LIE OF THE NEEDLE by Stephen Chapman

The aids epidemic has unleashed a slew of efforts to stop
transmission of the virusfrom distributing condoms to
teenagers to tightly screening blood transfusions. But, for
years, one of the most effective and inexpensive weapons
has languished on the shelf: needle exchange. Last
December, the Clinton administration recommended additional
money for aids research, but barely mentioned needle
exchange. The neglect comes at a price: though the virus
has abated among gay men, it has proliferated among
intravenous drug users, their sexual partners and their
children. According to the Centers for Disease Control,
this group now accounts for a full third of new HIV
infectionsup from just 12 percent in 1981. The news gets
worse. Unlike other groups, addicts are often cut off from
new treatments because of cost or regimen. So, while some
hail the coming end of the epidemic, for drug addicts the
plague is just entering a new phase.

President Clinton could change all of this. Although
current law prohibits federal funds for cleansyringe
programs, the executive branch can lift the ban if it finds
that needle exchanges slow the spread of aids without
promoting more drug use. Clinton, facing an election last
year, refused to do so. But this year, he had no political
pretext. He was not only free of election pressures but
Congress had handed him the perfect opportunity: it
instructed the administration to report by February 15 on
the efficacy of needle exchange. When the longawaited
report from the Department of Health and Human Services
arrived, it declared the obvious: needle exchanges do
indeed combat HIV transmission. Yet, in classic
Clintonesque style, the president straddled, saying such
programs may or may not encourage drug use. HHS hailed the
report as a change in policy. Meanwhile, the ban on federal
funding remains in place. Needleexchange advocates were
understandably upset. "I'd say they mugwumpedyou know,
mug on one side of the fence, wump on the other," says Dave
Purchase, head of the North American Syringe Exchange
Network in Tacoma, Washington. "The scientists have spoken
on this issue. It's time for the politicians to catch up,"
adds Dan Bigg, who runs Chicago's largest program. Bigg
says he's $130,000 short of what he needs to keep his
program going this year. Opening the federal tap even a
little would help a lot.

A*little more than a decade ago, needleexchange
programs began to provide sterile hypodermic syringes to
drug users. The first exchange was started in Boston in
1986, and the idea soon spread to San Francisco and other
cities. Often the programs defied state laws requiring a
prescription to obtain a syringe and treating possession of
them, except for medical purposes, as a crime. But they
soon won the blessing of many mayors and police chiefs, who
were willing to look the other way rather than discard a
weapon against aids. There are now some 111
needleexchange programs in the United States and Puerto
Rico, from the biggest cities to smaller urban areas such
as Rockford, Illinois, and Fairbanks, Alaska; together,
they collect and distribute some 10 million syringes every
year.

The initial theory behind the exchanges remains
unchanged: that addicts share their needles not because
they want to but because they have to. Since laws banning
overthecounter sale of syringes made the devices scarce,
drug users learned to hoard, reuse and share themeven
after the emergence and spread of aids made this
potentially fatal. Grant them cheap or free access to
sterile injecting equipment, activists argued, and many
users would act with more regard for selfpreservation. But
opponents contended that anyone eager to put heroin in his
arm was unlikely to be terribly fastidious about what he
used to inject it. Offering addicts access to clean
syringes at low or no cost, they maintained, would do
little to slow the epidemic and would foster more drug
addiction by signaling society's indulgence of such
behavior.

Both theories were entirely plausible, but only one has
turned out to be right. In recent years, one study after
another has reached the same conclusion. The most
definitive one was a report released in September 1995 by
the National Academy of Sciences' National Research
Council, which concluded that "wellimplemented needle
exchange programs can be effective in preventing the
spread of HIV and do not increase the use of illegal
drugs." The council endorsed an end to the federal funding
ban and proposed repealing state prescription and drug
paraphernalia laws that make syringes scarce.

But the Clinton administration has apparently decided
that the political price of endorsing needle exchange
outweighs any lives the programs might save. Certainly,
there is no potent lobby for drug addicts. And Republicans
would doubtless portray a reversal as proof of Clinton's
permissive attitude toward drug use. So inaction prevails.
After a federally financed study by researchers at the
University of California at San Francisco gave a strong
endorsement to such programs in 1993, HHS asked scientists
at the CDC to review the study and make their own
recommendationswhich turned out to be identical to those
of the ucsf panel. HHS, finding the results unsatisfactory,
simply declined to release the CDC analysis, even after it
was leaked to The Washington Post.

President Clinton will never have a more auspicious
opportunity to take the modest risk of giving his blessing
to needle exchange. The ferocity of drug czar Barry
McCaffrey has largely insulated the president from any
charge of being soft on drugs. And Clinton can offer
needle exchange as a way not only to prevent aids, but to
funnel addicts into treatment programsa claim that has
the virtue of being true. Besides sterile equipment, most
needleexchange providers offer counseling and drug
treatment referrals.

Lifting the ban can be easily justified to the public as
a simple matter of saving lives, not just of drug users,
but of their innocent spouses and children. Here Clinton
can count on the backing of public health experts. A recent
article in the British medical journal The Lancet by Peter
Lurie, a physician at the Center for aids Research at the
ucsf, and Ernest Drucker, an epidemiologist at Montefiore
Medical Center/Albert Einstein College of Medicine in New
York, estimates that, if the United States had begun widely
promoting clean syringes in 1987, as Australia did, it
could have prevented between 4,000 and 10,000 HIV
infections between 1987 and 1995. By 2000, another 11,000
might be averted. Clinton can also defend the policy change
on unsentimental fiscal grounds, since the aversion to
cleanneedle programs costs society a lot of money.
Preventing a single HIV transmission through syringe
exchanges, according to the 1993 ucsf study, costs between
$3,773 and $12,000. Repealing prescription and drug
paraphernalia laws offers an even better payoff, since many
addicts are more than willing to spend their own cash on
sterile equipment. Caring for an aids patient, by contrast,
means an average expense of some $119,000a cost that
usually falls on taxpayers.

After the 1995 White House conference on aids, one
attendee expressed pleasant surprise at hearing President
Clinton denounce homophobia, but said it would be nice to
hear him mention clean needles as well. For the president
to ignore the value of needle exchange in combating aids
is to invite a harsh historical judgment: that he knew what
needed to be done but, for flimsy political reasons,
refused to do it. For the likely victims of aids, of
course, the consequences will be even worse. Stephen
Chapman is a syndicated columnist on the staff of the
Chicago Tribune.