BOSTON — AMID the debate over whether the government should try to limit AIDS among drug users by supplying free hypodermic needles, the United States Senate has sounded a unanimous ``no.'' But to some people, the Senate's 99-to-0 vote on Sept. 25 to ban federal funding for needle-exchange programs and those that supply bleach to clean old needles looks a lot like political posturing. New York City Health Commissioner Stephen Joseph, for one, is not impressed. ``It's a knee-jerk reaction without thinking through what is entailed,'' he says.
Only Washington, D.C.; New York City; San Francisco; and Tacoma, Wash., have such programs, and none of those receive federal money. So some drug officials see this vote as a convenient way for senators to appear tough on drugs, without spending anything.
``What the feds have said is, from their point of view, there's no research that they can trust that shows that needle exchange works,'' says David Purchase, a coordinator for the Needle Exchange Program for AIDs Prevention in Tacoma-Pierce County. ``They won't spend money to do their own studies. In the meantime, people will die.''
Needle-exchange providers say the Senate-approved amendment to a much larger appropriations bill would not have much effect on them, but could have a chilling effect on proposed programs that aim to operate using federal funds.
Intravenous drug abuse has replaced homosexual contact as the leading cause of AIDs, according to medical specialists. The virus is spread, they say, when users share needles. The aim of exchanging needles is to cut sharing.
Law enforcement officers criticize needle-exchange programs, saying they encourage drug use. Other critics say giving out free needles puts a government stamp of approval on an illegal activity.
``We should be providing full treatment to these individuals, not subsidized addiction and death on the installment plan which free needles or bleach really are,'' says Rep. Charles Rangel (D) of New York, chairman of the House Select Committee on Narcotics Abuse and Control.
Treatment facilities are full, however, and long waiting lists often deter those who might seek treatment. Mr. Rangel says Congress appropriated $75 million last year in the Anti-Drug Abuse Act for reducing treatment waiting lists and earmarked another $125 million to pay for new treatment. Half of that total is earmarked for intravenous drug users.
Still, $75 million is only half of what was called for by the 1988 Presidential Commission on AIDS to expand treatment programs and outreach efforts.
Critics say needle-exchange programs have not been proven to stop needle sharing. But one study in Amsterdam, which began providing needles to 8,000 drug abusers in 1984, did find that the sharing of needles dropped. It found no evidence of increased drug use.
Dr. Joseph says the Senate ignored the data. ``One of the things we've found is that needle exchange gets people into treatment and off drugs,'' Joseph says. ``There's no evidence anywhere that needle exchange gets them on drugs.''
Mr. Purchase's Tacoma needle program, which he initially paid for himself until the state funded it, is a $43,000, no-frills, no-questions-asked operation consisting mainly of a van and a box for used needles. He says the program does more than pass out needles: It provides unusual access to street people.
``We're `user friendly,''' Purchase says. ``They ask us questions. As a result we get people into treatment.''
The debate over needle-exchange programs has also gone on within the Bush administration. Secretary of Health and Human Services Louis Sullivan in March backed the idea of a needle-exchange program and offered help with funding. In July, his idea ran afoul of William Bennett, director of the White House Office of Drug Control Policy. White House spokesman Marlin Fitzwater reported the new stance, saying there was not enough proof such programs worked.
If the bill restricting funding becomes law, ``it won't help,'' Purchase says. ``But we don't intend to quit.''