The New York Times

Thursday, April 09, 1998

The Politics of Needles and AIDS

By Julie Bruneau and Martin Schechter

Debate has started up again in Washington about whether the Government should renew its ban on subsidies for needle-exchange programs, which advocates say can help stop the spread of AIDS. In a letter to Congress, Barry McCaffrey, who is in charge of national drug policy, cited two Canadian studies to show that needle-exchange plans have failed to reduce the spread of H.I.V., the virus that causes AIDS, and may even have worsened the problem.

Congressional leaders have cited these studies to make the same argument.As the authors of the Canadian studies, we must point out that these officials have misinterpreted our research. True, we found that addicts

who took part in needle exchange programs in Vancouver and Montreal had higher H.I.V. infection rates than addicts who did not. That's not surprising. Because these programs are in inner-city neighborhoods, they serve user who are at greatest risk of infection. Those who didn't accept free needles often didn't need them since they could afford to buy syringes in drugstores. They also were less likely to engage in the riskiest activities.

Also, needle-exchange programs must be tailored to local conditions.

For example, in Montreal and Vancouver, cocaine injection is a major

source of H.I.V. transmission. Some users inject the drug up to 40 times a day. At that rate, we have calculated that the two cities we studied would each need 10 million clean needles a year to prevent the re-use of syringes.

Currently, the Vancouver program ex-changes two million syringes annually, and Montreal, half a million.

A study conducted last year and published in The Lancet, the British

medical journal, found that in 29 cities worldwide where programs are in place, H.I.V. infection dropped by an average of 5.8 percent a year among drug users. In 51 cities that had no needle-exchange plans, drug-related infection rose by 5.9 percent a year.

Clearly these efforts can work.

But clean needles are only part of the solution. A comprehensive approach that includes needle ex-change, health care, treatment, social support and counseling is also needed. In Canada, local governments acted on our research by expanding needle exchanges and adding related services. We hope the Clinton Administration and Congress

will provide the same kind of leader-ship in the United States.