Needle exchange programs (NEP) got a prominent hearing at last week's global conference on AIDS in Barcelona -- and with good reason. With researchers telling the conference that needle-sharing by hard drug users is fueling a fast-spreading outbreak of the disease in Eastern Europe and Asia, delegates paid close attention to accounts of NEPS that had worked to reduce infection rates in other countries. The NEP cause also got a boost -- belated but still welcome -- from former President Bill Clinton, who told the conference he was wrong to bar the use of federal funds for NEPs -- but the Bush administration appeared determined to keep the ban in place.
In a July 9 presentation, AIDS researcher Kasia Malinowska-Sempruch, who directs the Open Society Institute's AIDS program, riveted delegates with a blunt speech warning of the spread of AIDS. "Central Asia is a bomb waiting to explode," she said, adding that nearly 850,000 Russians and 250,000 Ukrainians have the AIDS virus. Russia has the highest increase in the rate of infection, she said, while the Ukraine boasts Europe's highest infection rate. According to Malinowska-Sempruch, the great majority of these AIDS cases are occurring among injection drug users or their partners and children.
Other researchers reported drug-related AIDS outbreaks spreading along the heroin routes of Asia from Afghanistan to Burma. Four million people are now infected in India, said the researchers, while AIDS rates are approaching 70% among Chinese heroin users.
"The world celebrated with us when the Berlin Wall fell and then left us alone to deal with the consequences," Malinowska-Sempruch told the delegates. "AIDS and drug use are the issues that will define whether or not we reverse the tide of economic and social disruption in this generation. If the world is unable or unwilling to turn its attention to this region and offer help, the consequences will be horrific."
Activists also heard from countries where NEPs have had success, with host country Spain providing some relevant examples. Dr. Joan Colom, regional director of Spain's Public Health Drug Addicts and AIDS department, told delegates that his country's integrated approach to NEPs, which includes a variety of social services as well as free needles, helped combat the spread of the disease in Spain. "We have changed Spain's situation enormously," said Dr. Colom. "Our goal is to connect with the drug addict and avoid the most negatives consequences if it's not possible to treat them."
More than 130,000 Spaniards suffer from AIDS, with most of them having been infected by dirty needles, said Dr. Colom. But although the country still registers 2,500 to 3,000 new cases each year, the number of new cases has dropped dramatically since the inception of the NEPs, and drug-related cases now account for less than half of new cases.
If Spanish and other researchers provided an example of effective medical intervention, former US President Bill Clinton provided an example of political cowardice too late overcome by remorse. Addressing delegates on July 11, Clinton said he should have fought to lift the federal funding ban for NEPs. "I think I was wrong about that," he said. "We were worried about drug use going up again in America." Besides, Clinton added, Barry McCaffrey told him fighting drug use was more important than saving junkies from AIDS.
And if Clinton provided an example of expediency, his successors in the Bush administration provided an example of drug war dogma overriding sensible, scientifically proven harm reduction measures. Secretary of Health and Human Services Tommy Thompson took his turn addressing the conference to reiterate the Bush administration's decision to keep the federal NEP funding ban in place.
Someone should have told one of Thompson's underlings to get on the same page. At the same time Thompson was standing firm against NEPs, Dr. Ronald Valdiserri, deputy HIV chief at the Centers for Disease Control and Prevention, was singing a different tune. Although not explicitly mentioning NEPs, Valdiserri called for increased prevention efforts. "That makes the case for prevention stronger than ever," said Valdiserri, referring to the continued spread of the disease. "We have to be careful not to let prevention be overshadowed by the significant treatment issues. Let's reinvigorate our efforts and approach this epidemic the way we did in the 1980s and 1990s, where we did see a tremendous change in behavior and decreases in transmission," he said.
For more information on the Barcelona conference, visit the Harm Reduction Coalition's "non-comprehensive, un-chronological, randomized sampling of news and medical reports" at http://www.harmreduction.org/issues/health/aids_conf_2002.html online.
Visit http://www.dogwoodcenter.org for extensive information on needle exchange.