WHITE HOUSE NEEDLE SWAP SURPRISE

A refusal to lift ban on program funding

Ending weeks of speculation, the Clinton administration yesterday refused
to lift a 10-year ban on using federal funds for needle exchange programs,
despite concluding for the first time that such exchanges prevent the
spread of HIV and do not encourage drug use.

Leaders in the fight against AIDS condemned the unexpected decision, which
was announced by Health and Human Services Secretary Donna Shalala. ``It is
a purely political decision, and an abdication of her public health
responsibilities,'' said Pat Christen, executive director of the San
Francisco AIDS Foundation, which runs the nation's largest needle exchange
program, which uses private and city funds. ``She has chosen to protect
herself politically, and people will die as a result of that decision.''

Pounding his fist at an AIDS prevention meeting in San Francisco, Thomas
Coates, director of the University of California at San Francisco's AIDS
Research Institutes, accused Shalala of ``public health malpractice.''

In recent weeks, the administration had led AIDS activists to believe it
was finally moving to lift the ban. However, the plan was derailed when
word of the administration's intentions leaked out late last week, and a
slew of conservative organizations issued a flurry of press releases
warning the administration not to do so.

Several influential GOP lawmakers said they would introduce legislation
reinstating the ban should the administration move to lift it. That brought
a weekend of intense discussions between the White House and Health and
Human Services officials, who were apparently ready to lift the ban. In a
political calculation, sources close to the discussions said, the White
House concluded that it would not have the votes to block legislation
reimposing the ban.

Also key was the the opposition of President Clinton's ``drug czar,''
retired General Barry McCaffrey, who continued to lobby vigorously against
allowing federal funds for needle exchange programs, arguing that it would
send the wrong message to the nation's young people and undermine the
administration's anti-drug message. McCaffrey also vehemently opposed a
compromise proposal that would have funded pilot programs in 10 cities.

Shalala had the authority to lift the ban if she could point to solid
scientific evidence demonstrating that needle exchange programs both reduce
the spread of AIDS and do not encourage drug use. Until now, Shalala had
said the evidence satisfied the first requirement but not the second. AIDS
experts assumed that once she had satisfied herself that needle exchange
programs do not encourage drug use, she would take action.

However, no one expected the administration to both declare that the
conditions for lifting the ban had been met -- and then refuse to lift it.

To help her make the decision, Shalala commissioned the nation's leading
scientists and public health officials to review all the available evidence
on needle exchange programs. They included Dr. Harold Varmus, director of
the National Institutes of Health; Dr. David Satcher, the newly appointed
surgeon general; Dr. Claire Broome, acting head of the Centers for Disease
Control and Prevention; and Alan Leshner, director of the National
Institute on Drug Abuse.

Yesterday morning, those officials met with Shalala, armed with a 300-page
report, which concluded that the conditions for lifting the ban have been
met.

But by that time, the White House had already decided against such a move.
After meeting with the scientists for an hour, Shalala issued a detailed
press release in which she extolled the value of needle exchange programs
- -- and in the same breath said the administration would not authorize using
federal funds to support them.

``A meticulous scientific review has now proven that needle exchange
programs can reduce the transmission of HIV and save lives without losing
ground in their fight against AIDS,'' she said. She noted that injection
drug use accounts for 60 percent of new AIDS cases in certain areas, and
that 40 percent of all 652,000 cases of AIDS reported in the United States
have been linked to injection drug use.

She also quoted NIH director Varmus, a Nobel laureate in biochemistry, as
saying: ``An exhaustive review of the science indicates that needle
exchange programs can be an effective component of the global effort to end
the AIDS epidemic. Recent findings have strengthened the scientific
evidence that needle exchange programs do not encourage the use of illegal
drugs.''

But without explanation, she said the administration has ``decided that the
best course at this time is to have local communities use their own dollars
to fund needle exchange programs.''

Representative Nancy Pelosi, D-San Francisco, who had lobbied vigorously
for lifting the ban, said ``it defies logic to determine a program's
efficacy, and then not fund the program, especially in the middle of an
epidemic.'' She said the decision reveals a ``a lack of political will in
the midst of a public health emergency.''

About 130 communities across the nation have set up their own needle
exchange programs without federal funds, but AIDS experts say that these
programs are often underfinanced, and that many communities and regions are
completely underserved.

Administration officials tried to put the best spin on their decision
yesterday, saying they hope the federal endorsement will encourage local
communities to set up their own programs.

``Hopefully local communities and states will see this as encouragement to
open their own needle exchange programs even as the federal government
ducks for cover,'' said Peter Lurie of the UCSF Center for AIDS Prevention
and the principal investigator of the first national survey showing the
effectiveness of needle exchange in 1993.

At the same time, Lurie said the decision ``made a mockery of the
administration's purported commitment to HIV prevention.''

He noted that President Clinton endorsed lifting the ban in his 1992
presidential campaign. That commitment, he said, dissipated in the face of
stiff Republican opposition. ``Republicans showed they were willing to play
hardball, and the administration has never been able to take a principled
stand on this issue when faced with a possible political fallout.''

)1998 San Francisco Chronicle