NEEDLE EXCHANGE I: Admin. Supports Science, Not Funding
Based on a review of extensive scientific research, needle-exchange programs can reduce the spread of HIV while not encouraging the use of illegal drugs, the Clinton administration announced yesterday. While the findings meet the criteria needed to lift a 10-year ban on federal funds for needle-exchange programs, the administration refused to allow federal funding to be spent on the controversial programs. The administration has decided that the best course at this time is to have local communities which choose to implement their own programs use their own dollars to fund needle exchange programs, Health and Human Services Secretary Donna Shalala said (HHS release, 4/20). "[N]o one expected the administration to both declare that the conditions for lifting the ban had been met -- and then refuse to lift it," the San Francisco Chronicle reports.
The Activists' Outcry
AIDS researchers and activists "condemned the unexpected decision." "It is a purely political decision, and an abdication of her public health responsibilities," said Pat Christen, executive director of San Francisco AIDS Foundation -- which runs the nation's largest needle-exchange program. Shalala "has chosen to protect herself politically, and people will die as a result of that decision," Christen said. Thomas Coates, director of the University of California at San Francisco's AIDS Research Institute, called Shalala's decision "public health malpractice" (Freedberg, 4/21). "At best this is hypocrisy. At worst, it's a lie. And no matter what it's immoral," said Dr. R. Scott Hitt, chair of the presidents AIDS advisory council "which last month issued a vote of 'no confidence' in the administration," the New York Times reports (Stolberg, 4/21). The Boston Globe reports that "surprised and angered" public health officials and AIDS activists "hoped the administration would bow to data rather than to politics." David Harvey of the AIDS Policy Center said, "This is like refusing to throw a life raft to a drowning person" (Knox, 4/21). Offering another analogy, Daniel Zingale, executive director of AIDS Action, said, "Today's action is like acknowledging the earth is not flat but refusing to fund Columbus' voyage" (Christensen/Puente, AP/Medical Tribune/Ft. Worth Star-Telegram, 4/21).
The Political Reality
By "divorcing the science from the matter of subsidies, the administration found a way to surmount lingering disagreements among President Clinton's top advisers over one of the most contentious public health questions they have confronted," the Washington Post reports. Shalala "preferred to begin allowing certain needle-exchange programs to qualify for federal aid," according to administration sources, but Clinton decided Sunday night to leave the ban in place but declare the scientific validity of the programs (Goldstein, 4/21). According to the New York Times, Clinton's advisors "feared political disaster" for the president and "worried that Republicans might push through legislation stripping federal money from groups that provide free needles, even though the money was used for other purposes." One source who spoke on the condition of anonymity said, "Any Republican could have offered a resolution and we almost certainly would have lost. We don't have the votes for this in an election year" (4/21).
The Vocal Opposition
The Washington Post notes that Sen. Paul Coverdell (R-GA) introduced a bill yesterday that would "prevent the HHS secretary from ever lifting the ban." But Coverdell's action was just one voice in the chorus of other needle exchange opponents, including the president's own drug czar, Gen. Barry McCaffrey. Critics of lifting the funding ban "contend that it tacitly condones the use of illegal drugs since it puts the government in the business of handing out free needles" (4/21). Sen. John Ashcroft (R-MO) asked, "Why not simply provide heroin itself, free of charge, courtesy of the American taxpayer?" (Neergard, AP/Philadelphia Inquirer, 4/21). Rep. Gerald Solomon (R-NY), who wants "to take away presidential discretion about funding such programs," said, "Supplying drug addicts with needles is counterproductive and sends entirely the wrong message" (Boston Globe, 4/21).
The San Francisco Chronicle reports that prior to making her announcement, Shalala had commissioned "the nation's leading scientists and public health officials to review all the available evidence on the needle-exchange programs." Dr. Harold Varmus, director of the National Institutes of Health; Dr. David Satcher, U.S. Surgeon General; Dr. Claire Broom, acting head of the Centers for Disease Control and Prevention; and Alan Leshner, director of the National Institute on Drug Abuse, were at the press conference where Shalala announced that needle-exchange programs work (4/21). Shalala cited a Baltimore program involving 3,000 addicts and a Lancet study of needle exchanges in 29 cities worldwide as evidence that such programs can cut the spread of HIV (AP/Philadelphia Inquirer, 4/21). But the funding "decision clearly made the government's top scientists uncomfortable," the New York Times reports, as they "shifted uncomfortably in their seats as reporters peppered" Shalala with questions. Varmus said a review of the data provided "increasingly strong evidence" that needle exchanges can help bring addicts in for treatment (4/21). In defending the decision not to allow federal funding for needle exchanges, Shalala said "programs that have been successful have had the strong support of their communities" (HHS release, 4/20). The San Francisco Chronicle reports this explanation was the administration's attempt "to put the best spin on their decision" (4/21).