Source: San Jose Mercury News (CA) Contact: http://www.sjmercury.com/ Pubdate: Tue, 21 Apr 1998 Author: Richard A. Knox, Boston Globe SCIENTIFIC VINDICATION FOR NEEDLE EXCHANGES Scientific evidence ``clearly shows'' that providing free sterile syringes to illicit drug users prevents the spread of AIDS but does not promote drug use, the Clinton administration said Monday. But it balked at allowing federal funds to pay for needle-exchange programs. The long-awaited decision surprised and outraged AIDS activists and public health authorities, who had hoped the administration would bow to data rather than to politics. ``This is like refusing to throw a life raft to a drowning person,'' said David Harvey of the AIDS Policy Center. Dr. Mathilde Krim, chairman of the American Foundation for AIDS Research, called the decision ``immoral and unethical'' and ``totally contrary to the practice of public health.'' Critics of needle exchanges claimed victory. ``Supplying drug addicts with needles is counterproductive and sends entirely the wrong message,'' said Rep. Gerald Solomon, R-N.Y., who proposes to take away presidential discretion about funding such programs. The split decision reflected a battle within the administration between health officials and General Barry McCaffrey, director of the White House Office on Drug Policy, who opposes needle exchange. U.S. Surgeon General David Satcher, former chief of the Centers for Disease Control and Prevention, favors more needle exchange programs. ``If we had more prime quality needle exchange programs, we would save more lives,'' Satcher said at a press briefing. In certifying the effectiveness of needle-exchange programs, the administration noted that more than 60 percent of new AIDS cases in many regions are due to drug users sharing needles. Needle-sharing also transmits hepatitis B and other blood-borne diseases. Proven effectiveness Nine years ago, Congress passed a law that bars federal funding of needle exchange programs unless the secretary of health and human services certifies, on the basis of scientific evidence, that they curtail transmission of the human immunodeficiency virus that causes AIDS, and do not increase illicit drug use. Secretary Donna Shalala, the nation's top health official, declared that a ``meticulous scientific review has now proven that needle exchange programs can reduce the transmission of HIV and save lives without losing ground in the battle against illegal drugs.'' And Dr. Harold Varmus, director of the National Institutes of Health, backed her up. ``Recent findings have strengthened the scientific evidence that needle exchange programs do not encourage the use of illegal drugs,'' Varmus said. But Shalala said the Clinton administration has decided that ``the best course at this time'' is to let local communities ``use their own dollars'' for needle exchange programs. The nation currently has about 110 needle exchange programs, about half of which are sanctioned. The rest are tolerated by law enforcement authorities or operate underground. But all are relatively small-scale, advocates said. Active needle exchange programs in the Bay Area include operations in Berkeley, San Francisco and Santa Cruz. Programs endorsed Needle exchange programs have been endorsed by a wide array of medical and public health organizations, including the American Medical Association and the American Public Health Association. The administration's announcement Monday was reminiscent of Clinton's past approaches to some hot-button issues -- gays in the military, for example -- where he has attempted to strike a middle ground that seemed to please few. Some observers of the long-running debate say the administration's decision represents a victory of election-year politics over public health. ``It's probably very smart politics to continue the restrictions on federal funds,'' said Donald DesJarlais, director of chemical dependency research at Beth Israel Medical Center in New York City. ``If Shalala had permitted the use of federal funds, there's a 99 percent chance Congress would have overridden it anyway,'' he said. ``Now the secretary of health and human services has made a scientific finding, but no one can get up and say Clinton tried to give needles to drug addicts.'' Uproar predicted While he was ``personally disappointed'' about the administration's decision to withhold federal funds, DesJarlais said its unequivocal statement about needle-exchange studies ``will be very helpful for local decision makers who want to make their prevention planning on scientific evidence.'' Krim, a longtime veteran of emotional battles over AIDS funding, predicted ``an uproar in the AIDS community,'' but said that was a calculated strategy on the administration's part. ``I think Mr. Clinton decided to let the Congress handle it,'' Krim said. ``He will let the activists go after Congress.'' State health officials said the administration's stance will not affect needle exchange programs already in operation, and may make it somewhat easier to expand them because of the explicit federal endorsement. Shalala noted that the use of needle-exchange programs has increased throughout the AIDS epidemic. Citing figures from the federal Centers for Disease Control and Prevention, she said communities in 28 states and one U.S. territory operate needle-exchange programs that are supported by state, local or private funds. Shalala said the administration decided ``that the best course at this time'' is to leave the creation and funding of needle-exchange programs to communities and ``to communicate what has been learned from science so that communities can construct the most successful programs possible to reduce the transmission of HIV.'' She said the programs should be part of a comprehensive HIV prevention strategy that includes referring participants to drug treatment and counseling, and that needles must be made available only on a replacement basis.