Making The Wrong Trade On AIDS

Do policymakers want drug users to drop dead?


Being a journalist, I'm no expert on making money. But you don't have to be Warren Buffett to recognize one way to get rich: Find someone who will give you $600,000 if you give them 25 cents. A few swaps like that, and you're a permanent resident of Easy Street.

You might assume that no such deal exists, and that if it did, no one would pass it up. You would be wrong. This advantageous exchange is available anytime our leaders in Washington want to take it. But so far, they've refused.

The reason for their reluctance is that the trade involves something unsavory: illegal drug use. More than 1 million people in this country regularly inject themselves with heroin, cocaine and other prohibited pharmaceuticals. Many of them also reuse and share their hypodermic syringes.

All it takes is one instance of sharing with someone carrying the HIV to create another AIDS victim—and possibly several, since those infected can transmit the virus to their spouses, sexual partners and even children. About 22 percent of all AIDS infections are attributable to intravenous drug use.

This is an incurable and lethal disease, and an expensive one. Caring for someone infected with the virus costs about $25,000 a year, or $600,000 over the typical patient's life. What would it take to prevent it? A sterile new syringe, which sells for about a quarter.

The federal government spends some $15 billion a year on health care and financial assistance for AIDS patients. But it refuses to lay out one thin dime for this type of prevention. By law, no federal money may be spent on programs furnishing clean injecting equipment to drug addicts. To top it off, Congress bars the District of Columbia—which has one of the biggest HIV problems in the country—from using its own locally generated revenues for that purpose.

This last policy, however, may be on the way out. The House of Representatives is expected to vote this week on a bill to let D.C. decide for itself whether to spend its own dollars to hand out syringes. It will encounter opposition from members who have previously supported the ban. Among them is Rep. Todd Tiahrt (R-Kan.), who recently told The Washington Post that needle exchange has "been proven in many studies to be ineffective and a threat to the surrounding community."

You can find studies that fail to vindicate needle distribution, just as you can find Sundays when the Detroit Lions win. But they are rare and unrepresentative. Among experts, the strong consensus is that these efforts have proven their value beyond dispute.

In 2000, the Surgeon General concluded that they reduce HIV transmission and "do not increase the use of illegal drugs among participants." The federal Institute of Medicine said in 1997 that needle exchange is "an effective component of a comprehensive strategy to prevent infectious disease."

A 2004 report by the World Health Organization found "no convincing evidence of major unintended negative consequences." The National Institutes of Health says, "There is no longer doubt that these programs work." The Centers for Disease Control … well, you get the idea.

When I contacted Tiahrt's office, an aide said he thinks that regardless of what the studies show, "It is a horrible message to send children that it must be okay to do drugs." But that's like saying that when the government pays for lung cancer treatment, it encourages kids to smoke. The existing policy sends a worse message: If drug users can't conquer their addiction, they deserve to die—and so do their innocent spouses and children.

The funding bans are not the only impediment. Scott Burris, a law professor at Temple University, says 23 states have laws that forbid or deter pharmacies from over-the-counter sale of syringes—which would allow drug users to forgo exchanges and buy their own. Local AIDS activists say the District of Columbia is guilty of the same mistake. While it's asking for help from Congress on needle exchange, it could help itself by deregulating needles.

Restrictions on the sale and possession of injecting equipment, like the funding bans, make it harder for drug users to take basic self-preservation measures. If you like throwing away money, preventing addicts from getting access to sterile syringes is an excellent strategy. If you like squandering lives, it's even better.


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