CLEAN BUT NOT SAFE

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.

Ms. 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 H.I.V. 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 H.I.V. 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 H.I.V. 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 test participants 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 H.I.V. 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 H.I.V. 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 H.I.V., 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 H.I.V. infection among this group. What addicts don't
need is the lure of free needles.

James L. Curtis is a professor of psychiatry at Columbia University's
medical school and the director of psychiatry at Harlem Hospital.