Science,Ideology,and Needle Exchange Programs

Abstract

Needle exchange programs (NEPs) to prevent HIV transmission among injection drug users are accepted in many countries but remain at the center of heated debate in the United States. In 1997, the author published a study of injection drug users in Vancouver showing an explosive outbreak of HIV. An incidental finding was higher HIV rates among frequent attendees of the local NEP. While this was expected because NEPs attract users at highest risk, opponents of needle exchange applied an unsupportable causal interpretation to this finding. If frequent NEP attendees had higher HIV rates, so the interpretation went, NEPs must be responsible for promoting the spread of HIV. Despite the author's admonitions against this misinterpretation of the data, it was used as part of a successful campaign to oppose U.S. federal funding of needle exchange. Regrettably, biased or even misleading interpretations often occur in the volatile interface of imperfect science and ideological debate.