Ban on Federal Funding of Needle Exchange Will Not Be Lifted, Says Clinton Administration

HARM REDUCTION March-April 1998

On April 20, the Clinton Administration declined to lift a nine-year-old ban on Federal funding on needle exchanges despite a finding by Donna Shalala, the Secretary of the U.S. Department of Health and Human Services, that such programs effectively reduce HIV transmission and do not encourage drug abuse. These two finding were required by Congress for the Secretary of HHS to lift the ban (Amy Goldstein, "Clinton Supports Needle Exchanges But Not Funding," Washington Post, April 21, 1998, p. A1; Sheryl Gay Stolberg, "President Decides Against Financing Needle Programs," New York Times, April 21, 1998, p. A1; Marlene Cimons, "Decision Against Funding Needle Plan Draws Fire," Los Angeles Times (Washington Edition), April 21, 1998, p. A4; Lynda Richardson, "U.S. Refusal to Finance Needle Exchanges Angers Agencies," New York Times, April 22, 1998, p. A27).

The announcement means that state and local governments which receive Federal funding for AIDS prevention efforts remain barred from using that money for needle exchange programs. Federal officials estimate 33 people are infected with HIV each day as a result of intravenous drug use. Surgeon General David Satcher, MD, said that 40% of new HIV infections in the U.S. are directly or indirectly attributed to contaminated needles, and that among women and children, the figure is 75%.

"At best this is hypocrisy," said Dr. R. Scott Hitt, Chairman of the President's Advisory Council on HIV and AIDS. "At worst, it's a lie. And no matter what, it's immoral." The advisory council issued a vote of "no confidence" in the Administration in March for not lifting the ban.

Gen. Barry McCaffrey, director of the White House Office of National Drug Control Policy, actively urged the Administration not to lift the ban saying that doing so would send the wrong message to children. According to the Washington Post, McCaffrey lobbied Congressional Republican opponents of needle exchanges to speak out before Shalala lifted the ban. One of the Republicans contacted was Rep. Dennis Hastert (R-IL), who heads a congressional anti-drug task force that is deeply critical of the Clinton Administration's drug strategy (John F. Harris and Amy Goldstein, "Puncturing an AIDS Initiative," Washington Post, April 23, 1998, p. A1).

McCaffrey had been in an open debate about the issue with Sandra L. Thurman, director of national AIDS policy for the White House, who argued strongly that the ban should be lifted. In a letter to Thurman, McCaffrey reiterated his belief that needle exchanges send the wrong message about drugs to children. He said he would rather see the money spent on drug treatment programs. "As public servants, citizens and parents, we owe our children an unambiguous `no use' message," he wrote (Christopher Wren, "White House Drug and AIDS Advisors Differ on Needle Exchange," New York Times, March 23, 1998, p. A10).

Reportedly, Shalala had been pressing to rescind the ban, with some restrictions, and was prepared to defend that decision before Congress. However, Clinton advisors said lifting the ban might motivate Republicans to strip Federal money from AIDS prevention projects that provide needle exchange. Funding needle exchanges "would have been voted down immediately [in Congress] and you would have scared off the local people," said White House advisor Rahm Emanuel. On April 20, Sen. Paul Coverdell (R-GA) introduced a bill that would prevent the HHS Secretary from ever lifting the ban (Louis Freedberg, "GOP Balks at Idea of Lifting Ban on Needle Funding," San Francisco Chronicle, April 18, 1998, p. A3).

Shalala said she hopes that the Administration's endorsement of needle exchanges will spur state and local governments to finance their own programs. Defending the failure to lift the Federal funding ban, she said studies show that such programs work best when they are carefully designed with local communities.

States for years have hidden behind Federal opposition to needle exchange to justify their own inaction, said Peter Lurie, MD, who in 1993 coordinated a federally-funded study of the effectiveness of needle exchange programs. Lurie, who is associated with the Washington, DC-based public interest group Public Citizen, says needle exchanges could have saved 17,000 lives since Clinton took office in 1993. "It's frustrating in the extreme," he said, "to see political considerations take precedence over health ones, particularly when a huge cost in human life is predictable."

Several major newspaper's editorial boards, including the Dallas Morning News, USA Today, the Washington Post, the New York Times and the Los Angeles Times, responded critically to the failure to fund needle exchange (Editorial, "AIDS prevention efforts should include syringe programs," Dallas Morning News, April 22, 1998; Editorial, "Sticking It To Needles," USA Today, April 22, 1998, Editorial, "Clean Needles, No Money," Washington Post, April 23, 1998, p. A24; Editorial, "Cowardice on Clean Needles," New York Times, April 22, 1998; Editorial, "Cop-Out on Needle Exchanges," Los Angeles Times (Wash. Edition), April 22, 1998, p. A10).

In a letter to Shalala on April 17, the mayors of San Francisco, Detroit, Seattle, New Haven and Baltimore urged the Clinton Administration to lift the ban (Reuters, "Five Big City Mayors Back Needle Exchanges," New York Times, April 19, 1998).

National Coalition to Save Lives Now, Chris Lanier - c/o The Harm Reduction Coalition, 22 West 27th St., 9th Floor, New York, NY 10001, Tel: (212) 213-6376 ext. 17, Fax: (212) 213-6582, E-mail: <nclsn@dti.net>.

Sandy Thurman, Office of National AIDS Policy - 808 17th Street, NW, Suite 820, Washington, DC 20006, Tel: (202) 632-1090, Fax: (202) 632-1096.

Sec. Donna Shalala - Department of Health and Human Services, 200 Independence Ave., SW, Washington, DC 20201, Tel: (202) 690-7000, Web: <http://www.dhhs.gov>.

Gen. Barry McCaffrey, Office of National Drug Control Policy - 750 17th Street, NW, 8th Floor, Washington, D.C. 20006, Tel: (202) 395-6618.

Peter Lurie - Institute for Social Research, Room 5055, University of Michigan, Box 1248, Ann Arbor, MI 48106, Tel: (313) 936-0552, Fax: (313) 647-8629, E-mail:<plurie@umich.edu>.