Subject: Commentary: Needle Exchange; The Point is Saving Lives
From: [email-masked]
Date: Sat, 6 Jul 1996 20:23:08 -0400

This commentary available for any progressive AIDS or Gay/Lesbian publication
to reprint. 
(Tear sheet appreciated to 825 5th St. NE, #A, Washington DC, 20002)
Needle Exchange
The Point is Saving Lives
by Wayne Turner and Steve Michael
ACT UP Washington, DC
202.547.6780

 Two men were recently convicted for possessing drug paraphernalia in a
Nashua, New Hampshire.  Dan Sundquist and Jon Parker were operating an
illegal needle exchange program in the state that gave Pat Buchanan his only
primary victory, getting sterile needles and syringes out to injection drug
users to help stop the spread of HIV.  
 Support for these programs was highlighted by Senator Richard Lugar's (R,
Indiana) endorsement of clean needle availability to injection drug users
during a town hall meeting during the New Hampshire primary.  The
decriminalization of the sale and possession of drug injection equipment
passed twice out of New Hampshire's Republican-majority state legislature.  
 They were convinced by overwhelming evidence that needle sharing among
injection drug users is the surest way to transmit HIV, and making clean
needles available is the surest way to reduce needle sharing, and reduce HIV
infection rates.  The bills were vetoed, most recently by Governor (and Dole
Campaign Chair) Steve Merrill.  
 Needle exchange programs have been operating in the United States for more
than ten years, often illegally and amid fierce controversy.  AIDS activists
recognized early on that tens of thousands of new HIV infections could be
prevented by exchanging clean syringes, costing 7.5 cents a piece, for dirty
ones.  Groups like ACT UP started needle exchange programs, pressured changes
in local laws, and continue to advocate for this highly effective yet
neglected HIV prevention strategy.  
 Activists like Sundquist and Parker put themselves at risk to save the lives
of a population long marginalized by society.  However, jurisdictions with
legal needle exchange programs are hard pressed to find resources because
federal funds cannot be used under a 1993 ban.  As a result, even AIDS
service organizations with multi-million dollar budgets like DC's
Whitman-Walker Clinic refuse to start their own needle exchange programs
least they jeopardize federal funding for other services like HIV testing and
counseling.
 The continued federal ban on needle exchange funding remains an Achilles
heel for the Clinton Administration, whose overall response to the AIDS
epidemic has been lack-luster.  The first comprehensive study commissioned by
the Centers for Disease Control published in October, 1993 called for lifting
the federal ban.  It has been followed by countless others, including the
National Research Council, the US Conference of Mayors, and the American
Foundation for AIDS Research.  They all come to the same conclusion:  needle
exchange works.
 In fact, President Clinton, while campaigning for votes in California in
1992, promised in a full-page ad in Frontiers magazine to "allow federal
money to be used for condom distribution and needle exchange where local
communities approve."  Yet four years later the ban remains, while over 50%
of new HIV infections can be traced to injection drug use.  Could needle
exchange be too politically volatile for a President seeking reelection?
 When activists grilled White House AIDS coordinator Patsy Fleming at a
recent town meeting in New York, she rejected suggestions that the President
could lift the federal needle exchange ban with the stroke of a pen.  "It's
up to the Republicans in Congress.  That's why we have to campaign for
Democrats." she said.  
 The activists persisted, pulling out the Congressional statute from the 1993
Appropriations Bill for Labor, Health and Human Services, and Education,
which states that in order for the ban to be lifted, "The Surgeon General
(sic) of the United States determine that such programs are effective in
preventing the spread of HIV and do not encourage the use of illegal drugs."
 Fleming retreated and said it up to Health and Human Services Secretary
Donna Shalala.
 In consultation with all four HHS agencies, the Centers of Disease Control
and Prevention, urged in December 1993 that, "the ban on Federal funding for
needle exchange be lifted."  Despite the overwhelming consensus within her
own Department, Shalala hasn't budged, earning her the nick-name 'Donna
Do-Nothing.'. 
 Yet while defending the most recent 'dancing condom' public service
announcements for AIDS prevention, Shalala stated on NBC's Dateline last
winter, "we can't wait for a scientific breakthrough, or we're going to lose
another generation of Americans.  It's not worth it.  I'd rather take all the
criticism and save lives."
 After six federally funded reviews supporting needle exchange effectiveness,
Shalala's comments ring false.  To deflect mounting criticism, the HHS
Secretary told the New York Times in December 1995 that there is still
"controversy over research" regarding needle exchange.  
 Indeed, the President's own Advisory Council on HIV/AIDS blasted the
Administration for its intransigence on the federal needle exchange ban in
its "Progress Report" issued June 7, 1996, "The Council continues to have
grave concerns that Federal policy regarding needle-exchange programs is not
consistent with current knowledge and understanding regarding the impact of
such programs on HIV prevention efforts."  Yet this urgent plea may be
destined to join the mountain of unimplemented recommendations and reports on
AIDS that continue to gather dust at the White House.
 Privately, Administration officials assure AIDS activists that the President
is on their side, and that Bill Clinton will lift the needle exchange ban,
after he wins reelection.  
 The AIDS epidemic won't wait until 'after November'.  How many new HIV
infections will occur between now and then among injection drug users, their
spouses, and their babies?  How many men, women, and children are now facing
an AIDS diagnosis, and how many have already died, because Bill Clinton fails
to act?  What about his other promises?  Who's the AIDS Czar?  Where's the
Manhattan/Apollo project to find a cure?  
 Expect to see from the White House, in the coming months, a flurry of
excuses, reports, and red ribbon photo-ops with AIDS Quilt panels.  Photo-ops
don't save lives.  There is no easy way out.  It takes firm, decisive
leadership to fight the war on AIDS, and it's not coming from Bill Clinton.

(Note:  The District of Columbia will soon have its first comprehensive
needle exchange program through locally appropriated funds.  ACT UP
Washington's Project Sero Zero, after exchanging clean needles on DC streets
for years, has designed a detailed proposal to operate the District's needle
exchange, which is still under review by the District government.)