Subject: AP: U.S. Won't Fund Needle Exchanges

     U.S. Won't Fund Needle Exchanges

     By LAURAN NEERGAARD
     .c The Associated Press

     WASHINGTON (AP) - Programs that let drug addicts exchange used
needles
     for clean ones fight AIDS and do not encourage illegal drug use, the
     Clinton administration declared today - but it will not allow federal
     tax dollars to fund the programs.

     The administration hopes that Health and Human Services Secretary
     Donna Shalala's strong endorsement will encourage communities to start
     their own needle exchanges. But AIDS activists have said that federal
     money - so far banned - is key, and they see Shalala's decision as a
     defeat.

     ``The scientific evidence does show needle exchange programs reduce
     the risk of infection with HIV and do not encourage the use of illegal
     drugs,'' said an administration official today, speaking on condition
     of anonymity. But ``the administration has decided that the best
     course at this time is to have local communities use their own dollars
     to fund needle exchange programs.''

     Shalala will tell state and local officials that to start a needle
     exchange, the programs must be part of a comprehensive HIV prevention
     strategy that includes referring participants to drug treatment and
     counseling. Also, needles must be made available only on a replacement
     basis, the administration official said.

     AIDS activists were stunned by the decision, questioning how federal
     public health officials could say that needle exchanges work but then
     decline to fund them.

     ``It's like saying the world is not flat but not funding Columbus'
     voyage,'' said Daniel Zingale of the activist group AIDS Action.

     ``It's politics rather than public science,'' added Winnie Stachelberg
     of the Human Rights Campaign. ``Local communities have been scraping
     together programs for the last several years, but it's clear federal
     funds are needed.''

     Needle exchange programs are one of the hottest topics in the AIDS
     crisis. Half of all people who catch HIV are infected by dirty
     needles, sex with injecting drug users or are children of infected
     addicts - totaling 33 people every day, AIDS experts say.

     Numerous scientific studies and public health groups have declared
     that needle exchanges reduce that risk, and 88 needle exchanges
     operate around the country with private, state or local funding.

     But Congress had banned letting communities use federal tax dollars to
     pay for needle exchanges until Shalala certified that scientific
     studies proved they both reduced spread of the HIV virus and did not
     encourage drug use.

     After a months-long review by her top scientific advisers, Shalala
     this morning decided that needle exchanges are scientifically backed.

     The scientific review found that the needle exchanges that work best
     are part of a larger anti-HIV program that pushes addicts toward drug
     treatment.

     Indeed, one study of a needle exchange in the Bronx, New York, found
     that providing clean needles to heroin addicts in addition to offering
     them methadone treatment both lowered the risk of HIV infection and
     lowered their overall drug use.

     But whether to allow federal funding was a politically charged
     question that administration officials debated heavily over the
     weekend. Ultimately, Shalala decided that whether to fund a needle
     exchange was up to each community.

     The decision came after Republicans in Congress had threatened to ban
     federal funding of needle exchanges altogether if Shalala did decide
     to attempt it. And President Clinton's own drug policy chief, Barry
     McCaffery, has vigorously fought that attempt, saying it would send
     the wrong message to children.

     ``Such a program would in reality use tax dollars and the authority of
     the federal government to push drug paraphernalia into already
     drug-ravaged inner cities. This is reckless and irresponsible,'' Sen.
     Chuck Grassley, R-Iowa, said in a weekend statement.

     Public health experts directly dispute that: ``Does needle exchange
     promote drug use? A preponderance of evidence shows either no change
     or decreased drug use,'' an NIH consensus conference concluded 14
     months ago, saying the ban on funding for these programs will lead to
     ``many thousands of unnecessary deaths.''

     Shalala last year agreed that science proved that needle exchanges
     were effective in fighting HIV, but said at that time that she needed
     to review further data on how they affect drug use.

     AP-NY-04-20-98 1241EDT



     Copyright 1998 The Associated Press. The information contained in the
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Dennis Raphael, Ph.D.
Associate Professor and Acting Director,
Masters of Health Science Program in Health Promotion
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
McMurrich Building, Room 101
Toronto, Ontario, CANADA M5S 1A8
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