San Francisco Chronicle; Saturday, April 11, 1998
Louis Freedberg, Chronicle Washington Bureau

Although the administration's official stand is that it is still studying the matter, a range of AIDS organizations and key individuals say they have been assured a decision is imminent -- and they are anticipating that the ban will be lifted.

"We have reason to be optimistic that the administration will lift the ban, because it will fit comfortably within their perspective of research, prevention and care of people with AIDS," said Representative Nancy Pelosi, D-San Francisco. "I know they are committed to stop the spread of AIDS, and I am confident they won't let politics stand in the way of that."

Dr. Scott Hitt, a Los Angeles physician and the chairman of President Clinton's advisory council on AIDS, said he believes an announcement could be made within a week.

About 100 communities -- approximately 30 of them in California -- run needle exchange programs without federal funds. The San Francisco AIDS Foundation runs the largest in the nation, using a combination of city and private funds to hand out 2.2 million needles a year.

State and federal laws require a public health emergency to operate a needle exchange program, forcing the Board of Supervisors to make such a declaration every two weeks since the program started in 1993.

Lifting the ban would allow San Francisco to spend federal AIDS prevention funds on needle exchanges and free up funds for other programs. It would also allow many other communities that do not have a needle exchange program to initiate one.

"There could certainly be a financial benefit to San Francisco, and it would certainly benefit hundreds of other programs around the country that do not have the kind of support that San Francisco has," said Regina Aragon, policy director of the San Francisco AIDS Foundation.

According to authoritative estimates, more than half of new cases of HIV infection are related to drug use. Some experts argue that at least 14,000 new cases of HIV could be prevented each year if needle exchange programs were widely in place across the nation.

The congressional ban imposed in 1988 gives the secretary of health and human services the authority to lift the ban if there is sufficient scientific evidence to meet two criteria: needle exchange programs reduce the spread of HIV, and they do not encourage drug use.

As late as this week, a spokesman for Health and Human Services Secretary Donna Shalala said the administration is not yet convinced that needle exchange programs do not promote drug use.

PRESSURE ON SHALALA

As frustration at the administration's inaction mounted, the president's advisory council approved a resolution of "no confidence" last month in the administration, marking an embarrassing rebuke to a president who has prided himself on his efforts to fight the AIDS epidemic. Hitt sent a sharply worded letter to Shalala saying that her failure to lift the ban represented an "abdication" of her responsibilities.

On Thursday, council members held a conference call to decide whether to approve an even tougher resolution calling on Shalala to resign. But they decided to hold off after administration officials said a decision on the ban was imminent -- although they didn't provide details about what the decision would be.

But those close to the controversy believe the administration will lift the ban in light of the mountain of scientific evidence demonstrating the efficacy of needle exchange programs. Scientific panels and reports commissioned by the National Institutes of Health, the Centers for Disease Control and Prevention, the National Academy of Sciences, as well as the American Medical Association and the American Public Health Association have come to similar conclusions.

Within the administration, the emotional debate among Clinton's top advisers on AIDS and drug policy has led some officials to wryly refer to the conflict as "czar wars."

On the one side is Clinton's "drug czar," retired General Barry McCaffrey, who insists that handing out clean needles to drug users would send the message that the government is condoning drug use. He has been supported in that view by a combination of conservative Republicans and some Democratic representatives of cities with large African American populations.

THE `AIDS CZAR'

On the other side is "AIDS czar" Sandra Thurman, head of Clinton's Office of National AIDS Policy, although she downplayed her differences with McCaffrey.

"We are not warring," said Thurman. "General McCaffrey is every bit as committed to stopping the AIDS epidemic as I am."

At the same time, she said "We have convincing evidence that the criteria (needed to lift the ban) have been met."

On Wednesday, a major obstacle appeared to be removed when the authors of the only major study suggesting that needle exchange programs lead to increased drug use contended that their research in Montreal and Vancouver had been misinterpreted by McCaffrey and others.

Some AIDS advocates say they are skeptical of administration assurances that it is moving on the issue, saying they have heard the same thing too many times before.

"Until the decision is made, it is premature to say we have a victory here," said San Francisco's Aragon. "This is not an easy thing for the administration to do, and I would caution my colleagues not to be overly optimistic."

But others believe the administration is finally ready to act. "I don't think it will be much longer now," said Daniel Zingale, executive director of AIDS Action in Washington, D.C. "They understand where the science comes down on this issue."

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