Incredibly, conservatives in Congress, led by Rep. Mark Souder, R-Ind., are considering a needle-exchange version of the abortion gag rule, which prevents U.S.-funded international aid organizations from mentioning abortion to pregnant women. This new move could stop American-funded groups from even telling intravenous drug users that they should use clean needles, let alone where to get them -- at a stage in the epidemic when clean needles would be maximally effective in preventing indirect, as well as direct, transmission in many countries.

The United States is already alone among developed countries in refusing to fund syringe-swap programs here or abroad. And rather than recognize the success of states like New York that fund their own programs, the president wants to export its failed and disastrous policy overseas. In yet another example of its attempts to suppress science that does not support its ideology, the Bush administration recently threatened the U.N. Office on Drugs and Crime with loss of funding if it did not remove from its literature and Web site supportive information about needle exchange and other "harm reduction" programs for addicts that do not demand complete, immediate abstinence from drugs. The United States is the major financial supporter of UNODC.

After a meeting with a U.S. State Department official last November, UNODC director Antonio Maria Costa promised to "review" its statements on the subject, saying the organization would now "neither endorse needle exchange as a solution for drug abuse nor support public statements advocating such practices."

Only months earlier, Costa had made the opposite pronouncement: "The HIV/AIDS epidemic among injecting drug users can be stopped -- and even reversed -- if drug users are provided, at an early stage and on a large scale, with comprehensive services such as outreach, provision of clean injecting equipment and a variety of treatment modalities, including substitution treatment [like methadone]."

He added that fewer than 5 percent of the world's I.V. drug users have access to such help, and he went on to criticize countries that incarcerate large numbers of addicts because this increases HIV rates. That last bit likely was a sensitive point, since America has the largest documented prison population in the world.

It's enough to make a former I.V. drug user like me think about shooting up again.

At a meeting of the 48th Session of the Commission on Narcotic Drugs in Vienna, Austria, in early March, Costa did make at least a modest attempt to stand up to American pressure, saying that needle exchanges are "appropriate as long as they are part of a comprehensive strategy to battle the overall drug problem."

Nonetheless, American drug czar John Walters reiterated U.S. opposition to needle exchange in his speech to the group. Japan was our only public ally -- with all of Europe, Latin America (led by Brazil), and even Iran favoring needle exchange. While China did not explicitly speak up for needle exchange, with 70 percent of its HIV infections linked to I.V. drug use, it is experimenting with such programs and argued passionately for other harm-reduction measures like methadone maintenance.

Though support of needle exchange by human rights groups, who raised the issue before the meeting started, may have blunted the impact of the U.S. attack, the American grandstanding did manage to kill a resolution that would have stated UNODC's support for needle access and human rights for addicts.

Public health experts worry that the Bush administration's stance will undermine still shaky political support in countries that need to expand needle-exchange programs if they are to successfully ward off HIV. A gag rule on needle exchange would force AIDS groups to drop their programs or lose funds, seriously undermining access to clean needles for millions around the world.

Even if the administration supports a death penalty by AIDS for I.V. drug users, you'd think the innocent lives of their children or unwitting spouses might count for something. Or perhaps, being fiscal conservatives, opponents might worry about the thousandfold greater expense of HIV/AIDS treatment, compared with pennies for sterile needles.

Although the Clinton administration declined to overturn the 1989 Helms amendment banning federal funding for needle-exchange programs, at least it was honest that it was making a political, rather than a scientific or fiscal, decision, as science writer Chris Mooney noted in the American Prospect.

But the Bush administration is trying to deny the science, too, which means the harm of its stance won't be limited to the current debate. One administration official even suggested that the Washington Post contact several AIDS researchers who'd done studies on needle exchange, claiming that their work supported its contentions that such programs are ineffective and dangerous. When the Post called the researchers, however, they denied the administration's charge, stating that their data demonstrated the opposite.

It's worth looking more closely at one of these studies, which is in the small minority of the hundreds now published to even suggest any kind of negative result. In 1997 in the journal AIDS, Stephanie Strathdee and her colleagues reported that despite having North America's largest needle-exchange program, instituted in the late '80s, Vancouver's rate of HIV infections had increased dramatically during the early to mid-'90s. Worse, needle exchange users were more likely than other addicts to be HIV positive.

But as Strathdee and others have noted repeatedly, this does not mean that needle exchange caused participants to become infected. In fact, during the period of the study, Vancouver began to be flooded with cocaine. Injectors, who had previously used primarily heroin, started shooting coke as well. Since cocaine is injected far more frequently than heroin because of its shorter-lasting high, the number of daily injections is often greater by a factor of 10 or more, increasing the odds of being exposed to HIV.

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