NEEDLE FUNDING BAN MAY SOON END
Shift in Congress Stirs Hope Among D.C. AIDS Officials
Nearly a decade after it was first imposed, a unique congressional ban limiting the District's effort to fight AIDS could be lifted and the city again allowed to use local tax dollars for needle-exchange programs.
The ban's changed prospects owe to the changed balance of power on Capitol Hill, particularly in the House of Representatives, which has attached the prohibition year after year to legislation governing the District's budget. With Democrats now in control and support growing to give the city a vote in Congress and greater autonomy generally, health advocates are optimistic that the restriction could be history by fall.
"The moment may have come. The stars may have aligned," said Walter Smith, executive director of the nonprofit DC Appleseed Center for Law and Justice.
The District has among the worst rates of HIV-AIDS infection in the country -- with intravenous drug users accounting for about one-third of new AIDS cases annually. But it is the only city prohibited from spending its own funds to provide clean syringes to addicts. "There is a connection between those two facts," Smith said, "and it is time to uncouple it."
The first hurdle will come today as a key House subcommittee takes up the appropriations bill that includes the city's spending plan. Its chairman, Rep. Jose E. Serrano ( D-N.Y. ), said he and his colleagues should not be telling the District what to do with its money.
"I don't appreciate the fact that so many people throughout the last few years have used the D.C. appropriations bill . . . as the punching bag or the battleground for so many social issues," Serrano said in an interview late last week.
Yet his opposition goes beyond political philosophy to public health and how best to attack the epidemic. The effectiveness of needle-exchange programs has been proven nationally, Serrano said: "This is where people who are really hurting go for help." Although a reversal of Congress's past action is not a certainty, he said he is ready to push the issue.
"This is one I'm really concerned about," he said.
Despite the controversy over such programs, more than 210 are in place in 36 states. About half receive local or state funding, according to the North American Syringe Exchange Network.
Proponents, armed with a significant body of research, say that giving clean needles to addicts saves lives by decreasing the shared use of potentially contaminated syringes and, therefore, the transmission of HIV and other blood-borne diseases such as hepatitis. They say the interaction with users also draws them into treatment and counseling -- without encouraging greater drug use, as critics maintain.
Congress first targeted the District in 1998, when opponents of needle-exchange programs not only strengthened a ban on federal financing but also barred using the city's resources on such efforts. The next year, it appeared the language might be dropped. But when the D.C. budget reached the House floor, conservative Republicans again added a rider.
Until now, there had been little hope of a different outcome.
"This is the worst example of political disempowerment and abuse of the city," said Del. Eleanor Holmes Norton ( D-D.C. ). "It's a life-and-death matter and a public health matter. There is no question that countless deaths have occurred because of this attachment."
Norton began lobbying her party's leadership early this year and expressed confidence last week that its majorities in the House and Senate will allow the District to resume public funding of its one local needle-exchange program. She can point to significant backing within the city. Serrano and Sen. Richard J. Durbin ( D-Ill. ), chairman of the subcommittee that initially handles the D.C. budget, received a letter last month endorsed by representatives of more than two dozen medical, public health, social service and philanthropic organizations.
"Please help us battle the HIV/AIDS epidemic in the District," it urged.
J. Channing Wickham, who signed the letter as executive director of the Washington AIDS Partnership, sees the timing as propitious. Between increasing acceptance of home rule and the accumulated medical evidence, he said, "all signs are very, very positive."
The ban's prime author, Rep. Todd Tiahrt ( R-Kan. ), remains on the Appropriations Committee. His position has not changed, and despite the new political equation, he will probably try once more to constrain District funds, spokesman Chuck Knapp said.
"We hope it passes," Knapp said, "but realistically it's a different political environment."
Mayor Adrian M. Fenty ( D ) already has pledged to direct dollars toward needle-exchange programs if the ban is removed, a commitment he reiterated in a statement Friday. The lack of city financing has hamstrung the small nonprofit group that drives into sometimes-bleak neighborhoods five days a week in search of those in the grips of heroin and other drugs.
"It has restricted our growth," said Paola Barahona, who has been executive director of Prevention Works! since its start nine years ago in response to the federal stricture. Even so, the privately funded organization passed out more than 236,000 needles last year. That count meant regular contact with about 2,000 users, many of them women. Statistics indicate that 40 percent of women living with AIDS here were exposed to the virus through injecting drugs.
"We're talking about people who are missed by all other health outreach programs," Barahona said. And numbers, she added, "that are just the tip of the iceberg." [/FONT]