'Give Them Dirty Needles and Let Them Die'

"Give them all dirty needles and let them die." So said TV's Judge Judy (Judy Sheindlin) on a trip to Australia in 1999 when she was asked about allowing people who inject drugs to have access to sterile syringes to prevent the spread of HIV, Hepatitis C and other blood-borne diseases.

This obscene comment might be taken as the ranting of a single public crank if it were not such a disturbing reflection of our federal government's attitude.

This year marks the 25th anniversary of the emergence of the HIV/AIDS epidemic. There has been much feel-good discussion and media coverage about how far the United States has come in the battle against HIV/AIDS. But there has been little discussion of the U.S. government's obstinate refusal to adopt successful methods to prevent the spread of HIV/AIDS among people who inject drugs, their partners and children.

This refusal is ostensibly grounded in moral considerations. Government opponents of syringe access programs say that such programs condone drug use. The scientific evidence overwhelmingly shows that such programs do not encourage drug use--they actually save lives by reducing the spread of HIV/AIDS. In the face of this data, one can only conclude that the government's failure to broadly implement such programs is based not on a reluctance to condone "immoral" activity, but on an immoral refusal to save the lives of people who engage in activities of which the government does not approve.

In the United States, 22 percent of HIV infections are caused by the sharing of contaminated syringes. In other industrialized countries that implemented "sterile syringe access" policies early on, the rate of HIV related to shared syringes is much lower: Australia, 4 percent; United Kingdom, 6 percent; Canada 17 percent. Yet the U.S. government remains determinedly opposed to such programs, even going so far as to actively discourage their adoption abroad.

Recently Iran, at the urging of its public health officials, began establishing syringe exchange programs--and expanding access to methadone treatment--to combat its growing HIV/AIDS epidemic. In doing so, Iran joined a growing list of developing countries implementing such programs. While this practical and effective response to a public health crisis, coming from a highly ideological regime that places a priority on enforcement of its moral code, came as a pleasant surprise to HIV/AIDS prevention advocates around the world, it also caused them to wonder how the United States could lag so far behind the rest of the word in implementing this proven HIV/AIDS prevention strategy.

Every medical, scientific and professional body to study the issue has concluded that access to sterile syringes reduces the spread of HIV/AIDS. Organizations which support sterile syringe access include the American Medical Association, the American Public Health Association, the National Academy of Sciences, the National Institutes of Health Consensus Panel and the AIDS Advisory Commissions of the first President Bush and President Clinton. In 2002, Surgeon General David Satcher issued a report to Congress that concluded:

After reviewing all of the research to date, the senior scientists of the Department and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs . . . are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs.

The U.S. government's response to this mountain of scientific support? Silence. Inaction. Implicit in that silence and inaction is the sentiment, "Give them all dirty needles and let them die." How else to interpret such a response when all the evidence indicates that with little effort and little money--a clean syringe costs 10 cents, life-time HIV/AIDS care for one person costs $195,000--the U.S. government could be saving thousands of lives and preventing incalculable suffering? Despite the evidence, an explicit ban on the use of federal money for syringe exchange programs remains in place, with the U.S. government having spent not one penny in 25 years on such programs. The United States is the only country in the world with such a ban.