monday. That decision sacrifices public health on the altar of political expedience. Many Americans believe that needle exchange programs are futile at best and unethical at worst. Critics feel the programs encourage illegal drug use, and public money shouldn't underwrite illegal behavior. Public health workers face a different ethical dilemma. Their duty is to prevent disease and to protect and improve the overall health of a community. To them, it is unethical not to marshal all effective voluntary strategies to slow the spread of AIDS. Those real concerns about public health should give critics pause. No one wants to encourage drug use; it is harmful even without the threat of AIDS. But there is little or no evidence that needle exchanges and the distribution of bleach sterilization kits increase intravenous drug use. And strong evidence shows that such programs, when carefully designed, can decrease transmission of HIV. Needle exchange programs also can serve as a doorway into rehabilitation. The best programs encourage addicts to seek drug treatment and view needle exchanges as a way to keep drug users HIV-negative until scarce treatment slots are available. If President Clinton and Congress really want to halt the spread of AIDS, they should allow health workers to incorporate needle exchanges into publicly funded AIDS prevention programs.