This week on Capitol Hill, supporters of syringe-exchange programs (SEP) for HIV prevention celebrated a victory. Last year, Rep. Josť Serrano (D-N.Y.) led successful efforts in the House of Representatives to allow the District of Columbia to spend its own funds on syringe exchange after a nine-year ban. D.C. has the highest HIV-infection rate in the country, and Congress' ban on local funding (interference not faced by the states) severely hampered prevention efforts. President Bush's 2009 budget proposal calls for reinstating the local funding ban in D.C., but that will likely be ignored by congressional Democrats.
A campaign is now underway to overturn the older nationwide ban on federal funds, dating to 1988. We came close 10 years ago.
In 1998, President Clinton's secretary of health and human services, Donna Shalala, was ready to call a press conference to confirm scientific findings that SEP helped decrease HIV infections without increasing drug abuse, and to announce that federal funds could be used for the purpose. At the last minute, Clinton bowed to pressure from his drug czar, Gen. Barry McCaffrey, who claimed syringe exchange sent the wrong message to children. In the end, Shalala had to defend continuation of the federal-funding ban despite confirming the effectiveness of syringe exchange.
Sean Strub in POZ urged Secretary Shalala to resign in protest. He added, ''Let's hope that Clinton's modestly supportive (albeit failed) initiatives on gay issues are never confused with his record on AIDS, which is one of cowardice, opportunism, callous disregard and cynical dismissal.'' Scott Hitt, head of Clinton's AIDS advisory panel, said, ''At best this is hypocrisy. At worst, it's a lie. And no matter what, it's immoral.''
For two decades, the federal government, in the name of its ill-conceived ''war on drugs,'' has blocked funding for a program proven to save lives. The irrationality of the ''Just Say No'' mindset, whether pertaining to drugs or sex, has been amply criticized. What is more disturbing is the silence and even complicity of people who know better. Clinton caved so many times on so many issues that one wonders what he thought the Oval Office was for. Oh, never mind.
What about the Clinton now running for president? Sen. Hillary Clinton (D-N.Y.) answered a question last April from AIDS activist Charles King about SEP by saying, ''I want to look at the evidence on it.'' Reminded that Secretary Shalala had affirmed the effectiveness of syringe exchange but that President Clinton had refused to end the federal-funding ban, Sen. Clinton cited political realities. King pointed out that Sen. Clinton has said we need a president with spine, to which she replied, ''We'll have as much spine as we possibly can, under the circumstances.'' By contrast, Sen. Barack Obama (D-Ill.) supports lifting the federal-funding ban. John McCain's (R-Ariz.) Senate office did not respond to an Associated Press query, but he voted on the Senate floor against D.C. funding of SEP in 2001.
It is not only the feds who have allowed ideology to trump the evidence on this issue. For example, in 2006, after Massachusetts lawmakers finally passed a bill permitting the sale of hypodermic syringes without a prescription, it was vetoed by then-Gov. Mitt Romney (R). Fortunately, the veto was overridden. On the other hand, life-saving needle-exchange programs have been limited to four Massachusetts cities (Boston, Cambridge, Northampton and Provincetown) due to local opposition. This underscores the need for federal leadership.
For now, with D.C. finally able to fund syringe exchange, there are many who deserve recognition for their leadership: Congresswoman Eleanor Holmes Norton (D-D.C.); D.C. Councilmember Jack Evans (D-Ward 2); PreventionWorks!, which in addition to operating an SEP without public funds, had to overcome police interference and community mistrust; AIDS Action; amfAR; DC Appleseed; Human Rights Campaign; The AIDS Institute and Director of Federal Affairs Carl Schmid; Washington AIDS Partnership and Executive Director Channing Wickham; and Whitman-Walker Clinic and Associate Executive Director Dr. Patricia Hawkins.
On Feb. 7, National Black HIV/AIDS Awareness Day, the Harm Reduction Coalition launched a campaign with the NAACP, the National Urban League and other groups to lift the federal-funding ban. African Americans are disproportionately affected by HIV, and intravenous drug use is a vector for new HIV infections. It is past time to put lives and science first; but experience shows that this requires more than a change of political party. It requires political will.