Syringe exchanges tend to attract only the poorest, highest-risk users in Canada because needles can be legally purchased at pharmacies there, which might have confounded the data, but the program also had a variety of limitations that contributed to its initial failure. As Vancouver improved its program, however, and even opened safe-injection rooms, infection levels among I.V. drug users stabilized and then began to drop, according to Canadian government statistics. New HIV infections among I.V. drug users fell by more than 70 percent between 1995 and 2000, though part of this drop may represent saturation of the I.V. user population. (A study on the injection rooms published this week in the Lancet found that addicts who used the facility were 70 percent less likely to share needles than those who didn't visit it.)

A 1997 study that compared cities around the world with and without needle-exchange programs found that those with programs had an average annual decrease in the prevalence of HIV of 5.8 percent, while those without programs had an increase of 5.7 percent. No study has ever found that the existence of needle exchange motivates addicts to keep taking drugs -- in fact, most find that syringe-exchange users are more likely than other addicts to seek treatment. It's no surprise, therefore, that every major public health body that has looked at the issue -- from the World Health Organization to the American Medical Association to the Institute on Medicine to the International Federation of Red Cross and Red Crescent Societies -- has strongly endorsed making sterile injection equipment available to addicts.

The policies that the Bush administration endorses as alternatives to needle exchange -- attempts to reduce the supply of illegal drugs, for example -- have not been shown to affect drug-use rates, let alone reduce HIV. Despite U.S. drug-control budgets that have increased almost exponentially since the 1980s, the purity of cocaine and heroin has at least quadrupled, the prices of both drugs have dropped by at least half, and neither addicts nor teenagers report difficulty purchasing most drugs.

It profoundly saddens me that I must still cite studies to defend needle exchange nearly 20 years after activists first began to fight for it. It also disturbs me that needle-exchange programs rarely get the credit they deserve. A Jan. 30 New York Times story on the virtual end of HIV infection in newborns in the United States didn't even mention the role of clean needle programs in this accomplishment.

And the articles about bisexual black men infecting heterosexual female sex partners have largely neglected the critical role that I.V. drug use in minority communities has played in the epidemic. One can make a good case, in fact, that there wouldn't even have been such an epidemic in black and Latino heterosexual populations if the United States had provided clean needles earlier and hadn't insisted on locking up (without access to condoms or needles) so many minority drug users.

The U.K. dodged this bullet: Under the conservative government of Margaret Thatcher, it rapidly implemented clean-needle measures in response to the outbreak of AIDS, starting in 1986. HIV prevalence has rarely reached more than 1 percent among intravenous drug users there, compared with over 50 percent at the epidemic's peak in New York. Heterosexual AIDS in the U.K., consequently, is almost entirely limited to immigrants who were infected in Africa. Says Neil Hunt, a director of the U.K. Harm Reduction Alliance and an honorary research fellow at Imperial College London, "It's a largely unheralded, astonishing success."

So why is it so hard for U.S. policymakers to accept that needle provision works? A large part of it is surely prejudice related to drug-war propaganda -- for instance, the belief that addicts are out of control and thus unwilling to protect themselves even when protection is offered. And some of it may even reflect a desire to simply let addicts die. But I also think some people believe that addicts like to share needles, the same way many people prefer to have sex without condoms, and that changing such behavior would take too much effort.

And for those who suggest that needle exchange encourages drug use and keeps addicts using longer, I would argue that it is not the presence or absence of needles that determines one's desire to get high. For many, drug use stems from deep unhappiness and an inability to handle distress, not from an effort to obtain extra pleasure in their lives. Compassion is the appropriate response to such suffering, and for many addicts, the first place they ever experience such grace is at a needle-exchange program. It's the one place that accepts them just as they are.

Contrary to critics' claims, needle-exchange programs offer a message of hope, not a "counsel of despair," as U.S. officials recently claimed. They do not tell addicts that they are forever doomed to addiction and might as well kill themselves. Instead, they say, "We want you to live; we believe you are valuable." And that message is often the spark that starts recovery. It's far from all that is needed, but without it, many are too demoralized to try.

I can't abide the idea that my country is still fighting against HIV prevention. But what's most infuriating is that such action is not only unnecessary but also inhumane. It's throwing a symbolic sop to the religious right (which isn't even especially focused on the issue) at the demonstrable cost of human lives.

Recent Stories