Risk Reduction Techniques Divide Doctors, Public
Harm reduction, or helping people "engage more safely in potentially risky behaviors, while they work toward the goal of stopping," has gained broad acceptance among doctors in recent years, but has also created a large rift between doctors and the general public. The Boston Globe reports that the nation "seems split on whether to emphasize public health over morality; to accept the sin ... to protect the sinner." Harm reduction includes endorsing condom use and emergency contraception rather than telling teen patients to abstain from sex, and advising oral sex between gay men rather than anal sex because it is safer. But the "most visceral debate" is over needle exchange programs, particularly in light of the growing number of HIV infections among intravenous drug users. A Rhode Island study found that 95% of physicians who work with addicts have "no moral qualms" about offering clean needles to prevent disease, while the Family Research Council points out that more than 50% of Americans consider needle distribution to be drug advocacy. Although the American Medical Association, the CDC, the Institute of Medicine, former HHS Secretary Donna Shalala and Surgeon General David Satcher all endorse needle exchange, saying it reduces HIV infection without increasing drug use, "conservative" groups pressured the Clinton administration into banning federal funding for exchange programs.
States also are torn on the issue: New York, New Hampshire, Rhode Island, Connecticut, Maine and many others have decriminalized syringe possession, but Massachusetts, among others, has not, the Boston Globe reports. Dr. Erik Garcia, a Massachusetts physician who works with addicts, is "outraged" that only addicts diagnosed with hepatitis C may receive a prescription for syringes as part of treatment, while uninfected drug users cannot obtain them to prevent the disease. The state Legislature in 1994 endorsed needle exchanges in 10 cities, but so far the programs have only been established in Boston, Cambridge, Provincetown and Northampton. Massachusetts Health Commissioner Howard Koh hopes to "convince the public of what health officials have long believed" by providing $10,000 to nine different communities for public education on the "benefits of needle exchange." But individuals like bar owner Barbara Haller worry that needle exchange programs will harm communities, even if they help addicts and, according to the Globe, "wan[t] to see measures short of needle exchange tried first." Heller stated, "To ask society to change its norms" without trying other methods, such as "zero tolerance" laws, "is unconscionable" (Barnard, Boston Globe, 2/13).