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D.C. health officials could have prevented as many as 650
intravenous drug users from getting AIDS and saved as much
as $ 36 million in medical treatment if they had started to
hand out clean hypodermic needles a decade ago, according
to a new study.

The findings, published in a leading medical journal
this week, suggest that the potential to avoid sickness and
expense has been greater in Washington than in many other
large U.S. cities, because drug use plays an unusually
large role in the local AIDS epidemic.

The study has appeared as the city's largest AIDS clinic
plans to announce today that, after several years of
delays, it has received a contract from the D.C. government
to run the first largescale " needle exchange" in the
Washington area.

The WhitmanWalker Clinic will distribute more than
100,000 sterile syringes during the next year at its branch
in Anacostia and at four mobile sites near drug markets in
Northeast and Southeast Washington. Jim Graham, the
clinic's executive director, predicted that the clean
needles, combined with a new oral AIDS test that will allow
addicts to be tested in their own neighborhoods, will begin
to control the epidemic in the population where it is
spreading most rapidly.

But in the four years that have elapsed since D.C.
officials first contemplated an exchange, "lives have been
lost, and human suffering has occurred that could have been
avoided," Graham said.

The study, published in the British journal the Lancet,
is the first attempt to concretely measure the human and
financial costs. Needle exchanges have been among the most
controversial strategies to try to control the spread of
the human immunodeficiency virus that leads to AIDS.
Opponents have said giving syringes to addicts fosters drug
use and fails to curb the sharing of HIVtainted needles.
However, recent studies, based on evaluations of some of
the nearly 90 needle exchanges in the United States, have
indicated that such fears are unfounded.

The new study is based on estimates of how many drug
addicts are infected with HIV nationwide and in 16 large
cities, including Washington. Its authors took into account
how widely existing needle exchanges have been used, how
successful they have proved in reducing AIDS and how often
drug users infect their sex partners and children. The
analysis began in 1987, about the time the epidemic began
to veer toward drug users and needle exchanges began to
be adopted in several other countries.

It found that such programs could have prevented as many
as 9,700 infections nationwide and saved up to $ 538
million.

For Washington, the study estimated that 294 to 646 drug
users could have avoided AIDS if a needle exchange had
been in place. It estimated that those people have required
$ 16.4 million to $ 35.9 million in medical treatment.
Among the cities included in the study, Washington ranked
second only to New York in preventable infections.

"The District waited far longer than was reasonable,
given the raging epidemic among drug users," said the main
author, Peter Lurie, a researcher at the University of
CaliforniaSan Francisco's Center for AIDS Prevention
Studies.

The study and the District's needle exchange come as
public health specialists are criticizing the federal
government and many states for failing to embrace
strategies that are divisive but have the greatest
potential to curb the epidemic.

The District's exchange is beginning four years after
city health officials conducted a brief experiment that was
widely judged a failure. In a city with an estimated 12,000
to 16,000 intravenous drug users, 33 people took part.

Two years ago, the D.C. Council directed health
officials to begin a bigger and more accessible program. In
recent months, WhitmanWalker has run a temporary,
privately sponsored exchange that has proved popular,
attracting 900 regular participants and dispensing 2,000
needles a week.

Mel Wilson, chief of the D.C. Agency for HIV/AIDS, said
yesterday that the study's findings were credible. "We are
just elated to get the program off the ground," he said.

An exchange in Baltimore also has been successful. When
it began in 1994, health officials there expected 500
participants the first year. Instead, the program attracted
nearly 3,000, and it has grown since then.

Yesterday, the Maryland General Assembly, which had
approved Baltimore's exchange for a threeyear period,
enacted a bill that will allow it to continue indefinitely.