The failure to achieve federal funding for needle exchange programs from 1988 to the present

The use of federal funds to support needle exchange programs has been prohibited by Congress since 1988.(1) The original intent was that the ban on federal support would remain in effect until the Secretary of Health and Human Services of the United States determined that such programs were effective in preventing the spread of HIV and did not encourage the use of illegal drugs.

In the years since the ban on federal funding of needle exchange programs was put into effect, an impressive number of scientific studies and medical organizations have carefully examined this issue and concluded that needle exchange programs are effective and needed.

The Clinton administration
In April 1998, then Secretary of Health and Human Services, Donna E. Shalala publicly announced that the scientific evidence was in: needle exchange programs were effective in preventing the spread of HIV and did not encourage the use of illegal drugs.  But after Secretary Shalala made the determination, she nonetheless continued the federal ban on funding needle exchange programs.(2)

Controversy erupted.

bullet The Clinton administration defended itself.
bullet Those in favor of federal funding for needle exchange spoke out angrily.
bullet Congressional Black Caucus leaders called for General McCaffrey's resignation.

In 2002, former President Clinton said he had erred in not supporting needle exchange programs to prevent the spread of HIV among drug users.(2a)

The Bush administration
As a presidential candidate, George W. Bush opposed needle exchange programs.(3) That policy continues into the present.  Bush's Secretary of Health and Human Services, Tommy Thompson, has said that the Bush administration has no plans to permit federal funding of needle exchange programs.(4)  

In an administration known for its demands of loyalty, President Bush's first AIDS czar, Scott Evertz, nonetheless once let it be known that, in his (Evertz's) own view, needle exchange is saving lives and that the evidence in its favor is conclusive.(5) 

With the coming of the Bush administration, the terms of the debate on AIDS have changed.  Needle exchange, although recommended by all the medical authorities referenced above, is not even under discussion.  Instead questions are being raised about the effectiveness of condoms, prevention funds are being shifted to abstinence-only prevention, and in spite of the increasing numbers of those living with HIV/AIDS, AIDS funding is leveling off.(6)

Footnotes

(1) National Research Council and Institute of Medicine. 1995. Jacques Normand, David Vlahov, and Lincoln E. Moses, eds., Preventing HIV transmission: The role of sterile needles and bleach. Executive summary. The full report is available from  Washington, DC: National Academy Press, 1995.  page 2.

(2) U.S. Department of Health and Human Services. 1998. "Research shows needle exchange programs reduce HIV infections without increasing drug use." Press release, April 20.

Secretary Shalala's press release had been a long time in coming. In 1993, top federal health officials had already concluded that needle exchange programs should be supported with public funds. However, their views only became public two years later, when internal government documents were leaked to the Drug Policy Alliance (then the Drug Policy Foundation) and published in the San Francisco Chronicle.  See:

(2a) Lawrence K. Altman. 2002. "Clinton urges global planning to halt HIV." New York Times. July 12. page A8.

(3) Response of Governor George W. Bush to the AIDS Foundation of Chicago. Fall 2000. 

Candidate Bush's statement: I do not favor needle exchange programs and other so-called “harm reduction” strategies to combat drug use. I support a comprehensive mix of prevention, education, treatment, law enforcement, and supply interdiction to curb drug use and promote a healthy, drug-free America, not misguided efforts to weaken drug laws. Drug use in America, especially among children, has increased dramatically under the Clinton-Gore Administration, and needle exchange programs signal nothing but abdication, that these dangers are here to stay. Children deserve a clear, unmixed message that there are right choices in life and wrong choices in life, that we are all responsible for our actions, and that using drugs will destroy your life. America needs a President who will aim not just for risk reduction, but for risk elimination that offers people hope and recovery, not a dead-end approach that offers despair and addiction.

(4) Steve Sternberg. 2001. "Abstinence Only' Funding May Rise." USA Today. June 6.

(5) Peter LaBarbera. 2001. "White house AIDS czar backs needle exchange."  November 1. C & F Report of the Culture and Family Institute.

(6) Laura Meckler. 2002. "Conservative Ex-Congressman to Head AIDS Advisory Panel." Associated Press. January 23. See also Ceci Connolly. 2002. "Bush aides defend AIDS policies from council criticism." Washington Post. March 15.

For a list of other materials used on this website, see References.