Needle exchange programs have made substantial progress toward gaining acceptance, but the right to perform AIDS prevention is far from won. Last April, in the midst of a major controversy that pitted New Jersey Governor Whitman against her own AIDS advisors, volunteers at the Chai Project needle exchange program in New Brunswick were arrested at the behest of the Middlesex County Prosecutor, despite support from local police officials. The arrests came amidst a prolonged, highly publicized debate between Gov. Christine Todd Whitman, who passionately opposes needle exchange, and the Governor's Advisory Council on AIDS, which endorsed needle exchange in their report despite pressure from the Governor not to make such a recommendation; ironically, a report by the U.S. Centers for Disease Control, showing that the nation's highest HIV rates were in Jersey City, was released the same month. DRCNet participated in a letter writing campaign on the project's behalf. The volunteers were charged with misdemeanors and released, and the prosecutor's office indicated that further arrests were not likely even though the program continued to operate. But the program's private funding has been delayed until its legal status is more clear, rendering the program's financial future uncertain. It's important to note that the Governor has always attacked the idea of government giving out needles and avoided the more basic issue of state laws that criminalize over-the-counter sales and privately funded exchanges like the Chai Project.

Also during April, a needle exchange program was removed from a list of suggestions by the Denver Human Services Planning committee to the Colorado Legislature. The proposal was dropped after news that it angered some lawmakers, according to the April 12 AIDS Daily Summary of the National AIDS Clearinghouse. PEERS, a Denver-based HIV prevention group, hopes to work with the committee to restore the needle exchange.

In Santa Clara County, California, during May, funding for the local NEP was withdrawn reluctantly by county supervisors after Attorney General Dan Lungren had threatened a lawsuit by the state. The county had used a "declaration of emergency" to make an exception to the state's anti-needle laws; Lungren argued that the declaration was not valid. The program subsequently reopened with volunteer labor and needles from the North American Syringe Exchange Network (NASEN); but we'll never know who or how many contracted HIV in the interim.

Two AIDS activists were convicted in New Hampshire of illegal possession of hypodermic needles after agreeing to let a judge decide their case rather than go through a second trial after a jury deadlocked 6-6 on their case. (All 12 jurors later said they agreed the law should be changed to allow needle exchange programs.) Dan Sundquist, of the New Hampshire Harm Reduction Alliance, and long-time needle exchange activist Jon Parker, were arrested for trying to run needle exchange programs in Nashua and Manchester. Judge Linda Dalianis rejected prosecutors' recommendations of jail time and fines, instead giving both suspended sentences and suspended fines, with the condition that they not operate needle exchange programs in the state until it becomes legal to do so. Judge Dalianis expressed support for the activists' goals, saying "I never had any issue with the motives of these defendants, only their means. I do hope, however, that the Legislature has heard them and that something good will come of this." Dalianis was attacked for her statement by Rep. Bill Zeliff, the Republican candidate for governor. "We don't need judicial activists telling legislators what to do," said Zeliff, adding "As governor, I will appoint conservative judges who will not tolerate the violation of New Hampshire law," and that Dalianis should have sentenced Sundquist and Parker to jail. Both activists plan to appeal their convictions to the state Supreme Court.

Last May needle exchange was debated in Nashville, when a community group, in conjunction with the Metro Health Dept., was offered a $28,000 grant to run an NEP. The plan was derailed, largely by objections from one member of the Metro Council.

In July the New Bedford, MA City Council voted for the second time in 11 months to approve a pilot needle exchange program; the legislation was vetoed by Mayor Rosemary Tierney, but the margin of passage, 9-2, was sufficient to override the veto. The occasion afforded the opportunity for the fringe of the anti-drug movement to come out and protest on July 25, including DrugWatch activist Lea Palleria Cox, who claimed "[needle exchange] is only a ploy by people who want to legalize drugs."

DrugWatch publishes a document titled "No Stampedes Please," by former DEA Demand Reduction Coordinator Wayne Roques, which falsely states that there is no evidence that needle exchange reduces the spread of HIV. In fact, six federally funded reports, by the Centers for Disease Control, the General Accounting Office, the University of California, the National Academy of Science/Institute of Medicine, the Presidential Commission on AIDS, and the Office of Technology Assessment, have all concluded that NEPs reduce the spread of HIV, without increasing the use of drugs. But the existence of overwhelming evidence of needle exchange's effectiveness has not prevented DrugWatch from saying there is no evidence.

Not all the needle exchange news has been negative. The DC Needle Exchange Coalition began exchanging needles in the nation's capitol last August 12, and at last report was far ahead of schedule in attracting clients. The Coalition consists of the Whitman Walker Clinic, KOBA, and other organizations, many of which have previously been rivals. Initial funding for the Coalition's formation was supplied by a grant from the Drug Policy Foundation; the Coalition has since been awarded a $200,000 grant from the city.

In May, US drug czar Barry McCaffrey criticized needle exchange programs, saying "The problem isn't dirty needles; it's injection of illegal drugs." But support came from an unexpected quarter: Tom Hedrick of the Partnership for a Drug-Free America, who countered that he believed the evidence supported needle exchange as a "short-term remedy." (Both McCaffrey and Hedrick are similarly unrealistic in believing that anti-drug efforts could ever be so successful that injection drug use would disappear.) Patricia Fleming, senior White House AIDS policy advisor, during a meeting with AIDS activists and service providers at the Veterans Administration mental health department in Oakland, California, stated "I have seen evidence that needle exchange programs work."

Fleming is not the first Clinton AIDS advisor to support needle exchange, but naturally the President is not interested. A report in the November issue of Poz, a national magazinefor people infected with the AIDS virus, reported that the Clinton administration had been on the verge of lifting the ban on use of federal AIDS funds for needle exchange, but had changed course following the Republic takeover of Congress in 1994. This report was confirmed by former Surgeon General Joycelyn Elders in an interview with the Washington Times in early October, following release of her autobiography, Joycelyn Elders, M.D. It is not known whether the administration based its decision on election campaign considerations or out of fear that Congress would react by passing even more restrictive legislation against needle exchange.

The list of organizations endorsing syringe exchange continues to grow. On October 2, the Association of State and Territorial Health Officials (ASTHO) released "Preventing HIV Infection Among Drug Injectors: The Role of Sterile Syringes and Substance Abuse Treatment." The report details presentations made at a conference held in December, 1995 in Alexandria, Virginia. The conference was cosponsored by one of ASTHO's affiliates, the National Alliance of State and Territorial AIDS Directors (NASTAD), as well as the National Association of State Alcohol and Drug Abuse Directors (NASADAD). The conference was also cosponsored by the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA). For a copy of the report send $5 to HIV/AIDS Project, ASTHO, 415 Second Street, NE, Suite 200, Washington, DC 20002, (202) 546-5400 (voice), (202) 544-9349 (fax), e-mail [email protected].

Those who are interested in lending financial support to needle exchange programs around the country can do so by sending tax-deductible contributions to the North American Syringe Exchange Network; make checks out to PDAP/NASEN, 535 Dock St. #112, Tacoma, WA 98402. All donations go entirely into the NASEN grants program for un- and underfunded programs. The Chai Project in New Jersey is trying to raise $10,000 to take the place of the private funding that has been delayed pending resolution of their legal status. Contributions can be sent to Diana McCague, The Chai Project, 11 Woodbridge St., New Brunswick, NJ 08901, (908) 246-8884.

Conclusions and Recommendations of U.S. Government-funded Reports on the Efficacy of Needle Exchange Programs (NEPs)

1. Legal barriers precluding needle exchange lead to increased HIV transmission
2. "Research suggests promise as an AIDS prevention strategy"
3. The OTA and GAO reviewed the data without making policy recommendations

NCOA=National Commission on AIDS
GAO=General Accounting Office
UC=University of California
CDC=Centers for Disease Control and Prevention
NAS=National Academy of Sciences
OTA=Office of Technology Assessment