Testimony before the Subcommittee on Human Resources, Committee on Government Reform and Oversight, U.S. House of Representatives

sex partners and children. Every one of those reviews has concluded that
needle exchange programs reduce the transmission of HIV infection and that
there is no evidence that they lead to increases in community levels of drug
use. Even Health and Human Services Secretary Donna Shalala finally
conceded in February 1997 that needle exchange programs reduce the
number of new HIV infections, although she still failed to remove the ban on
federal funding for needle exchange programs.
Despite this unanimity in the research world, including a recent NIH
Consensus Development Panel, the NIH has decided to provide $2.8 million
for a randomized, controlled trial of the effectiveness of needle exchange to
be conducted by Dr. Dennis Fisher of the University of Alaska Anchorage.
It is worth noting that, although there is no evidence from a randomized
controlled trial that condoms reduce the number of new HIV infections, noone would consider such a study and effective public health policy has been
formulated even in the absence of such evidence.
At least 600 injection drug users will be randomized to either receive sterile
syringes for free from a needle exchange program or to receiving
information on how to purchase syringes from pharmacies in Anchorage,
information all or most will already have. When a subject seeks to obtain
syringes at the needle exchange program, the researchers will use the
subject's bar-coded identification card to generate the subject's image on a
computer screen and thereby establish to which arm of the study the subject
has been randomized; those assigned to the pharmacy condition will be
turned away and advised how to purchase syringes at pharmacies.
Remarkably, the researchers themselves admit in their grant proposal that
this "represents the withholding of a potentially life-saving service."
Because HIV infection is relatively rare among the drug injectors of
Anchorage, the researchers plan to measure the number of new infections
with hepatitis B. This will act as a proxy for HIV infection and will allow
the researchers to compare the effectiveness of the needle exchange and
pharmacy groups in reducing blood-borne infection.
The research is unethical for at least three reasons:
1. If an injection drug user does not enroll in the study, he or she cannot use
the needle exchange program at all, thus coercing subjects to enroll;
2. Of injection drug users who enroll in the study, only 50% will be
permitted to attend the needle exchange program; the others will be turned
away if they seek syringes at the needle exchange program; and

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