[Congressional Record Volume 145, Number 124 (Wednesday, September 22, 1999)]
[Senate]
[Pages S11251-S11253]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            MORNING BUSINESS

  Mr. BOND. Mr. President, I ask unanimous consent that the Senate now 
proceed to a period of morning business, with Senators permitted to 
speak for up to 10 minutes each.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WELLSTONE. Mr. President, I opposed the District of Columbia 
appropriations conference report for a number of reasons but the reason 
I speak out today is my grave concern with provisions in the report 
that continue to prohibit the government of the District of Columbia 
from engaging in needle exchange programs. These valuable programs curb 
the spread of HIV/AIDS by allowing injecting drug users to exchange 
their used, potentially contaminated needles for sterile ones. Yet, the 
District of Columbia appropriations conference report not only banned 
the use of Federal funds but prohibited the District from using its own 
monies to support this valuable program.
  We in the Senate wisely did not include such a provision in the DC 
appropriations bill that passed this body, and it should not have been 
in the conference report.
  Therefore, I opposed the conference report because it was an attack 
on this city's public health. AIDS is the leading cause of death for 
D.C. residents ages 30 to 44, an AIDS death rate seven

[[Page S11252]]

times the national average. What this conference report did to needle 
exchange programs was both unnecessary and unjustifiable. Indeed, 
including a needle exchange prohibition in this conference report is a 
hazard to the public health.
  The prohibition in this report is unnecessary because there was 
already a ban on Federal funding for needle exchange programs. This ban 
dates to 1989, when Congress declared that no Federal funds could be 
spent to support needle exchange programs until there was scientific 
evidence that the programs, first, could reduce the spread of HIV and, 
second, did not encourage drug use. There are thus two main questions 
facing us as we decide the fate of federal needle exchange program 
funding: Do these programs achieve their public health purpose of 
slowing the spread of a deadly, infectious disease? And do these 
programs compromise our drug abuse prevention efforts by encouraging 
illicit drug use? Science has provided answers to these questions.
  A preponderance of evidence shows that needle exchange programs cause 
a decrease in HIV infection rates. The National Institutes of Health 
found that needle exchange programs reduce risk behaviors by as much as 
80 percent in injecting drug users while reducing HIV infection rates 
by an estimated 30 percent. In addition, a 1997 study published in 
Lancet, the respected British medical journal, compared HIV 
seroprevalence over time among injecting drug users in 29 cities with 
needle exchange programs and 52 cities without needle exchange 
programs. While seroprevalence increased by 5.9 percent per year in the 
52 cities without needle exchange programs, it decreased by 5.8 percent 
per year in the 29 cities with programs.
  Similarly, in the city of Baltimore, HIV infections among IV drug 
users have declined 30 percent since the start of its needle exchange 
in 1993 while the infection rate has increased 5 percent in Baltimore 
County, which has no exchange program. Numerous studies also show that 
needle exchange programs decrease needle sharing; decrease unsafe 
disposal of syringes; decrease re-use and passing of syringes; and 
increase needle disinfection.
  Needle exchanges also do not encourage drug use--they compliment our 
efforts to stop drug use. Needle exchange programs can be linked with 
greater entry of addicts into drug treatment. After using a needle 
exchange program for more than 6 months, 58 percent of participants 
report having enrolled in detox or drug treatment. In New Haven, 
Connecticut, drug treatment entries doubled in the three years 
following the opening to its needle exchange. In Tacoma, Washington, 
needle exchange programs constitute the largest referral source for 
drug treatment, accounting for 43 percent of treatment participants.
  In addition, injection drug users referred by needle exchange 
programs are more likely to enter drug treatment and to be retained, 
even in the face of the greater severity of drug use and psychosocial 
problems common among this population. Needle exchanges therefore 
supply a valuable opportunity to provide additional preventive services 
to difficult-to-reach individuals. Furthermore, studies show that 
needle exchange programs decrease the frequency of injection among 
participants and do not tempt individuals to begin using drugs.
  These overwhelmingly conclusive results have fostered wide support 
for improving access to sterile needles. Groups supporting needle 
exchange programs include: the American Medical Association, the 
National Institutes of Health, the National Academy of Sciences, the 
U.S. Department of Health and Human Services, the Centers for Disease 
Control and Prevention, the American Foundation for AIDS Research, the 
American Public Health Association, the National Association of County 
& City Health Officials, and the U.S. Conference of Mayors. As a 
National Institutes of Health Consensus Statement concludes ``There is 
no longer any doubt that these programs work, yet there is a striking 
disjunction between what science dictates and what policy delivers. . . 
. Can the opposition to needle exchange in the United States be 
justified on scientific grounds? Our answer is simple and emphatic--
no.''
  Because of this evidence I believe policies that inhibit the creation 
and expansion of needle exchange programs are unjustifiable. I am 
baffled and outraged by such policies. We all come to Washington to 
make laws that help the American people, that combat social ills and 
that raise the quality of life in our country. We all want to win the 
war on drugs. We all want to stop the spread of HIV. So then why, when 
we have evidence that needle exchange programs work, do we continue to 
put millions of citizens at unnecessary risk? Cutting funding to these 
programs is a death sentence to thousands of men, women, and children.
  I want you all to think for a moment about those children. It is 
imperative to realize that needle exchange programs go far beyond 
aiding addicts; they protects the partners and children of addicts. 70 
percent of cases of women of childbearing age with HIV are directly or 
indirectly linked to IV drug use, causing 75 percent of the cases of 
babies born HIV positive to be the result of the use of dirty needles. 
For this reason, the American Academy of Pediatrics supports needle 
exchange programs as a means of reducing the spread of HIV to infants, 
children and adolescents. These programs are pro-family and pro-child.
  We should not be undermining the District of Columbia's local control 
of pubic health decisions and to setting a dangerous precedent for the 
many states and localities that fund needle exchange programs through a 
combination of local, state, and private funds. Right now more than 110 
communities in 30 states use needle exchange programs to slow the 
spread of HIV. Despite continued lack of federal funding, needle 
exchange programs have expanded in terms of the number of syringes 
exchanged, the geographic distribution of programs, and the range of 
services offered. Needle exchange programs were able to do this because 
they are supported by two-thirds of the American people as well as many 
state and local governments.
  In Minnesota, needle exchange programs are an important component of 
efforts to decrease the transmission of HIV and to end drug use. 
Minnesota has two successful needle exchange programs. One program, 
Women with a Point, has exchanged approximately 63,000 syringes in the 
past 18 months while providing on-site HIV testing, referrals for 
chemical abuse recovery programs, information on risk reduction 
techniques and Hepatitis C, and case management for HIV positive 
injection drug users. The other, Minnesota AIDS Project, has also 
exchanged thousands of needles and provided users with HIV testing, 
needle disinfection kits, numerous services for HIV positive 
individuals, and information about risk reduction techniques.
  We must face the reality that the second most frequent reported risk 
behavior for HIV infection is injecting drug use. Data from the Centers 
for Disease Control and Prevention indicate that approximately one-
third of AIDS cases in the United States are directly or indirectly 
associated with injecting drug use. Moreover, according to a report in 
the American Journal of Public Health, 50 percent of new HIV infections 
are occurring among injection drug users.
  We know that lowering the rate of injection-related HIV infections 
requires increasing the availability of drug treatment and increasing 
access to clean needles. We have scientific evidence that broad 
implementation of needle exchange programs would aid us in our battle 
against HIV.
  In other words, we have scientific evidence that legal impediments to 
clean needle possession encourage high-risk behavior and do nothing to 
reduce drug use. We should not therefore be passing legislation that 
further hinders the establishment and expansion of needle exchange 
programs. We should instead of pushing for the removal of the Federal 
ban on funding--not enacting legislation that prohibits local 
governments, like the District of Columbia, from adopting good public 
health practices, practices that have been shown in communities across 
the United States to reduce the circulation of contaminated needles and 
the rate of HIV infection.
  My colleagues in the Senate, President Clinton has threatened to veto 
this conference report because of its unwarranted intrusion into the 
public health of the citizens of the District of

[[Page S11253]]

Columbia. And he is right. Colleagues, I ask you to avoid that veto, 
and to send this report back to the conference committee so this 
intrusion can be eliminated. Please join me and vote ``no'' on this 
conference report as it now reads.

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