NEEDLE EXCHANGE IN VANCOUVER/MONTREAL WORKED

Opinion: The Politics of Needles and AIDS

Debate has started up again in Washington about whether the Government
should renew its ban on subsidies for needle-exchange programs, which
advocates say can help stop the spread of AIDS.

In a letter to Congress, Barry McCaffrey, who is in charge of national drug
policy, cited two Canadian studies to show that needle-exchange plans have
failed to reduce the spread of H.I.V., the virus that causes AIDS, and may
even have worsened the problem. Congressional leaders have cited these
studies to make the same argument.

As the authors of the Canadian studies, we must point out that these
officials have misinterpreted our research. True, we found that addicts who
took part in needle exchange programs in Vancouver and Montreal had higher
H.I.V. infection rates than addicts who did not. That's not surprising.
Because these programs are in inner-city neighborhoods, they serve users
who are at greatest risk of infection. Those who didn't accept free needles
often didn't need them since they could afford to buy syringes in drug
stores. The also were less likely to engage in the riskiest activities.

Also, needle-exchange programs must be tailored to local conditions. For
example, in Montreal and Vancouver, cocaine injection is a major source of
H.I.V. transmission. Some users inject the drug up to 40 times a day. At
that rate, we have calculated that the two cities we studied would each
need 10 million clean needles a year to prevent the re-use of syringes.
Currently, the Vancouver program exchanges two million syringes annually,
and Montreal, half a million.

A study conducted last year and published in The Lancet, the British
medical journal, found that in 29 cities worldwide where programs are in
place, H.I.V. infection dropped by an average of 5.8 percent a year among
drug users. In 51 cities that had no needle-exchange plans, drug-related
infection rose by 5.9 percent a year. Clearly these efforts can work.

But clean needles are only part of the solution. A comprehensive approach
that includes needle exchange, health care, treatment for drug addiction,
social support and counseling is also needed. In Canada, local governments
acted on our research by expanding needle exchanges and adding related
services. We hope the Clinton Administration and Congress will provide the
same kind of leadership in the United States.

Julie Bruneau is an assistant professor of psychiatry at the University of
Montreal. Martin T. Schechter is a professor of epidemiology at the
University of British Columbia.

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