Source: Boston Globe (MA) Contact: http://www.boston.com/globe/ Pubdate: April 23, 1998 Author: Ellen Goodman (columnist) I WAS WRONG! NEEDLE-EXCHANGE PROGRAMS WORK Sooner or later, anyone who makes a living offering up opinions gets asked the same question: ''Have you ever changed your mind?'' After the ink is dry, after the column is sent into the electronic ozone, have you ever disagreed with you? There must be so me primal anxiety behind this frequent inquiry. I suppose people all share a high school nightmare of being exposed, seen mentally unzipped, caught changing our minds in public. But since the only way to avoid changing a mind is by closing that mind, it h appens. Today I disagree with me, or rather with the me that once opposed needle-exchange programs. When AIDS activists first proposed that we pass out clean needles to drug addicts as a way of slowing the spread of HIV, I thought it was a bad idea. In the moral struggle between principle and pragmatism, I went for this principle: The government should n't oppose drugs with the one hand and provide paraphernalia with the other. Too much ambiguity would be passed out with the needles. Back then in 1988, the evidence, mostly from Europe, was scant. No one knew whether a needle-exchange program truly slowed the rate of HIV infection. No one knew whether it encouraged more drug users. In that atmosphere, there was a strong argument to be made against allowing the same government to arrest a drug user and to supply him with a syringe. Now I know better. Now we all should know better. Now the moral equation has shifted. The pragmatic view is the more principled. On Monday, we got another one of those split-the-difference decisions for which the Clinton administration is infamous. A reluctant Donna Shalala, secretary of health and human services, delivered the real mince d message on AIDS and needles: Yes, for the first time, government officials acknowledged scientific evidence proving that needle-exchange programs reduce HIV and save lives without increasing drug use. No, the ban against allowing communities to use fede ral AIDS prevention money for such programs will not be lifted. They said: We know it works, but we won't do it. They encouraged local communities to support such programs, but refused them federal money. The much-heralded dispute inside the government over this policy could be read in the body language of squirming public health officials. Some 33 people a day are infected with HIV as a result of intravenous drug use. Forty percent of the new cases - addicts, their partners, their children - come directly or indirectly from contaminated needles. By one estimate as many as 17,000 lives coul d have been saved since 1993 when Clinton came into office. At a cost of 10 cents a syringe. But at the same time, the drug czar, former General Barry McCaffrey was more intent on saving kids from mixed messages than saving civilians from HIV. And the president, who is far better at reading the public than leadin g it, sided with those political honchos who fear being vulnerable to one virus above all others: political attacks. It was widely assumed that if the White House lifted the ban, the Congress would have clamped it back down with new legislation. But even in this split-the-difference format, Gingrich & Company made a predictable hit. On Tuesday, at a press conference about smoking, Republicans accused the president of throwing ''in the towel when it comes to the war on drugs.'' Indeed, in one of the rare moments when I ring with Gingrichian agreement, the speaker said sarcastically, ''Now the president should be clear. If he thinks that needle exchanges are good, why is he not paying for them?'' May I add seriously: Why not let local communities decide how to use federal money for AIDS prevention? This is a president who picks his fights carefully. So carefully that he rarely loses. And rarely wins. Needle-sharing drug addicts at risk for HIV are nobody's favorite underdog. As a new convert, I am still uneasy about providing addicts with clean needles when we want them to ''get clean.'' But since everybody seems to be worrying about mixed messages, try the far bleaker ones in today's air: We know how to slow a lethal epidemic. We know one way to help prevent the spread of HIV from drug addict to partner to child. We just aren't going to do it. Go ahead, explain that to the kids.