CLINTON SUPPORTS NEEDLE EXCHANGES BUT NOT FUNDING

The Clinton administration declared yesterday that needle exchange programs
can help curb the AIDS epidemic without fostering the use of illegal drugs,
but refused to allow federal money to be spent on the controversial approach.

The continued ban on federal funds stunned leading AIDS researchers and
many activists, who had long believed that government money would begin
flowing as soon as the administration determined there is enough scientific
evidence to show that needle exchange programs work.

But by divorcing the science from the matter of subsidies, the
administration found a way to surmount lingering disagreements among
President Clinton's top advisers over one of the most contentious public
health questions they have confronted.

Needle exchanges have become a lightning rod in the debate over how the
nation will combat the AIDS epidemic, now that it is well into its second
decade. The programs, which have sprung up in more than 100 cities across
the country, including Washington and Baltimore, attempt to slow the spread
of HIV by giving clean syringes to intravenous drug users, thus lessening
the sharing of needles that contain residue of tainted blood.

Advocates of the programs say such a strategy is increasingly important as
the epidemic has veered more heavily into populations of drug users and
their sex partners and children. Such drug-related cases account for nearly
one-third of the more than 600,000 AIDS cases reported in the United States
since the epidemic began. The proportion is substantially higher among
people who have been infected in recent years and particularly in the
nation's large cities.

But the strategy also has a large army of critics, including many
conservatives and President Clinton's drug czar, Barry McCaffrey, who
contend that it tacitly condones the use of illegal drugs since it puts the
government in the business of handing out free needles.

Administration sources said yesterday that Secretary of Health and Human
Services Donna E. Shalala preferred to begin allowing certain needle
exchange programs to qualify for federal aid, even though such a decision
would have touched off a fight with Congress that even some Democratic
leaders had warned would be foolhardy. "She knew this would be tough, but
she was willing to defend it on the Hill," said one administration official
close to the discussions.

But Sunday night, while flying back to Washington from a South American
trip, Clinton decided in favor of a second alternative Shalala had
proposed: leaving the ban in place while announcing that needle exchanges
were scientifically sound. His decision ended an agonizing debate among his
senior aides.

Yesterday, Shalala said that, even without the subsidies, the
administration's decision that needle exchanges have scientific merit will
galvanize syringe programs at the state and local level by sending a signal
that the federal government endorses the efforts. "This is another
life-saving intervention, which requires a careful local design," she said
at a news briefing, surrounding the director of the National Institutes of
Health, the acting director of the Centers for Disease Control and
Prevention, the surgeon general, and other top federal health officials.

In the Washington area, the District and Baltimore operate needle exchange
programs with local funds. The Maryland General Assembly this year decided
to allow a similar program to begin in Prince George's County, but defeated
a measure that would have allowed exchanges statewide. There are no needle
exchanges in Virginia.

Shalala's announcement, in effect, answered the second of a pair of
questions Congress posed several years ago. Congress said that federal
money could be spent on needle exchanges only if research conclusively
established that they met two criteria.

Last year, Shalala told Congress the administration was satisfied that the
programs met one of those criteria -- determining that the programs do
indeed diminish the spread of HIV. Until yesterday, the administration had
said it remained uncertain on the question of whether exchanges
inadvertently contribute to increased drug use, despite six major reviews
of the research literature, including one by NIH last year, that found they
do not.

Shalala's announcement was derided immediately by major AIDS organizations.
"It is like saying, 'We acknowledge the world is not flat, but we are not
going to give Columbus the money for the ships,' " said Daniel Zingale,
executive director of AIDS Action.

"It's helpful to get the scientific obstacles out of the way once and for
all," said Peter Lurie, a University of Michigan AIDS researcher, "but
absent the federal funding, it's unlikely the programs will expand to meet
the tremendous need."

But the political dangers of expressing support for the programs, much less
allowing federal money to be used for them, were quickly evident.
Determining that the programs work "is an intolerable message that it's
time to accept drug use as a way of life," said Sen. John D. Ashcroft
(Mo.), one of several congressional Republicans who denounced the
administration's decision. Sen. Paul Coverdell (R-Ga.), introduced a bill
yesterday that would prevent the HHS secretary from ever lifting the ban.

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