- The Washington Times - Friday, July 19, 2002

A Republican lawmaker from New Jersey plans to fight a proposed state needle-exchange program, using the results of a study that found high-risk sex not needle sharing to be the strongest predictor of HIV infection among injection-drug users.
Democratic Gov. James E. McGreevey has proposed a hospital-based pilot program in which addicts could exchange dirty needles for clean ones to prevent transmission of HIV and hepatitis.
State Sen. Gerald Cardinale said this week he intends to highlight the findings of the federally funded 10-year study by researchers at the Johns Hopkins University Bloomberg School of Public Health as ammunition to oppose Mr. McGreevey's plan.
"It's counterproductive for the government to be facilitating injection-drug use," said Mr. Cardinale, who is a dentist. "The best program is to tell people, starting when they are young and in grammar school, that the use of drugs is destructive and stupid behavior."
"It will be a difficult battle to stop," said Mr. Cardinale in a telephone interview. "A lot of Democrats and some Republicans who are gullible and politically correct undoubtedly will go for" the plan.
He said he only recently learned of the Johns Hopkins study, reported last week in The Washington Times. The study tracked from 1988 to 1998 a total of 1,800 initially HIV-negative men and women from Baltimore who injected drugs.
The rate of HIV incidence among sexually active homosexual males who injected drugs was 10.4 percent annually, compared with 4.5 percent per year for heterosexual males who shared needles. Among female injection-drug users, 8.1 percent per year contracted HIV through heterosexual sex with infected men. That compared with 4.4 percent infected through needle sharing.
In a telephone interview yesterday, Dr. Steffanie Strathdee, associate professor of epidemiology at the Hopkins school of public health, who led the research, said she presented the results of a newer, separate study last week at the International AIDS Conference in Spain that focused on young injection-drug users, between the ages of 18 and 30.
Like the broader study, this one also found high-risk sex not needle sharing to be the strongest predictor of HIV infection among those who inject drugs.
The Hopkins researchers say their work should not be interpreted as meaning there is less need for needle-exchange programs to reduce HIV risk.
"Over the course of the [10-year] study, we found 35 percent of the participants ever took part in needle-exchange programs. And we showed a protective effect ranging from 30 to 80 percent per person," Dr. Strathdee said.
But some on Capitol Hill hope the Hopkins research will slow the growth of needle-exchange programs and help keep in place the federal ban that now exists on funding for such programs.
"It turns out many of the assumptions of needle-exchange proponents have been wrong. Frequency of drug use and sex are the behaviors that are most likely to cause addicts to become infected. Needle distribution does nothing to address these risks but contributes to the drug abuse that fuels both," said Roland Foster, staff member of the House Committee on Government Reform's subcommittee on criminal justice, drug policy and human resources.
Gabe Neville, spokesman for Rep. Joseph R. Pitts, Pennsylvania Republican, said the new findings are "certainly an arrow in the quiver of conservatives on this issue."
"This is further evidence that HIV and other sexually transmitted diseases are the result of behavior and not a lack of clean needles or condoms," Mr. Neville said.
Public health officials are standing by their needle-exchange programs and say the new studies don't undermine the rationale.
Dr. Peter L. Beilenson, Baltimore's health commissioner, said his city's needle-exchange program, which began in 1994, has resulted in "a lot fewer dirty needles on the streets today than there were then. We're not going to decrease our emphasis on needle exchange."
Dr. Beilenson said there has been a 70 percent reduction in HIV infection among regular participants in the NEP and a 40 percent reduction among all participants.
Dr. Strathdee said addicts who make use of needle-exchange programs tend to be those from inner-city neighborhoods "who are at highest risk" for HIV infection.
"These are vulnerable people. Many engage in sex for drugs" or money, she said.
In contrast, she said, some heroin addicts in the Hopkins study were able to hold down full-time jobs and buy syringes legally at drugstores, feigning diabetes. So they ignored needle-exchange programs.

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