Pubdate: Thu, 23 Apr 1998 Source: Houston Chronicle (TX) Contact: http://www.chron.com/ Author: James L. Curtis NO DEFENSIBLE CASE FOR NEEDLE-EXCHANGE PROGRAMS DONNA Shalala, the secretary of health and human services, wanted it both ways this week. She announced that federal money would not be used for programs that distribute clean needles to addicts. But she offered only a halfhearted defense of that decision, even stating that while the Clinton administration would not finance such programs, it supported them in theory. Shalala should have defended the administration's decision vigorously. Instead, she chose to placate AIDS activists, who insist that giving free needles to addicts is a cheap and easy way to prevent HIV infection. This is simplistic nonsense that stands common sense on its head. For the past 10 years, as a black psychiatrist specializing in addiction, I have warned about the dangers of needle-exchange policies, which hurt not only individual addicts but also poor and minority communities. There is no evidence that such programs work. Take a look at the way many of them are conducted in the United States. An addict is enrolled anonymously, without being given an HIV test to determine whether he or she is already infected. The addict is given a coded identification card exempting him or her from arrest for carrying drug paraphernalia. There is no strict accounting of how many needles are given out or returned. How can such an effort prove it is preventing the spread of HIV if the participants are anonymous and if they aren't tested for the virus before and after entering the program? Studies in Montreal and Vancouver did systematically testparticipants in needle-exchange programs. And the studies found that those addicts who took part in such exchanges were two to three times more likely to become infected with HIV than those who did not participate. They also found that almost half the addicts frequently shared needles with others anyway. This was unwelcome news to the AIDS establishment. For almost two years, the Montreal study was not reported in scientific journals. After the study finally appeared last year in a medical journal, two of the researchers, Julie Bruneau and Martin T. Schechter, said that their results had been misinterpreted. The results, they said, needed to be seen in the context of HIV rates in other inner-city neighborhoods. They even suggested that maybe the number of needles given out in Vancouver should be raised to 10 million from 2 million. Needle-exchange programs are reckless experiments. Clearly there is more than a minimal risk of contracting the virus. And addicts already infected with HIV, or infected while in the program, are not given antiretroviral medications, which we know combats the virus in its earliest stages. Needle exchanges also affect poor communities adversely. For instance, the Lower East Side Harm Reduction Center is one of New York City's largest needle-exchange programs. According to tenant groups I have talked to, the center, since it began in 1992, has become a magnet not only for addicts but for dealers as well. Used needles, syringes and crack vials litter the sidewalk. Tenants who live next door to the center complain that the police don't arrest addicts who hang out near it, even though they are openly buying drugs and injecting them. The indisputable fact is that needle exchanges merely help addicts continue to use drugs. It's not unlike giving an alcoholic a clean Scotch tumbler to prevent meningitis. Drug addicts suffer from a serious disease requiring comprehensive treatment, sometimes under compulsion. Ultimately, that's the best way to reduce HIV infection among this group. What addicts don't need is the lure of free needles. Curtis is a professor of psychiatry at Columbia University's medical school and the director of psychiatry at Harlem Hospital.