New Jersey Medicine
Copyright 1996: Medical Society of New Jersey

August 1996, volume 93, no. 8, pages 55-59

Dawn Day, Ph.D.

A major cause of the spread of HIV/AIDS is dirty needles.  Making it possible for injecting drug users to get access to sterile needles would save thousands of lives and uncountable human misery.  A happy, additional consequence would be that hundreds of millions of dollars in medical treatment costs would also be avoided.

So why do we in New Jersey make it difficult or impossible for persons who inject drugs to get sterile needles?  Some people, including Governor Christine Todd Whitman [of New Jersey], say they are concerned about sending a double message.  But a double message is unavoidable.  When a person is suffering from an overdose, we rush that person to a hospital and give them the best medical care we can.  We do not say to the drug user's family and friends, "Sorry, we cannot give your family member life-saving medical care because it would send the wrong message." 

Getting sterile needles to persons who inject drugs is about medical care and saving lives.  In fact it is about sending the message that human life is valuable.

In our society, medical interventions go way beyond pills, bandages, and surgery.  In the name of public health we remove asbestos, cover over lead-based paint, and purify water.

Given the medical consensus that has emerged on the effectiveness of sterile needles as a way of avoiding the spread of drug-related HIV/AIDS, it is difficult to see the denial of access to sterile needles as anything other than the denial of access to a lifesaving medical intervention. 

In the history of modern medicine in the United States, I am aware of only one other instance where a life-saving medical intervention involving a deadly infectious disease was deliberately denied to a group of people.  That instance is the now infamous case of the Tuskegee syphilis experiment.  The originators of the "experiment" justified their activity by saying they wanted to study the course of untreated syphilis.  The unfortunate victims of this study were 400 black men in Tuskegee County, Alabama, who were denied medical treatment for their syphilis from 1932 when the study began until they died or, if they lived, until 1972, when the "experiment" was exposed and stopped.

In the age of AIDS, people who advocate the denial of access to sterile needles should give careful thought to what they are saying and the company they are keeping.

The nature of the argument used to deny federal funding for needle-exchange programs is also worth exploring.  According to federal law, needle exchanges and other programs that would make sterile needles available to injecting drug users cannot be financed by federal dollars until it has been shown that such programs do not encourage the use of illegal drugs. 

Since 1991, six different US government-funded reports have concluded that needle-exchange programs do not increase drug use.  In the face of this overwhelming evidence, the federal government still refuses to release funds for sterile needle programs.  Ignoring their scientific advisors, key officials assert that not all the evidence is in. Examining this situation, it is hard to escape the unpleasant conclusion that some misguided political consideration and not scientific evidence is governing federal decision making in this life-and-death situation.

Having informed the reader of the massive scientific evidence showing that the distribution of sterile needles does not increase drug use, my presentation as a social scientist is at an end.  But as a religious person, I must raise a question about the morality behind the criteria being applied.

How can it be ethical to deny life-saving medical care to one person in an attempt to influence the behavior of another?  Would we ever consider denying medical treatment to John, an alcoholic, until we could prove that John's treatment for kidney disease will not cause someone else to become an alcoholic?  Would we ever consider denying medical care to Mary, a smoker, until we could prove that Mary's treatment for lung cancer will not cause someone else to start smoking?

The fact that drug use is illegal cannot be used to justify this strange federal criteria.  Under criminal law, we punish people for the crimes they themselves have committed sometime in the past. We do not punish people for crimes someone else might commit sometime in the future.

Clean needle programs save lives.  We must make it possible for such programs to exist.

The people of America favor clean needle programs.  A recent national survey funded by the Kaiser Family Foundation found that two-thirds of Americans favor needle exchange as a means of slowing the spread of HIV/AIDS. 

The Medical Society of New Jersey and the many other medical professional organizations that have passed resolutions in favor of clean needle programs need to continue to speak out forcefully.  Together we can make the thin strata of political leaders who oppose needle exchange realize that they are out of step both with the common sense of the American people and the scientific research of the US and international medical communities.

_____________________

References  

Jones J. H. Bad Blood: The Tuskegee Syphilis Experiment.  New York: The Free Press.  263pp. 1981.

The six US Government studies reporting the effectiveness of clean needle programs are:

• National Commission on AIDS. 1991.

• General Accounting Office. 1993.

• University of California. Lurie P, Reingold AL, Bowser B, et al. 1993.

• Centers for Disease Control.   1993.

• National Research Council/Institute of Medicine.  1995.

• Office of Technology Assessment of the US Congress.  1995.

Dr. Dawn Day is  the Director of the Dogwood Center, Princeton, NJ.  Dr. Day, a sociologist and activist scholar, writes on issues of social justice and AIDS.  She is the author of Health Emergency: The Spread of Drug-Related AIDS Among African Americans and Latinos.