OBAMA DISAPPOINTS NEEDLE-EXCHANGE ADVOCATES

President Obama has called for repealing the ban on federal funding
for anti-AIDS programs that supply clean needles to drug users. His
drug policy director supported such a program when he was Seattle's
police chief. And last week, Obama's nominee to head the Food and Drug
Administration won praise in a Senate committee for her leadership on
needle exchange.

So advocates of the programs in the Bay Area and elsewhere were
surprised and dismayed when Obama's budget for 2009-10 proposed to
continue the funding prohibition that dates from the 1980s.

"We hoped that the president would seize the first opportunity for
lifting federal restrictions on this life-saving prevention strategy,"
said Paola Barahona of Physicians for Human Rights. "Denying people at
risk for HIV a proven prevention intervention is a denial of their
basic human rights."

"Without the federal funding, we're missing people that we could
reach," said Laura Thomas, who heads the Drug Policy Alliance office
in San Francisco and volunteers at a local needle-exchange program.
"It's ridiculous that at this point in the epidemic, we're not looking
to science in determining what we're funding."

A similar view could be found on the White House Web site soon after
Obama took office in January: "The president also supports lifting
the federal ban on needle exchange, which could dramatically reduce
rates of infection among drug users."

That comment was erased from the site recently. But Bill Piper,
national affairs director of the Drug Policy Alliance, said the
removal appeared to be part of a housecleaning of statements from the
transition period rather than a signal of a policy shift.

He noted that Gil Kerlikowske, director of the White Office of
National Drug Control Policy, supported needle exchange during his
confirmation hearing and ended police interference with the program in
Seattle. Margaret Hamburg, Obama's candidate to run the FDA, sponsored
New York City's first such program as its health commissioner in the
early 1990s.

"I think the Obama administration wants to repeal the syringe ban,"
Piper said. "They've showed moral leadership on the issue, but they
really need to show political leadership."

The White House issued a statement Friday by Jeffrey Crowley, director
of the Office of National AIDS Policy, saying Obama "is looking
forward to working with Congress and the American people to build
support for this change, and his administration is committed to moving
forward to address the federal ban on syringe exchange programs as a
part of a national HIV/AIDS strategy."

Crowley did not say why the budget continued the funding
ban.

The administration's approach may reflect the political controversy
over a program whose opponents depict it as an acceptance of illegal
drug use. But advocates say there is no dispute among researchers
about its effectiveness in preventing AIDS and other diseases, such as
hepatitis C, that are transmitted by contaminated syringes.

State officials quote a 1997 study that found HIV infection rates
decreased 5.8 percent in 29 cities around the world with
needle-exchange programs, and increased 5.9 percent a year in 52
cities without them. A five-year study of needle exchange in San
Francisco, published in 1994, found that participants in the program -
which included referrals to treatment - reduced their own drug
injections by more than 60 percent.

The city's implementation of needle exchange since the 1980s "has
prevented a huge HIV epidemic in the injection-drug-using population"
and may have kept the disease from spreading to uninfected
populations, said Grant Colfax, director of HIV prevention in San
Francisco's Department of Public Health.

California law allows cities and counties to oversee the programs and
exempts them from a ban on distribution of hypodermic needles without
a prescription. The state provides about $750,000 a year to selected
local needle-exchange programs, and San Francisco spends another
$900,000 on its programs, which are run by the AIDS Foundation and
other contractors, Colfax said.

Thomas, of the Drug Policy Alliance, said funding from state and local
governments and private foundations still leaves the programs without
the resources they need to reach all intravenous drug users.

Drug addicts have the same desire as anyone else to protect their
health, Thomas said, but "without a way to get sterile syringes,
they're not always able to follow through on their best intentions."