POLITICIANS and public health officials are treating the drug-related AIDS epidemic as if it were a common cold and not the plague it has become.
They're letting it run its course, ignoring the need for a massive dose of prevention even as the problem worsens. Last year there were 14,000 new drug-related AIDS cases nationwide, more than double the total of 1987.
The numbers grow because addicts spread the infection by sharing needles and having unprotected sex. What's so surprising, given this, is the extraordinary resistance of politicians and public health officials to programs in which addicts turn in used needles for clean ones.
Politicians would rather advocate higher taxes than needle exchanges. Look at Mayor Kurt L. Schmoke, who has expressed interest in needle exchanges but won't push for even an experimental program until other officials back him. He doesn't want to hand a campaign issue to Bill Swisher or Clarence "Du" Burns.
What scares officialdom is that shortsighted naysayers can make this promising idea look like a boon to dopers: "Free needles! Get your free needles from the government!" But what should really scare leaders and citizens alike is the unchecked toll that AIDS is taking among intravenous drug users, their lovers and their children.
Those not moved by humanitarian concern should consider the cost. These people don't have money to pay for AIDS treatment. One way or another, their huge medical bills -- and burial fees -- will be borne by taxpayers.
But the federal government and too many state governments are unmoved. The Bush administration rejected out of hand the recent report of the National Commission on AIDS, which in the name of prevention recommended expanding drug treatment programs and endorsed needle exchange programs.
The administration clings to a criminal justice approach to drug abuse, when what is needed is a public health approach that recognizes the deadly link between drug abuse and AIDS.
The commission believes that drug treatment is the most effective way to reduce the number of needle users and hence the number of AIDS cases among them. But while treatment funding has risen sharply in the past three years, it falls short of meeting the demand. There are about 107,000 persons on waiting lists for treatment, according to National Institute on Drug Abuse numbers cited by the commission.
Until there's enough treatment, the government should take other steps, the commission says, such as giving addicts access to needles and free bleach to clean them. But here the commission loses the support of most politicians and many public health professionals, who, while generally favoring the modestly successful bleach programs, are leery of needle exchanges.
They argue there's no evidence of their effectiveness and claim they might encourage drug use. In fact, there's increasing evidence that they help and none that they hurt. Needle exchange programs have run successfully in Tacoma, Wash., New Haven, Conn., and several European countries.
Typically, these programs offer new needles only as part of an array of services designed to persuade drug users to accept treatment and use condoms. A study by Yale University released in July estimated that New Haven's program has reduced new infections by 33 percent among participants.
"This program is not a solution to AIDS or to drug addiction,"
New Haven Mayor John C. Daniels was quoted as saying. "It is one more Band-Aid, but it is a Band-Aid we cannot afford to do without."
But not even the Yale study has ended the skepticism of many public health experts. Rather than take a chance on measures that might ameliorate a public health emergency, they look for reasons not to, saying none of the needle exchange programs has been run scientifically enough to trust the results.
June E. Osborn, chairwoman of the AIDS commission, is frustrated by the response to the problem.
"I often have the physical urge to find the tallest building I can and start shouting," she said in an interview last December following a commission meeting in Baltimore.
She is shouting now, eight months later, in a report calling for action. Is anybody listening?