'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.

Fortunately, despite federal opposition and inaction, most states have chosen to allow at least some access to sterile syringes. As of 1999 there were more than 160 syringe exchange programs in 39 U.S. states, the District of Columbia and Puerto Rico. Forty-seven states allow non-prescription sale of syringes in pharmacies. Only one state, New Jersey, has no access whatsoever to clean needles to prevent the spread of disease.

While these programs have been hampered by lack of federal funding and leadership, they have been able to achieve some significant results in cities and states where they have been given support. In New York City, the rate of HIV among injection drug users was cut in half between 1992 and 2002. Such successes are a powerful indication of what could be achieved in terms of HIV/AIDS prevention with federal support and leadership. They are also a devastating indictment of the federal government's refusal to provide that support and leadership.

Some of the coverage marking the 25th year of the epidemic reported on the fear, hysteria and stigma that surrounded the disease in its early years. Those who were diagnosed with HIV lived in terror that friends, loved ones and employers might find out. People, even some medical professionals, feared to touch those diagnosed with the disease. Some religious congregations even expelled HIV-positive congregants. There was talk of putting people with HIV/AIDS in concentration camps. President Reagan, presiding over the early years of the epidemic, refused to even say the word "AIDS" in public until the end of his second term in office.

We pride ourselves that those dark days are long past. But are they? How far have we really come? At least when it comes to preventing HIV/AIDS among people who inject drugs, we have not come very far at all. Our government defies logic and ignores science by refusing to fund an HIV/AIDS prevention strategy that has saved thousand of lives in other countries. Our government turns its back on its most vulnerable citizens refusing to allow them access to a life-saving health intervention. And you can bet that our current president will not be saying the words "syringe exchange" any time soon--if ever.

Twenty-five years into the HIV/AIDS epidemic, the U.S. government's response to preventing HIV/AIDS among people who inject drugs, their partners and children is still "give them all dirty needles and let them die."

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