18. Scientific Support for Needle Exchange Suppressed

Sources: IN THESE TIMES Date: 1/9/95; "Political Science" Author: Shawn Neidorf; WASHINGTON POST Date: 2/16/95; "Reports Back Needle Exchange Programs" Author: John Schwartz

SYNOPSIS: After reviewing a massive study on the effectiveness of intravenous needle-exchange programs to curtail the spread of disease, including AIDS, the Centers for Disease Control and Prevention (CDC) recommended that a ban on federal funding for such programs be lifted. But no action has been taken and the review itself has been suppressed.

The 700-page California study, originally released in October 1993, found it was "likely" that needle-exchange programs (NEPs) decrease the rate of new HIV infections, while finding "no evidence" that the programs increase changed nothing, at least on the federal level. "The problem is that one story or one editorial in a particular paper isn't going to do it," Neidorf explained. "To make a difference -- to be "sufficient' -- extensive coverage has to do several things: "First, it has to remind the post-Watergate, post-Iran-Contra public that it's wrong -- unacceptable -- for the government to keep this information secret. Second, it has to make it clear to readers why needle exchange should matter to them. They need to know that they can contract HIV from injection drug use, even if they're not using. All members of the "general population" have to do is have unprotected sex with a user or someone who has had unprotected sex with a user. Third and this is essential-reporters need to demand specifics from the public health officials and hold them accountable for their statements. Just what type of evidence do they need before they'll acknowledge the efficacy of needle exchange?

"The general public is going to pay for AIDS, in one way or another. Drug users who share needles, their sex partners and the future sex partners of their sex partners, and all of their children are at risk for contracting HIV Those who don't contract it will pay for it financially. A few years ago, Dr. Fred Hellinger estimated that it costs about $119,000 to care for drug use in the communities they serve.

CDC scientists were asked by their parent agency, the Public Health Service, to review the California study's methodology, findings, and conclusions. That review, which has yet to be made public, determined that the federal funding ban (in effect since 1988) "should be lifted to allow communities and states to use federal funds to support NEPs as components of comprehensive HIV prevention programs."

A second review of the California study was ordered by the Department of Health and Human Services in 1994. While making no specific recommendations, this second analysis also concluded that the study demonstrates more clearly than any previous research that use of NEPs is associated with decreases in bloodborne infections.

Nonetheless, the Clinton administration has taken no action on the issue. Dr. Peter Lurie, the lead researcher for the California study, suggests that the potential political consequences of advocating a controversial program account for the inaction. The release of the review would be significant, Lurie contends, because it would be the first document in which a government health agency publicly endorsed needle-exchange programs to prevent transmission of AIDS.

Regarding the legal and philosophical obstacles which apparently block federal involvement in the activation of NEPs, Lurie said the failure of the government to release the report is inexcusable. "The federal government is playing politics with the lives of drug users, their sex partners and their children," he said, adding, "Delay, delay, delay, delay-people are dying."

Meanwhile, the Administration hesitates to ruffle conservative feathers, and scientific credibility for NEPs remains under wraps while grim statistics keep piling up.

A quarter of all adult AIDS cases reported to the CDC through June 1994 were traced to the sharing of needles. Either sharing a needle or having sex with someone who did accounted for nearly 75 percent of all cases in women.

Since the original study, others, including one by the National Academy of Sciences, have confirmed that NEPs greatly reduce the spread of the virus that causes AIDS while not encouraging more illicit drug use.

SSU Censored Researcher: Mike Thomas

COMMENTS: Shawn Neidorf, author of the In These Times article, said that while several of the largest U.S. dailies have covered needle exchange and the suppression of the study, the coverage has one person with HIV until he or she dies. He estimated that the cost could jump by as much as 48 percent by 1995. Injection drug users don't have the health insurance that many gay men did. Their bills are going to be the public's. Personally, I'd rather pay for a needle exchange program. The median cost to run one is about $169,000 a year, according to Dr. Peter Lurie's study-a great deal if each program prevents only two HIV infections a year. I think most taxpayers would appreciate that efficiency, even if they hate drug users on principle."

Neidorf identified three groups that benefit from the lack of coverage given the subject: "Politicians with an uncompromising allegiance to the War on Drugs; politicians who would back needle exchange if they weren't afraid of the "you-coddled-drug-users" backlash at reelection time; and public health officials who know the data, but are afraid for their careers to act on it."

John Schwartz, author of the needle exchange article in the Washington Post, said, "Needle exchange programs get a great deal of attention -- not only because they are part of the broad spectrum of AIDS programs, but also because such programs tend to generate controversy wherever they are started. What wasn't covered was the government's own conclusions that the programs are effective -- because the government wasn't releasing those reports."

"There are a number of obstacles to getting effective needle programs implemented," Schwartz said. "Even if the Administration decided to take a hard stand in favor of such programs, a tangle of conflicting legal restrictions on the programs would make it very difficult to pass and implement them. If people had enough information to see this as a public health issue and not a political issue, lives could be saved."

Schwartz noted that he was neither an AIDS activist nor a full-time AIDS reporter, and added, "This was simply a story about common sense needlessly tangled up in politics -- the kind of story that no reporter could screw up. I'm glad to have gotten a chance to work on it."