Backed by hundreds of studies, including work done in Baltimore, a national panel of scientists declared yesterday that needle-exchange programs reduce the spread of HIV without encouraging greater drug use by participants.
Programs that swap dirty needles for new, sterile ones are so effective that the scientists recommended lifting the ban on federal funding of needle-exchange programs, allowing people to get needles over the counter without a prescription and making it legal to carry needles and syringes.
Existing local and state laws that make it difficult to get needles are forcing addicts to share them, and in turn causing a cascade of new infections.
The joint panel of the National Research Council and Institute of Medicine has been studying the issue for two years, analyzing old, new and as yet unpublished studies. This report is the first to determine conclusively that needle-exchange programs can reduce the spread of HIV, the virus that leads to AIDS.
"It's a public health strategy that will reduce harm and save lives," said David R. Williams, a member of the panel and associate professor of sociology at the University of Michigan.
That finding is significant because of the changing nature of the AIDS epidemic. Once spread mainly by men having sex with men, human immunodeficiency virus is increasingly transmitted through dirty needles. The proportion of new AIDS cases involving people who inject illegal drugs has doubled, from 12 percent in 1981 to 28 percent in 1993.
"Drug users are a very important part of the HIV epidemic right now," said Dr. David Vlahov, a panel member and professor at the Johns Hopkins School of Hygiene and Public Health. "Needle sharing is responsible for a lot of that."
In Baltimore and other cities, AIDS has become the No. 1 killer of women and men ages 25 to 44. In the past few years, the number of U.S. needle-exchange programs has doubled to more than 75.
Many programs operate just outside the law, and access to federal drug abuse-prevention money would be a big help, experts said.
While federal health officials said yesterday that they will immediately review the recommendations, the panel stressed that needle-exchange programs should be seen as just one piece of a comprehensive strategy.
Baltimore's needle-exchange program, for instance, is linked with 100 treatment sites, which in one year have helped 200 drug addicts. The program has been so successful that other neighborhoods have asked for facilities, and in December it will be expanded to Cherry Hill and Park Heights, said Dr. Peter Beilenson, city health commissioner.
But critics said efforts should focus solely on drug treatment and education.
"What's next?" asked Mike Gimbel, a former addict and director of Baltimore County's Office of Substance Abuse. "Is the next scenario going to be, maybe we ought to make sure we give them clean heroin? . . . I really believe we should be putting this energy into . . . programs that aren't giving a mixed message."
The Rev. Graylan Ellis-Hagler, senior pastor at Plymouth United Church of Christ in Washington, said needle-exchange programs may not be able to contain AIDS. He's seeing a shift from intravenous drug use to crack addicts who exchange sex for their next dosage. That sexual activity, he said, may be spreading HIV more than sharing dirty needles.
"Very often what studies do is ignore culture," said Rev. Ellis-Hagler, a Baltimore native who has also worked in urban ministries in Chicago and Boston, where he helped shut down a needle-exchange program. The recovering addicts in that Boston parish demanded it, he said, because they felt it was undercutting their efforts to stay away from drugs.
Indeed, the national panel -- through interviews with pharmacists, police officers, religious and minority leaders -- discovered that putting together successful needle-exchange programs is a delicate process.
In Baltimore, where the country's largest government funded program has served 3,200 people so far, a broad-based advisory committee helped develop the program. According to a Hopkins study, sharing of used needles has dropped by about half among those in the program.
Dr. Beilenson said that it's not clear yet that the program has reduced the spread of HIV in Baltimore, but if the Hopkins study proves it, he would like to see legislation introduced that would make it legal to buy needles over the counter.
"This is such a major issue," said Dr. Beilenson. "You really shouldn't play politics with this killer."