U.S. Decision Against Funding Needle Plan Draws Fire

The Clinton administration declared Monday that needle exchange programs reduce the spread of AIDS and do not encourage illegal drug use--but it will continue to oppose federal funding for this approach, a decision that provoked anger on both sides of the long-raging debate.

Health and Human Services Secretary Donna Shalala said that, although the administration has concluded that it is best to leave the funding of such programs to state and local sources, she encouraged communities to include needle exchanges as part of their AIDS prevention strategies.

But many AIDS service organizations were stunned by the administration’s announcement, given that half of all new HIV infections are linked to needle-injected drug use, according to federal health officials.

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“This is like acknowledging the world is not flat, then refusing to fund Columbus’ voyage,” said Daniel Zingale, executive director of AIDS Action Council, a Washington-based lobbying group.

Congressional conservatives, meanwhile, expressed chagrin over the administration’s ringing endorsement of needle exchange programs.

Sen. John Ashcroft (R-Mo.) said that the administration’s expression of support “accepts and encourages drug use as a way of life.” He also expressed concern that “it opens the door” to future federal funding of needle exchange programs.

Numerous studies have shown the efficacy of such programs but the subject of government-backed needle exchanges has remained a politically volatile one. Not only have conservatives adamantly opposed such programs but President Clinton’s own advisors have argued heatedly over whether to support them. Barry R. McCaffrey, director of the White House office of drug control policy, for example, has insisted that such programs send the wrong message about drug use.

The administration’s announcement Monday was reminiscent of Clinton’s past approaches to some hot-button issues--gays in the military, for example--where he has attempted to strike a middle ground that pleased few.

Federal funding of needle exchange programs was banned by Congress in 1988 but the secretary of Health and Human Services has the authority to remove the ban. Many public health officials, AIDS activists and others--including Clinton’s own AIDS advisory panel--have called on her repeatedly to do so.

Armed with new scientific findings by high-ranking administration health officials showing that the programs help reduce HIV transmission, Shalala was willing to defend funding the programs before lawmakers on Capitol Hill, sources said.

But White House officials said they doubted they could win such a fight with the GOP-controlled Congress and were afraid that the battle would dampen state and local efforts to establish or sustain the programs.

Funding efforts “would have been voted down immediately and you would have scared off the local people,” White House advisor Rahm Emanuel said.

Ultimately, Clinton decided that it was not worth the fight with Congress, sources said.

Referring to the politics surrounding the issue, Emanuel said: “You’ve got to see three, four or five moves down the checkerboard.” And Clinton, by endorsing the concept that needle exchanges help reduce HIV transmission, hopes to boost local efforts to fund needle exchanges, he said.

But AIDS activists predicted that it would have the opposite effect, saying they feared local programs now will founder without federal help.

Monday’s decision “has the potential to do damage to the funding that exists today,” said James Loyce Jr., chief executive officer of AIDS Project/Los Angeles. “The funding is barely there now. The local governments, such as [the city of] Los Angeles . . . that have taken [needle exchanges] on have already taken a big risk--this will only undermine the advocacy that’s already been done on the local level.”

Shalala noted that the use of needle exchange programs has increased throughout the AIDS epidemic. Citing figures from the federal Centers for Disease Control and Prevention, she said communities in 28 states and one U.S. territory operate needle exchange programs supported by state, local or private funds.

In Los Angeles, three organizations run needle exchange programs at multiple sites throughout the region. They are funded in part by a $180,000 grant from the city, according to AIDS Project/Los Angeles.

Shalala said the administration decided “that the best course at this time” is to leave the creation and funding of needle exchange programs to communities and “to communicate what has been learned from the science so that communities can construct the most successful programs possible to reduce the transmission of HIV.”

She said the programs should be part of a comprehensive HIV prevention strategy that includes referring participants to drug treatment and counseling and that needles must be made available only on a replacement basis.

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Rep. Nancy Pelosi (D-San Francisco), a longtime advocate of needle exchange programs, said the administration’s stance “shows a lack of political will in the midst of a public health emergency.”

And Rep. Henry A. Waxman (D-Los Angeles) said: “It is unfortunate that fear of congressional backlash sustains the funding freeze.”

But Rep. Gerald B. H. Solomon (R-N.Y.), in a letter sent Monday to Clinton, condemned the administration’s “seemingly continued support for such programs” and urged administration support “in pursuing a permanent ban on the use of federal tax dollars for needle exchange programs.”

Times staff writer Alissa J. Rubin contributed to this story.

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Needle Swaps

Los Angeles and San Francisco are among major cities that offer legally sanctioned needle exchange programs. But many cities still don’t. Half of all new HIV infections are associated with needle injections.

MAJOR CITIES LACKING NEEDLE PROGRAMS:

San Diego

Dallas

Houston

Fort Worth

Miami

St. Louis

Newark, N.J.

New Orleans