Dreading the Needle

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There’s nothing ambiguous about the Family Research Council’s stance on needle exchange programs. The conservative Washington think-tank warned readers in a 1997 report that the federal government is “on the verge of funding needle giveaways for drug addicts,” describing such an eventuality as a “tragic mistake.”

The Clinton administration’s position, on the other hand, is much less clear. Congressional efforts to prevent federal funding of needle exchanges, which most experts consider an important part of efforts to stop the spread of HIV and AIDS, are stuck in neutral for the moment. But the administration’s refusal to take advantage of a wide-open opportunity to provide federal backing for needle exchanges is keeping thousands of programs from expanding their work.

In New York City, roughly 50 percent of new HIV cases can be traced to intravenous drug use, according to the Centers for Disease Control (CDC). Most local exchanges are eager for federal money to extend their services to the estimated 80 percent of intravenous drug users who currently do not have adequate access to clean needles.

However, more than federal funding is at stake for the estimated 80,000 to 200,000 at-risk intravenous drug users who live here. Despite overwhelming proof that needle exchanges succeed in preventing the spread of HIV, advocates say local and state governments are often reluctant to support them. The still-awaited federal stamp of approval could help change that.

“Sending the appropriate public health message is a very important step,” says Jane Silver, director of public policy at the American Foundation for AIDS Research (AMFAR). “It will give states and communities the information they need so they can do what they can do.”

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Providing clean needles to intravenous drug users has always been controversial. Congress erected the first obstacle to federal funding of exchange programs through a restrictive amendment on a 1988 AIDS bill.

But the latest hurdle was written into the 1997 Omnibus Appropriations Act: “No funds appropriated under this Act shall be used to carry out any program of distributing sterile needles for the hypodermic injection of any illegal drugs,” Congress declared, “unless the Secretary of Health and Human Services determines that such programs are effective in preventing the spread of HIV and do not encourage the use of illegal drugs.”

Evidence that providing access to clean needles works as intended–without increasing drug use–is readily available. For example, the CDC reports that after the Connecticut legislature legalized the sale and possessionof syringes without a prescription in 1992, the rate of needle sharing among intravenous drug users fell from 71 percent to 15 percent in three years without increasing drug use.

Last February, after a three-day review of existing studies and literature, an independent conference of experts convened by the National Institutes of Health endorsed needle exchange programs as essential to reducing behavioral risks for HIV and AIDS and called for the restrictions on exchanges to be lifted. “This is a battle of ideology versus science,” says local Congressman Jerrold Nadler, who is one of the programs’ most vocal advocates in the House. “My support of needle exchange is based on the simple fact that it saves lives.”

But Shalala has refused to make the declaration required by Congress. Victor Zonano, a Health and Human Services spokesperson, says the department has made it clear that their findings show the exchanges are effective in reducing HIV, but they have withheld their endorsement until they can prove exchanges don’t increase drug use. “It would do us no good to certify and then be reversed by Congress,” he adds.

They may not get the chance. In September, fearing Shalala might change her mind and come out in favor of the programs, the House of Representatives amended her agency’s appropriations bill and rescinded her right to make such a declaration. After a similar measure failed in the Senate, a conference committee compromise preserved the secretary’s authority–but also placed a moratorium on federal funding for needle distribution until at least March 31, 1998.

This temporary compromise has set the stage for a renewed battle this spring. “Make no mistake, the opponents of needle exchange programs have already declared that they intend to codify the federal ban,” Silver says.In October, several members of the President’s AIDS Advisory Council, which recommended lifting the needle exchange ban back in 1995, threatened to resign if progress was not made soon. A December report from the council called the lack of federal funding for the programs the “most disturbing” aspect of federal HIV policy.

Exchange activists and lobbyists at organizations such as AMFAR and the National Association of People With AIDS are pressuring Secretary Shalala to immediately exercise her authority. In September, the National Coalition to Save Lives Now! organized a demonstration outside Health and Human Services headquarters that drew 1,000 protestors.

Not everyone in the field agrees this federal fight is the best strategy. Some activists worry that pressuring the President to seize the opportunity to fund needle exchanges could backfire and hand his opponents an issue that is easy to politicize. Others fear that federal funds would come wrapped in burdensome regulations.

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Drew Kramer, director of the Harm Reduction Care Network of New York, says the money is a secondary concern, however. “The critical issue isfor Secretary Shalala to put the Health and Human Services stamp of approval on syringe exchanges as good public health,” he asserts, because that would likely free up other resources.

Part of government’s reluctance to support needle exchanges–let alone fund them–comes from right-wing pressure but the programs’ outlaw roots may also be a factor. Before 1992, most needle exchanges in New York were initiated by members of the radical AIDS group ACT UP. But in the last five years, more than 51,000 drug users have received syringes from authorized exchanges across the state. By giving the programs greater legitimacy, federal officials could also help open up resources from other levels of government.

A case in point is a New York State Assembly bill introduced by Assemblyman Richard Gottfried, which, like the 1992 Connecticut law, seeks to legalize the sale and possession of needles. In the seven years since Gottfried’s bill was first introduced in Albany, it has never even come up for a vote. “The politics of this issue make people jittery, and they don’t know how to handle it,” says Richard Conti, senior legislative aide to the assemblyman. “That’s why we haven’t gotten a vote on it.”

Gottfried says interest in his legislation has grown in recent years, but he admits, “The federal reluctance to participate [in needle exchange programs] certainly gives credence to the opposition’s arguments.”

Similar trouble has dogged pro-exchange efforts on Staten Island, where 59 percent of HIV cases can be traced to intravenous drug use, according to Wendy Hoefler, former coordinator of the Staten Island HIV Care Network. In December, the Republican Steering Committee of the New York State Assembly held a hearing to debate the borough’s first proposed needle exchange program. “One of the things [Assemblyman Robert] Straniere kept saying over and over again was, ‘The federal government hasn’t come out in favor of this,'” she says. The panel was one of many political attacks on the proposed project–which, after two years of effort, has yet to get underway.

Robin Campbell is a former reporter for the Staten Island Advance.