BAN ON FUNDING FOR NEEDLE SWAP EXPECTED TO END

White House decision is imminent, sources say Louis Freedberg, Chronicle
Washington Bureau

Under intense pressure from scientists, public health experts, activists
and its own AIDS advisers, the Clinton administration is moving to lift a
10-year-old ban on using federal funds for needle exchange programs,
according to key individuals close to the issue.

Although the administration's official stand is that it is still studying
the matter, a range of AIDS organizations and key individuals say they have
been assured a decision is imminent -- and they are anticipating that the
ban will be lifted.

``We have reason to be optimistic that the administration will lift the
ban, because it will fit comfortably within their perspective of research,
prevention and care of people with AIDS,'' said Representative Nancy
Pelosi, D-San Francisco. ``I know they are committed to stop the spread of
AIDS, and I am confident they won't let politics stand in the way of
that.''

Dr. Scott Hitt, a Los Angeles physician and the chairman of President
Clinton's advisory council on AIDS, said he believes an announcement could
be made within a week.

About 100 communities -- approximately 30 of them in California -- run
needle exchange programs without federal funds. The San Francisco AIDS
Foundation runs the largest in the nation, using a combination of city and
private funds to hand out 2.2 million needles a year.

State and federal laws require a public health emergency to operate a
needle exchange program, forcing the Board of Supervisors to make such a
declaration every two weeks since the program started in 1993.

Lifting the ban would allow San Francisco to spend federal AIDS prevention
funds on needle exchanges and free up funds for other programs. It would
also allow many other communities that do not have a needle exchange
program to initiate one.

``There could certainly be a financial benefit to San Francisco, and it
would certainly benefit hundreds of other programs around the country that
do not have the kind of support that San Francisco has,'' said Regina
Aragon, policy director of the San Francisco AIDS Foundation.

According to authoritative estimates, more than half of new cases of HIV
infection are related to drug use. Some experts argue that at least 14,000
new cases of HIV could be prevented each year if needle exchange programs
were widely in place across the nation.

The congressional ban imposed in 1988 gives the secretary of health and
human services the authority to lift the ban if there is sufficient
scientific evidence to meet two criteria: needle exchange programs reduce
the spread of HIV, and they do not encourage drug use.

As late as this week, a spokesman for Health and Human Services Secretary
Donna Shalala said the administration is not yet convinced that needle
exchange programs do not promote drug use.

PRESSURE ON SHALALA

As frustration at the administration's inaction mounted, the president's
advisory council approved a resolution of ``no confidence'' last month in
the administration, marking an embarrassing rebuke to a president who has
prided himself on his efforts to fight the AIDS epidemic. Hitt sent a
sharply worded letter to Shalala saying that her failure to lift the ban
represented an ``abdication'' of her responsibilities.

On Thursday, council members held a conference call to decide whether to
approve an even tougher resolution calling on Shalala to resign. But they
decided to hold off after administration officials said a decision on the
ban was imminent -- although they didn't provide details about what the
decision would be.

But those close to the controversy believe the administration will lift the
ban in light of the mountain of scientific evidence demonstrating the
efficacy of needle exchange programs. Scientific panels and reports
commissioned by the National Institutes of Health, the Centers for Disease
Control and Prevention, the National Academy of Sciences, as well as the
American Medical Association and the American Public Health Association
have come to similar conclusions.

Within the administration, the emotional debate among Clinton's top
advisers on AIDS and drug policy has led some officials to wryly refer to
the conflict as ``czar wars.''

On the one side is Clinton's ``drug czar,'' retired General Barry
McCaffrey, who insists that handing out clean needles to drug users would
send the message that the government is condoning drug use. He has been
supported in that view by a combination of conservative Republicans and
some Democratic representatives of cities with large African American
populations.

THE `AIDS CZAR'

On the other side is ``AIDS czar'' Sandra Thurman, head of Clinton's Office
of National AIDS Policy, although she downplayed her differences with
McCaffrey.

``We are not warring,'' said Thurman. ``General McCaffrey is every bit as
committed to stopping the AIDS epidemic as I am.''

At the same time, she said ``We have convincing evidence that the criteria
(needed to lift the ban) have been met.''

On Wednesday, a major obstacle appeared to be removed when the authors of
the only major study suggesting that needle exchange programs lead to
increased drug use contended that their research in Montreal and Vancouver
had been misinterpreted by McCaffrey and others.

Some AIDS advocates say they are skeptical of administration assurances
that it is moving on the issue, saying they have heard the same thing too
many times before.

``Until the decision is made, it is premature to say we have a victory
here,'' said San Francisco's Aragon. ``This is not an easy thing for the
administration to do, and I would caution my colleagues not to be overly
optimistic.''

But others believe the administration is finally ready to act. ``I don't
think it will be much longer now,'' said Daniel Zingale, executive director
of AIDS Action in Washington, D.C. ``They understand where the science
comes down on this issue.''