Source: San Jose Mercury News (CA)
Pubdate: Tue, 21 Apr 1998
Author: Richard A. Knox, Boston Globe


Scientific evidence ``clearly shows'' that providing free sterile syringes
to illicit drug users prevents the spread of AIDS but does not promote drug
use, the Clinton administration said Monday. But it balked at allowing
federal funds to pay for needle-exchange programs.

The long-awaited decision surprised and outraged AIDS activists and public
health authorities, who had hoped the administration would bow to data
rather than to politics.

``This is like refusing to throw a life raft to a drowning person,'' said
David Harvey of the AIDS Policy Center.

Dr. Mathilde Krim, chairman of the American Foundation for AIDS Research,
called the decision ``immoral and unethical'' and ``totally contrary to the
practice of public health.''

Critics of needle exchanges claimed victory. ``Supplying drug addicts with
needles is counterproductive and sends entirely the wrong message,'' said
Rep. Gerald Solomon, R-N.Y., who proposes to take away presidential
discretion about funding such programs.

The split decision reflected a battle within the administration between
health officials and General Barry McCaffrey, director of the White House
Office on Drug Policy, who opposes needle exchange.

U.S. Surgeon General David Satcher, former chief of the Centers for Disease
Control and Prevention, favors more needle exchange programs. ``If we had
more prime quality needle exchange programs, we would save more lives,''
Satcher said at a press briefing.

In certifying the effectiveness of needle-exchange programs, the
administration noted that more than 60 percent of new AIDS cases in many
regions are due to drug users sharing needles. Needle-sharing also transmits
hepatitis B and other blood-borne diseases.

Proven effectiveness

Nine years ago, Congress passed a law that bars federal funding of needle
exchange programs unless the secretary of health and human services
certifies, on the basis of scientific evidence, that they curtail
transmission of the human immunodeficiency virus that causes AIDS, and do
not increase illicit drug use.

Secretary Donna Shalala, the nation's top health official, declared that a
``meticulous scientific review has now proven that needle exchange programs
can reduce the transmission of HIV and save lives without losing ground in
the battle against illegal drugs.''

And Dr. Harold Varmus, director of the National Institutes of Health, backed
her up. ``Recent findings have strengthened the scientific evidence that
needle exchange programs do not encourage the use of illegal drugs,'' Varmus

But Shalala said the Clinton administration has decided that ``the best
course at this time'' is to let local communities ``use their own dollars''
for needle exchange programs.

The nation currently has about 110 needle exchange programs, about half of
which are sanctioned. The rest are tolerated by law enforcement authorities
or operate underground. But all are relatively small-scale, advocates said.
Active needle exchange programs in the Bay Area include operations in
Berkeley, San Francisco and Santa Cruz.

Programs endorsed

Needle exchange programs have been endorsed by a wide array of medical and
public health organizations, including the American Medical Association and
the American Public Health Association.

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 seemed to please few.

Some observers of the long-running debate say the administration's decision
represents a victory of election-year politics over public health.

``It's probably very smart politics to continue the restrictions on federal
funds,'' said Donald DesJarlais, director of chemical dependency research at
Beth Israel Medical Center in New York City.

``If Shalala had permitted the use of federal funds, there's a 99 percent
chance Congress would have overridden it anyway,'' he said. ``Now the
secretary of health and human services has made a scientific finding, but no
one can get up and say Clinton tried to give needles to drug addicts.''

Uproar predicted

While he was ``personally disappointed'' about the administration's decision
to withhold federal funds, DesJarlais said its unequivocal statement about
needle-exchange studies ``will be very helpful for local decision makers who
want to make their prevention planning on scientific evidence.''

Krim, a longtime veteran of emotional battles over AIDS funding, predicted
``an uproar in the AIDS community,'' but said that was a calculated strategy
on the administration's part.

``I think Mr. Clinton decided to let the Congress handle it,'' Krim said.
``He will let the activists go after Congress.''

State health officials said the administration's stance will not affect
needle exchange programs already in operation, and may make it somewhat
easier to expand them because of the explicit federal endorsement.

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 that are supported by state,
local or private funds.

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 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