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AR: In our last meeting, in Atlanta this past July, there was a motion presented which highlighted three issues which we felt that the administration had negligently failed to act upon. The first and most prominent of these was the ban on the use of federal AIDS prevention funds for needle exchange, the second were content restrictions on AIDS prevention materials created with federal money, and the third was the continuation of outdated discriminatory policies against people who ware HIV-positive in certain government programs such as the Peace Corps.

The motion presented stated that if these issues were not addressed by a certain time, that we would tender our resignations. The motion was ultimately withdrawn, but with a verbal agreement that we would reopen discussion of such a possibility at our December meeting.

AS: What factors were considered while you were discussing the possibility of resignations?

AR: There was some concern that perhaps there were steps short of resignation which hadn't been taken. There were people within the administration whom we hadn't spoken to, including Secretary Shalala, and that we ought to make every effort to be heard so that our action, if we decided to take it, would be grounded in the belief that we had done all that we could.

There was also an argument made that although we were being frustrated on these issues, there was value in our continued participation because we still might have an impact on other policy decisions. The question was asked whether the symbolic value of resignation, even as an activist strategy, was worth giving up a seat at the table, even if at times it seemed as if we were eating alone.

AS: And how did you come down on these issues?

AR: Well, I'm the chair of the Prevention Committee, and although the idea of needle exchange was counter-intuitive to me early on, I've looked at the facts and they're indisputable. Therefore, I am truly invested, both on a personal level and by virtue of my position, in the best and most effective means of preventing the spread of this disease. It seemed incongruous to me therefore that I should remain in a position of supposed influence when no one, in fact, was listening.

AS: So, since July, the committee has set about to speak to people in the administration. Have you spoken with Secretary Shalala?

AR: As a matter of fact, we finally got our first opportunity to meet with her the day after the needle exchange protest in Washington, D.C.

AS: Really? Do you think that the protest was an impetus for that meeting?

AR: We had been attempting to get a meeting for some time, but that protest presaged a lot of activity on this issue within the administration. So, yes, in part, the protest played a role.

AS: And what was the result of that meeting?

AR: It was much the same as the responses we've been getting from the administration overall. On one hand, there's this overriding message to us that we are being ungrateful in some way. That this administration has done more on this issue than its predecessors (which wouldn't have been difficult, in any case), and has spent all of this money, and that we ought to be thankful.

On the other hand, there has been a very clear pattern of delay. Every time we've pressed on this issue we've been told to wait for this or that political concern. Whether it was to wait until after the '96 elections, or until the appropriations process is complete, or until the nominations of the new Surgeon General and assistant secretary of Health and Human Services go through. And within the AIDS issue, there has been such a history of disappointment, we're so used to being told to wait, or that we have to play the "insiders game" that there was a tendency, I think, to go along and just say "maybe you're right. Let's not do harm in our zeal to do good. Perhaps this isn't the most opportune time."

AS: And what was the motivation to press forward now?

AR: Actually, for me, it was Robert Fogel. He was new to the Council and this was his first experience with the AIDS issue. He was less conditioned, perhaps, to being put off. He had far less patience and he was adamant about the need for the administration to muster the political courage to do the right thing.

AS: And you found yourself in agreement?

AR: It seems to me that this administration has been masterful at managing the consequences of their political actions. They've avoided so many pitfalls that I just feel that if they were to get behind this issue, to do the right thing, they would survive politically. It has become relatively apparent, however, that the lives at stake here aren't important enough to them to make this type of effort. I find myself in agreement therefore, yes, that the time for more delay has come and gone, and that nothing short of action will be acceptable anymore.

AS: You come to the issue of needle exchange from the perspective of fighting the AIDS epidemic. But tell me how you see this debate in the context of our larger drug policy. Do you feel that it is drug policy, rather than AIDS policy that is driving these decisions?

AR: Clearly this is an administration that is greatly conflicted over drug policy. But so is the nation as a whole. On needle exchange, as in other areas of drug policy, the truth is counter-intuitive. If we look at the African American community, and the destruction and the misery associated with substance abuse, as well as the violence that is part of the trade (and which we insure by creating the black market,) the system of enforcement that we've put into place seems on the surface to be the right thing to do.

But the facts on needle exchange, and on drug policy as a whole, don't necessarily point to the solutions which seem obvious on the surface. A short time ago, it would have been absurd to think that the Congressional Black Caucus would have come out in favor of needle exchange. Most of those legislators were adamantly opposed to the idea from the beginning. It seemed to them that needle exchange somehow enabled or sanctioned drug use. Yet ultimately, they have come out in support. Which shows that when you present honest information to intelligent people, they can be persuaded despite their initial inclinations.

AS: Have you considered the possibility that some of the highest-level opposition to needle exchange comes from a desire to avoid questions of drug policy on any level? I mean, an entire industry has emerged out of the imprisonment of enormous numbers of young, poor, primarily African American males. The prison industry, the defense industry, the armed forces, police, all of them are benefiting from the status quo. I look at the medical marijuana debate during last year's elections. Was it really necessary to bring out three former presidents to campaign against the right of an AIDS patient to smoke pot to relieve his nausea?

AR: I can tell you as someone who has worked within Washington that there's a lot to that argument. This administration has been very good at spin. They've played well on people's fears. Because of that, people, and this includes the African American community which has been most negatively impacted, can unwittingly become part of a system of community destruction. They are sold on, and cling to, strategies which may not, in reality, have much to do with the issues of substance abuse that they are concerned about. They accept policies which may really be about the maintenance of an industry. Even an industry which feeds off of the very destruction those people are trying to end. As I said, needle exchange is illustrative here because on its surface it's counter-intuitive, but in reality, it is effective.

AS: So you are saying that the acceptance of needle exchange is dependent upon a change in the ways that people view substance abuse as a whole?

AR: Yes. Even a change in the way that people view people who use drugs. We need to accept that not every addict considers him or herself to be self-destructive. They may want their fix, but they will take precautions for their safety and well-being. Needle exchange functions to foster those changes in perception in that once we begin to treat this illness, substance abuse, and once we begin to bring those afflicted into the system, instead of chasing them away, it becomes apparent that these are in fact human beings, and that they're worthy of compassion. I think that that whole concept is threatening to the status quo in that it tends to de-legitimize the dehumanization which has taken place and upon which some of our current policies depend.

AS: So what will happen in December? Are you, are others on the President's council still considering resignation?

AR: Still considering? Yes. I think a lot will depend upon where we are on needle exchange in December. If the administration has allowed the authority to lift the ban to be taken from them, or if they still have the authority but have declined to use it, I think that their is a very real possibility that you will see people resigning.

There is a lot of frustration on the council with the administration. So much time has been spent on the politics of this that we've failed to use the public health system to educate people. People have to be able to separate out the illness of substance addiction, and the people who use drugs, from the drug trade. The two are connected, but they aren't synonymous.

In the end, holding a "position of influence" is pretty empty if no one is listening to you. For me, my attitude is that coming to Washington three or four times per year just to make well-informed, considered recommendations which are then ignored... I don't want to be a party to that process. I have more important things to do with my time.

AS: Thanks so much for your time.