Deadly Ignorance

[Guest guest]

http://www.washingtonpost.com/wp-dyn/articles/A56611-2005Feb26.html

 

 

 

 

Sunday, February 27, 2005; Page B06

 

THE BUSH administration is quietly extending a policy that undermines the global

battle against AIDS. It is being pushed in this direction by Congress, notably

by Rep. Mark Edward Souder (R-Ind.). But some administration officials zealously

defend this policy error, claiming scientific evidence that doesn't exist.

 

The administration's error is to oppose the distribution of uncontaminated

needles to drug addicts. A large body of scientific evidence suggests that the

free provision of clean needles curbs the spread of AIDS among drug users

without increasing rates of addiction. Given that addicts are at the center of

many of the AIDS epidemics in Eastern Europe and Asia, ignoring this science

could cost millions of lives. In Russia, as of 2004, 80 percent of all HIV cases

involved drug injectors, and many of these infections occurred because addicts

share contaminated needles. In Malaysia, China, Vietnam and Ukraine, drug

injectors also account for more than half of all HIV cases. Once a critical mass

of drug users carries the virus, the epidemic spreads via unprotected sex to

non-drug users.

 

The administration claims that the evidence for the effectiveness of needle

exchange is shaky. An official who requested anonymity directed us to a number

of researchers who have allegedly cast doubt on the pro-exchange consensus. One

of them is Steffanie A. Strathdee of the University of California at San Diego;

when we contacted her, she responded that her research " supports the expansion

of needle exchange programs, not the opposite. " Another researcher cited by the

administration is Martin T. Schechter of the University of British Columbia; he

wrote us that " Our research here in Vancouver has been repeatedly used to cast

doubt on needle exchange programs. I believe this is a clear misinterpretation

of the facts. " Yet a third researcher cited by the administration is Julie

Bruneau at the University of Montreal; she told us that " in the vast majority of

cases needle exchange programs drive HIV incidence lower. " We asked Dr. Bruneau

whether she favored needle exchanges in countries

such as Russia or Thailand. " Yes, sure, " she responded.

 

The Bush administration attempted to bolster its case by providing us with three

scientific articles. One, which has yet to be published in a peer-reviewed

journal, was produced by an author unknown to leading experts in this field who

is affiliated with a group called the Children's AIDS Fund. This group is more

renowned for its ties to the Bush administration than for its public health

rigor: As the Post's David Brown has reported, it recently received an

administration grant despite the fact that an expert panel had deemed its

application " not suitable for funding. " The two other articles supplied by the

administration had been published in the American Journal of Public Health.

Although each raised questions about the certainty with which needle-exchange

advocates state their case, neither opposed such programs.

 

Evidence that the administration does not cite leaves little doubt about the

case for needle exchange. A study of 81 cities published in 1997 in the Lancet,

a medical journal, found that in cities without needle-exchange programs, HIV

infection rates among injection drug users rose by nearly 6 percent per year; by

contrast, cities that had introduced free-needle programs witnessed a decrease

in infection rates of about the same magnitude. Elias A. Zerhouni, the director

of the National Institutes of Health, wrote last year that exchange programs

" can be an effective component of a comprehensive community-based HIV prevention

effort, " and a World Health Organization technical paper agreed that the

provision of clean needles and syringes should be " a fundamental component of

any comprehensive and effective HIV-prevention programme. " Addressing legitimate

methodological questions about the research favoring needle exchange, the WHO

reasonably concluded that incomplete scientific

evidence does not confer the freedom to ignore the knowledge we do have.

 

Respecting science does not appear to be the administration's priority, however.

Not only is it refusing to spend federal dollars on needle exchange, but the

administration also is waging a campaign to persuade the United Nations to toe

its misguided line. The U.N. Office on Drugs and Crime, which is heavily reliant

on U.S. funding, has been made to expunge references to needle exchange from its

literature, and the administration is expected to continue its pressure on the

United Nations at a meeting that starts March 7. The State Department's new

leadership needs to end this bullying flat-earthism. It won't help President

Bush's current effort to relaunch his image among allies. And it's almost

certain to kill people.

 

 

 

© 2005 The Washington Post Company

 

 

 

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