Source: Boston Globe (MA)
Pubdate: April 23, 1998
Author: Ellen Goodman (columnist)


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

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

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.