Wall Street Journal - August 15, 2006
Marilyn Chase, marilyn.chase@wsj.com

Harm reduction is a controversial strategy of providing hopelessly-addicted persons with the means to stay HIV-free -- even if they are unable or unwilling to stop using drugs. Usually this involves prevention in the form of clean-needle exchange, a practice that many people, including conservative politicians in the U.S. and elsewhere, find unacceptable.

Intravenous drug users account for 30% of HIV cases outside Africa, and one-in 10 new infections occurs in people who inject drugs, said Alex Wodak, director of Alcohol and Drug Services at St. Vincent's Hospital Sydney Ltd., in Darlinghurst, NSW, Australia. But medically sound interventions can spare addicts from HIV.

"We've known how to control infections among intravenous drug users for 15 years," Dr. Wodak said.

"The toolkit is simple: education, sterile kits, getting rid of dirty equipment, providing addiction treatment, and involving users not as passive but as active participants."

But there are waiting lists for methadone clinics in many places, and needle-exchange is against the policy of President George W. Bush. But his predecessor Bill Clinton -- once ambivalent about needle exchange -- is now singing a different tune. Asked if he regretted his failure to support needle-exchange to curb the explosion of HIV, Mr. Clinton said yes.

"I was wrong," Mr. Clinton told a packed press conference. "The evidence shows that it doesn't lead to increased drug usage."

Mr. Clinton explained that his administration did allow for state and local governments to pursue "the local option" of adopting the practice, with politically disastrous results. "I was excoriated for it," he said.

Similarly, Mr. Clinton challenged what's known as the anti-prostitution pledge -- the current Administration's policy requiring its partners in the AIDS fight to publicly repudiate the practice of prostitution before undertaking to help affected populations abroad.

"I don't understand how you can go in to a country where there is sex work and not deal with sex workers," he said. Why not go in and say: We disapprove of prostitution but here is the money. Now go save lives?"

He echoed sentiments of other global health officials here who said that saving the health of a prostitute shouldn't be discounted because it ultimately prevents HIV in their patrons, who may be married. This in turn saves health of their wives -- and the mothers of their children -- whose fidelity won't protect them if their husbands bring HIV home. Besides, the former president said, everyone deserves prevention.

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