A SHARPER APPROACH TO FIGHTING AIDS

Twenty years ago, as executive director of AID Atlanta, I would
arrive at the office at the crack of dawn to find a cast of homeless
intravenous drug users waiting at our door. Their faces and the
countless more living with HIV I've met since still haunt my dreams.
I often wonder if a clean needle could have saved their lives.

Ten years later, during my tenure as Director of the Office of
National AIDS Policy in the second Clinton term, we allowed bad
politics to override good science when the White House pulled the
plug on support for federal funding for needle-exchange programs.
Later President Clinton had the fortitude to admit that decision was
wrong. Today, nothing much has changed, except increasing numbers of
IV drug users infected with HIV. What's wrong with this picture?

There is a misperception that we have a cure for AIDS and that
treatment is widely available to deal with the epidemic. Neither is
true, and a false sense of security continues to fuel a very real
epidemic. What is true is that needle exchange -- a program that
gives clean needles to IV drug users -- reduces the risk of HIV
infection. What's more, it's an act of compassion that gets people
into treatment, including programs that can get them off drugs.

Efforts to prevent HIV infection in the United States traditionally
focus on individual behavior, ignoring the fact that two individuals
from different communities can engage in the same activity but be at
opposite ends of the spectrum when it comes to being at risk of HIV.
It is this paradox that we grapple with in trying to understand why
certain communities -- like poor IV drug users -- bear such a
disproportionate burden of HIV infection, while others -- like
wealthy IV drug users -- do not. If we really want to fight HIV and
the vast disparities in our communities, we must adopt appropriate
prevention justice policies that address the health and dignity of
all people, including drug users.

The Centers for Disease Control and Prevention recently set out to
reduce HIV transmission by half, but traditional interventions have
failed to achieve the goal. In fact, in some communities, HIV/AIDS
rates may once again be on the rise. This does not mean that
prevention efforts do not work. Rather, it means that we have to do
things differently and invest in innovative new approaches.

Georgia is a good place to start. Recent data rank this state as
having the eighth-highest HIV caseload in the United States. Not only
does Georgia rank high with cumulative HIV infections, the state also
ranks fifth for the highest number of new annual AIDS diagnoses.
While risk behavior may be similar across the populations,
African-American Georgians are more than five times as likely to be
newly diagnosed with HIV. The continued spread of HIV is propagated
by a number of factors, but what many people don't realize is that of
the estimated 1.2 million HIV infections nationwide, approximately
one-third can be attributed to an exposure involving injection drug use.

The public health community tells us that we cannot completely
eliminate injection drug use. So it's vital we reduce the risk of
contracting HIV and other diseases for this population. Eight major
government-sponsored studies -- by the CDC, NIH, the Office of the
Surgeon General, and the National Academy of Science, among others --
say that needle-exchange programs slow the spread of HIV among
persons who inject drugs.

Twenty five years of research and the endorsement of multiple U.S.
government agencies and medical professionals across the world has
not quelled domestic political opposition to these programs. Do we
honestly believe that any previously non-using individual will
suddenly decide to inject drugs just because sterile syringes are
available? Research shows there's little cause for concern. There is
no increase in drug use through needle-exchange programs or in the
number of used syringes found in public places.

No matter the excuses, ultimately the lack of federal funding for
these programs and community-based support to implement them whenever
possible is contributing to HIV infection among thousands of
injection drug users, their sexual partners and their children. When
the science is strong but the political will is not, we in the
community must demand the respect, dignity and compassion our
brothers and sisters deserve. That includes accepting needle exchange
as part of our collective human fight against AIDS.