Needle Exchange

AIDS PREVENTION EFFORTS SHOULD INCLUDE SYRINGE PROGRAMS

Oh, those radicals at the American Medical Association. They endorse needle
exchange programs as one element of a comprehensive AIDS prevention
strategy. They also support less controversial measures such as expanded
drug treatment programs and improved care for HIV-positive infants and
children.

Their position isn't radical; it's common sense. AIDS endangers drug users
and non-users alike. About 40 percent of HIV infections now occur among
intravenous drug addicts - who have used dirty needles - and their intimate
companions.

Nevertheless, the Clinton White House, fearing a conservative backlash,
refuses to allow any federal money to support needle exchange programs.
Health and Human Services Secretary Donna Shalala reaffirmed the
administration's position Monday. That decision sacrifices public health on
the altar of political expedience.

Many Americans believe that needle exchange programs are futile at best and
unethical at worst. Critics feel the programs encourage illegal drug use,
and public money shouldn't underwrite illegal behavior.

Public health workers face a different ethical dilemma. Their duty is to
prevent disease and to protect and improve the overall health of a
community. To them, it is unethical not to marshal all effective voluntary
strategies to slow the spread of AIDS.

Those real concerns about public health should give critics pause. No one
wants to encourage drug use; it is harmful even without the threat of AIDS.
But there is little or no evidence that needle exchanges and the
distribution of bleach sterilization kits increase intravenous drug use.
And strong evidence shows that such programs, when carefully designed, can
decrease transmission of HIV.

Needle exchange programs also can serve as a doorway into rehabilitation.
The best programs encourage addicts to seek drug treatment and view needle
exchanges as a way to keep drug users HIV-negative until scarce treatment
slots are available.

If President Clinton and Congress really want to halt the spread of AIDS,
they should allow health workers to incorporate needle exchanges into
publicly funded AIDS prevention programs.