Ending weeks of speculation, the Clinton administration
yesterday refused to lift a 10-year ban on using federal funds
for needle exchange programs, despite concluding for the first
time that such exchanges prevent the spread of HIV and do not
encourage drug use.
Leaders in the fight against AIDS condemned the unexpected
decision, which was announced by Health and Human Services
Secretary Donna Shalala. "It is a purely political decision,
and an abdication of her public health responsibilities," said
Pat Christen, executive director of the San Francisco AIDS
Foundation, which runs the nation's largest needle exchange
program, which uses private and city funds. "She has chosen to
protect herself politically, and people will die as a result of
Pounding his fist at an AIDS prevention meeting in San
Francisco, Thomas Coates, director of the University of
California at San Francisco's AIDS Research Institutes, accused
Shalala of "public health malpractice."
In recent weeks, the administration had led AIDS activists to
believe it was finally moving to lift the ban. However, the
plan was derailed when word of the administration's intentions
leaked out late last week, and a slew of conservative
organizations issued a flurry of press releases warning the
administration not to do so.
Several influential GOP lawmakers said they would introduce
legislation reinstating the ban should the administration move
to lift it. That brought a weekend of intense discussions
between the White House and Health and Human Services
officials, who were apparently ready to lift the ban. In a
political calculation, sources close to the discussions said,
the White House concluded that it would not have the votes to
block legislation reimposing the ban. Also key was the the
opposition of President Clinton's "drug czar," retired
General Barry McCaffrey, who continued to lobby vigorously
against allowing federal funds for needle exchange programs,
arguing that it would send the wrong message to the nation's
young people and undermine the administration's anti-drug
message. McCaffrey also vehemently opposed a compromise
proposal that would have funded pilot programs in 10 cities.
Shalala had the authority to lift the ban if she could point to
solid scientific evidence demonstrating that needle exchange
programs both reduce the spread of AIDS and do not encourage
drug use. Until now, Shalala had said the evidence satisfied
the first requirement but not the second. AIDS experts assumed
that once she had satisfied herself that needle exchange
programs do not encourage drug use, she would take action.
However, no one expected the administration to both declare
that the conditions for lifting the ban had been met -- and
then refuse to lift it.
To help her make the decision, Shalala commissioned the
nation's leading scientists and public health officials to
review all the available evidence on needle exchange programs.
They included Dr. Harold Varmus, director of the National
Institutes of Health; Dr. David Satcher, the newly appointed
surgeon general; Dr. Claire Broome, acting head of the Centers
for Disease Control and Prevention; and Alan Leshner, director
of the National Institute on Drug Abuse.
Yesterday morning, those officials met with Shalala, armed with
a 300-page report, which concluded that the conditions for
lifting the ban have been met.
But by that time, the White House had already decided against
such a move. After meeting with the scientists for an hour,
Shalala issued a detailed press release in which she extolled
the value of needle exchange programs -- and in the same breath
said the administration would not authorize using federal funds
to support them.
"A meticulous scientific review has now proven that needle
exchange programs can reduce the transmission of HIV and save
lives without losing ground in their fight against AIDS," she
said. She noted that injection drug use accounts for 60 percent
of new AIDS cases in certain areas, and that 40 percent of all
652,000 cases of AIDS reported in the United States have been
linked to injection drug use.
She also quoted NIH director Varmus, a Nobel laureate in
biochemistry, as saying: "An exhaustive review of the science
indicates that needle exchange programs can be an effective
component of the global effort to end the AIDS epidemic. Recent
findings have strengthened the scientific evidence that needle
exchange programs do not encourage the use of illegal drugs."
But without explanation, she said the administration has
"decided that the best course at this time is to have local
communities use their own dollars to fund needle exchange
Representative Nancy Pelosi, D-San Francisco, who had lobbied
vigorously for lifting the ban, said "it defies logic to
determine a program's efficacy, and then not fund the program,
especially in the middle of an epidemic." She said the
decision reveals a "a lack of political will in the midst of a
public health emergency."
About 130 communities across the nation have set up their own
needle exchange programs without federal funds, but AIDS
experts say that these programs are often underfinanced, and
that many communities and regions are completely underserved.
Administration officials tried to put the best spin on their
decision yesterday, saying they hope the federal endorsement
will encourage local communities to set up their own programs.
"Hopefully local communities and states will see this as
encouragement to open their own needle exchange programs even
as the federal government ducks for cover," said Peter Lurie
of the UCSF Center for AIDS Prevention and the principal
investigator of the first national survey showing the
effectiveness of needle exchange in 1993.
At the same time, Lurie said the decision "made a mockery of
the administration's purported commitment to HIV prevention."
He noted that President Clinton endorsed lifting the ban in his
1992 presidential campaign. That commitment, he said,
dissipated in the face of stiff Republican opposition.
"Republicans showed they were willing to play hardball, and
the administration has never been able to take a principled
stand on this issue when faced with a possible political