U.S. under fire over needle exchanges for AIDS prevention

VIENNA, March 8, 2005   Tribune de Geneve  (AFP)

Non-governmental organizations have charged at a UN meeting that US opposition to programs offering needle exchanges to drug users to fight the spread of HIV/AIDS is threatening the lives of thousands.

In an open letter to a UN drug meeting that opened in Vienna Monday, the Human Rights Watch group said the United Nations "under pressure from the United States, is being asked to withdraw support from proven HIV prevention strategies at precisely the moment when increased commitment to measures such as syringe exchange and opiate substition treatment is needed."

"The United States should be encouraging proven HIV prevention strategies, not attacking them," Human Rights Watch said in the letter, written in cooperation with 300 NGO's from 56 countries.

"In most countries outside Africa, the largest number of new infections now occurs among injection drug users," the letter said.

"We must not deny these addicts any genuine opportunities to remain HIV negative," Antonio Maria Costa, head of the UN Office on Drugs and Crime (UNODC) told in Vienna on Monday the 48th session of the UN Commission on Narcotic Drugs (CND).

Costa said that contaminated syringes were a major source of transmission of the HIV virus and other diseases including hepatitis, especially among drug users whose capacity for rational thought was diminished.

"We reject the false dichotomy that either drug control prevails, with no consideration for HIV, or that HIV prevention prevails with no consideration for drug abuse," he added.

John Walters, director of the US Office of National drug control policy disagreed, telling reporters at the commission session that the United States remained "concerned about the global danger of HIV/aids transmission."

"The single greatest way of preventing the spread of HIV/aids through drug users is taking those addicted and get them to recover," Walters said.

The United States thinks the UN body "should not be involved with needle exchange because this is promoting drug use," said an unnamed US government official.

But Walters said that the points of agreement in the fight against drug abuse outweighed the differences, saying "there has been a kind of caricature" of the two sides' positions.

But the influential US newspaper, the New York Times, pointed to stark differences of opinion when it said in an editorial last week that "Washington's antipathy toward needle exchanges is a triumph of ideology over science, logic and compassion."

The Times said such exchanges were "a proven weapons against AIDS transmission" and that the US government's blocking money for such programs as it does for abortion programs, "would be an even more deadly mistake."

Jane Francis, a spokeswoman for the Council of Senlis think tank said "forced abstinence does not work if the drug addicts are not ready to stop."

"Needle exchange is the biggest life saver," she said, adding that the idea that "AIDS is getting spread through drug users" was "totally ridiculous."

Costa had said in a letter sent in November to the US State Department that the controversy over US objections to needle exchanges "continue to place... (Costa's office) in a difficult position," according to a copy of the letter obtained by AFP.

Costa said the United Nations does not "endorse needle exchanges as a solution for drug abuse nor support public statements advocating such practices" and feels such "prophylactic measures to prevent the spread of HIV/AIDS should be undertaken only within the overall effort to reduce druge abuse," the letter said.

               © AFP Agence France-Presse

 
Deadly Ignorance       and more Lies from this White House!

Sunday, February 27, 2005; Page B06  The Washington Post   
Editorial

Washington Monthly's Kevin Drum cites a recent editorial in The Washington Post on one way to reduce the incidence of AIDS and challenges the paper to give up its sources:

"The administration claims that the evidence for the effectiveness of needle exchange is shaky. An official who requested anonymity directed us to a number of researchers who have allegedly cast doubt on the pro-exchange consensus.

"One of them is Steffanie A. Strathdee of the University of California at San Diego; when we contacted her, she responded that her research 'supports the expansion of needle exchange programs, not the opposite.'

"Another researcher cited by the administration is Martin T. Schechter of the University of British Columbia; he wrote us that 'Our research here in Vancouver has been repeatedly used to cast doubt on needle exchange programs. I believe this is a clear misinterpretation of the facts.'

"Yet a third researcher cited by the administration is Julie Bruneau at the University of Montreal; she told us that 'in the vast majority of cases needle exchange programs drive HIV incidence lower.' We asked Dr. Bruneau whether she favored needle exchanges in countries such as Russia or Thailand. 'Yes, sure,' she responded.

"Note the familiar MO of an administration official who demands anonymity on a subject that should be perfectly open. Why? Because he knows perfectly well he's lying and doesn't want his name associated with it in case he gets caught. . . . He's flatly lying and hoping that it's not a big enough story for anyone to bother tracking down his sources.

"There are two lessons here. First, the Post should feel no obligation to keep this person's name anonymous. He lied to them. Second, even in a blatant case like this the Post was still unwilling to flatly call these statements lies. What does it take, guys? "Oh, and a third lesson too: the press should never believe a word the Bush administration says unless they confirm it themselves. Maybe that's really lesson #1."
THE BUSH administration is quietly extending a policy that undermines the global battle against AIDS. It is being pushed in this direction by Congress, notably by Rep. Mark Edward Souder (R-Ind.). But some administration officials zealously defend this policy error, claiming scientific evidence that doesn't exist.

The administration's error is to oppose the distribution of uncontaminated needles to drug addicts. A large body of scientific evidence suggests that the free provision of clean needles curbs the spread of AIDS among drug users without increasing rates of addiction. Given that addicts are at the center of many of the AIDS epidemics in Eastern Europe and Asia, ignoring this science could cost millions of lives. In Russia, as of 2004, 80 percent of all HIV cases involved drug injectors, and many of these infections occurred because addicts share contaminated needles. In Malaysia, China, Vietnam and Ukraine, drug injectors also account for more than half of all HIV cases. Once a critical mass of drug users carries the virus, the epidemic spreads via unprotected sex to non-drug users.

The administration claims that the evidence for the effectiveness of needle exchange is shaky. An official who requested anonymity directed us to a number of researchers who have allegedly cast doubt on the pro-exchange consensus. One of them is Steffanie A. Strathdee of the University of California at San Diego; when we contacted her, she responded that her research "supports the expansion of needle exchange programs, not the opposite." Another researcher cited by the administration is Martin T. Schechter of the University of British Columbia; he wrote us that "Our research here in Vancouver has been repeatedly used to cast doubt on needle exchange programs. I believe this is a clear misinterpretation of the facts." Yet a third researcher cited by the administration is Julie Bruneau at the University of Montreal; she told us that "in the vast majority of cases needle exchange programs drive HIV incidence lower." We asked Dr. Bruneau whether she favored needle exchanges in countries such as Russia or Thailand. "Yes, sure," she responded.

The Bush administration attempted to bolster its case by providing us with three scientific articles. One, which has yet to be published in a peer-reviewed journal, was produced by an author unknown to leading experts in this field who is affiliated with a group called the Children's AIDS Fund. This group is more renowned for its ties to the Bush administration than for its public health rigor: As the Post's David Brown has reported, it recently received an administration grant despite the fact that an expert panel had deemed its application "not suitable for funding." The two other articles supplied by the administration had been published in the American Journal of Public Health. Although each raised questions about the certainty with which needle-exchange advocates state their case, neither opposed such programs.

Evidence that the administration does not cite leaves little doubt about the case for needle exchange. A study of 81 cities published in 1997 in the Lancet, a medical journal, found that in cities without needle-exchange programs, HIV infection rates among injection drug users rose by nearly 6 percent per year; by contrast, cities that had introduced free-needle programs witnessed a decrease in infection rates of about the same magnitude. Elias A. Zerhouni, the director of the National Institutes of Health, wrote last year that exchange programs "can be an effective component of a comprehensive community-based HIV prevention effort," and a World Health Organization technical paper agreed that the provision of clean needles and syringes should be "a fundamental component of any comprehensive and effective HIV-prevention programme." Addressing legitimate methodological questions about the research favoring needle exchange, the WHO reasonably concluded that incomplete scientific evidence does not confer the freedom to ignore the knowledge we do have.

Respecting science does not appear to be the administration's priority, however. Not only is it refusing to spend federal dollars on needle exchange, but the administration also is waging a campaign to persuade the United Nations to toe its misguided line. The U.N. Office on Drugs and Crime, which is heavily reliant on U.S. funding, has been made to expunge references to needle exchange from its literature, and the administration is expected to continue its pressure on the United Nations at a meeting that starts March 7. The State Department's new leadership needs to end this bullying flat-earthism. It won't help President Bush's current effort to relaunch his image among allies. And it's almost certain to kill people.

Ideology and AIDS

Published: February 26, 2005   The New York Times   Editorial

The Bush administration has contributed to suffering and death through the so-called global gag rule, which prohibits Washington from giving money to any group that performs - or even talks about - abortions. Organizations that provide desperately needed family planning and women's health services have lost their financing. Now there are moves in Congress and inside the administration to apply a similar rule to needle exchange programs. That would be an even more deadly mistake.

Allowing drug users to trade used needles for clean ones gets dangerous needles off the street and minimizes needle sharing. A proven weapon against AIDS transmission, it has not been shown to increase drug use, and indeed may reduce drug addiction by providing a way to talk to drug users and lead them to treatment. It is endorsed by virtually every mainstream public health group.

Getting users into drug treatment is the best way to keep them safe. But the push for treatment - which is expensive and difficult - should come with needle exchanges.

Drug use is not a significant source of AIDS infection in Africa. In parts of Asia, the former Soviet bloc and Eastern Europe, needles are the major source of infection; three-quarters of all newly infected people in Russia are intravenous drug abusers, as are half of those newly infected in China. These are just the places where the AIDS epidemic is likely to explode next. A bumper poppy crop in Afghanistan will worsen the outlook, producing cheap heroin that could turn opium smokers into heroin injectors and thus fuel the epidemic.

Opponents of needle exchanges, mainly among the religious right, argue that the practice muddies the message that illegal drug use is unacceptable, and keeps drug abusers from suffering the consequences of their addiction. By this twisted logic, doctors should refuse to treat lung cancer in smokers. In any case, AIDS infections from sharing needles are not limited to drug users. They infect sexual partners, spreading the epidemic through societies.

While Washington does not buy syringes for needle-exchange programs, it does give money to groups that use other people's money to administer needle exchanges. But some conservatives are attempting to stop even that. The assistant secretary of state for international narcotics and law enforcement, Robert Charles, warned the United Nations Office on Drugs and Crime, which currently holds the rotating chairmanship of the joint program Unaids, that the organization should not work on needle exchange issues and should remove positive references to them from its Web site, which it did.

Representatives Mark Souder of Indiana and Tom Davis of Virginia, both Republicans, have asked the United States Agency for International Development for details on all financing for programs in which any group strongly advocating needle exchanges also participates. These lawmakers claim that a U.N. drug agency report attacks needle exchange as encouraging drug use. In fact, the report makes no such accusation and endorses needle exchanges.

In the Senate, a member of the staff of Sam Brownback, the Kansas Republican, has compiled a grossly inaccurate chart of programs financed by the Global Fund to fight AIDS, Tuberculosis and Malaria that is subtitled "Immoral, Illegal (with bilateral funds) or Inconsistent with U.S. Foreign Policy." Needle exchanges rank high. At the moment, Mr. Brownback's office says he does not intend to attempt to block these programs. But some newer right-wing lawmakers are considering it.

So far, attempts to eliminate needle-exchange programs overseas seem to have limited support. Many administration officials and conservatives in Congress do not want to see crucial AIDS prevention measures derailed or American support withdrawn from such organizations as the Global Fund. One important test will be what the administration does in early March at the annual meeting of the United Nations Commission on Narcotic Drugs. Last year, United States representatives there attacked the scientific evidence in favor of needle exchanges as unconvincing. This year, the United States should refrain from such attacks - and members of Congress should call off their budding witch hunt.

Washington's antipathy toward needle exchanges is a triumph of ideology over science, logic and compassion. The United States should help pay for these important programs. If it cannot bring itself to do so, it should at least allow the rest of the world to get on with saving millions of lives.



The U.N. Commission on Narcotic Drugs, the U.N. policy-making agency on drug-related issues, on Monday in Vienna, Austria, began reviewing and analyzing international drug policy and is scheduled to discuss how to combine the war against drugs with HIV/AIDS prevention methods, the AP/Officer.com reports (AP/Officer.com, 3/7). Some congressional Republicans have been working to prevent federal funding from going to groups that advocate needle-exchange programs to reduce the spread of HIV among injection drug users, with Reps. Mark Souder (R-Ind.) and Tom Davis (R-Va.) leading the effort. Sen. Sam Brownback (R-Kan.) last month in a memo to his political allies outlined a strategy seeking a ban on USAID grants going to any organizations that do not completely support President Bush's views on certain issues, including drug use. USAID policy already prohibits federal funding from going to needle-exchange efforts. However, more than 300 scientists, policy analysts and human rights and HIV/AIDS advocates from 56 countries last week signed an open letter urging delegates attending the UNCND meeting to resist U.S. pressure to withdraw from needle-exchange programs. "Strategies that attempt solely to achieve abstinence from drug use do not constitute an acceptable alternative to programs, such as syringe exchange, that help active drug users protect themselves from HIV/AIDS," the letter states (Kaiser Daily HIV/AIDS Report, 3/4). Several newspapers and journals have published editorials and opinion pieces in response to the issue, some of which are summarized below.

Editorial

* Canadian Medical Association Journal: The "soaring" number of HIV/AIDS cases among injection drug users is "in large measure the byproduct of a law-enforcement approach to drug policy," a CMAJ editorial says. Such policies "deepe[n] the social isolation" of injection drug users and present "barriers to harm-reduction strategies," such as needle-exchange programs and opioid substitution therapy, which aim to reduce harmful effects from injecting drugs, according to CMAJ (Canadian Medical Association Journal, 3/1).

* Chicago Tribune: Although needle-exchange programs are "effective" in curbing the spread of HIV and other bloodborne diseases, "resistance in Washington to such efforts has been strong," a Tribune editorial says. The efforts by some members of Congress to "cut off American support" for international initiatives administering needle-exchange programs are a "blow to worldwide efforts to contain the epidemic," the editorial says. Although needle-exchange programs are "imperfect solution[s]," they "lessen the chances" of HIV transmission among injection drug users, as well as to their sexual partners and children. More importantly, "clean needles offer the hope of breaking the chain of contagion" and are an "essential item to fight the spread of AIDS here and abroad," the editorial concludes (Chicago Tribune, 3/8).

Opinion Pieces

* Richard Elliott et al., Canadian Medical Association Journal: The UNCND meeting and other upcoming meetings will indicate whether member nations can "rise to the challenge of mitigating the negative health impacts of global drug control treaties or whether timidity in the face of ideological bullying will prevail," Elliott, director of legal policy and research at the Canadian HIV/AIDS Legal Network, and colleagues write in a CMAJ opinion piece. Canada, which has implemented a "wide range of harm-reduction measures," should play the role of a "strong global advocate for harm reduction" at the UNCND meeting, the authors conclude (Elliott et al., Canadian Medical Association Journal, 3/1).

* Arieh Neier, International Herald Tribune: Millions of people "at risk" of HIV infection, particularly in Asia and the former Soviet Union, will "pay the price" if the Bush administration successfully "override[s] the best available evidence in deciding how best to fight HIV related to drug use," columnist Neier writes in a Herald Tribune opinion piece. The U.N. Office of Drugs and Crime -- which includes UNCND and to which the United States is the largest donor -- "is caught between the rock of American intransigence on drug policy and the hard facts that show needle exchange and other harm-reduction strategies to be effective," Neier says, concluding that UNCND needs to provide "unanimous commitment to deploying the tools, including needle exchange, known to reduce HIV among drug users, not the American policy of scuttling prevention methods proven to save lives" (Neier, International Herald Tribune, 3/5).

* Mike Trace/Ruth Runciman, Guardian: Harm-reduction policies that do not "demand abstinence," such as needle-exchange and drug treatment services, have made the United Kingdom a "world leader" in keeping HIV prevalence among injection drug users low, Trace, chair of the Beckley Foundation's International Drug Policy Consortium, and Runciman, chair of the British not-for-profit group National AIDS Trust, write in an opinion piece in London's Guardian. The HIV prevalence rate among injection drug users in the United Kingdom has remained below 1% since the early 1980s, and similar policies in other countries have had "positive results," according to Trace and Runciman. Conversely, the "tactic of applying pressure to national governments and international agencies to pursue policies preferred by U.S. conservatives" is "[d]isturbin[g]," Trace and Runciman write, concluding, "If the outcome [of the UNCND meeting] is a retrenchment from the progress made in recent years by U.N. agencies, this would represent a victory of moralism and financial muscle over evidence and tolerance" (Trace/Runciman, Guardian, 3/3).



Published on Friday, March 4, 2005 by the International Herald Tribune
The AIDS Epidemic: US Ideologues Put Millions At Risk
by Aryeh Neier

Global fanfare accompanies every International AIDS Conference, but an obscure United Nations meeting next week in Vienna may prove more critical to the course of the global HIV epidemic. Delegates are gathering for the 48th meeting of the Commission on Narcotic Drugs, a largely unpublicized UN entity that sets the international drug control agenda and that this year is focusing on questions of HIV prevention. If recent events are any gauge, the commission - cowed by American hard-liners - will challenge the efficacy of programs, like needle exchange, proven to reduce HIV transmission among active drug users. With the world's fastest-growing epidemics now fueled by intravenous drug use, millions of people at risk for HIV, particularly in Asia and the former Soviet Union, will pay the price.

Shown in dozens of studies in America and elsewhere to reduce transmission without increasing drug use, needle exchange is perhaps the most effective of all strategies to prevent the spread of HIV . Yet in a pattern familiar from debates over sex education, Washington conservatives seem eager to hold up distortions of science as a model for the rest of the world. At last year's meeting of the Commission on Narcotic Drugs, Europeans and Australians watched in amazement as American delegates declared the evidence for needle exchange "unconvincing."

U.S. representatives also blasted as a "counsel of despair" the harm-reduction approach, which recognizes that even drug users unable or unwilling to stop using drugs can be helped to avoid the AIDS virus and other problems. Backed by a coalition of prohibitionists that included Russia, Sweden and Japan, the United States ensured that the resolutions adopted by last year's commission were stripped of every mention of harm reduction. Any discussion of human rights of drug users was similarly excised.

This year the United States has not waited for a global gathering to force the UN to pledge allegiance to "zero tolerance." American officials have put significant back-channel pressure on the UN Office on Drugs and Crime - the current chair of the UN's joint program on HIV/AIDS - to retreat from needle exchange and other harm-reduction measures.

After a November meeting with Robert Charles, an assistant secretary of state in charge of the U.S. Bureau of International Narcotics and Law Enforcement Affairs, the director of the Office on Drugs and Crime, Antonio Maria Costa, promised that he would review all of the office's printed and electronic statements to remove references to harm reduction. Costa also pledged that the office would be "even more vigilant in the future." As a start, a senior staffer directed subordinates to "ensure that references to harm reduction and needle/syringe exchange are avoided in UNODC documents, publications and statements."

More than semantic sanitation is at stake. In Russia, where estimated HIV cases now surpass those in all of North America and where 75 percent of new infections are attributable to intravenous drug use, officials have long pointed to the proceedings of the Commission on Narcotic Drugs to justify misgivings about needle exchange and refusal to treat addicts with noninjectable opiate substitutes like methadone.

Last year, Ukrainian officials returned from the commission to announce that they were shelving plans for a methadone pilot program.

In Thailand, government officials claimed that Costa had given his blessing to drug control efforts that included mass arrests, forced internments and more than 2,500 killings of suspected drug dealers. Costa strenuously denied the claim. But his office recently suspended a Bangkok-based program dedicated to reducing intravenous drug users' vulnerability to the AIDS virus in East Asia.

Completely dependent on donor contributions - the largest share from the United States - the Office on Drugs and Crime is caught between the rock of American intransigence on drug policy and the hard facts that show needle exchange and other harm-reduction strategies to be effective.

Having removed condom information from federal Web sites and insisting on abstinence-only sex education at home and abroad, the Bush administration is now poised to override the best available evidence in deciding how best to fight HIV related to drug use. What is needed at this year's Commission on Narcotic Drugs is unanimous commitment to deploying the tools, including needle exchange, known to reduce HIV among drug users, not the American policy of scuttling prevention methods proven to save lives.

             Aryeh Neier is president of the Open Society Institute.

 
U.S. 'Trying to Influence' Drug Project Spends

By David Barrett, PA Home Affairs Correspondent

The United States is attempting to restrict the global expansion of schemes designed to reduce the harm done by drugs such as needle exchange programmes, it was claimed today.

The International Drug Policy Consortium – funded by a British charity – said the US was attempting to influence the way its donations to United Nations drug projects were spent.

Director Mike Trace – Britain’s former deputy drug tsar – said: “There is an attempt – certainly within the US Congress – to tie all US policy aid to recipient agencies to US moral lines.

“They are saying they don’t want money to go to any part of the world unless people sign up to neo-Conservative moral values.”

A meeting of international delegates to the Commission on Narcotic Drugs in Vienna next week could see further pressure brought by the US, he added.

Professor Gerry Stimson of the International Harm Reduction Association said: “The position of the US threatens to destabilise the global attempt to control HIV/Aids among injecting drug users.

“Since November the United Nations Office on Drugs and Crime (UNODC) has come under pressure from the US to withdraw its support from harm reduction schemes.

“This may have serious implications for developing countries which look to the UN for guidance on these issues.”

Needle exchange programmes can swiftly bring HIV/Aids infections under control when drugs such as heroin begin to become popular in developing countries, he added.

Infections run at 11% of the drug injecting population in the UK – which has offered harm reduction programmes since the 1980s – compared with 80% to 90% in Burma, he said.

Mr Trace said the US was the major contributor to the UNODC, which is entirely donor-funded.

 

 


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