According to White House sources, senior health officials in the Department of Health and Human Services (HHS)--including HHS Secretary Dr. Donna Shalala--recently recommended to President Clinton a move toward some kind of federal funding for needle exchanges. Leading national health experts also made public statements supportive of such programs. But following the lobbying of General Barry R. McCaffrey, director of the Office of Drug Control Policy, and after political pressure from congressional Republicans, President Clinton decided that the nine-year ban on federal funding for needle exchanges should remain in place. Dr. Shalala, caught in the middle between politics and what is best for the public welfare, stated that while the Clinton administration would not finance needle exchange programs, it "supported them in theory."

Programs

like the Monterey County Needle Exchange Project are very effective in decreasing HIV transmission and do not encourage illegal drug use. According to a recent edition of The Lancet, in 29 cities worldwide where needle exchange programs are in place, HIV infection dropped an average of 5.8 percent a year among drug users. In 51 cities that had no needle exchange, drug-related infection rose by 5.9 percent a year.

In Monterey County, there are an estimated 2,500 to 3,000 injection drug users. Approximately 10,000 syringes are exchanged per month. According to county service providers, the HIV seroprevalance rate has remained below 5 percent in this population due to needle exchanges combined with community-based harm reduction outreach.

Needle exchange is a proven method for HIV prevention and will save lives. Half of all new HIV infections are attributed to injection drug use. Minority populations are disproportionately affected. Although overall AIDS deaths have declined since the pandemic started, these declines have been less dramatic in minority populations. AIDS is still the number one killer of African-Americans and Latinos between the ages of 25 and 44. It is estimated that 33 American men, women, and children infected with HIV daily would not be infected if comprehensive needle exchanges were implemented. Among African-Americans diagnosed with AIDS through June 1997, injection drug use accounted for 36 percent of the total cases in men and 46 percent of the total cases in women (compared with 9 percent of white men and 43 percent of white women). In 1996, injection drug use accounted for 39 percent of the total AIDS cases in Latino men and 51 percent in Latino women.

Needle exchange programs are proven to reduce the risk of HIV, Hepatitis B, and Hepatitis C transmission without simultaneously increasing the use of illegal drugs. Needle exchange programs are cost-effective. The cost of a syringe is only 10 cents. This amount is small when compared to the lifetime costs of treating one HIV infected person. One year of HIV/AIDS treatment, including diagnostic tests, costs approximately $14,000.

Following the Clinton administration''s decision, billionaire financier George Soros offered $1 million to finance the distribution of syringes, adding to the over $20 million he has already spent trying to change the way Americans think about illegal drugs. Recently, Mr. Soros stated, "It is now up to individuals, philanthropic groups, and state and local governments to fill the void left by the federal government."

It is not enough to support important health interventions like needle exchange in theory; support must be forthcoming through concrete actions. Hopefully there are more people like Mr. Soros who will put their money where their theories are.

G. Cajetan Luna is executive director of the Monterey County AIDS Project. Lorraine Faherty is chairman of the Board of Directors of the Monterey County AIDS Project and a deputy public defender for Monterey County.

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