Misguided political considerations have prevented the nation from using powerful, proven weapons to fight the AIDS epidemic, a National Institutes of Health panel concluded Thursday.
Needle-exchange and treatment programs for drug addicts and explicit safe-sex education for teenagers have been proved to reduce the spread of the AIDS virus, which continues to be a public-health emergency, the panel said.
But the widespread use of such strategies in this country has been hampered by political and social opposition, creating a “dangerous chasm” between science and public policy, the panel said.
“The behavior placing the public health at greatest risk may be occurring in legislative and other decision-making bodies,” the panel concluded at the end of a threeday conference.
Needle-exchange programs have faced political opposition because of fears they would encourage drug abuse, while aggressive safe-sex programs have prompted concern they would promote adolescent promiscuity and homosexuality.
The 12-member panel reached its conclusions after conducting an exhaustive review of the scientific evidence on various behavioral strategies for reducing the risk of acquiring the AIDS virus.
The conclusions prompted an unusual standing ovation from the audience of AIDS researchers, health experts and community activists attending the conference on the National Institutes of Health’s Bethesda, Md., campus.
“It’s exactly what we need right now,” said Thomas J. Coates, director of the AIDS Research Institute at the University of California at San Francisco. “Maybe it will help the legislators wake up and say, ‘We’re not listening to the science.”’
But the panel’s statements, particularly those regarding sex-education programs that focus on abstinence, prompted disagreement from some lawmakers and representatives of conservative organizations.
“The reasons why kids become sexually active and why HIV is a problem now … have to do with our cultural atmosphere of saying sex within the teenage years is not just permissible but absolutely normal,” said Gracie Hsu of the Family Research Council.
The panel’s findings reflect “a complete absence of anybody that has a different point of view,” said Rep. Tom Coburn, R-Okla. He cited promising results from abstinence-based programs such as Best Friends, which has been tested in the District of Columbia, but said no scientific studies have compared such programs with those that include information on condoms and other risk-reduction measures for sexually active teenagers. “If in fact there haven’t been studies, how can they say” that such programs don’t work? Coburn asked.
An estimated 40,000 to 80,000 Americans become infected with HIV every year, mostly through behaviors that are preventable, the panel found. One in 250 Americans is infected with the virus. AIDS is the leading cause of death in people between the ages of 25 and 44.
The panel particularly criticized the government’s failure to fund programs that allow intravenous drug users to exchange used needles and syringes for clean ones, despite multiple studies that have shown that such programs reduce needle-sharing and slow the spread of the human immunodeficiency virus (HIV) without increasing drug use.
The panel cited the impact of a 1992 Connecticut law that allowed drug users to buy sterile needles and syringes at pharmacies without a prescription. Studies in the state have found that the frequency of needle-sharing among drug users declined from 71 percent in 1992, before the law was passed, to 15 percent in 1995.
Among the panel’s conclusions:
Federal funding should be increased for drug-abuse treatment programs, which reduce HIV spread. Funding for such programs has decreased in the last few years, and only about 15 percent of drug users who want treatment can get it, according to Michael Merson, dean of the Yale School of Public Health.
Education and counseling programs that provide information about HIV and teach people how to use condoms and how to negotiate safer sex reduce the risk of HIV transmission in gay men, heterosexual women and adolescents. (Few studies have focused on heterosexual men.)
Fifty percent of new HIV infections are occurring in people under 25, and more prevention efforts should target adolescents and young adults.
Condoms are highly effective in preventing HIV transmission. In a study of 256 couples in which one member was HIV-positive, consistent condom use completely prevented infection.
Needle-exchange programs do not increase drug use, according to a number of studies, and sex-education programs do not increase teenage sexual activity. On the contrary, studies have found beneficial effects on behavior from both types of programs. Teenagers in sex-education programs tend to delay sexual activity and to have fewer sexual partners.
Unlike the United States, countries such as Thailand, Switzerland and Australia have greatly reduced the spread of HIV by aggressive prevention programs, Merson and other speakers told the panel.
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