San Francisco Chronicle - Monday, May 11, 2009
Bob Egelko, Chronicle Staff Writer

So advocates of the programs in the Bay Area and elsewhere were surprised and dismayed when Obama's budget for 2009-10 proposed to continue the funding prohibition that dates from the 1980s.

"We hoped that the president would seize the first opportunity for lifting federal restrictions on this life-saving prevention strategy," said Paola Barahona of Physicians for Human Rights. "Denying people at risk for HIV a proven prevention intervention is a denial of their basic human rights."

"Without the federal funding, we're missing people that we could reach," said Laura Thomas, who heads the Drug Policy Alliance office in San Francisco and volunteers at a local needle-exchange program. "It's ridiculous that at this point in the epidemic, we're not looking to science in determining what we're funding."

A similar view could be found on the White House Web site soon after Obama took office in January: "The president also supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users."

That comment was erased from the site recently. But Bill Piper, national affairs director of the Drug Policy Alliance, said the removal appeared to be part of a housecleaning of statements from the transition period rather than a signal of a policy shift.

He noted that Gil Kerlikowske, director of the White Office of National Drug Control Policy, supported needle exchange during his confirmation hearing and ended police interference with the program in Seattle. Margaret Hamburg, Obama's candidate to run the FDA, sponsored New York City's first such program as its health commissioner in the early 1990s.

"I think the Obama administration wants to repeal the syringe ban," Piper said. "They've showed moral leadership on the issue, but they really need to show political leadership."

The White House issued a statement Friday by Jeffrey Crowley, director of the Office of National AIDS Policy, saying Obama "is looking forward to working with Congress and the American people to build support for this change, and his administration is committed to moving forward to address the federal ban on syringe exchange programs as a part of a national HIV/AIDS strategy."

Crowley did not say why the budget continued the funding ban.

The administration's approach may reflect the political controversy over a program whose opponents depict it as an acceptance of illegal drug use. But advocates say there is no dispute among researchers about its effectiveness in preventing AIDS and other diseases, such as hepatitis C, that are transmitted by contaminated syringes.

State officials quote a 1997 study that found HIV infection rates decreased 5.8 percent in 29 cities around the world with needle-exchange programs, and increased 5.9 percent a year in 52 cities without them. A five-year study of needle exchange in San Francisco, published in 1994, found that participants in the program - which included referrals to treatment - reduced their own drug injections by more than 60 percent.

The city's implementation of needle exchange since the 1980s "has prevented a huge HIV epidemic in the injection-drug-using population" and may have kept the disease from spreading to uninfected populations, said Grant Colfax, director of HIV prevention in San Francisco's Department of Public Health.

California law allows cities and counties to oversee the programs and exempts them from a ban on distribution of hypodermic needles without a prescription. The state provides about $750,000 a year to selected local needle-exchange programs, and San Francisco spends another $900,000 on its programs, which are run by the AIDS Foundation and other contractors, Colfax said.

Thomas, of the Drug Policy Alliance, said funding from state and local governments and private foundations still leaves the programs without the resources they need to reach all intravenous drug users.

Drug addicts have the same desire as anyone else to protect their health, Thomas said, but "without a way to get sterile syringes, they're not always able to follow through on their best intentions."

E-mail Bob Egelko at begelko@sfchronicle.com.
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