APRIL is turning out to be the cruelest month for efforts to fight AIDS. Early in the month, a bill that would have allowed Maryland counties to implement needle-exchange programs was killed in the state legislature. This week, Health and Human Services Secretary Donna E. Shalala announced that the Clinton administration has no plans to lift a decade-old ban on federal funding for such programs, though it recognizes needle exchanges fight AIDS without encouraging illegal drug use.
As medical experts who have fought the spread of acquired immune deficiency syndrome for more than a decade, we are stunned and frustrated by these developments.
A healthy choice
Scientific evidence indicates that needle exchanges, which let addicts swap dirty needles for clean ones, reduce HIV transmission without increasing drug use. As such, needle exchange is a powerful preventive tool for saving the lives of people who are often poor, uninsured and otherwise disconnected from the formal health care system.
Half of all people who catch HIV are infected by needles or by sex with injecting drug users or are children of infected addicts.
President Clinton's AIDS advisory council unanimously supports needle exchange and has harshly criticized Mr. Clinton's own drug policy chief, Barry R. McCaffrey, for ignoring the scientific research and playing into a political rhetoric that translates into new HIV infections, more human suffering and millions of health-care dollars spent unnecessarily.
The research supporting needle exchange has been compelling enough to garner support from the National Institutes of Health, the National Academy of Science, the American Medical Association, the American Public Health Association and the U.S. Conference of Mayors.
Mr. McCaffrey had his own recent embarrassment. Earlier this month, the authors of Canadian needle exchange studies -- research the retired general cited as scientific support for his opposition -- publicly corrected his misinterpretation of their work in a commentary published by the New York Times.
Baltimore has an estimated 35,000 active intravenous drug users, about one-fourth of whom are infected with HIV. To curb the spread of the virus, the city's health department has operated a needle-exchange program for the past 3 1/2 years. Researchers at Johns Hopkins School of Public Health estimate that this program has reduced needle sharing by more than half without an increase in drug use and has referred many drug users to treatment programs. The program also has been credited with a citywide decline in new HIV cases.
Baltimore has the only legal needle-exchange program in the state; one is soon to begin in Prince George's County. But they are not the only Maryland jurisdictions needing such a program.
Since the beginning of the AIDS epidemic, 1,100 Marylanders living outside Baltimore and Prince George's County have become infected with HIV as the result of using dirty needles. Some 630 were residents of suburban Baltimore, which has an estimated 8,300 intravenous drug users.
In light of the clear evidence that needle-exchange programs save lives, more needle exchanges must be established in Maryland. The time for prevention is now -- while the number of people infected with HIV through dirty needles is in the thousands, not the tens of thousands.
Michele Brown and Ben Junge are officials with the Baltimore City Needle Exchange Program. They are participants in the eighth annual North American Syringe Exchange Network meeting in Baltimore this week.
Pub Date: 4/24/98