Needle Exchange Programs and HIV Prevention: The Greater Good or the Promotion of Evil?

Altman Lawrence K. , “At AIDS Conference, A Call to Arms Against ‘Runaway Epidemic'” The New York Times 29 June 1998, A-13.

Pear R. , “U.N. Estimate Doubles Rate of Speed of AIDS Virus,” The New York Times 26 November 1997, A-6.

Wren Christopher S. , “White House Drug and AIDS Advisors Differ on Needle Exchange,” The New York Times 23 March 1998, A-10.

Centers for Disease Control and Prevention, “HIV/AIDS Surveillance Report, 1996,” (Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, 1997): Vol. 8, 1–39.

Stolberg Sheryl Gay , “Clinton Decides Not to Finance Needle Programs,” The New York Times 21 April 1998, A-18.

Jon Fuller S.J. M.D. , “Needle Exchange: Saving Lives,” America 179 (July 18-25, 1998): 9.

Staff Editorial , “Shifting Demographics of HIV,” The New York Times 1 July 1998, A-22.

Fuller , 11.

Wren , A-10.

Wren , A-10.

Wren , A-10.

United States Conference of Bishops, “Called to Compassion and Responsibility: A Response to the HIV/AIDS Crisis,” Origins 19 (November 30, 1989): 429.

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American Medical Association's Council on Scientific Affairs, “The Reduction of Medical and Public Health Consequences of Drug Abuse Resolutions 409 and 422 (I-95) and Resolution 405 (I-96),” American Medical Association (Chicago, IL: A.M.A. Publication, 1998): 8-A-97, page 10.

For a more detailed analysis, see Stover H. , and Schuller K. , “AIDS Prevention with Injecting Drug Users in the Former West Germany: A User-Friendly Approach on a Municipal Level,” in The Reduction of Drug Related Harm, eds. O'Hare P.A. (New York: Routledge, 1992), 186–194.

Fuller, 9. See also, Buning E. , “The Impact of Harm Reduction Drug Policy on AIDS Prevention in Amsterdam,” in The Reduction of Drug Related Harm, eds. O'Hare P.A. (New York: Routledge, 1992), 30–38.

Des Jarlais D.C. , and Friedman S.R. , “AIDS Prevention Programs for Injecting Drug Users,” in AIDS and Other Manifestations of HIV Infection, ed. Wormser G.P. (New York: Raven Press, 1992), 645–658.

American Medical Association's Council of Scientific Affairs, 8-A-97, page 8. “For example, while the HIV infection rate among injection drug users remained 1% to 2% in the Scottish city of Glasgow, where a needle exchange program was quickly established, it reached 70% in nearby Edinburgh, where the response of government officials was to implement even more stringent controls over injection equipment. While the intended purpose of the increased controls was to discourage drug injection, the consequences included increased needle-sharing and escalating HIV rates.” Ibid. See also, Stimson G.V. “Risk Reduction by Drug Users With Regard to HIV Infection,” International Review in Psychiatry 3 (1991): 401–415; and R.P. Brettle, “HIV and Harm Reduction for Injecting Drug Users,” AIDS 5 (1991): 125-136.

Needle exchange programs are defined as legal if they operate in a state that has no law requiring a prescription to purchase a hypodermic syringe (i.e., a prescription law) or has an exemption to the state prescription law allowing needle exchange programs to operate; illegal-but-tolerated if they operate in a state with a prescription law but have received a formal vote of support or approval from a local elected body (e.g., city council); and illegal-underground if the needle exchange program operates in a state with a prescription law but have not received formal support from local elected officials. For a more detailed analysis, see Paone D. “Update: Syringe-Exchange Programs–United States, 1996,” Morbidity and Mortality Weekly Report (Rockville, MD: U.S. Health and Human Services, Public Health Service, June 20, 1997): Vol. 46, 565–568.

Nelson K.E. , Vlahov D. , Cohn S. , “Human Immunodeficiency Virus Infection In Diabetic Intravenous Drug Users,” Journal of the American Medical Association 266 (1991): 2259–2261.

Lee F.R. , “Data Shows Needle Exchange Curbs HIV Among Addicts,” The New York Times 24 November 1994, A-9.

Bruneau Julie , and Schechter Martin , “The Politics of Needles and AIDS,” The New York Times 9 April 1998, a-27. The authors go on to say that, “needle exchange programs must be tailored to local conditions. For example, in Montreal and Vancouver, cocaine injection is a major source of HIV transmission. Some users inject the drug up to 40 times a day. At that rate, we have calculated that the two cities we studied would each need 10 million clean needles a year to prevent the re-use of syringes.” The New York Times.

Laurie Peter , and DeCarlo Pamela , “Does Needle Exchange Work?” HIV Prevention: Looking Back, Looking Ahead, (San Francisco, CA: University of California Press, 1996). See also, J.K. Watters, M.J. Estilo, G.L. Clark, et al., “Syringe and Needle Exchange as HIV/AIDS Prevention for Injecting Drug Users,” Journal of the American Medical Association 271 (1994): 115-120.

In a 1996 study conducted by Beth Israel Medical Center in New York City and in collaboration with the North American Syringe Exchange Network of 87 needle exchange programs found that needle exchange programs led to many other services. “Other services included referral of clients to substance-abuse treatment programs (84 [97%)), instruction in the use of condoms and dental dams to prevent sexual transmission of HIV and other sexually transmitted diseases (84 [97%]), and sexually transmitted disease-prevention education (70 [8l%]). Health services offered on-site included HIV counseling and testing (35 [40%]), primary health care (15 [17%]), tuberculosis skin testing (23 [26%]), and sexually transmitted disease screening (17 [20%]).” See Paone, et al., “Update: Syringe-Exchange Programs – Unites States, 1996,” 2.

In a 1996 study conducted by Beth Israel Medical Center in New York City and in collaboration with the North American Syringe Exchange Network of 87 needle exchange programs found that needle exchange programs led to many other services. “Other services included referral of clients to substance-abuse treatment programs (84 [97%)), instruction in the use of condoms and dental dams to prevent sexual transmission of HIV and other sexually transmitted diseases (84 [97%]), and sexually transmitted disease-prevention education (70 [8l%]). Health services offered on-site included HIV counseling and testing (35 [40%]), primary health care (15 [17%]), tuberculosis skin testing (23 [26%]), and sexually transmitted disease screening (17 [20%]), See also, Seattle-King County Department of Public Health, “Update on the Seattle-King County Needle Exchange Program,” (Seattle, WA: 1992): 1.

American Medical Association's Council of Scientific Affairs, 8-A-p7, page 12. A study conducted last year and published in The Lancet, the British Medical Journal, “found that in 29 cities worldwide where programs are in place, HIV infection dropped by an average of 5.8 percent a year among drug users. In 51 cities that had no needle exchange plans, drug-related infection rose by 5.9 percent a year. Clearly these efforts can work.” See, Bruneau and Schechter, A-27.

Laurie , & DeCarlo , 1; see also Peter Laurie, A.L. Reingold, B. Bowser, et al., “The Public Health Impact of Needle Exchange Programs in the United States,” Update (Atlanta, GA: Centers for Disease Control and Prevention, September, 1993).

Fuller , 10.

Henry Davis S.J. , Moral and Pastoral Theology, Volume I, (New York: Sheed and Ward, 1958): 333.

Fuller , 9.

Joseph Mangan S.J. , “An Historical Analysis of the Principle of Double Effect,” Theological Studies 10 (March, 1949): 41.

Gerald Kelly S.J. , Medico-Moral Problems (St. Louis, MO: The Catholic Health Association of the United States and Canada, 1958), 13–14.

Walter James J. , “Proportionate Reason and Its Three Levels of Inquiry: Structuring the Ongoing Debate,” Louvain Studies 10 (Spring, 1984): 32.

McCormick's criteria for proportionate reason first appeared in Richard McCormick, Ambiguity In Moral Choice (Milwaukee, WI: Marquette University Press, 1973). He later reworked the criteria in response to criticism. His revised criteria can be found in Doing Evil to Achieve Good, eds. Richard McCormick and Paul Ramsey (Chicago, IL: Loyola University Press, 1978).

American Medical Association's Council on Scientific Affairs, 10. See also, Booth R. , and Wiebel W. , “Effectiveness of Reducing Needle-Related Risks for HIV through Indigenous Outreach to Drug Users,” American Journal of Addictions 1 (1992): 277–287; A. Neaigus, M. Sufian, S.R. Friedman, et al., “Efforts of Outreach Intervention on Risk Reduction Among Intravenous Drug Users,” AIDS Education Prevention 2 (1990): 253-271; and J. Watters, M. Downing, P. Case, et al., “AIDS Prevention for Intravenous Drug Users in the Community: Street Based Education and Risk Behavior,” American Journal of Community Psychology 18 (1990): 587-596.

Fuller , 9.

For a more detailed analysis of the “Principle of Cooperation,” see Davis, 341–342.

Fuller , 10–11.

Fuller , 11.

Stolberg , A-18.

Altman , A-13.