The Bush administration and drug czar Martinez should heed the advice of the National Commission on AIDS, whose July 1991 report, "The Twin Epidemics of Substance Use and HIV," urged implementation of clean needle exchange and other programs targeting addicts. The report stated in part:

We must take immediate steps to curb the current spread of HIV infection among those who cannot get treatment or who cannot stop taking drugs. Outreach programs which operate needle exchanges and distribute bleach not only help to control the spread of HIV, but also refer many individuals to treatment programs. Legal sanctions on injection equipment do not reduce illicit drug use, but they do increase the sharing of injection equipment and hence the spread of HIV infection.

The AIDS Commission used figures from the Centers for Disease Control to calculate that 32 percent of known American AIDS cases began with a dirty needle. These cases do not just reflect drug-injecting addicts coming down with the disease, but also their sexual partners and chil-dren. Injecting addicts are a major vehicle for transmission of the HIV virus because their lack of access to clean needles forces them to share injecting equipment, which is tantamount to sharing blood.

Needle Exchange is an Urgent Requirement for AIDS Policy

There is no excuse for delaying needle exchange any longer. The nation is facing a public health crisis in the form of AIDS, and all mea-sures to curtail the spread of the disease are urgent requirements in public policy. Recent reports from needle exchanges in Takoma, Washing-ton and New Haven, Connecticut — as well as most of Europe and Aus-tralia — show clearly and convincingly that providing addicts with sterile needles in return for used needles reduces the prevalence of AIDS and gets addicts into drug treatment programs.

President Bush and drug czar Martinez have firmly opposed needle exchange, even in the wake of the National Commission on AIDS report. Like many Americans, they have a lingering fear that needle exchange might appear to condone drug use, and they would rather addicts stop using drugs than use them more safely with clean needles. This fear ignores the studies that show needle exchange programs increase the number of addicts seeking drug treatment. Such concerns argue force-fully for providing expanded treatment options, but are insufficient to override the immediate need for needle exchange. No one can avoid the underlying reality — drug addiction is rarely fatal, but AIDS always is. An addict who contracts AIDS is ultimately lost forever, as are all the people he or she infects.

It is time to end the posturing against clean needles that results in thousands of deaths every year, and will only add more casualties the longer it persists. Continuing the present course will sow the seeds for an even greater crisis in health care, as the cost of treating AIDS patients vvill help bankrupt the already strapped health care system. The administra-tion must reverse its stand on needle exchange to send a clear and urgent signal to the states and cities.

Repeal the Federal Ban on Needle Exchange Research

In addition, the drug czar should work with Congress to repeal the federal ban on use of government funds to study needle exchange. U.S. Sen. Jesse Helms (R-N.C.) sponsored a successful amendment to a 1988 public health funding bill that prohibited many federal agencies and their contractors from associating with or studying needle exchange programs. After repeal of this cruel ban, studies can be commissioned looking at the experiences of several American and foreign cities with underground and legal needle exchanges. But such studies will be no substitute for action — they must be undertaken concurrently with wider use of legal clean needle programs.

Action Now Will Help Shut Down a Major Source of HIV Infections

The administration has the opportunity to take the lead in shut-ting down one major vehicle for transmission of HIV, one that has led to nearly one third of American AIDS cases. Failing to take action would be a dereliction of public health responsibility of the highest order.