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New York Times
Clinton Decides Not to Finance Needle Program
Sheryl Gay Stolberg After
a bitter internal debate, the Clinton Administration today declined to
lift a nine-year-old ban on Federal financing for programs to distribute
clean needles to drug addicts, even as the Government's top scientists
certified that such programs did not encourage drug abuse and could save
lives by reducing the spread of AIDS. The decision, announced by Donna E. Shalala, the
Secretary of Health and Human Services, was immediately denounced by
public health experts and advocates for people with AIDS, who had been
told in recent days that the ban was about to be lifted. The announcement has no practical effect; it simply
means that state and local governments, which receive block grants from
Washington for AIDS prevention efforts, remain barred from using that
money for needle exchange. But the decision is of huge significance to
advocates for people with AIDS, who have viewed it as a test of the
Administration's commitment to reducing the spread of the disease.
"At best this is hypocrisy," said Dr. R. Scott Hitt, chairman
of the President's Advisory Council on H.I.V. and AIDS, which last month
issued a vote of "no confidence" in the Administration.
"At worst, it's a lie. And no matter what, it's immoral." Many Administration officials strongly supported
lifting the ban and were disappointed with the final decision. But the
position taken by Gen. Barry R. McCaffrey, the Administration's director
of national drug policy, was that lifting the ban would send the wrong
message to the nation's children. One official called that issue
"an important consideration" for Mr. Clinton. The announcement
came after a week of negotiations between Dr. Shalala's staff and the
White House, according to three Administration officials familiar with
the talks. Dr. Shalala had been pressing to rescind the ban, with some
restrictions, and was prepared to defend that decision on Capitol Hill,
knowing it was bound to be controversial. But his advisers feared a political disaster for
Mr. Clinton and worried that Republicans might push through legislation
stripping Federal money from groupsthat provide free needles, even
though the money was used for other purposes. "Any Republican could have offered a
resolution and we almost certainly would have lost," said one of
the officials, all of whom spoke on the condition of anonymity. "We
don't have the votes for this in an election year." To further complicate matters, General McCaffrey
had been in an open debate on the issue with Sandra L. Thurman, the
White House director of national AIDS policy, who had argued strenuously
against the ban. Ms. Thurman made no public comment about the decision
today. The ban dates to 1989, when Congress declared that
no Federal money could be spent to support clean-needle programs until
the Government could provide scientific evidence that such programs both
reduced the spread of H.I.V., the virus that causes AIDS, and did not
encourage drug use. The two prong test was difficult to meet. In February, the Administration certified that
needle exchange reduced the spread of AIDS, but it took until today for
officials to provide evidence that the programs did not promote drug
use. With that evidence in hand, the Administration was free to begin
drafting guidelines for how Federal money might be spent for needle
exchange programs. Although Dr. Shalala's staff had come up with
such guidelines, the President declined to endorse them, officials said. Over the last decade, needle exchange programs have
cropped up across the country; today there are about 100 in more than 20
states. Many operate on a shoestring budget, with private or local
money. In many states, needle exchange remains illegal,
but law-enforcement officers look the other way and allow the programs
to continue. Public health experts had been hoping a release of Federal
money would have legitimized these programs. (In New York, officials can
grant permission for certain needle exchange programs to operate.) "There are states that for years have hidden
behind Federal opposition to needle exchange to justify their own
inaction," said Dr. Peter Lurie, who in 1993, while teaching at the
University of California at San Francisco, published the first
Government-financed survey of the effectiveness of needle exchanges. Federal officials have estimated that each day, 33
people are infected with the AIDS virus as a result of intravenous drug
use, a figure that includes drug abusers, their partners and their
children. Intravenous drug use is also responsible for most
of the growth in the spread of AIDS, particularly among the poor and
minorities. Dr. David Satcher, the Surgeon General, said today that 40
percent of new AIDS infections in the United States are either directly
or indirectly attributed to infection with contaminated needles; among
women and children, the figure is 75 percent. Dr. Lurie, who works as a research associate at
Public Citizen, a Washington advocacy group specializing in public
health issues, estimated today that had the Government paid for needle
exchange programs, 17,000 lives could have been saved in Mr. Clinton's
terms in office. "It is frustrating in the extreme," he
said, "to see political considerations take precedence over public
health ones, particularly when a huge cost in human life is
predictable." The decision clearly made the Government's top
scientists uncomfortable. At the news conference announcing it, Dr.
Shalala was flanked by many of them, including Dr. Satcher and Dr.
Harold Varmus, director of the National Institutes of Health. Most shifted uncomfortably in their seats as
reporters peppered Dr. Shalala with questions about the Administration's
decision, although none publicly disagreed with it. Dr. Shalala declined to discuss the internal debate
between her office and the White House, or even her recommendations to
the President, but said the Administration hoped that its pronouncement
would spur state and local governments to pay for the programs on their
own. In defending the decision not to release Federal money, she said
studies showed that needle exchange programs worked best when they were
carefully designed within local communities. "We are sending the message that the senior
scientists of this Government, in conjunction with a number of
scientists around the world," have concluded that these needle
exchange programs do reduce H.I.V. transmission and do not encourage
drug use, she said. Dr. Varmus said a review of the scientific
literature, provided "increasingly strong evidence" that
needle exchange programs can be an effective means of bringing addicts
in for treatment. He cited a Baltimore study of nearly 3,000 addicts,
which found that the needle exchange program dramatically reduced the
sharing of tainted needles and that half the participants in the program
entered treatment. As expected, today's decision prompted a flurry of
announcements from Congress. Senator John Ashcroft, Republican of
Missouri, called the Administration's position "an intolerable
message that it's time to accept drug use as a way of life." But Representative Nancy Pelosi, Democrat of California, complained that the Administration had missed an opportunity to save lives. "It defies logic," she said, "to determine a program's efficacy and then not fund the program, especially in the middle of an epidemic."
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