New information on the injectionrelatedAIDS epidemic is building pressure on the Clinton administration, which to date has effectively opposed the use of needle exchange programs (NEPs) to curb the spread of the disease. Two new reports show both the depth of scientific support for NEPs and the urgency of acting now.

The first report, Preventing HIV Transmission: The Role of Sterile Needles and Bleach, was unveiled September 19 by the National Academy of Sciences. At Congress's request, NAS had organized a special study panel under the auspices of the National Research Council and the Institute of Medicine. Like much research that came before it, the NAS investigation found solid scientific support for the notion that NEPs slow the spread of HIV and do not increase drug abuse. Based on those findings, the panel of experts recommended that the Clinton administration lift the ban on federal funding of these programs.

The panel also urged states with laws requiring a doctor's prescription to purchase and possess syringes to repeal them, thereby increasing access to clean needles. Any such move at the state level, the panel advised, should be accompanied by measures to collect and safely dispose of used syringes.

All these findings and recommendations should be familiar to the Clinton administration's decision-makers. The NAS findings echo the points made in two different authoritative studies submitted to federal health agencies since 1993 (see Peter Lurie, "Needed: A Zero Tolerance Policy on AIDS," The Drug Policy Letter, Summer 1995).

However, the administration is playing dumb. Secretary of Health and Human Services Donna Shalala, who will soon be the person responsible for making official findings thatwould permit federal funding of needle exchanges, told the New York Times
December 6 that there was a "controversy over research" that prevented the administration from moving on the issue.

There's a controversy, and there's research, but the new NAS report underscores the fact that there is no controversy within the peer-reviewed research on needle exchanges. It appears that Shalala has opted for a disinformation strategy instead of planning how to move forward.

Adding pressure for action was the second new report, entitled "Health Emergency," which focuses on the disproportionate impact of drug injection-related AIDS among African-Americans and Latinos. This report, produced by Dawn Day of the Dogwood Center in New Jersey and released October 20, shows the deadly results of the lack of access to clean needles combined with higher drug arrest rates in communities of color. According to Day's analysis:

•    Through the end of 1994, over 73,400 African-Americans and 28,000 Latinos either had been diagnosed with AIDS related to sharing of HIV-infected drug injection equipment, or had died from the disease.

•    Among drug-injecting populations, African-Americans and Latinos are statistically much more likely to get AIDS than are white injectors. Available data indicate that African-Americans are five times more likely to get AIDS than white injectors, while for Latinos, the likelihood is more than three times that for whites.*

•    Among African-Americans as a whole, the risk of contracting HW — and ultimately dying of AIDS — from infected needles is more than seven times the risk of dying from a drug overdose. For Latinos as a whole, the risk is nearly five times greater that infected needles, rather than illegal drugs, would lead to death.

"Health Emergency" serves as a "wake-up call," Day says, "to all people concerned about health in African-American and Latino communities."
— Dave Fratello

TO ORDER THESE REPORTS:
•    Preventing H1VTransmission: The Role of Sterile Needles and Bleach— 318 pages, hardcover, $37.95 plus $4 shipping; $0.50 shipping per additional copy. Call National Academy Press at (202) 334-3313.
•    "Health Emergency: The Spread of Injection-Related AIDS Arhong African-Americans and Latinos" —24 pages, softcover, $5 from DPF.

CDC REVIEWS NOW ON-LINE:

The Clinton administration's internal reviews of needle exchange research are still not officially public, but you can order them from DPF ($5) or access them on the Internet. They can be found at the Drug Reform Coordination Network's home page at The internal reviews, which were publicly released by DPF in March 1995, show federal health officials validating NEP research and advocating federal funding of NEPs.

* This part of Day's analysis relies on data from the National Household Survey on Drug Abuse, an annual survey conducted by the federal government. The survey may undercount African-American and Latino drug injectors, which, if true, would inflate the disparity stated here. However, the NHSDA contains the only national data available on drug use; hence its use here with other national figures to estimate the impact of injection-related AIDS among these populations.