San Francisco Chronicle (SF) - TUESDAY, December 6, 1994 Edition: FINAL Section: News Page: A1 Word Count: 1,066
Louis Freedberg, Chronicle Washington Bureau

The confidential internal review was completed last December by the Centers for Disease Control, the main federal agency responsible for preventing disease. The findings are regarded as critical to any government attempt to overturn a five-year congressional ban against using federal funds for needle exchange programs.

After months of delay, a key congressional committee received the report last month on condition that it not make it public. Numerous copies of the confidential report are in circulation in several government agencies, and sources say they believe that it substantiates the main conclusions of a landmark study by University of California at San Francisco researchers, which recommended that the administration repeal the ban.

The refusal to release the report, the only known government document to endorse needle exchange programs, strongly suggests that the administration has decided not to try to lift the ban. A clause in the law allows the administration to lift the ban if the surgeon general declares needle exchange programs to be safe and effective.

But officials are keeping the lid on the report, despite frequent requests from The Chronicle as well as appeals under the Freedom of Information Act.

"Officially, the matter is still under review," said a Public Health Service official who requested anonymity.

Several leading scientists and physicians said the administration's lack of action, including failing to issue the report, could endanger public health and contribute unnecessarily to AIDS-related deaths. `LIVES AT RISK'

"There is no excuse to the government's failure to release this," said Dr. Peter Lurie, an assistant professor at UCSF and a principal investigator on the UCSF study. "The science is more than adequate, and for the administration to take no action is to continue to place the lives of drug users, sex partners and their children at risk."

If the administration were to make the report public, its findings could well force it to take a position on a highly sensitive issue, which it is apparently reluctant to do as conservative Republicans prepare to take over key congressional committees.

There is speculation that the administration has concluded that despite the congressional ban, needle exchange programs are in place in dozens of cities, and that trying to lift the prohibition on using federal funds could backfire. Lifting the ban could cause lawmakers to impose even more severe restrictions that could endanger even those programs that are locally financed, such as those in San Francisco and other Bay Area cities.

Ironically, the key administration official handling the matter is former UCSF Professor Philip Lee, deputy secretary for Health and Human Services and director of the Public Health Service. Lee headed the UCSF needle exchange study before taking his Washington post in 1993.

Lee did not respond to numerous requests for interviews during the past week or for the report itself. However, a Public Health official said the needle exchange issue is "officially still under review."

RESEARCHERS FRUSTRATED

The drawn-out review has frustrated many researchers who say keeping the ban in the face of mounting scientific evidence is irresponsible.

Injection drug use has now become the main path of AIDS transmission in the United States, especially in the heterosexual population. Although the majority of AIDS cases are still among gay men, the rate of increase among drug related cases has been increasing, while that for gay men has decreased for each of the past three years.

One third of almost 350,000 reported AIDS cases have been tied to injection drug use. Almost 60 percent of those who have contracted the virus have died. "The evidence has now become very, very clear (about the effectiveness of needle exchange programs), to the point where you could consider it public health malpractice to keep the ban in place," said Dr. Don Des Jarlais, director of the Chemical Dependency Institute at Beth Israel Medical Center in New York.

Des Jarlais, a widely respected AIDS researcher, last month issued a study, the most comprehensive to date, that showed that the rate of HIV infection was twice as high among drug users who did not participate in a needle exchange program.

The CDC report first came to light at a congressional subcommittee hearing in July. Representative Henry Waxman, chairman of the influential House Subcommittee on Health and Environment, asked Lee and CDC Director David Satcher about the CDC's failure to release the report.

REPORT WAS TO BE PUBLIC

Lee assured Waxman that he would send the report to the committee and that the report would then be made public. However, the committee received the report only last month, and the committee staff also declined to release it. Sources say the committee was given the report on the understanding that it not be released publicly. The administration has also turned down Freedom of Information Act requests for what it insists is an "internal document."

With Democrats no longer controlling Congress, many advocates feel that by delaying taking action over the past year, the Clinton administration lost its best chance to bypass the ban on using federal funds for needle exchange programs. The ban, sponsored by Senator Jesse Helms, R-N.C., was first approved by Congress in 1989.

Two years ago, the San Francisco Board of Supervisors declared a local AIDS emergency, which allowed the city to spend its own funds for needle exchange programs. Aragon said the program has been effective in reducing the rate of HIV infection among drug users to a far lower level than in other cities.

"There is a real moral outrage among many people who've looked at all the evaluations and can say definitely that it works," said Regina Aragon, policy director of the San Francisco AIDS Foundation. "Yet because of unfounded fears and various political agendas, we are unable to implement this on a national level."

As to the administration's lack of action, she said, "Sitting back and saying they are not going to do anything because of the political consequences is not good enough."

In an interview with The Chronicle in July, Public Health Service Director Lee said lifting the ban was especially complicated because many states, including California, have laws prohibiting the sale of syringes without a prescription.

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