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On needles, breasts and bullets: health and the conflict of values

Each year over 40 000 Americans are infected with HIV, and dirty needles are responsible for up to 30% of these new cases (I, 2). Needle-exchange programmes, besides preventing the spread of HIV, also prevent hepatitis transmission and can bring addicts into contact with drug rehabilitation services, instruction in condom use and general health care. In addition, dean needles reduce the transmission of HIV to the sex partners and children of drug users. In September 1995, a National Academy of Sciences panel issued a report concluding that needle-exchange programmes for i.v. drug users reduce the spread of HIV without encouraging more drug use in society (2). Actually, the efficacy of such programmes had been known for some time, but certain politicians and policy makers belonging to the 'just say no' or zero tolerance camp succeeded in getting Congress to pass legislation barring federal funds for needle-exchange programmes (3-6). In 1992, however, health minded legislators were able to pass new legislation ordering the Department of Health and Human Services (HSS) to request the above mentioned report from the National Academy of Sciences. The legislation also stipulated that if the report found needle-exchange programmes to be effective (it did), and if these programmes did not cause a higher prevalence of drug use (they did not), then the Surgeon General was empowered to lift the ban on federal funding. Lifting the federal ban on funding, however, would still leave a plethora of state and local anti-needleexchange laws that would have to be rescinded in order to have an effective national needle-exchange programme. Some of these state and local laws criminalize needle-exchange programmes outright, while others criminalize the purchase and possession of needles and syringes without a prescription.