Letting Science Lead, Again

Needle-exchange programs are efficient, cost-effective means for HIV/AIDS prevention. Will a controversial, 21-year-old ban stand in the way?

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This week offers a potentially historic turning point in America’s response to HIV/AIDS, as the Senate weighs whether to show the courage of President Obama’s convictions and end one of the most counterproductive public health laws Congress has ever written: the ban on federal funding for needle-exchange programs.

The Senate Appropriations Committee is expected to vote on lifting the long-standing ban by the week’s end, with Sen. Tom Harkin’s health subcommittee leading the way early in the week. The House Appropriations Committee has already passed a 2010 budget that does away with the ban.

As a candidate, Barack Obama vowed repeatedly to end the ban—a 21-year-old policy that blocks federal dollars from supporting the most effective, cost-efficient HIV prevention tool ever dreamed up. President Obama, however, retained the ban in his budget proposal—punting the issue to Congress.

Thankfully, Wisconsin Rep. David Obey was happy to pick it up. Obey led his House committee in repealing the ban, and AIDS activists in Washington are confident the House will approve the reform as well (after some old-school civil disobedience, in which a couple dozen activists were arrested for occupying the Capitol rotunda).

The funding ban stands among the most glaring examples of politics trumping science in modern governance. Congress imposed it in 1988, arguing that by letting addicts swap dirty needles for clean ones, syringe exchanges encourage drug use. But research from all over the world has proven that notion apocryphal. It’s now clear beyond a doubt that these programs not only dramatically reduce HIV transmission, they’re also excellent conduits to addiction recovery.

Moreover, since we’re all so concerned about our government’s solvency, syringe exchanges are stunningly good for the balance sheet. Research pegs the lifetime cost of treating an HIV infection at around $620,000—and given the real overlap between HIV infection and poverty, particularly among drug users, much of that tab is born by publicly financed programs like Medicaid. Needle exchanges, meanwhile, cost between $4,000 and $12,000 per infection avoided, according to a 2006 study. (Here’s an AIDS Action fact sheet that describes the study.)

All of which is why candidate Obama so emphatically endorsed lifting the funding ban. He already has the power to do so, actually: Congress gave the Department of Health and Human Services the right to repeal it if the secretary could establish that syringe-exchange programs don’t foster drug abuse. Bill Clinton’s health secretary, Donna Shalala, did just that way back in 1998—but the Clinton political team overruled her effort to let science guide policy.

Even now, politics is undermining Obey’s effort to put science back out front. An amendment to the House bill still bars money for any program that’s within 1,000 feet of a long list of venues, ranging from schools to swimming pools and video arcades. It’s a poison pill: There’s no meaningful place you could put an exchange in a dense urban area without violating this rule.

Obey has said he’ll try to strip the amendment once the bill reaches conference committee, where it must be reconciled with whatever the Senate passes. Of course, that assumes the Senate doesn’t pass a bill with the same counterproductive language. And we know what they say about assumptions.

So now, advocates say, supportive Senate staffers are furiously trying to come up with language that at least allows local governments to decide for themselves what restrictions are needed. “The ideal is to get it down to where local communities are making decisions that are useful for local communities,” says Bill McColl of AIDS Action.

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