QUESTIONABLE NEEDLE EXCHANGES

The March 25 front-page story "Pr. George's Needle Plan Wins Vote" carries
the claim that "numerous federally funded studies have shown that needle
exchange programs nationwide have helped reduce new HIV infections." This
overstates the scientific status of the effectiveness of those programs.

The difficulty of conducting careful epidemiology research among heroin
addicts has been seriously underestimated. Though some scientific bodies
have offered endorsement of needle exchange programs, all of the studies to
date suffer from serious methodological limitations, including
self-selection and self-reporting biases, inadequate samples, improper
controls and limited proxy measures.

In fact, the most recent and large-scale study, conducted in Montreal using
a sophisticated observational design with prospective and case-control
methods, found a consistent and independent positive association between
attendance of needle exchange programs and risk of HIV infection.

Moreover, the promising figures the story cites from Baltimore may not be
reliable. The data are non-published and ignore the fact that surrounding
counties, with which Baltimore's 20 percent putative decline in new HIV
infection is contrasted, have a dramatically lower level of HIV prevalence.

Health and Human Services Secretary Donna Shalala is correct to insist that
support for needle exchange programs must await more convincing science. To
err on this issue without strong evidence that dispensing needles to the
addicted will neither place them at greater risk for HIV nor enhance the
legitimacy of hard drug use would be to perpetrate a public health tragedy.

DAVID MURRAY
BRYAN KIM
Statistical Assessment Service
Washington

© Copyright 1998 The Washington Post Company