In the aftermath of the decision, hotly contested within the Clinton Administration, against lifting the ban on the use of federal anti-AIDS funding for needle exchange, several members of the Congressional Black Caucus have called for the resignation of Drug Czar Barry McCaffrey. Several members of the Congressional Black Caucus, made the demand. CBC chair Maxine Waters (D-CA) stated, "This is a life and death issue. You can save lives with needle exchange as we work at getting rid of drugs."
The Clinton Administration's decision to keep the ban in place, even as they made the determination that syringe exchange saves lives without promoting increasing the use of drugs and called on states and local communities to support the programs, got strong reaction from the reform community, although there was disagreement about its impact. In the final weeks leading up to the decision, it became apparent through information leaked to various media that it was McCaffrey who was lobbying the president to ignore the advice of AIDS Director Sandra Thurman, Secretary of Health and Human Services Donna Shalala, the presidential Advisory Commission on AIDS, Surgeon General David Satcher and others who were urging that the ban be lifted. And in the end, McCaffrey, who is seen as critical to the president's credibility on the drug issue, got his way.
Chris Lanier, coordinator of the National Coalition to Save Lives Now, told The Week Online, "This is just outright political spinelessness. They didn't even try to hide the fact that they are making a decision which goes against the scientific evidence. There is no way to justify this. This administration bears direct responsibility for thousands of preventable infections and deaths."
But DRCNet Board Member Joey Tranchina, Executive Director of the AIDS/Hepatitis Prevention Action Network, told The Week Online, "I think that this (the administration advocating exchange without lifting the ban) is probably the best possible scenario. Let's be honest, the federal government has a long and distinguished record of destroying nearly everything it touches. Federal funding would have come with massive amounts of restrictive regulation which would, in all likelihood, have kept us from doing this work in the ways that work best. Now, we have the department of Health and Human Services virtually locked in to promoting these programs on the state and local levels, without giving them control. In addition, federal AIDS money would not have covered the entire costs of most exchanges, but it would have been hard to convince our private funders to continue to support us once they heard that the government was picking up the tab. There are lots of worthy causes, and I think that a lot of the private money coming in now would have been redirected."
And Robert Fogel, a member of the Presidential Advisory Commission on AIDS, which three weeks ago was hours away from calling for the resignation of Donna Shalala, until a call from the White House assured them that a decision on the ban was forthcoming, took a similar view.
"I'm not 100 percent sure what the commission will decide to do now," Fogel told The Week Online. "But personally, I think that this could work out very well. The key issue is going to be how out-front HHS Secretary Donna Shalala will be in urging localities to support the programs. It's going to make it much easier, in places where exchange is still illegal, to get them established and recognized by the local authorities. We'll have to see how it plays out from here, but I'm hopeful that this decision will prove to be a positive development."