COMMENTARY: NEEDLE-EXCHANGE ISSUE SHOWS CLINTON'S LOST HIS EDGE

ATLANTA -- With his presidency trembling in the hot wind of alleged scandal
and hanging by the thread of an amazingly indulgent electorate, this is not
the time to expect Bill Clinton to take policy risks. For the record,
though, his own AIDS advisory council was right to read him the riot act.

The 30-member panel appointed by Clinton three years ago says the
administration's failure to support needle-exchange programs for
intravenous drug users mocks Clinton's proclaimed commitment to cutting the
spread of AIDS.

The efficacy of needle exchanges is past serious argument, but it remains a
political flashpoint as conservatives, building on their belief that
condoms cause sex, insist that the availability of clean needles would make
drug addiction sound like a swell idea.

"Say, Maude, d'you read where we could get clean needles if we become dope
fiends?"

"Well, lordy, Frank, what are we waitin' for? You just run on out now and
score us some of that fine smack."

Please.

Indeed, a research review by the National Institutes of Health found that
"a preponderance of evidence shows either no change or reduced drug use"
from exchange programs, the latter because turning in needles brings
addicts into contact with persons who can guide them to treatment.

This is not conjecture. We have experience from pilot programs in several
cities -- New York City and San Francisco among them -- and from Canada,
Britain, Sweden and the Netherlands.

Studies last year by NIH and Beth Israel Medical Center in New York City
found that exchanges slow the spread of HIV significantly. The Centers for
Disease Control and Prevention report that half of new AIDS cases are
contracted from used IV needles.

Dirty needles are expected to account for as much as 75 percent of the
increase within three years. The rate could be cut 38 percent by needle
exchanges. And cut at notable savings to the public, which picks up the
AIDS tab either through higher insurance premiums or public health costs.
The average case costs $119,000.

The idea doesn't lack for pedigreed endorsement. It is supported, the
president's council points out, by the American Medical Association and the
Public Health Association.

But Congress has forbidden funding for exchanges unless the secretary of
Health and Human Services certifies no increase in drug use would follow,
and Donna Shalala continues to balk, repeating her skepticism even in the
wake of the AIDS council's zinger.

Shalala's hesitance is loyal service to a president whose boat already is
rocking enough.

It is widely noted that the ring of accusations eating away at Clinton has
failed to knock down his high approval ratings. That's so. And that is
cited as evidence he remains unhampered in his office.

That's not so. Given his longtime concern about AIDS, signing off on needle
exchange is just the sort of mildly progressive step that might have been
expected from Clinton in his valedictory term. More, so far, in smallish
matters like this one than in large issues, his troubles do have the
president pinned down.