The Washington Post, 27 February 2005
The Bush administration is quietly extending a policy that undermines the global battle against AIDS. It is being pushed in this direction by Congress, notably by Rep. Mark Edward Souder (R-Ind.). But some administration officials zealously defend this policy error, claiming scientific evidence that doesn't exist.
The administration's error is to oppose the distribution of uncontaminated needles to drug addicts. A large body of scientific evidence suggests that the free provision of clean needles curbs the spread of AIDS among drug users without increasing rates of addiction. Given that addicts are at the center of many of the AIDS epidemics in Eastern Europe and Asia, ignoring this science could cost millions of lives. In Russia, as of 2004, 80 percent of all HIV cases involved drug injectors, and many of these infections occurred because addicts share contaminated needles. In Malaysia, China, Vietnam and Ukraine, drug injectors also account for more than half of all HIV cases. Once a critical mass of drug users carries the virus, the epidemic spreads via unprotected sex to non-drug users.
The administration claims that the evidence for the effectiveness of needle exchange is shaky. An official who requested anonymity directed us to a number of researchers who have allegedly cast doubt on the pro-exchange consensus. One of them is Steffanie A. Strathdee of the University of California at San Diego; when we contacted her, she responded that her research "supports the expansion of needle exchange programs, not the opposite." Another researcher cited by the administration is Martin T. Schechter of the University of British Columbia; he wrote us that "Our research here in Vancouver has been repeatedly used to cast doubt on needle exchange programs. I believe this is a clear misinterpretation of the facts." Yet a third researcher cited by the administration is Julie Bruneau at the University of Montreal; she told us that "in the vast majority of cases needle exchange programs drive HIV incidence lower." We asked Dr. Bruneau whether she favored needle exchanges in countries such as Russia or Thailand. "Yes, sure," she responded.
The Bush administration attempted to bolster its case by providing us with three scientific articles. One, which has yet to be published in a peer-reviewed journal, was produced by an author unknown to leading experts in this field who is affiliated with a group called the Children's AIDS Fund. This group is more renowned for its ties to the Bush administration than for its public health rigor: As the Post's David Brown has reported, it recently received an administration grant despite the fact that an expert panel had deemed its application "not suitable for funding." The two other articles supplied by the administration had been published in the American Journal of Public Health. Although each raised questions about the certainty with which needle-exchange advocates state their case, neither opposed such programs.
Evidence that the administration does not cite leaves little doubt about the case for needle exchange. A study of 81 cities published in 1997 in the Lancet, a medical journal, found that in cities without needle-exchange programs, HIV infection rates among injection drug users rose by nearly 6 percent per year; by contrast, cities that had introduced free-needle programs witnessed a decrease in infection rates of about the same magnitude. Elias A. Zerhouni, the director of the National Institutes of Health, wrote last year that exchange programs "can be an effective component of a comprehensive community-based HIV prevention effort," and a World Health Organization technical paper agreed that the provision of clean needles and syringes should be "a fundamental component of any comprehensive and effective HIV-prevention programme." Addressing legitimate methodological questions about the research favoring needle exchange, the WHO reasonably concluded that incomplete scient ific evidence does not confer the freedom to ignore the knowledge we do have.
Respecting science does not appear to be the administration's priority, however. Not only is it refusing to spend federal dollars on needle exchange, but the administration also is waging a campaign to persuade the United Nations to toe its misguided line. The U.N. Office on Drugs and Crime, which is heavily reliant on U.S. funding, has been made to expunge references to needle exchange from its literature, and the administration is expected to continue its pressure on the United Nations at a meeting that starts March 7. The State Department's new leadership needs to end this bullying flat-earthism. It won't help President Bush's current effort to relaunch his image among allies. And it's almost certain to kill people.
Copyright 2005 The Washington Post