A Dirge for D.C.

Poor, poor Washington, D.C. Stuck under the thumb of the Federal government and unable to stretch its independent legs.

Washington, D.C. is the city with the fastest HIV/AIDS rate in the country — it’s growing 10 times faster than the national average. According to recent CDC reports, the rate of new cases of HIV/AIDS in D.C. was 128.4 per 100,000 in 2005, compared with a national average hovering around 13 per 100,000. That’s about 1 in 20 D.C. residents who are living with HIV/AIDS.

And the virus is spreading fast through the city’s community of intravenous drug users. D.C. is also, according to a recent NY Times article, the only city in the counry unable to use local funds for a needle exchange program. In other cities, state and local funds support needle exchange programs and other outreach. But not in D.C., where Congress controls the budget and has long barred the appropriation of money to any type of harm reduction.

There’s a clear opinion divide about needle exchange programs. Mostly conservative politicians who want to be seen as “tough on crime” oppose them (duh), and ignore the connections between drug use and public health. From the NY Times article:

Critics of needle exchange programs argue that rather than reducing the suffering of drug users and preventing them from spreading diseases, the programs foster further drug use.

“We need to fight drugs, not show people that they can be used in a safe manner,” Representative Sam Graves, Republican of Missouri, said last year during House floor debate about drug policy.

But those who operate the programs see needle exchanges as a gateway to the provision of social services:

“The needle is just an enticement, really,” [Ron Daniels, an HIV+ former heroin addict who now runs a needle exchange program in DC] said, looking through the screen door of his van at a line of about 10 people who gathered within minutes of his arrival at a corner on the city’s grittier Northeast side.

He said his program, which reaches about one third of Washington’s estimated 9,700 intravenous drug users, relied on clean syringes to attract users so he and his staff of four could counsel them about drug rehabilitation and testing for H.I.V., the virus that causes AIDS.

Daniels’ program is funded wholly by private donations.

Yet despite the mountains of evidence that needle exchanges don’t raise levels of drug use and do prevent HIV, the federal ban remains in effect. Clinton, who had the chance to change course, chickened out.

In 1988, Congress banned federal money from being used on needle exchange programs, though it included an exception allowing the president to waive the federal ban if review by the surgeon general or secretary of Health and Human Services determined that syringe exchange programs were proven effective and did not increase drug use.

A number of federal studies found that such programs did not increase drug use, and in 1998 Donna Shalala, then the secretary of Health and Human Services, concluded, “A meticulous scientific review has now proven that needle exchange programs can reduce the transmission of H.I.V. and save lives without losing ground in the battle against illegal drugs.”

However, President Bill Clinton did not remove the ban on syringe exchange financing, and in 1998 Congress reinforced the ban by removing the executive waiver.

The attention paid to the issue helped embolden critics in Congress, who decided not only to tighten the federal ban but also to block Washington’s own financing of such programs. In recent years, Mr. Clinton has said he regrets not having done more to lift the ban.

So what are we to do with a vindictive federal policy that runs counter to the data and that has a disproportionate effect on the city that could most live without it? At least one Congressman (NY’s Jose Serrano) is trying to change it. But it’s almost ten years and probably thousands of lives too late. Anyone still think the “War on Drugs” and all its attendant human costs is a good idea?