President's
Advisory
Council
on
HIV#AIDS
Votes
"No
Confidence"
in
Administration
--
Demands
Immediate
Action
on
Syringe
Exchange
3/20/98
Never, as far as anyone can remember, has a presidentially- appointed advisory council passed a resolution of "no confidence" in the administration which appointed them, but that is exactly what the President's Advisory Council on AIDS did this week (3/17). And they did it unanimously. "We are angry," council chair Dr. Scott Hitt told reporters at a press conference called to announce the Council's twin resolution. "In 1995, at the White House Conference on AIDS, the President gave his word to us that he would do whatever it took to reduce new infections down to zero. Thirteen months ago, Sandra Thurman was appointed Director of AIDS policy. At that time Ms. Thurman pledged to 'follow the science' in determining the federal response to the AIDS crisis. Well, the science is in... and it has been in for some time. The scientific community has reached the conclusion the needle exchange is a vital part of an overall strategy to stem the spread of AIDS. And yet this administration has failed to act on the issue of needle exchange. During that time thousands of people have become needlessly infected with HIV, and thousands will die as a result." Standing behind Dr. Hitt, all 30 members of the Advisory Council nodded in agreement. Less than 24 hours prior to the press conference, they had voted unanimously to pass a two-pronged resolution. The first part was a resolution of "no confidence" in the administration's "commitment and willingness to achieve the President's stated goal of 'reducing the number of new infections annually until there are no new infections,'" and the second urged that Secretary of Health and Human Services Donna Shalala "issue an immediate determination declaring the efficacy of needle exchange programs in preventing the spread of HIV while not encouraging the use of illegal drugs." The Secretary is required to make such a determination before federal AIDS- prevention funds -- already in the hands of states and localities -- can be used to fund the programs. Dr. Hitt, addressing the issue of the impact of syringe exchange availability on drug use, told reporters, "Every credible study has determined that syringe exchange does not lead to increased drug use. The National Institutes of Health has determined that the 'preponderance of evidence shows that syringe exchange participants show no change or a decrease in use.'" Insiders believe that there is much support within the administration for lifting the ban, but that several key policy advisors and officials have warned the President against it. The wildcard within the administration seems to be Drug Czar Barry McCaffrey. While it is believed that McCaffrey opposes syringe exchange, he has yet to make a public statement one way or the other on the issue. The prospect of such a statement, and the political obstacles which would be presented in the face of McCaffrey's public opposition to lifting the ban, seemed to weigh on the minds of several people in attendance. "We do not believe that the Drug Czar ought to be imposing himself on issues of health policy. This is a decision reserved for the Secretary of Health and Human Services, and we are urging her to make it based upon science and health policy considerations" said Dr. Hitt. Ronald Johnson, a member of the Council and the Managing Director of Public Policy at Gay Men's Health Crisis in New York, told reporters, "IV drug use is the driving force behind new HIV infections. Over 50% of new infections are injection-related. In addition, the overwhelming majority of new infections are occurring among African Americans and Latinos. We will not control this disease until we reduce its spread among drug users and those who come into contact with them." According to Dr. Hitt, lifting the federal ban would have an impact beyond bringing federal dollars into new and existing programs. "There is a lot of moral authority behind an official determination by the Secretary. Such action would very likely increase the flow of private money into these programs." Asked for his thoughts about the process which led to the resolution, Dr. Hitt told The Week Online, "We felt very strongly that we needed to take decisive action. It's the first time, as far as I know, that a body such as this has passed a no-confidence resolution against an administration, so we see it as a very strong message. We're aware that this action has spurred activity within the administration and we're hopeful that a decision is made to do the right thing. The science is there... it's indisputable. Whatever the political reasoning has been behind this prolonged inaction, the time has come for the administration to act in the interests of American citizens and the public health." But as much as advocates would like to separate syringe exchange from drug policy, the fact remains that the issue has long been a victim of Drug War rhetoric and posturing. This point has been illustrated again and again by those who oppose the programs on the premise that they will somehow legitimize or encourage drug use. Earlier this month in Colorado, for example, State Republican Chair Steve Curtis issued a direct threat that any state house Republican who voted in favor of a bill to legalize syringe exchange would face party-funded opposition in their next primary. The bill was killed in a House committee, 7-4 along party lines, despite strong support from the entire city government of Denver, including the Mayor and the District Attorney, who want to start a program in their city, and despite the fact that it was Republicans who successfully sponsored the bill in the Senate. (http://www.drcnet.org/rapid/1998/3-13.html#coloradonep and http://www.drcnet.org/rapid/1998/2-27.html#colorado) An AP story on Monday (3/16) quoted Melissa Skolfield of the Department of Health and Human Services as saying that Secretary Shalala was awaiting the results of additional federal studies on needle exchange before making a determination. On Wednesday however a spokesperson for the Department of Health and Human Services told the Week Online, "We're not waiting for any further studies. We are continuing, as before, to review the existing information and we have not yet made a determination as to whether or not syringe exchange leads to increased drug use. There is no timetable for the completion of that process." Long-time AIDS activist Keith Cylar, co-executive director of Housing Works Inc., a full-service harm-reduction service-provider in New York, told The Week Online, "In view of the short-term goal of getting the federal ban lifted, it's understandable that people want to take the syringe- exchange issue out of the context of drug policy. The reality is, however, that the Drug War is a war on AIDS patients, and on people at risk of infection, as well as a war on African Americans and Latinos and poor folks in general. It doesn't make a lot of sense to say 'well, we need the funding so that we can save these people's lives -- get them stabilized and to a point where they are ready to help themselves -- but we'll ignore the fact that a lot of our clients' problems stem from operating in and around a black market and the ongoing prospect of imprisonment.'" Cylar continued, "I'm not questioning the strategy of the Council, given the short-term goal they are after. But the fact is that the underlying problem is a national policy which has demonized drug users and which treats them like animals unfit to live. Politicians are going to continue to allow people to die rather than have to exchange their Drug War rhetoric for reality-based approaches. Rhetoric is much easier to sell, there are no nuances, no gray areas. But that's true for both sides. The time is coming when the rhetoric of complicity -- saying 'the drug war's OK except for the little piece that affects me' - is not going to cut it anymore." [DRCNet reported last week, three days before the AP story, that the Council was considering such action, scooping the major media for the second time in 15 days. (Colorado on 2/27 was the first.) Hmm... sounds like a good reason to... become a member! (http://www.drcnet.org/drcreg.html) See http://www.drcnet.org/rapid/1998/3-13.html#aidscommission for this report as well as an interview with AIDS Council member Robert Fogel.]
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