Prevention Justice Partnership
Early Media Coverage of HIV/AIDS — p. 2-6
Opinion Media Examples:
- Op-eds — p. 7-11
- Letters to the editors — p. 12-13
- Press releases — p. 14-15
- Backgrounder — p. 16
Our Issues in the Media
- Condom access — p. 17-23
- Needle exchange — p. 24-32
Other Examples of HIV/AIDS and Advocacy in the Media — p.33-52
EARLY MEDIA COVERAGE OF HIV/AIDS
The New York Times
- July 3, 1981 -
RARE CANCER SEEN IN 41 HOMOSEXUALS
Outbreak Occurs Among Men in New York and California--8 Died Inside 2 Years
By LAWRENCE K. ALTMAN
Doctors in New York and California have diagnosed among homosexual men 41 cases of a rare and
often rapidly fatal form of cancer. Eight of the victims died less than 24 months after the diagnosis
The cause of the outbreak is unknown, and there is as yet no evidence of contagion. But the doctors
who have made the diagnoses, mostly in New York City and the San Francisco Bay area, are
alerting other physicians who treat large numbers of homosexual men to the problem in an effort to
help identify more cases and to reduce the delay in offering chemotherapy treatment.
The sudden appearance of the cancer, called Kaposi's Sarcoma, has prompted a medical
investigation that experts say could have as much scientific as public health importance because of
what it may teach about determining the causes of more common types of cancer.
First Appears in Spots
Doctors have been taught in the past that the cancer usually appeared first in spots on the legs and
that the disease took a slow course of up to 10 years. But these recent cases have shown that it
appears in one or more violet-colored spots anywhere on the body. The spots generally do not itch
or cause other symptoms, often can be mistaken for bruises, sometimes appear as lumps and can turn
brown after a period of time. The cancer often causes swollen lymph glands, and then kills by
spreading throughout the body.
Doctors investigating the outbreak believe that many cases have gone undetected because of the
rarity of the condition and the difficulty even dermatologists may have in diagnosing it.
In a letter alerting other physicians to the problem, Dr. Alvin E. Friedman-Kien of New York
University Medical Center, one of the investigators, described the appearance of the outbreak as
Dr. Friedman-Kien said in an interview yesterday that he knew of 41 cases collated in the last five
weeks, with the cases themselves dating to the past 30 months. The Federal Centers for Disease
Control in Atlanta is expected to publish the first description of the outbreak in its weekly report
today, according to a spokesman, Dr. James Curran. The report notes 26 of the cases--20 in New
York and six in California.
There is no national registry of cancer victims, but the nationwide incidence of Kaposi's Sarcoma in
the past had been estimated by the Centers for Disease Control to be less than six-one-hundredths of
a case per 100,000 people annually, or about two cases in every three million people. However, the
disease accounts for up to 9 percent of all cancers in a belt across equatorial Africa, where it
commonly affects children and young adults.
In the United States, it has primarily affected men older than 50 years. But in the recent cases,
doctors at nine medical centers in New York and seven hospitals in California have been diagnosing
the condition among younger men, all of whom said in the course of standard diagnostic interview
that they were homosexual. Although the ages of the patients have ranged from 26 to 51 years,
many have been under 40, with the mean at 39.
Nine of the 41 cases known to Dr. Friedman-Kien were diagnosed in California, and several of those
victims reported that they had been in New York in the period preceding the diagnosis. Dr.
Friedman-Kien said that his colleagues were checking on reports of two victims diagnosed in
Copenhagen, one of whom had visited New York.
Viral Infections Indicated
No one medical investigator has yet interviewed all the victims. Dr. Curran said. According to Dr.
Friedman-Kien, the reporting doctors said that most cases had involved homosexual men who have
had multiple and frequent sexual encounters with different partners, as many as 10 sexual encounters
each night up to four times a week.
Many of the patients have also been treated for viral infections such as herpes, cytomegalovirus and
hepatitis B as well as parasitic infections such as amebiasis and giardiasis. Many patients also
reported that they had used drugs such as amyl nitrite and LSD to heighten sexual pleasure.
Cancer is not believed to be contagious, but conditions that might precipitate it, such as particular
viruses or environmental factors, might account for an outbreak among a single group.
The medical investigators say some indirect evidence actually points away from contagion as a
cause. None of the patients knew each other, although the theoretical possibility that some may
have had sexual contact with a person with Kaposi's Sarcoma at some point in the past could not be
excluded, Dr. Friedman-Kien said.
Dr. Curran said there was no apparent danger to nonhomosexuals from contagion. "The best
evidence against contagion," he said, "is that no cases have been reported to date outside the
homosexual community or in women."
Dr. Friedman-Kien said he had tested nine of the victims and found severe defects in their
immunological systems. The patients had serious malfunctions of two types of cells called T and B
cell lymphocytes, which have important roles in fighting infections and cancer.
But Dr. Friedman-Kien emphasized that the researchers did not know whether the immunological
defects were the underlying problem or had developed secondarily to the infections of drug use.
The research team is testing various hypotheses, one of which is a possible link between past
infection with cytomegalovirus and development of Kaposi's Sarcoma.
The New York Times
- June 18, 1982 -
Clue Found on Homosexuals' Precancer Syndrome
By LAWRENCE K. ALTMAN
Federal epidemiologists investigating a serious disorder of the body's immune system that has
mostly afflicted male homosexuals reported new evidence yesterday suggesting that the outbreak is
linked to an infectious agent.
"We think the findings are important but they don't solve the problem," Dr. Harold W. Jaffe, one of
the epidemiologists at the Centers for Disease Control in Atlanta, said in an interview. "They do
show pretty convincingly that this is not occurring as a random event among homosexual men."
No specific infectious agent has been identified, he said, but scientists at the Atlanta facilities are
intensifying laboratory efforts to identify a virus, bacteria or other micro-organism as a possible
The immune system breakdown has been implicated in a rare form of cancer, called Kaposi's
sarcoma, and seems to lead to a wide variety of serious disorders. Scientists have designated the
immune disorder GRID, for "gay-related immunodeficiency disease."
The Suspected Infectious Agent
From the time the disorder came to public attention a year ago, epidemiologists have suspected that
it might be attributable to an infectious agent, although they have investigated several alternative
The latest clue to an infectious origin came from an intensive medical investigation of a cluster of 19
cases in Los Angeles and Orange Counties in California. It was the first detailed study of such a
cluster in the syndrome.
Investigating epidemiologists from the Atlanta center and those in California said that "within five
years of the onset of symptoms, nine patients had had sexual contact with other patients" with the
They made that determination by interviewing the eight survivors among the 19 cases as well as
friends of seven of the 11 who died. From those 15 cases, the epidemiologists obtained data on
sexual partners for 13.
Of the nine people who had had exposure to other cases, they found that four had had contact with
more than one case.
Links Are Interconnected
Further, they said, "The nine patients from Los Angeles and Orange Counties directly linked to other
patients are part of an interconnected series of cases that may include 16 additional patients from
eight other cities."
Epidemiologists are planning to conduct further study of the links to the cases outside southern
California and to seek similar clusters elsewhere.
"The more cases you put together in a diagramatic fashion, the more that supports an infectious
agent, although it certainly does not exclude other possibilities," Dr. Jaffe said. "We would like to
see how far we can go pursuing connections outside of southern California."
Scientists are using "as many ways as we can think of to identify" the infectious agent in the
laboratory, he said.
However, the epidemiologists said in their weekly report that they were still considering alternative
hypotheses. One, they said, is that sexual contact with patients with GRID syndrome does not lead
directly to the breakdown of the immunological system, "but simply indicates a certain style of life."
"The number of homosexually active males who share this life style," he said, "may be much smaller
than the number of homosexual males in the general population."
Still another hypothesis under investigation is that the syndrome is related in some way to drugs,
other environmental agents or some other common factors not yet detected.
The Washington Post
- March 17, 1982 -
Disease of Immune System Becoming a U.S. Epidemic
By Christine Russell
Washington Post Staff Writer
In late 1980, a 4-month-old baby entered a Newark N.J., hospital with pneumonia. Within a month,
she was dead, her immune system devastated.
More than a year later a heroin addict was referred to a Newark laboratory for blood tests. He was a
suspected victim of Acquired Immune Deficiency Syndrome (AIDS), a new disease that wipes out
the body's immune defenses and leaves its victims vulnerable to cancer, pneumonia and a host of
other deadly infections.
Dr. James Oleske recognized the addict. He was the infant's father.
"That was a dramatic moment," Oleske said. "A light was turned on. I was convinced at that point
there was a possible connection."
The death of a baby, and the chance of discovery that her father may carry AIDS, is one of the clues
scientists are using to track the elusive cause of the new American epidemic. Despite one of the
longest and most extensive searches in the history of the Public Health Service, doctors don't known
what causes AIDS or exactly how it spreads.
It was first discovered in 1981 in the homosexual communities of New York and Los Angeles.
Then it turned up in drug addicts, Haitians, children and sexual partners of AIDS victims. Some
hemophiliacs and recipients of blood transfusions also have begun to die of AIDS.
Whatever it is, modern life seems to nourish it, and life styles and technology seem to spread it.
One researcher described it as torture. "With other diseases you die very fast. This is just horrible, a
dwindling of the healthy body. I've worked with miserable diseases, but none as miserable as this."
As of March 9, 1,145 Americans had contracted AIDS; 428 of them are dead. Twenty percent of the
cases appeared in the last two months. Half of the victims are under 35.
It may be one of the most lethal diseases of modern times, more deadly than smallpox once was. So
far the overall death rate among AIDS victims stands at 40 percent....
New York Times Op-Ed Contributor
By JOHN MOORE and NICOLI NATTRASS
Published: June 4, 2006
H.I.V. causes AIDS. This is not a controversial claim but an established fact, based on more than 20
years of solid science. It is as certain as the descent of humans from apes and the falling of dropped
objects to the ground.
So why reiterate the obvious? Because lately, a bizarre theory has gained ground — one that claims
that H.I.V. is harmless, and that the antiretroviral drugs that curb the growth of the virus cause rather
than treat AIDS. Such talk sounds to most of us like quackery, but the theory has emerged as a
genuine menace to public health in the United States and, particularly, in South Africa.
The theory, which we call AIDS denialism, has gained such currency with President Thabo Mbeki
of South Africa that his administration is reluctant to expand access to antiretroviral drugs. Despite
generous allocations from the country's Treasury and substantial assistance from foreign donors,
only a quarter of those needing antiretrovirals receive them. This response is poor by the standards
of middle-income countries, but it is especially troublesome in South Africa, which has more H.I.V.-
positive people than any other country.
American AIDS denialists are partly to blame for South Africa's backsliding AIDS policy. Manto
Tshabalala-Msimang, the health minister, has described antiretrovirals as poisons. She is supported
in these views by Roberto Giraldo, a New York hospital technologist who says AIDS is caused by
deficiencies in the diet, and who served on President Mbeki's AIDS advisory panel in 2000. The
minister promotes nutritional alternatives like lemons, garlic and olive oil to treat H.I.V. infection.
Several prominent South Africans have died of AIDS after opting to change their diets instead of
Another American AIDS denialist, David Rasnick, a regular letter-writer to South African
newspapers, absurdly claims that H.I.V. cannot be transmitted between heterosexuals. Mr. Rasnick
now works in South Africa for a multinational vitamin company, the Rath Foundation, conducting
clinical trials in which AIDS patients are encouraged to take multivitamins instead of
In the past, South Africa's Medicines Control Council acted swiftly to curb such abuses, and the
Medical Research Council condemned AIDS denialism. But recent high-level political appointments
of administration supporters to both bodies have neutered their influence. In South Africa, AIDS
denialism now underpins a lucrative nutritional supplements industry that has the tacit, and
sometimes active, support of the Mbeki administration.
By courting the AIDS denialists, President Mbeki has increased their stature in the United States. He
lent credibility to Christine Maggiore, a Californian who campaigns against using antiretrovirals to
prevent transmission of H.I.V. from mothers to children, when he was photographed meeting her.
Two years later, Ms. Maggiore gave birth to an H.I.V.-infected daughter, Eliza Jane, who acquired
an AIDS-related infection last year and died at age 3.
Mother-to-child H.I.V. transmission is now rare in the United States, thanks to the widespread use of
preventive therapy and the activities of organizations like the National Institutes of Health and the
Elizabeth Glaser Pediatric AIDS Foundation. Sadly, this is not so in South Africa, where many
children are born infected and then face short, painful lives. The health and lives of American
children are also still under threat: a small clique of AIDS denialists is trying to block the provision
of antiretrovirals to H.I.V.-infected children in the New York City foster care system.
Until recently, AIDS researchers and activists in the United States tended to regard the denialists
with derision, assuming they would fade away. Unfortunately, this has not happened. Harper's
Magazine recently published an article by Celia Farber promoting the denialist view. There is a real
risk that a new generation of Americans could be persuaded that H.I.V. either doesn't exist or is
harmless, that safe sex isn't important and that they don't need to protect their children from this
deadly virus. A resurgence of denialism in the United States would have far reaching effects on the
global AIDS pandemic, just as it already has in South Africa.
The AIDS denialists use pseudoscience and non-peer-reviewed Internet postings to bolster their
false claims about H.I.V. The real facts about this virus have been uncovered by scientists supported
by the National Institutes of Health, the British and South African Medical Research Councils, the
Pasteur Institute and many other national research organizations. The public should seek AIDS truth
from the latter sources.
It is sad when selling magazines and vitamin supplements is considered more important than
promoting public health and scientific truth. The truth is that H.I.V. does exist, that it causes AIDS
and that antiretroviral drugs can prevent H.I.V. transmission and death from AIDS. To deny these
facts is not just wrong — it's deadly.
John Moore is a professor of microbiology and immunology at Cornell University. Nicoli Nattrass is
the director of the AIDS and Society Research Unit at the University of Cape Town.
The danger of good intentions
Published June 3, 2006
The federal Centers for Disease Control and Prevention would like to see testing for HIV become a
part of routine physical exams for every American between the ages of 13 and 64, as common as a
cholesterol test. To bring that about, the agency plans to issue new guidelines this summer that
would eliminate the requirements for pretest counseling and written consent.
Patients would have the option of declining the test with a simple "no thanks." But those who agree
to be tested would not have to sign a separate consent form attesting that the blood test and all its
ramifications have been explained to them--as is required by Illinois law.
The CDC apparently believes that pesky informed-consent process is an obstacle to testing, and thus
to reducing the spread of HIV.
Wider testing to control HIV seems like a good idea. People need to know they have the virus in
order to get treatment and avoid infecting others. Making HIV testing a part of routine health care
can help to reduce the stigma attached to a diagnosis. But it's unclear if removing the pretest
counseling and written consent would have the desired effect.
CDC officials point proudly to the reduction of HIV infection in newborns due to routine testing and
treatment of pregnant women. Illinois' program of counseling pregnant women and urging them to
be tested has been particularly successful. Nearly every woman who is told how she can protect her
baby from HIV agrees to be tested, either during her prenatal care or when she arrives at the hospital
But that testing is voluntary. And in Illinois, which has been particularly successful, it is part of a
comprehensive counseling program. (A bill passed by the legislature this year will make HIV testing
mandatory for newborns whose mothers' HIV status is unknown. It remains to be seen whether that
will reduce the already low number of babies infected at birth.)
Advocates for patients fear testing won't be truly voluntary without pretest counseling. Their bigger
concern is that, without counseling, people at risk for HIV won't get the information they need to
avoid risky behavior and to find care if they are infected.
There's no scientific evidence that universal HIV testing is beneficial, which could mean insurers
may not pay for the test. The CDC's plan could turn out to be harmful if it ends up undermining
current prevention efforts. Illinois law in the area of HIV testing is sensible. It is sensitive to the
needs of people who might find out they're positive for the virus and it helps get those people into
treatment. The wishful thinking of the CDC is no reason to change it.
Big Brother hits HIV programs
Julie Davids, Community HIV/AIDS Mobilization Project
Ever had sex with someone of the same gender, or exchanged sex for drugs or money? The U.S.
government now wants to know about it -- if you get an HIV test or participate in a group discussion
on safer sex that's supported with any federal dollars.
Starting on Jan. 1, the federal Centers for Disease Control will require a first wave of states to start
reporting an unprecedented range of information from federally funded HIV prevention programs.
It's called "PEMS" (Program Evaluation and Monitoring System), and it's a mandatory computerized
database with hundreds of questions designed to evaluate and monitor HIV prevention efforts.
Isn't it reasonable for the CDC to collect information about the effectiveness of the programs it
funds? Yes, we all want to know how HIV prevention works, and to make sure the scarce dollars are
spent well. But PEMS won't give us the answers we need.
Universal outcome evaluation is a huge, and perhaps impossible, challenge. Any hope to get
accurate data would require better training, funding and support than the CDC now provides. Many
prevention providers remain in the dark about what PEMS will involve or mean for them. It is likely
that frustration will only continue to build as these new requirements roll out.
Even though the CDC has demanded that funded programs follow pre-approved intervention
models, providers have also warned that PEMS may, instead, become the intervention. Not
surprisingly, many prevention programs emphasize building a rapport with people before plunging
into explicit or invasive topics -- but PEMS mandates questioning on sex and drug use from the very
And the more time it takes to collect this data, the less time there is to actually discuss HIV risk-
reduction strategies. Clearly, PEMS will place a major burden on already strained HIV prevention
programs that have experienced several years of budget cuts.
In addition, serious legal questions have not been answered. "Prevention with positives" services for
people living with HIV will document that individuals know their serostatus, and then will track
their reported sexual behavior -- and people with AIDS can be charged with a crime in all 50 states
if accused of "exposing" another person. The CDC has not publicly clarified if and when it would
crack the database code and turn over information to outside authorities.
So what can be done? The CDC should act swiftly to answer the concerns of all the AIDS
community -- both those people who are providing services, and those targeted by these programs.
To start, separate out the "E" from the "M": The CDC can make PEMS less burdensome by
simplifying the collection of data to monitor services. Evaluation could be done in representative
sites, rather than everywhere, with adequate support to do the quality research it takes to get real
answers. The CDC should convene a community-driven panel to figure out how to do this right.
The CDC should immediately and publicly declare that sensitive personal data will be separated
from any identifying information about a client so that, whether through accident or legal procedure,
no one will be able to access information to use in criminal proceedings.
Finally, we're not going to significantly improve HIV prevention unless there's enough funding to
transform and expand the reach of prevention efforts. President Bush and Congress need to back any
new reporting requirements with new money to help implement them, and to commit to addressing
the current shortfall in prevention dollars by increasing funding by $600 million when the budget
process starts again in 2006.
Julie Davids is the executive director of the Community HIV/AIDS Mobilization Project
LETTERS TO THE EDITOR EXAMPLES
Wednesday, June 7, 2006; A22
An AIDS Vaccine Is Still Worth Seeking
The Post's coverage of AIDS vaccine research and development ["AIDS Vaccine Testing Goes
Overseas," front page, May 22] represents the kind of healthy debate that benefits the field overall.
Clearly, with the number of new HIV infections climbing to 4.1 million each year, a vaccine remains
the best hope of reversing the pandemic.
Yet while I agree that HIV is often an underestimated adversary, I take issue with the article's
general premise that the virus is unassailable and that efforts to find new technologies to stem its
spread are futile. Today scientists think that an AIDS vaccine is challenging yet possible. More than
30 vaccine candidates are undergoing early trials on four continents. We've found that AIDS
vaccines can protect monkeys from the simian equivalent of HIV and that virtually all persons'
immune systems can keep the virus in check for a number of years, some for more than two decades.
Thanks to increased political and financial commitments, new scientific consortia formed by leading
HIV researchers are tackling the most crucial scientific questions. One involves designing vaccines
that can elicit antibodies that neutralize the virus. Detailed structural analyses of these antibodies and
their targets -- possible only in the past few years--are giving us important clues for new vaccine
AIDS vaccine research -- similar to the search for new antiretrovirals to address growing resistance
to current therapies and for new diagnostics to identify infection -- is crucial if we are to beat back
the pandemic. For the millions of people throughout the developing world who are key constituents
for an eventual vaccine, The Post's story highlights the need for greater attention to and resources for
President and Chief Executive
The International AIDS Vaccine Initiative
New York Times
May 20, 2006
Preventing AIDS in Africa
To the Editor:
As "Ideology Only" (editorial, May 13) aptly points out, Congress and the administration have made
an unprecedented commitment to fighting AIDS in Africa and beyond. But given that there's no one-
size-fits-all approach to H.I.V. prevention, a policy adjustment is needed to get the job done right.
Within any community there is a need for multiple strategies to prevent new H.I.V. infections
among adults and children. In Swaziland, almost 50 percent of the pregnant women who visit our
health clinics test positive for H.I.V. For these women, messages about abstinence are not
appropriate. These women need the drug intervention that can help prevent H.I.V. in their babies.
It would be a tragedy if Swazi women were denied this critical intervention because lawmakers in
Washington decided another prevention method was more important.
Congress and the administration should see a recent Government Accountability Office report -
which found that focusing money on abstinence and fidelity undermined other strategies against
AIDS - as an opportunity to ensure that the generous effort to fight AIDS best matches the needs of
the people it is designed to help.
Pamela W. Barnes
President, Elizabeth Glaser
Pediatric AIDS Foundation
Washington, May 16, 2006
For Immediate Release November 1, 2005
Contact: Sarah Howell: 212-966-0466 x 1302 / 646-675-1438 /firstname.lastname@example.org
Student spokespeople available upon request
City Records Show Majority of High Schools Stock No Condoms,
Despite City and State Laws Requiring Schools to Provide as HIV Prevention
As mayoral candidates joust on school issues, procurement documents validate student claims of
widespread shortfalls, with only 1.4 condoms per year ordered for each sexually active student
Documents acquired by the Community HIV/AIDS Mobilization Project (CHAMP) confirm the experiences of students
who are part of their HIV Prevention Organizing Project (H-POP), who report a drastic and dangerous shortage of
condoms, despite city and state mandates that require their provision in public high schools.
The documents, received through a FOIA request after students were denied information by the DOE, lists all city high
schools and the dates of condom orders for an 18-month period from May 2004 to present. The schools ordered 320
boxes, each containing 1000 condoms, which would provide only 1.4 condoms each year per sexually active
student. The majority of schools (212 schools) ordered zero condoms. City and state mandates require that high
school students receive six HIV education lessons each year and that schools make condoms available in staffed Health
The students note that even though 29 percent of HIV-positive adolescents in the US live in NYC, the city with the
nation’s largest number of HIV cases, neither the Department of Education nor the Department of Health has a person in
charge of monitoring schools’ compliance with the mandates. In addition, they point out that the school system has
taken over two years to implement updated health education curricula to replace that which was implemented in 1991
and contains significant misinformation on HIV. The DOE still lacks a plan to evaluate the curricula’s pilot year.
“Now I know why we’re told there are no condoms when we ask for them, or sometimes are given old condoms that
have expired,” said Kwanique Andrews, a student at the Martin Luther King Arts and Technology high school. “The
schools are absent when it comes to following the laws that are supposed to help us stay healthy, and I’m giving the
mayor a failing grade for letting this happen. The DOE is leaving us without cover against HIV.”
“We still haven’t seen this new health program that’s supposed to replace the one that hasn’t changed its AIDS
information since I was two years old, but every student already knows that four-tenths of a condom won’t do anything
for you,” said Bailey Ramos, a student at the Martin Luther King Arts and Technology high school. “We’ve got city and
state laws that say we should have condom access in our high schools, and a mayor and mayor wannabe who haven’t
spoken up. This is no joke – we’re in the city with the most people with HIV in the country, and across the nation, over
1/2 of new infections are in young people like ourselves.
This month, H-POP members around the city are participating in the Find the Condoms in Your Schools campaign
(FTC), in which they are reporting their experiences with condom availability in their schools. As members of the FTC,
they are demanding: • clear and consistent access to condoms in all New York City public high schools
• that information and training on how to correctly use condoms is made available
• clear and transparent evaluation and oversight of school’s compliance with the mandates.
“I commend these students for speaking out for their rights, and doing so much to protect the lives of their peers” said
Julie Davids, Executive Director of CHAMP. “It’s shocking that they are the ones that have to teach the DOE what’s
actually happening in their schools. Our next mayor needs to assume full responsibility for the health of our city’s next
generation, and that means making sure the HIV prevention mandates are being followed.”
For Immediate Release:
December 20th, 2005
Contact: Sean Barry, 212.937.7955 (office), ext. 5, 202.787.8211 (mobile)
"PEMS won’t give us the answers we need”
CHAMP alerts AIDS community to pending imposition of sweeping data collection on U.S. prevention
activities by Federal government
Activists warn that PEMS, the impending CDC reporting program, will risk program effectiveness and
participant privacy, and demand community-led program redesign, adequate resources for
comprehensive monitoring and research, and assurances of privacy safeguards
Providence, RI – The Community HIV/AIDS Mobilization Project (CHAMP) is notifying the AIDS community
about widely-held concerns about CDC’s Program Evaluation and Monitoring System (PEMS), a massive and
unprecedented set of new data reporting requirements for federally funded HIV prevention programs. They
are calling for a postponement of deadlines for all programs to become PEMS-compliant, for fundamental
changes in the program, and assurances that community providers who speak out will not be penalized
with funding cuts.
“Just like everyone else, we are eager to collect necessary information that will help us continue to improve
our prevention efforts. But PEMS prioritizes invasive data collection above the actual work of HIV prevention
itself, threatening to turn educators into interrogators and overwhelm already understaffed HIV prevention
agencies with paperwork,” said Julie Davids, Executive Director of CHAMP. “Meanwhile, barely-monitored
abstinence-only programs get funding increases, despite no evidence that they prevent HIV, and much
documentation that they do spread misinformation.”
CHAMP notes that many AIDS organizations have been facing cutbacks in funding and staff for multiple
years, due to flat funding for HIV prevention programs at the federal level and increased competition over
limited resources at the community level. All programs will be required to dedicate a staff person as a PEMS
coordinator, even though there is no additional funding being provided to support the position.
Community members have noted that PEMS resembles behavioral research more than simple monitoring,
and believe that it should be governed by the legal protections of research – such as informed consent and
IRB approval – and providers should be compensated adequately for research expenses.
Many of the current CDC-funded prevention programs emphasize the importance of building rapport with
people before entering into intensive discussions of stigmatized topics. However, PEMS requires that
counselors ask a lengthy list of questions. This can be both invasive and time-consuming, alienating clients
with intrusive questions while limiting the amount of time available for actual risk-reduction counseling.
For prevention efforts targeting HIV positive people, questions include the date a client became aware of
HIV status, subsequent risk-taking behaviors, and identifying information for their partner. This information can
put the client at risk for criminal charges in certain states. CDC has refused to clarify the circumstances
under which they would override the encryption key that safeguards this data.
“This program is not going to give us the answers we need,” said Sean Barry, CHAMP Director of Prevention
Policy. “Data collection that is too hard to do, and that conflicts with good and ethical prevention
education, will not happen in a thorough way. We need to simplify monitoring, and then support real
research to track the outcomes of prevention programs. PEMS will give us neither good monitoring, nor good
information on outcomes. We demand a fundamental re-think of monitoring and evaluation that is shaped
by full community involvement.”
CHAMP’s recommendations for PEMS follow.
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CONDOM ACCESS IN THE NEWS
‘Landmark’ study shows HIV spread in Ga. prisons
CDC research spurs renewed call for condoms behind bars
By DYANA BAGBY
Friday, April 28, 2006
A study of HIV infection rates among Georgia prisoners released last week by the federal Centers
for Disease Control & Prevention prompted AIDS activists to renew calls to make condoms
available to inmates.
"This is the most in-depth study done within the U.S. prison system on HIV transmission, making it
a landmark study," said Jeff Graham, senior director for advocacy and communications for Atlanta-
based AIDS Survival Project.
"As advocates, we’ve always known anecdotally that HIV was spread in prisons," Graham said.
"But without solid proof, it was hard to make a case for prevention measures. Hopefully we can use
this study not only in Georgia but around the country."
The report, "HIV Transmission Among Male Inmates in a State Prison System - Georgia, 1992-
2005," was published April 21 in the CDC’s Morbidity & Mortality Weekly Report.
In October 2005, the Georgia Department of Correction housed 44,990 male inmates with 856 —
nearly 2 percent — reported to be HIV positive. Of that 856 total, 780 (or 91 percent) were infected
before incarceration, and 732 (or 86 percent) were black, the report states.
From July 1988 through February 2005, a total of 88 male inmates were HIV negative when
sentenced but then contracted HIV while in prison, according to the report.
Not surprisingly, the CDC identified sex between male inmates and sharing needles for tattoos and
drug use as the most common risk behaviors for HIV inside prison walls.
"CDC recommends that HIV education, testing, and prevention counseling be made available to
populations at increased behavioral or clinical risk for HIV infection, including inmates in
correctional facilities," the report said.
CDC epidemiologist Patrick Sullivan, who led the study, noted that the Georgia Department of
Corrections offered voluntary HIV testing during part of the study period, from 2003 until 2005, but
then stopped it. The CDC is recommending the prison system re-implement the voluntary HIV
testing, Sullivan added.
"We know that most people who find they are HIV positive take steps to reduce risk to their
partners," Sullivan said. "One-third of inmates said they used some kind of barrier — like rubber
gloves or plastic wrap — which shows an interest on their part to want to have protected sex."
The CDC report notes that condoms are provided to some inmates in state prisons in Mississippi and
Vermont and jails in Los Angeles, New York, Philadelphia, San Francisco, and Washington, D.C.
"Departments of corrections without condom distribution programs should assess relevant state
laws, policies, and circumstances to determine the feasibility and benefits and risks of implementing
such programs," the report states.
But Yolanda Thompson, public affairs director for the state Department of Corrections, said Georgia
has no immediate plans to implement any new HIV initiatives, although the CDC study may spark
"What this study will enable us to do is to identify and broaden our definition of public safety and
public health," she said.
Thompson confirmed that condoms are considered "contraband" in Georgia prisons and sex between
inmates is forbidden by both state law and prison policy.
But according to Graham of AIDS Survival Project, the state needs to reconsider its policies in light
of the CDC findings.
"This study really challenges the corrections officials to recreate policy that will make sense in terms
of protecting public health," he said.
John Cole Vodicka, director of the Prison & Jail Project, a statewide prisoners’ rights advocacy
group, agreed that simply banning sex in prison is ineffective.
"You’d have more success stopping HIV in prison by having better education, better protection like
condoms, and more attention to human rights than you would if you just said ‘no sex allowed,’" he
Study refutes idea that many inmates get HIV in prison
Surprise finding was frequency of sex with staff
David Brown, Washington Post
Friday, April 21, 2006
Although male prisoners have a relatively high rate of HIV infection, very few of them actually
acquire the virus while behind bars, according to a federal study that is the largest and longest one to
look at the controversial issue.
About 90 percent of HIV-positive men in Georgia's prison system -- the nation's fifth-largest -- were
infected before they arrived, the study found. Over a 15-year period, only 88 men became infected
inside prison by the virus that causes AIDS, chiefly through homosexual intercourse. Georgia
prisons currently house about 45,000 men.
The study, published Thursday by the Centers for Disease Control and Prevention, refutes the
widespread impression that American prisons are hotbeds of the AIDS epidemic and that
incarceration contributes directly to the high rates of HIV in black men, who make up the majority
of male prisoners in many states.
The study revealed a surprising and unexplored aspect of HIV infection in prisoners. Of the men
who became infected behind bars and acknowledged having homosexual sex there, half reported that
their partners were prison staff, not other inmates. Whether guards were the source of infection, or
became infected themselves, in any of those liaisons is unknown.
Nearly three-quarters of inmates reporting male-to-male sex described it as consensual, and almost
one-third of those said they used condoms or an improvised protective method such as rubber gloves
or plastic wrap.
"The popular assumption is that prison is a very good place to contract HIV infection," said Richard
Tewksbury, a professor of justice administration at the University of Louisville, who has studied
HIV prevention strategies inside and outside prison.
"Both inmates and society as a whole have long held the belief that transmission is common among
prison inmates. The interesting thing about this study is that it directly contradicts that," he said.
Terry Butler, in CDC's press office, said "media coverage of this issue over the past several years
has been characterized by misperceptions that HIV transmission in prisons is widespread." Most
news stories provide little evidence for that idea, she said.
The findings, published in CDC's Mortality and Morbidity Weekly Report, raise numerous policy
questions that prison officials in Georgia, and possibly in other states, may need to address.
An obvious one is whether to make condoms available. They are contraband in Georgia prisons, as
in nearly all American prison institutions. Another is whether prison staff should be tested for HIV,
as incoming prisoners are.
"We can now begin the policy discussion about ways to prevent (new infections) in the prison
population," said Brian Owens, assistant commissioner of the Georgia Department of Corrections.
He would not discuss what, if any, changes officials are considering.
Patrick Sullivan, a CDC epidemiologist who helped lead the study, said prison is an opportunity to
get AIDS prevention messages to a hard-to-reach, high-risk population -- something that is
especially important given that 97 percent of inmates nationwide eventually get out and go home.
In 1988, Georgia began testing convicts on arrival at prison. As of February 2005, 88 men who
entered uninfected had been diagnosed with HIV. Two-thirds were black and one-third were white.
As of last fall, Georgia prisons held 856 HIV-positive men in all.
To try to determine how the in-house infections occurred, CDC and Georgia state epidemiologists
compared each newly infected prisoner with an uninfected one who had served a similar length of
Not all 88 were available, however. Eleven had been released, two had died, and some refused to
cooperate. In the end, 68 infected men and a similar number of uninfected ones were interviewed.
The infected men were 10 times more likely than the uninfected to have had homosexual intercourse
in prison, and 13 times more likely to have received a tattoo there.
Among the 68 infected men, 20 reported no sex in prison, 61 reported no use of injected drugs and
28 reported no tattoos. Six of the 68 reported none of those activities. Curiously, although tattooing
is often mentioned as a risk factor, there are no confirmed cases of HIV infection through tattooing
on record anywhere, Sullivan said.
Forty-five reported having homosexual liaisons in prison. Of them, 22 said they had had sex with
"male prison staff." That was also true of four of 68 uninfected men. Of the 48 who reported sex of
any type, 15 infected men reported liaisons with female staff, as did six of the 68 comparison
Ideals Collide as Vatican Rethinks Condom Ban
By IAN FISHER
Published: May 2, 2006
ROME, May 1 — Even at the Vatican, not all sacred beliefs are absolute: Thou shalt not kill, but
war can be just. Now, behind the quiet walls, a clash is shaping up involving two poles of near
certainty: the church's long-held ban on condoms and its advocacy of human life.
Benedict XVI Monday at a shrine to Mary in Rome. He is studying condoms as a defense against
The issue is AIDS. Church officials recently confirmed that Pope Benedict XVI had requested a
report on whether it might be acceptable for Catholics to use condoms in one narrow circumstance:
to protect life inside a marriage when one partner is infected with H.I.V. or is sick with AIDS.
Whatever the pope decides, church officials and other experts broadly agree that it is remarkable that
so delicate an issue is being taken up. But they also agree that such an inquiry is logical, and
particularly significant from this pope, who was Pope John Paul II's strict enforcer of church
"In some ways, maybe he has got the greatest capacity to do it because there is no doubt about his
orthodoxy," said the Rev. Jon Fuller, a Jesuit physician who runs an AIDS clinic at the Boston
The issue has surfaced repeatedly as one of the most complicated and delicate facing the church. For
years, some influential cardinals and theologians have argued for a change for couples affected by
AIDS in the name of protecting life, while others have fiercely attacked the possibility as demoting
the church's long advocacy of abstinence and marital fidelity to fight the disease.
The news broke just after Benedict celebrated his first anniversary as pope, a relatively quiet papal
year. But he devoted his first encyclical to love, specifically between a man and a woman in
Indeed, with regard to condoms, the only change apparently being considered is in the specific case
of married couples. But any change would be unpopular with conservative Catholics, some of whom
have expressed disappointment that Benedict has displayed a softer face now as defender of the faith
than he did when he was still Cardinal Joseph Ratzinger, the papal adviser.
"It's just hard to imagine that any pope — and this pope — would change the teaching," said Austin
Ruse, president of the Culture of Life Foundation, a Catholic-oriented advocacy group in
Washington that opposes abortion and contraception.
It is too soon to know where the pope is heading. Far less contentious issues can take years to inch
through the Vatican's nexus of belief and bureaucracy, prayer and politics, and Cardinal Javier
Lozano Barragán, the pope's top aide on health care issues, and other officials declined requests for
The news reports have been contradictory, except to confirm that the pope has asked for such a
Cardinal Lozano Barragán was quoted in a daily newspaper, La Repubblica, as saying Benedict
made the request two months ago, as part of a broader examination of bioethical issues. "My
department is carefully studying it, along with scientists and theologians entrusted with drawing up a
document about the subject," he was quoted as saying.
He backtracked slightly a few days later: "We are in the first stage," the cardinal told the Zenit News
Agency, which specializes in covering the Catholic Church. Would there be a document? "There
might or might not be."
The debate has two levels: one on moral theology and church doctrine, the other on public relations
and politics. Many factors are driving the debate: The church is experiencing its greatest growth in
Africa, which has the most severe AIDS problem. Much health care in Africa is provided by
Catholic charities, whose workers often speak of being torn between church doctrine and the need to
More broadly, critics of the current Vatican policy say it is hard for the church to remain consistent
on so-called life issues, like its opposition to abortion, euthanasia and the death penalty, when
condom use can help prevent the spread of AIDS.
But there is a deep vein of feeling against any change. Some oppose any perceived erosion of
Humanae Vitae, the 1968 encyclical that banned artificial contraception, while other opponents say
approving condoms for AIDS prevention might be interpreted as a wider acceptance of their use.
"That will be picked up as 'Church O.K.'s Condoms,' and that would seem to undermine the whole
church teaching on sexuality and marriage," said the Rev. Brian V. Johnstone, a moral theologian at
the Alphonsian Academy in Rome.
The debate was reopened, in public at least, in a long discussion in the newsweekly L'Espresso last
month between Cardinal Carlo Maria Martini, the retired archbishop of Milan and an influential
thinker in the church, and an Italian bioethicist, Ignazio Marino.
"Certainly the use of prophylactics can, in some situations, constitute a lesser evil," Cardinal Martini
said. "There is, then, the particular situation of spouses, one of whom is affected by AIDS."
But he recognized arguments against any such official statement, saying, "The question is really if it
is wise for religious authorities to propagandize in favor of this method of defense, almost implying
that the other morally defensible means, including abstinence, should be put on a secondary plane."
The moral arguments stretch back nearly two millenniums, to the idea that the church has a
responsibility, in difficult moral cases, to advocate the "lesser evil."
"It is not considering that using a condom is morally good or right," Father Johnstone said. "You are
simply trying to persuade that person to do the lesser evil — but it is still considered evil."
There are other related arguments: One is "self defense," in which an uninfected partner could
demand condom use to protect against infection. Another is that using a condom against AIDS could
be considered medical intervention rather than contraception.
But the "lesser evil" argument is not universally accepted among Catholic thinkers, and the theology
is complicated. Among many other issues, there is the user's intent: whether it is possible to use a
condom without the intention of contraception.
"Putting on a condom is clearly something someone chooses," the Rev. Thomas Berg, an ethicist and
executive director of the Westchester Institute, an institute for Catholic studies in New York, said by
e-mail. "And to do so in sexual relations, even if one's purpose is not to contracept, but merely to
stop the spread of disease, one would still be opting for something that drastically disorders those
sexual relations. And this, the church has taught to be immoral."
Echoing other conservative voices, Father Berg said he believed that in the end, Benedict would
make no changes but use the debate to "vigorously re-endorse ethically acceptable answers to the
AIDS crisis, namely, the virtue of chastity and abstinence."
But others point to what they say is Benedict's capacity to surprise, using the shorthand of "Nixon in
China" to make the case that a hard-liner could, without reversing church doctrine, more easily make
such a change.
Making a change would address a relatively small part of the problem because transmission of AIDS
usually involves unmarried people. But if Benedict did so, "it will have a huge influence," said
Rebecca Schleifer, a researcher on AIDS issues for Human Rights Watch, though that influence may
be exactly what many in the Vatican fear.
She and other experts said it could help break down resistance to condom use in places like the
Philippines or parts of Africa, where Catholic officials or clerics have a large influence.
"The church taking a step forward in saying, 'They do work and we believe in them in this situation'
is important to help protect the lives and health of millions of people around the world," Ms.
NEEDLE EXCHANGE IN THE NEWS
Judge Acquits 4 of Distributing Needles in an Effort to Curb AIDS
By EVELYN NIEVES,
Published: November 8, 1991
Four people were acquitted today of all charges stemming from their attempts to distribute clean
needles to drug addicts to help prevent the spread of the AIDS virus.
Judge Alan Horowitz of Municipal Court said he believed that the defendants had made a moral
decision to risk arrest in order to save lives and to "send a message to the country and to New
The nonjury trial was the first on the issue in New Jersey, one of 11 states that prohibit the
distribution of needles.
In rendering his decision, Judge Horowitz also pointed out that in the only two other cases of this
kind, in Boston and New York City, the trials ended in acquittals. But he warned that his decision
was not to be "considered or construed to be a license for well-meaning groups to canvass
communities in New Jersey distributing needles."
"Each case presents its own set of facts," he said.
The jubilant defendants said they hoped the decision would lead New Jersey legislators to change
the ban on distribution of clean needles as part of the effort to stem the spread of HIV, the virus that
causes AIDS. Near Methadone Clinic
"I hope it will cause other people to feel empowered to talk about this issue," said Rod Sorge, 23
years old from New York City, who said he regularly distributes clean needles to intravenous drug
users throughout New York.
The four defendants -- Mr. Sorge; Brad Taylor, 35, also of New York City; Jon Parker, 35, of
Boston, and Carl Sigmon, 65, of Plainfield, N.J. -- were on trial on charges filed on April 19, 1990.
The four were arrested as they set up a table with clean needles, bleach, condoms and bilingual safe
sex information across the street from a methadone clinic here.
They were charged with possession of drug paraphernalia and illegal possession of hypodermic
needles, misdemeanors punishable by up to one year in prison and a $2,000 fine.
During the trial, which lasted less than two days, the defense lawyer, Brian Neary, arguing the case
on behalf of the American Civil Liberties Union, said his clients were not protesting or practicing
civil disobedience to make a political point. Rather, he said, they were compelled to act because of
the urgency of their mission to stop the spread of the AIDS virus. Doctor's Testimony
All four defendants are members of the AIDS Coalition to Unleash Power, known as Act Up. Mr.
Parker, formerly of New York City, is a founder of the Boston-based National AIDS Brigade. Mr.
Sigmon, who said he lost a companion of 24 years to AIDS, said members of Act Up decided to start
a needle exchange in Jersey City because they estimated that New Jersey had the highest percentage
of transmissions of the HIV virus from shared needles in the nation.
His testimony was backed up by Dr. Ernest Drucker, director of epidemiology and social medicine
at Montefiore Medical Center in the Bronx. In testimony for the defense on Wednesday, Dr. Drucker
said that intravenous drug users in Hudson and Essex Counties accounted for more than 60 percent
of all reported AIDS cases, three times the national proportion. And he added that dozens of studies
showed that needle-exchange programs did not encourage drug use but definitely did help stop
The assistant municipal prosecutor, Ana Moreira, argued that her witness, Detective Richard Vogel,
a narcotics officer with the Jersey City police, believed needle exchanges would make things harder
for the police to do their job.
"I have no alternative but to prosecute this case based on case law," Moreira said. "There is no
authority for this type of program."
AIDS advocacy groups argue that needle-exchange programs help save lives since HIV is spread
with contaminated needles. But opponents say such programs can promote more drug activity and
send the wrong moral message.
After the trial, Mr. Neary said: "This was a wise decision. These men didn't intend to commit crimes
and what they did was necessary."
No Compromise in Sight on Plan to Fight H.I.V.
By DAVID W. CHEN
Published: June 4, 2006
TRENTON, May 31 — In every legislative session here but one since 1992, at least one bill has
been introduced to allow drug users to exchange used syringes for new ones. And though the details
have differed from year to year, one goal has remained constant: to reduce the spread of H.I.V. in a
state with one of the nation's highest infection rates.
But 14 years later, New Jersey remains one of only two states — the other is Delaware — that still
prohibit both needle exchanges and access to syringes at pharmacies without a prescription.
No one disputes that H.I.V. and AIDS are major public health problems in New Jersey. The state has
the country's highest rate of H.I.V. infection among women, 36 percent, and the third highest among
children. Over all, almost 33,000 people in New Jersey have AIDS, up from 26,000 at the end of
1998. Forty-one percent of all cases resulted from injection drug use, according to the state health
Yet in New Jersey, the effort to make needles freely or more easily available has been blocked
repeatedly over the years. Gov. Christie Whitman, a Republican, adamantly opposed the idea, for
instance, while Gov. James E. McGreevey, a Democrat, dropped his support in the face of
opposition from police chiefs and some legislators.
Now Gov. Jon S. Corzine and the State Assembly are determined to legalize needle exchanges. But
once again, the effort is being blocked, this time in the State Senate, where Ronald L. Rice, a
Democrat, has struck an alliance with Republican lawmakers, who are in the minority, to keep the
legislation bottled up in committee.
To Mr. Rice and other critics, including John P. Walters, the director of the White House Office of
National Drug Control Policy, making needles more accessible suggests that government is
condoning an illegal — and destructive — activity. They favor educational campaigns and treatment
programs to discourage drug use.
"Needle exchange is a form of keeping people junkies the rest of their lives," said Mr. Rice, a former
Newark police officer.
"You don't wipe out a whole lot of people by gassing them," he said. "And you don't wipe people
out like the Tuskegee Institute, where we had a bad experience.
"That's what you're doing with this needle exchange," Mr. Rice said. "Those aren't offensive
statements; those are examples of what people have been doing to people, and it shouldn't be."
Supporters of needle exchanges counter that they are backed by just about every major scientific or
medical organization, including the National Institutes of Health, the American Medical
Association, the Centers for Disease Control and Prevention and, closer to home, the New Jersey
In New York City, studies have shown that such programs had reduced the rate of new H.I.V.
infections by roughly 75 percent since the 1990's, according to Dr. Don C. Des Jarlais, the director
of research for the Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel
He cautioned that individual studies might have had flaws, but emphasized that "the sum of these
less-than-perfect studies is sufficiently conclusive: All of the research syntheses have come to the
conclusion that the programs can and do work."
Across the Hudson, meanwhile, Governor Corzine has said that one of his biggest disappointments
since his inauguration in January has been the lack of progress toward a needle exchange program.
Other officials have voiced similar complaints.
"It's a disgrace, a disgrace, that we are so far out of step with other states," said Assembly Speaker
Joseph J. Roberts Jr., a Democrat from Camden County.
Noting that California recently made it easier to buy syringes without prescriptions, Mr. Roberts
added: "That great liberal voice Arnold Schwarzenegger has been able to tackle this issue, but New
Jersey hasn't. We've allowed a few people who have had very loud voices to demagogue the issue
and to tie it up, and people are dying each and every day."
The late Senator Wynona M. Lipman, a Democrat, introduced the first needle-exchange bill in 1993.
Republicans controlled the Legislature for most of the 1990's, though, and Governor Whitman was
one of the most vocal opponents.
In 1996, Mrs. Whitman appointed David W. Troast, a wealthy businessman and social acquaintance
from Somerset County, as the head of the state's Advisory Commission on AIDS. But much to
everyone's surprise, he endorsed needle exchange after interviewing experts in public health, AIDS
prevention and epidemiology.
"There is nothing that we can come up with as effective as a clean-needle program and the retail
distribution of needles," Mr. Troast said at the time, a stance that prompted a public spat with Mrs.
By the time the Democrats regained control of the Legislature in 2002, needle-exchange supporters
were more optimistic. But it was not until after Mr. McGreevey announced plans to resign in August
2004 that he got behind the effort and issued an executive order authorizing pilot exchange programs
in Camden and Atlantic City.
Mr. Rice and three Republican legislators, including State Senator Thomas H. Kean Jr., who is now
running for the United States Senate, quickly went to court and blocked those programs.
"If the governor could go so greatly beyond his executive order to obviate criminal standards, that
was a very bad precedent," Mr. Kean said. "It sends the absolute wrong message to the youth of our
Mr. Rice has often worked with Republicans on the Senate health committee, like Mr. Kean, to
prevent his Democratic colleagues from garnering a majority of votes. There are five Democrats and
three Republicans now, so Mr. Rice's opposition virtually guarantees a deadlock.
Senate Democrats tried earlier this year to expand the health committee by adding Senator Loretta
Weinberg, a Bergen County Democrat and needle-exchange advocate, but the proposal fizzled out.
Some legislators and aides have said that Democrats were uncomfortable expanding a committee
just to push through one bill.
One ardent needle-exchange supporter, Senator Nia H. Gill, a Democrat, has vowed to use her
privilege of "senatorial courtesy" to block nominees to various governmental entities when they are
from her home county, Essex, and are supported by the Senate president, Richard J. Codey, also
She wants him to use his power to bring the needle measure directly to the Senate floor for a vote,
bypassing Senator Rice and his Republican allies. But Mr. Codey, a supporter of needle exchange,
has been loath to do so, in part because it would break Senate protocol.
"It's about invoking your power and using it for people who have little or no voice in the process,"
Ms. Gill said.
In another maneuver, some legislators and aides say Mr. Roberts, the Assembly speaker, may be
holding up passage of one of Mr. Codey's signature causes, a stem cell research bill, until needle-
exchange legislation passes. When asked about a possible link, Mr. Roberts demurred and said only
that "we're going to get this done, and I need some help in the Senate to get it done."
But he also said that he was "hopeful they'll both be advanced before we leave in June."
In recent weeks, Mr. Corzine has also made more noise, prompting speculation that he, Mr. Codey
or Mr. Roberts might try to find a creative compromise soon.
"He has signaled a more aggressive stance and a willingness to speak out," said Anthony Coley, Mr.
Corzine's press secretary. "We have an opportunity here to save people's lives, and that's not
overstating the case."
Mr. Rice says he is frustrated that his $100 million proposal for residential substance abuse
treatment centers has gotten no traction, while proposals on mental health and stem cell research
totaling more than $400 million have either become, or are close to becoming, a reality. Yet he says
he also knows that his longtime efforts may come up short.
"I may lose the battle at the end, but I'm never going to vote — never," said Mr. Rice, who recently
lost the Newark mayor's race. "I'll die before I give a vote to give free needles to people."
Ideas & Trends
Between Addiction and Abstinence
GOING STRAIGHT Abstinence was long thought to be the only cure for addiction. But new
treatments suggest that, for some, moderation may work better.
By BENEDICT CAREY
Published: May 7, 2006
A HUMILIATING accident. An apparent memory lapse. A sudden, emotional confession.
Representative Patrick Kennedy's car crash on Capitol Hill early Thursday and a news conference a
day later had a familiar rhythm, especially for those who study addiction or know it firsthand.
Mr. Kennedy, a six-term Democrat from Rhode Island, said that his addiction was to prescription
medication and that he planned to seek treatment at an addiction clinic, as he had done before.
"I struggle every day with this disease, as do millions of Americans," said Mr. Kennedy, who is 38.
But will a cure that apparently didn't take the first time be successful the second time around? Mr.
Kennedy, for one, ruefully acknowledged how easy it was for him to backslide.
Mr. Kennedy is seeking treatment at a time when the entire field is undergoing a transformation.
Once akin to exorcists, committed to casting out the demons altogether, those who work with
addictive behavior of all kinds are now trying less dogmatic approaches — ones that allow for
moderate use as a bridge to abstinence.
A government-financed study of alcoholism released last week, the largest to date, suggests how
deeply this "moderate use" idea has taken hold. The study found that the treatment produced
"good clinical outcomes" in about three-quarters of the almost 1,400 heavy, chronic drinkers in
the study. Some quit altogether; most, however, had moderated their drinking — to 14 drinks a
week or fewer for men, 11 or fewer for women.
"The fact is that these moderate measures are becoming more and more accepted in judging
treatments," said Dr. Edward Nunes, a professor of clinical psychiatry at Columbia University.
Millions of recovering addicts and their families as well as counselors working in the trenches
consider this approach to be foolhardy and immoral. Addicts are by definition unable to control
or manage their addictions, they say, and leaving an opening for moderate use only encourages
the experimentation that can lead to ruin or death.
Cases like that of Mr. Kennedy dramatically illustrate how close to breakdown many addicts live,
they say. "Implying you can simply cut down does a tremendous disservice to those who have this
addiction," said Stanley L., a recovering alcoholic in Pennsylvania who still attends group
Yet the openness to moderate use is likely to increase, driven by changes in the science of
addiction, like pharmaceutical treatments.
The latest option for opiate addiction, bupenorphine, is a substitute drug, like methadone,
replacing one habit with another. The drug naltrexone, which seems to numb the brain to the
euphoria from drinking or gambling binges, is more likely to reduce the consumption than shut it
down altogether. And perhaps the biggest recent advance in smoking cessation, the nicotine
patch, is itself a badge of compromise, an admission that many smokers need a habit to lean on,
temporarily or perhaps indefinitely, as they strive for life without.
When studying these pharmaceutical crutches and prescribing them, doctors tend to emphasize
improvement over abstinence for good reasons, researchers say.
"Third-party payers," said Dr. Barbara Mason of the Scripps Research Institute, where she treats
and studies addiction. "One way you can convince people holding the purse strings to cover
treatment is to say, look, if you pay for this and it lowers the level of drinking or substance use
you won't have to pay for E.R. visits. That's really important. If you prevent one case of fetal
alcohol syndrome, you don't have to pay for a lifetime of care."
Some studies of drug use and gambling have also contributed to shifting the thinking about
addiction. For example, surveys find that most smokers who quit do so on their own, after many
attempts and periods of moderation. An estimated 20 percent of compulsive drug users and
drinkers have had similar recoveries, experts say.
In a 2002 study, researchers at Harvard Medical School tracked the behavior of more than 6,000
casino employees, many of whom were heavy drinkers, gamblers or both. Over a period of three
years, many of those with diagnosable disorders changed their behavior, moving from heavy use
to moderate levels, and sometimes back up again.
"The conventional wisdom is that you get the habit and start down this slippery slope and it just
gets worse and worse, but that was not true for many of these people," said Christine Reilly,
executive director of the Institute for Research on Pathological Gambling and Related Disorders,
in Medford, Mass.
Heavy gamblers and drug users are much more diverse groups, in short, than many presume, and
their compulsions have different meanings in the context of their lives that are important guides
Some addicts are depressed and anxious and in need of psychotherapy but can't get it because
therapists require that they give up their habits first, said Alan Marlatt, director of the Addictive
Behaviors Research Center at the University of Washington. "Maybe the drug use is responsible for
the depression, or the depression led to the drug, but it's all mixed up and they never find out,
because they can't get treatment," he said.
Many addicts, it is true, spiral only downward, and must quit to stay alive. But others are
ambivalent about whether they want to quit or not. Their routines, their pleasures, some of their
most sustaining relationships are tied up with their habits, and it is far from clear what will
nourish them if they suddenly give up. The very idea, common in abstinence-based programs,
that one "slip" can lead to total loss of control may undermine their best efforts to self-regulate.
"It's very scary for them to contemplate life without this habit, because it has become very
meaningful for them," Ms. Reilly said.
Offering moderate use as a first step, some therapists say, is the only way of "meeting people
where they are," and getting them down to a level of use that keeps them from driving under the
influence, petty crime or other trouble.
"The idea is to reduce the consequences of the heavy use, and work from there," said Mr. Marlatt.
This was more or less the view offered by Charles Barkley, the former N.B.A. star, in an interview
on ESPN last week: "Do I have a gambling problem? Yeah, I do have a gambling problem but I
don't consider it a problem because I can afford to gamble. It's just a stupid habit that I've got to
get under control, because it's just not a good thing to be broke after all of these years."
By treating the habit as just that — a habit — and not a disease, therapists may be able to make
progress in reducing the bad consequences, whether a broken marriage or an embarrassing car
On the other hand, the risk to addicts of this approach is incontestably real, and no one knows in
advance who can and cannot safely moderate their addictive behavior.
"I am deeply concerned about my reaction to the medication and my lack of knowledge of the
accident that evening," Representative Kennedy said on Friday. "But I do know enough to know
that I need to seek expert help."
OTHER EXAMPLES OF HIV ADVOCACY IN THE MEDIA
Coming to a clinical trial near you.
By Jon Cohen
Posted Tuesday, Feb. 21, 2006, at 3:00 PM ET
In July 2004, AIDS activists trashed a Gilead Sciences exhibit booth at the international AIDS
conference in Bangkok, Thailand, because of a proposed study of the company's drug tenofovir. The
trial sought to assess whether tenofovir, arguably the safest AIDS drug on the market and already
approved by the Food and Drug Administration, could prevent infection if given in daily doses. The
proposed subjects were volunteer HIV-negative Cambodian sex workers. No matter. AIDS
advocates objected because they thought the company was taking advantage of a vulnerable
population and failing to offer the women medication if they became infected. Helping to lead the
"zap" was ACT UP Paris, which splashed fake blood on the Gilead booth, hung a large banner that
read "Closed Due to Death," and plastered the walls with signs that said "Sex Workers Infected by
Gilead" and "Gilead Prefers Us HIV+."
The protest against Gilead is one example of pharmanoia, the extreme distrust of drug research and
development that's sweeping the world. As Joep Lange, head of the International AIDS Society at
the time of the Bangkok meeting recently wrote, the protest was based on "uninformed demagogy"
and threatened to derail "arguably the most important studies for those at high risk of acquiring HIV
infection around the globe." When Cambodian President Hun Sen pulled the plug on the study a
month after the protest, he added his own uninformed demagogy to the fracas.
To be sure, major drug companies and the battalions of academic researchers on their payrolls
deserve intense scrutiny. And they have received it, in this story in Bloomberg News about
questionable clinical trials in Miami and in these stories in the New York Times about a defective
heart device, which were honored this week by the George Polk journalism awards. Also justifiably
unsparing is the Washington Post's 2000 series "The Body Hunters," which critically examined
Pfizer's experiments with Trovan on Nigerian children who had meningococcal meningitis, and the
recent hammering of Merck for its decision not to report heart problems in trials of Vioxx. But as
Big Pharma becomes the new Big Tobacco, some critics wildly exaggerate—see Celia Farber's
article on AIDS and the corruption of medical science in the March issue of Harper's—turning
shades of moral gray into black.
Consider other recent narratives that involve AIDS and the testing of drugs on humans. In John le
Carré's The Constant Gardener and the movie based on it, a big drug company and its affiliates
cover up the toxicities of an experimental tuberculosis drug that they're testing on Kenyan AIDS
patients. They then murder the people who try to expose their wrongdoing. Le Carré writes in an
author's note: "by comparison with reality, my story was as tame as a holiday postcard." In fact, the
plot is so over the top, it's a hoot. In January, the Toronto Globe and Mail, Canada's leading daily,
ran an article titled "Sex Slaves for Science?" featuring Salome Simon, a woman described as "a
medical guinea pig" who participated in a long-running Canadian program that's hunting for clues to
develop an AIDS vaccine. Simon volunteered for the study. She can leave it at any time. And the
researchers provide her with free medical care, as well as counseling about how to avoid infection.
(Read more about this study.) Here are two other examples of drug R & D criticism run amok.
By overplaying unproved but sensational misdeeds, Big Pharma's watchdogs obscure serious
ones—like the inane lawsuit that 39 drug makers filed against the South African government in 1998
to block it from making generic versions of anti-HIV drugs. The scattershot approach also draws
attention away from a critical and increasingly complicated issue that AIDS has pushed to the fore:
What do researchers owe people who volunteer to test new medicines and devices?
There's a fundamental rule of thumb for the ethics of conducting human biomedical studies: Don't
behave like a Nazi. It was the cruel and deadly Nazi experiments on concentration-camp prisoners
that led to the 1947 Nuremberg Code, which spelled out 10 core principles for human experiments.
These include the requirement that research subjects must freely join a study with full knowledge of
the risks and that researchers must make every effort to minimize unnecessary mental or physical
suffering. After the Nuremberg Code came several, more specific canons—the Declaration of
Helsinki, guidelines from the Council for International Organizations of Medical Sciences, and the
Belmont Report—that together spell out the international ethical tenets for human research.
The AIDS epidemic has spotlighted the ethics of clinical research like no disease in history. Early
on, AIDS activists demanded a voice in drug R & D; today they sit on influential panels that help
governments set research guidelines and evaluate the worth of HIV-fighting drugs. AIDS also brings
ethics to the forefront because it preys on ostracized groups—sex workers, gay men, minorities, drug
users, migrants. And when powerful but expensive anti-HIV drug cocktails became available, the
developed world was forced to recognize that patents and profits were standing in the way of
reaching the vast majority of the HIV infected.
Should researchers conducting a study that aims to prevent HIV infection be required to provide
anti-HIV drugs to participants who become infected during the trial, for reasons that have nothing to
do with it? No official guidelines address this difficult question, which was central to the protests
surrounding the abandoned study in Cambodia. In a sophisticated exchange between two bioethicists
a few years ago, one, Ruth Macklin of Albert Einstein College of Medicine, argued that researchers
have this "moral obligation." The other, Charles Weijer of the University of Western Ontario,
countered that in "moral theory, causation is a necessary condition of compensatory claims." In other
words, the researchers had no obligation to provide treatment unless their trial caused the infection.
Weijer also argued that providing anti-HIV drugs to subjects was an "undue inducement" because it
might lead poor people to volunteer. There is "something strange about this worry," wrote Ezekiel
Emanuel, the chief bioethicist at NIH, in the Lancet last July. "No person would become HIV
positive just to get antiretroviral drugs," Emanuel and his co-authors reasoned. If someone joins a
trial because of the offer of anti-HIV drugs, they concluded, then the inducement is not undue.
Last May, an unusual meeting of activists, researchers, and bioethicists convened at the Bill and
Melinda Gates Foundation to hash out the questions raised by the protest over the Cambodia trial.
The group's report, "Building Collaboration to Advance HIV Prevention," wisely asserts that
providing anti-HIV drugs to people who become infected during a prevention trial "is steadily
becoming a question of logistics and implementation rather than a hot topic of ethical debate." This
has major implications for ongoing tenofovir pre-exposure prophylaxis experiments, as well as trials
of AIDS vaccines and topical gels and creams known as microbicides. Indeed, as the report notes,
several large sponsors of AIDS vaccine trials now have promised to help make sure that people
infected during studies receive the medicines.
The ethical canons haven't changed. But as the price of anti-HIV drugs has plummeted from $15,000
per person a year to a few hundred dollars, major international efforts are under way to bring these
medicines to poor people. In essence, increased access to drugs revealed that the ethical quandary
came down to cost, not right or wrong.
Researchers from wealthy countries typically provide research subjects in poor ones better health
care. They also train colleagues and bring medical equipment that remains in use long after studies
end. But there are financial and practical limits to what they can offer. No ethical manifesto,
however, spells out precisely how much is enough. The unstated message of "Building
Collaboration" is that researchers and communities that participate in clinical studies have to
negotiate this bottom line.
AIDS has ushered in an ethos in which more and more people, especially in desperately poor
countries, want to know what's in it for them to participate in a clinical trial. They want some say in
establishing what researchers call the risk/benefit ratio. These are reasonable demands. But
pharmanoia makes them harder to hear.
Related in SlateAmanda Schaffer describes microbicides, a new method of AIDS prevention for
women. Carl Elliott and Trudo Lemmens attack for-profit ethical reviews of clinical trials. Jim
Fallows, Brent Staples, and Jon Cohen discuss Cohen's book, Shots in the Dark: The Wayward
Search for an AIDS Vaccine.
Jon Cohen writes for Science magazine. You can reach him at email@example.com.
‘New age ACT UP’ to battle AIDS apathy
Campaign to End AIDS cites freedom from funding conflicts
By ANDREW KEEGAN
WEDNESDAY, MARCH 1, 2006
Following a less than stellar turnout for a four-day summit in Washington, D.C., last year, a national
AIDS advocacy group plans to adopt an even more grassroots, radical approach.
The newly formed Campaign to End AIDS organized the event in Washington last fall to demand
federal leaders do more to combat AIDS, including increasing funding for services. But only 500
people with HIV and their supporters turned out for four days of lobbying and protests. The Centers
for Disease Control & Prevention estimates that more than one million people in the U.S. are HIV-
This year, C2EA asked each state to establish a chapter group and work locally to address AIDS
issues. The first Atlanta meeting was held Feb. 15, with eight people attending. The next meeting is
set for March 2.
"We anticipate on being the new age ACT UP," said local organizer Tracy Bruce, who is bisexual,
has two children and has been HIV-positive since 1985. "It’s time to bring the topic of AIDS back to
the forefront because people are still dying."
Several of the local members, including Bruce, were involved in the national campaign last year and
were arrested in D.C. during demonstrations. Bruce described the protests as perhaps the most
exhilarating moment of her life — taking a stand for herself and others.
In-your-face tactics like getting arrested may become part of the local C2EA strategy, although the
chapter is still in the organizational phase and has not outlined specific methods of advocacy.
"I don’t want to see this generation or their children become infected," Bruce said. "People have
become complacent and there is still that element who think we are better off dead anyway."
C2EA chapters will also differ from AIDS service providers by not receiving federal funding, which
some AIDS activists say limits the ability for real advocacy.
Advocacy in action
Last year the Campaign to End AIDS launched 10 caravans nationwide that traveled to more than
100 cities to raise awareness about HIV. The caravans converged in D.C. for "Four Days of Action
to End AIDS."
Some 29 C2EA advocates were arrested in front of the White House for lying on the ground with
tombstone-shaped signs reading, "Bush’s war on AIDS." More than 100 lined the street chanting,
"Bush is a jerk, condoms work."
A dozen other advocates were arrested while protesting outside the D.C. office of the conservative
Family Research Council.
But no caravans are currently planned for this year.
"It was very exciting, but also very grueling," said local organizer Larry Cook, who joined the
southern caravan in Atlanta. "If there is an organized event, each state will be in charge of getting
Cook said he is fed up with hearing the word AIDS followed by another word: gay.
"It’s everyone’s disease," said Cook, who is gay and was diagnosed with HIV in 1997. "Why is
there such a stigma attached? It’s no different than living with diabetes or cancer."
Part of the group’s strategy will be not focusing on "gay advocacy," Cook said.
The group sees gay people as a subset of HIV-positive people, and C2EA is fighting for access to
services, prevention efforts and other issues that affect all people with HIV in Georgia, he said.
"Nearly half of new infections are in the black community," Cook said. "The churches can say this is
a gay disease but the numbers tell a different story. We have straight black women being infected by
Cook said getting a foothold among African Americans may be the group’s biggest challenge.
"Those who are infected play the part of not wanting the church to know," he said. "But being silent
is not helping anyone. We need to stand up for what’s right now, because there will be future
generations of HIV-positive people."
But while the local C2EA isn’t focused only on gay issues, the group wants gay participation, Bruce
"We’d like to have all demographics involved that this disease affects," she said. "We want gays,
folks from the transgender community, Latinos, women of color, younger infected or affected, both
gay and straight, parents, kids, deaf folks, HIV-positive white straight men and any negative people
with a desire to help in the struggle."
ACT UP template
Jeff Graham, senior director of public policy at AIDS Survival Project, was a member of the Atlanta
chapter of ACT UP — the AIDS Coalition to Unleash Power — during the late 1980s. ACT UP
chapters around the country were known for their grassroots activism, and Graham said there is still
a role for direct action in AIDS advocacy.
"Back then issues were pretty much black and white," Graham said. "Thousands of people were
dying and no one was doing anything. Today, I see nothing but shades of gray."
Graham said even the most well intentioned AIDS advocacy group has multiple constituents to
answer to, which removes any sense of independence.
"In the days of ACT UP we were highly effective because we didn’t need a lot of fundraising to
engage in our activities," he said. "We could piss everyone off."
Graham admits that when most people think of ACT UP, they envision Doc Martins, leather jackets
and getting arrested.
"We were always so much more than that," Graham said. "There were a lot of behind-the-scenes
meetings and letter writing, which were all just as effective as the direct action that got us on the
Today, a few chapters of ACT UP remain — primarily led by New York and Philadelphia — but
their mission has changed. More than a decade ago, ACT UP made global headlines with radical
protests against government and religious leaders.
But with the introduction of new treatments, lower drug prices and the death of many of its early
leaders, the organization’s intensity subsided. With the emerging pandemic in Africa, some ACT UP
groups focus on combating AIDS in developing nations.
The Silver Ring Thing
ACLU Reproductive Rights Blog
Thursday, February 23. 2006
The Silver Ring Thing
Back in May, the ACLU filed a lawsuit against the federal government for its funding of religious
activities in the abstinence-only-until-marriage program the Silver Ring Thing. Today, the ACLU
finally has a settlement in the case.
The Silver Ring Thing is a nationwide ministry program that uses abstinence-only-until-marriage
sex education as a means to bring "unchurched" students to Jesus Christ. Over the past three years
the federal government awarded over one million taxpayer dollars to the program.
During the Silver Ring Thing's flagship three-hour program members testify about how accepting
Jesus Christ improved their lives, quote Bible passages, and urge audience members to ask the Lord
Jesus Christ to come into their lives. In addition, the official silver ring of the program is inscribed
with a reference to the biblical verse "1 Thess. 4:3-4," which reads "God wants you to be holy, so
you should keep clear of all sexual sin. Then each of you will control your body and live in holiness
Obviously the Silver Ring Thing is free to hold these types of programs; however, a problem arises,
and the ACLU gets involved, when taxpayer dollars are used to fund religious activities.
Now, just over nine months later, the government has agreed to settle the lawsuit and not to fund the
Silver Ring Thing's abstinence-only-until-marriage education program as it is currently structured.
Additionally, any future funding of the program is contingent on the Silver Ring Thing’s compliance
with federal law prohibiting the use of federal funds to support religious activities, and the
government has agreed to closely monitor any future grants to the program.
The organizer for our Immigrant Rights coalition, Evelyn Sanchez, recently found herself
(somewhat unexpectedly) debating Pat Buchanan on "Scarborough Country" (the far-right talk show
on MSNBC) about the so-called "controversy" around singing the national anthem in Spanish.
We're very proud of her message discipline! Even though these conservative talk shows are a
complete set-up, we think she won the debate- at least by the standard of appearing more reasonable
than her opponents.
SCARBOROUGH: “The Star Spangled Banner”–it‘s a song that‘s been ingrained in American
culture since Francis Scott Key penned a poem for the original flag that survived a night of British
bombardment at Fort McHenry back in 1814. Now, maybe the national anthem‘s long and storied
history is why so many Americans are upset that a new Spanish version has not only changed the
language but also key words. So now even “The Star Spangled Banner” has made its way into the
increasingly contentious immigration debate. Changing the national anthem‘s words is not a
concept that caught on with the Kid From Brooklyn, either. And if you don‘t like the sound of
bleeps, time to go pour yourself another cup of Sanka because the Kid is back, he‘s mad as hell, and
he‘s not going take it anymore.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: About the national anthem, Joe, what the (DELETED)‘s the story? They
want to do it in (DELETED) Spanish now? Are you (DELETED) kidding me? The last time I
heard, this was the United States of America! If you don‘t know how to sing the national anthem in
English, then get the (DELETED) out! Go back where the (DELETED) you came from! This is
America! Anyway, this is the big man. I‘m steaming up with that national anthem,
www.thekidfrombrooklyn.com <http://www.thekidfrombrooklyn.com/> and the big man‘s always
happy to see you!
(END VIDEO CLIP)
SCARBOROUGH: And I‘m sure some of our viewers are always happy to see you, big man. Our
thanks to the Kid From Brooklyn for celebrating the 2nd Amendment with us tonight. Now, if you
want your voice to be heard, send us your video blog to firstname.lastname@example.org.
A lot of Americans are so angry, and we‘re going to continue celebrating the 1st Amendment now,
though, through a more dignified manner with MSNBC analyst Pat Buchanan, and also, from
northern California, Immigrant Workers Freedom Ride Coalition person Evelyn Sanchez.
Pat, let me begin with you. Americans–so many Americans I‘ve talked to are very angry about this
PAT BUCHANAN, MSNBC ANALYST: Well, it‘s a provocation and an insult. And you know, as
the great grandson of Francis Scott Key said, I mean, for a foreigner to come into this country and
then insult and alter our national anthem is simply despicable.
SCARBOROUGH: But isn‘t America the melting pot?
BUCHANAN: Yes, America‘s the melting pot, Joe, but we have our own–we have our own
symbols of nationhood. People are welcome to come here and become Americans. They‘re not
welcome to come here and insult the symbols of our country, and that‘s what these outsiders have
But it‘s a good thing in this sense. The American people are awakening to the character of these
SCARBOROUGH: Well, you say they‘re awakening to the character of these people–you see this
as a direct assault. Others would say–the State Department, in fact, Condoleezza Rice, said it was a
good idea because it would have more people singing their allegiance to the America. Do you
disagree with Condoleezza Rice?
BUCHANAN: I certainly do. I think this is an insult. Even Teddy Kennedy said “The Star
Spangled Banner” ought to be sung in English, and it ought to be sung with the words of our
national anthem. The good thing about this insult is that I think a lot of Americans are going to tell
their senators and congressmen, You had better not capitulate to these people demanding amnesty
and demanding the right to control our border, when a whole bunch of them are here illegally.
SCARBOROUGH: Evelyn Sanchez, what‘s your take on the Spanish national anthem? Do you
think this is going to actually hurt immigration reform being passed?
EVELYN SANCHEZ, CA IMMIGRANT WORKERS FREEDOM RIDE COALITION: Well, no
doubt that the national anthem being sung in Spanish, as you have said in the introduction, has
entered the debate, but by no means is it the central issue of this debate. What‘s more, I think it‘s
just a distraction point.
The important thing here is that there are millions of both immigrants and U.S. citizens that are
family members of these immigrants that have taken the streets today, proclaiming that they want
citizenship, that they want to become part of society, that they want Green Cards so that they can
integrate into our communities fully. I think that is the important thing that we need to focus on
SANCHEZ: ... and not get distracted by little–go ahead.
SCARBOROUGH: No, I was just going to say, Pat Buchanan, do you think that this–this Spanish
national anthem is a red herring?
BUCHANAN: No (INAUDIBLE) Well, look, it was done as a deliberate provocation and insult,
but there‘s also a side effort here. These characters want to make some money. They know if they
offend the Americans, the Americans will react because we love the national anthem and will act
like your friend did in Brooklyn.
But I do think–to get back to the fundamental point, I think the lady is correct, there is a basic point
here, and our basic point is you cannot break our laws, walk into our country, then march in our
streets under foreign flags and say, Give us citizenship in the United States. If you‘re so happy
under that flag, return to the country whose flag it is.
SCARBOROUGH: Evelyn Sanchez, respond to that.
SANCHEZ: Well, I would only have to say that these immigrants are people that have been here
now for literally years. They have formed families here. They have jobs here. Many have even
bought houses, have contributed to the economy as consumers, as workers, as taxpayers, as cultural
assets, et cetera. So they have won their right to become fully integrated into these communities,
and that‘s what the point of all these mobilizations are today. But...
BUCHANAN: These are not immigrants. These are not immigrants, these are intruders. We have
legitimate immigrants in this country who are entitled to all their rights, includes marching, if they
wish to do so. We have American citizens. These are people who broke in and do not belong here.
And if you take a look at it, they cost us in net (ph) enormous amounts of money. Their crime rate
is far above the national crime rate. They come in without health inspections. There many diseases
now in the United States that were not here 10 years ago, that are being brought from the third
world. And we got to get control of our borders. And they‘re not the ones to decide this. American
SCARBOROUGH: Evelyn Sanchez, do you understand why many American citizens would be
angry about these people taking to the streets today, protesting, using our 1st Amendment to protest
and then claiming that America is shutting them out, when many Americans just believe they don‘t
belong here because the first act they took was a crime, when they crossed the border?
SANCHEZ: Well, I don‘t know how many mobilizations Mr. Buchanan has been to, but I‘ve been
to several now. And I can tell you that there is widespread support on behalf of citizens for
immigrants. America has always welcomed immigrants, and it‘s no different today as it was in the
beginning of last century or in the founding of this country.
So I believe that all Americans accept immigrants and are willing to embrace them, and that what is
more, there are thousands (ph), and most American citizens are pushing for the Senate to do the right
thing and to integrate these people into our society and to give them citizenship.
BUCHANAN: We welcome immigration. We don‘t welcome an invasion by 12 million illegals!
SCARBOROUGH: And Pat, very quickly, do you believe that, in the end, that this immigration bill
will die because of this issue and because of the marches today?
BUCHANAN: I think today‘s marches–and I think this–this “Star Spangled Banner” insult will
make it very, very difficult for Republicans or Democrats to start declaring amnesty for the people
that did it!
SCARBOROUGH: And I think we heard that today, as you say, even from Teddy Kennedy. This
was not helpful today for those that believe in the president‘s immigration reform bill. Pat
Buchanan, Evelyn Sanchez, thank you so much for being with us tonight.
CQ WEEKLY ˆ COVER STORY
June 5, 2006 ˆ Page 1548
Meth vs. Crack: Different Legislative Approaches
By Seth Stern, CQ Staff
When Rep. Elijah E. Cummings visits rural communities in the Midwest that have been ravaged by
methamphetamine use, he hears stories of despair and damage not unlike those he heard during the
crack epidemic of the 1980s. His hometown of Baltimore includes some of the neighborhoods that
were devastated the worst by crack, the last drug epidemic to draw an intense response from the
federal government and local law enforcement.
The similarities exist despite fundamental differences between the populations affected by the two
drugs. Meth is used mostly by white people in rural areas, while the epicenters of the crack epidemic
were the African-American communities of the inner cities.
"If you were to close your eyes and listen to how they talk about the effect on communities, how it
breaks up families and drives down property values, you would swear they were in any urban
community" during crack's heyday, Cummings says.
What's different this time are the solutions that his congressional colleagues are promoting. The first
comprehensive federal anti-meth law, enacted this year, focuses on cutting off the supply of the
chemical ingredients used to make the drug ˜ not on toughening punishments for dealers or users.
"There seems to be more of an emphasis on shutting down these meth labs and trying to figure out
ways to treat these addicts and then get them back into flow of society," says Cummings, a Maryland
Democrat. "We don't get for crack or heroin that kind of support for prevention, treatment and
Cummings is not alone in pointing out the apparent double standard, in both policy and rhetoric, that
Congress is applying to the growing scourge of methamphetamine abuse. Lawmakers in both parties
consistently characterize meth addicts in more sympathetic terms than they describe crack addicts,
and they are showing far less enthusiasm for imprisoning users than at the height of the crack
problem two decades ago.
It's not that meth is generating any less concern in affected areas today than crack did two decades
ago. In both instances, members of Congress warned loudly that police in their communities were
overwhelmed by a cheap, easy to obtain, highly addictive and almost untreatable menace.
Although lawmakers almost always rebut the notion, their own rhetoric suggests that race is an
essential ˜ albeit, perhaps subconscious ˜ reason they are treating the two drug epidemics differently.
Some sociologists and criminologists say the racial component is obvious.
"The difference is, meth is a white drug," says Daniel F. Wilhelm of the Vera Institute of Justice, a
New York nonprofit organization that seeks to reduce racially disparate prosecutions.
"You don't see any pictures of young black men and women described as the face of meth," said
Marc Mauer of the Sentencing Project, which advocates for overhauling sentencing law ˜ a reference
to the before-and-after mug shots that sheriffs' offices and lawmakers often display to highlight the
physical toll of meth addiction.
Sixty percent of people sent to federal prison for meth crimes were white and just 2 percent were
black in fiscal 2004, the last year with complete statistics reported by the U.S. Sentencing
Commission. By contrast, 10 percent of the people convicted of crack crimes that year were white
and 80 percent were black. (In both cases, Hispanics represent the bulk of the difference.)
Leaders in setting drug policy on Capitol Hill have three principal explanations for why Washington
is approaching the meth problem differently from the crack problem. First, manufacturers of
methamphetamines ˜ also known as crank or speed ˜ are uniquely dependent on a few commercially
available chemical ingredients, so targeting them instead of the people involved is the more efficient
way to limit the drug. Second, congressional enthusiasm for tough mandatory minimum prison
sentences has waned recently among Republicans and Democrats alike. And, finally, the political
benefits of waging a war on drugs has declined in recent years, especially as the nation's voters'
attention has been shifted more to the war on terrorism since Sept. 11.
Still, listening to the way members of Congress talk about meth users and the images they invoke to
portray the problem leaves observers such as Craig Reinarman, a sociology professor at the
University of California Santa Cruz convinced that many lawmakers at least talk about drug users
differently when they're "drawn from the good old boy segment of our society, the us rather than the
The 'Most Virulent' Drug
What hasn't changed is the level of alarm that members of Congress from both parties profess when
they decide there's a drug crisis.
Who Gets Convicted
In 1986, they expressed anxiety over the emergence of crack, a cheap cocaine derivative that
delivers a quick, powerful but relatively short-lived high when smoked. Then, too, there was a racial
subtext to the rhetoric ˜ particularly after the death of Len Bias, who had been picked first by the
Boston Celtics in that year's NBA draft.
His high-profile death on the suburban University of Maryland campus exactly 20 years ago this
month was initially attributed to an overdose of crack. Though an autopsy later showed cocaine
rather than crack caused Bias' death, it nonetheless helped fuel a hysteria that summer about the
drug, driven in part by fears that crack would jump "into the suburbs on both coasts," as a
Newsweek cover story warned at the time.
In the succeeding months, lawmakers competed to describe crack in dire terms. Peter W. Rodino Jr.,
the New Jersey Democrat who then chaired the House Judiciary Committee, called it a "plague on
our nation." Republican Sen. Paula Hawkins of Florida, warned that it turned people "into walking
crime machines." That state's other senator at the time, Democrat Lawton Chiles, said it can "make
people into slaves."
Twenty years later, there is a new and bipartisan push to describe meth as an even worse drug
plague. While it has been available much longer than crack, its use has grown ˜ and spread
geographically ˜ much slower. Motorcycle gangs sold meth along the Pacific coast in the 1960s, but
only in the last decade has its use spread widely throughout the West and into the Midwest. The
drug's popularity has been principally in rural communities, which lack police forces and treatment
centers to fight it.
The number of meth addicts more than doubled between 2002 and 2004, the year when the number
of people who said they'd used meth in the previous year (1.4 million) for the first time exceeded the
number who said they'd used crack (1.3 million), according to the Department of Health and Human
Services. By 2005, a National Association of Counties survey of mostly rural and suburban
jurisdictions found meth as the biggest drug problem for local law enforcement agencies.
Where the Labs Are
Lawmakers argue that meth ˜ which can be smoked, snorted, orally ingested or injected ˜ is even
cheaper to purchase, easier to find, more addictive and more harmful to the body than crack. Orrin
G. Hatch, the No. 2 Republican on the Senate Judiciary Committee, calls it "the most virulent drug
there is." Another Utah Republican, Rep. Chris Cannon, says that while "crack is associated with
fast living," meth "is like crashing into a wall."
Rural and suburban lawmakers from the West and Midwest profess shock at the level of addiction
that has reached into their parts of the country, which have never before been associated with
widespread drug abuse.
Meth "is disturbing the quiet peaceful feelings in rural parts of the country," laments Republican
Rep. Mark Kennedy of Minnesota, who represents suburbs north and east of the Twin Cities. "Its use
is now also transcending social classes and gender," says Rep. Ra??l M. Grijalva, a Democrat whose
Hispanic-majority district includes most of Arizona's border with Mexico. "There is no common
denominator in categorizing a meth user. It could be your neighbor, a family member, a teenager, a
Users as Victims
The lawmakers most vocally concerned about meth reject the notion that they're sympathetic to meth
users because they tend to come from a higher-income, less urban and more white demographic than
users of other narcotics.
In fact, Republican Mark Souder, who sponsored the House version of the anti-meth legislation
enacted this year, says he and his northeastern Indiana constituents have less compassion for meth
users than for other addicts. "When you come from areas where you see opportunities exist and you
get whacked out on drugs, the sympathy is less than for in urban areas where they have no jobs or
may not have fathers," he says.
But when many members talk about meth users, their sympathy often shines through.
"I view many of them as victims," says GOP Rep. Ken Calvert of Southern California.
Kennedy invoked "the tragic story of a young girl named Megan from a beautiful town" in his state
when he appeared before a House Judiciary panel last fall to promote his own meth-fighting
legislation. She got hooked on meth in seventh grade and turned to prostitution to pay for her habit,
he said, and "In the face of so much suffering, we have an obligation to act."
Democrat Rick Larsen, who represents suburban territory north of Seattle, volunteers that he has no
particular sympathy for meth users. But when talking about them, the constituent he first invokes by
name is Ashley Kerwin, who became addicted at age 15 even though she is from "a good family,
solid family" with a father who is "a successful commercial realtor."
And, at a Senate Finance Committee hearing in April on meth's effects on the welfare system,
Republican Chairman Charles E. Grassley of Iowa and ranking Democrat Max Baucus of Montana
clapped after a pair of recovering meth addicts from suburban St. Louis, Aaronette and Darren
Noble, described their recovery. They applauded even though Darren, 34, had described how he
served 46 months in prison for manufacturing meth. (Baucus also cooed over the "big blue eyes" of
the couple's 15-month-old daughter, Summer, who sat on her mother's lap. The Nobles had only
recently regained custody because she was born with meth in her system.)
In an interview later, Baucus said he was "quite certain" he would have reacted the same way to
similar testimony by crack addicts. But, minutes later, he conceded that he feels more sympathy for
meth users because "there are more kids involved, it's harder to solve, addictiveness is higher than
crack or heroin."
The greater sympathy expressed by members of Congress, such as Baucus, is not much different
than how African-American members responded to crack: Lawmakers are most concerned with
problems that affect their constituents most directly. The problem is how little overlap there is
between those two groups of lawmakers. Of the 138 members of the Congressional Meth Caucus,
127 are white.
Law enforcement officers on the front lines view the issue quite differently. Jim Tilley, who runs the
Drug Enforcement Administration (DEA) field office in Baucus' home state and worked as an agent
in New York City during the peak of the crack epidemic, rejects the idea that meth users are "just
our neighbors or just people with some problems."
"The same people who use meth also sell meth, or cook it and sell it, and it ends up in our schools,
your neighborhood," Tilley said. "Most people realize that, whether it's meth or crack, people have
problems, but it doesn't get into our schools by itself."
Mark A.R. Kleiman, a UCLA public policy professor who studies drug addiction, says such lack of
sympathy among law enforcement is typical: "If you talk to rural deputy sheriffs about meth users
and urban cops about crackheads, you're going to hear exactly the same thing: These are bad scary
Tough on Crack
Concern about crack infused the writing of the anti-drug statutes of both 1986 and 1988 ˜ the statutes
that continue to dominate the way federal lawbooks address narcotics, and the baseline from which
Congress starts in reshaping drug laws.
The 1980s laws did everything from mandating drug testing to funding domestic drug treatment and
education and international interdiction. And buried in each were provisions subjecting people
connected with crack to more stringent punishments than those connected to any other drug.
Without any legislative hearing and little controversy at the time, Congress in the 1986 law created
the first mandatory minimum prison sentences for traffickers in different types of narcotics. For
every drug except crack, the amount required to subject a person to the mandatory minimum
appeared to approximate the quantity that a mid-level dealer might have in his possession for resale
and was far above the amount someone would normally obtain for personal use.
For crack, however, the trigger was set much lower. And so there is a 100-to-1 differential between
what subjects a powder cocaine dealer versus a crack cocaine dealer to a mandatory minimum stay
in federal prison. Trafficking in 500 grams of powder ˜ which can yield 10,000 or more "lines," or
doses ˜ draws the same five-year sentence as trafficking in five grams of crack, which yields no
more than 50 "hits" off a pipe. Trafficking in 5,000 grams (or 11 pounds) of powder or 50 grams of
crack triggers yields an identical a 10-year mandatory minimum.
The disparity was motivated partly by crack's perceived role at the time in spawning particularly
violent crime and partly by the nature of the drug's distribution: Generally street dealers, not
wholesaler "kingpins," put cocaine, baking powder and water in a microwave oven to create crack
rocks for retail sale.
The 100-to-1 differential has contributed to the incarceration of huge numbers of African-
Americans, who commit more than 80 percent of crack crimes. The average sentence for someone
convicted of a crack crime in fiscal 2004 was 118 months, 38 months longer than for a cocaine
crime and 26 months longer than for a meth crime.
The differential was determined not by any objective determinations of crack's more serious impact
on society, said law professor David Alan Sklansky of the University of California at Berkeley, but
instead was the result of a drive among lawmakers to come up with the toughest possible response.
The differential "was driven by this hysteria about crack cocaine and by a lack of concern about who
would be receiving these sentences," Sklansky said. "That lack of concern was related to the fact that
everybody understood that crack dealers were black men."
That view is echoed by Eleanor Holmes Norton, Washington's non-voting Democratic delegate in
the House: "Nobody in the African- American community will think it's not racially connected," she
says of the differential. "It has to do with being unsympathetic towards drug dealers in the ghetto."
Those sentiments hardly surfaced in the congressional debate. In fact, such influential black
lawmakers as Democrat Charles B. Rangel of New York, who at the time chaired a House Select
Committee on Narcotics Abuse, initially supported the differential as a way to curb what that they
viewed as a dangerous and potent drug devastating their constituents.
In 1988, Congress went on to create the first ˜ and still only ˜ mandatory minimum federal sentence
for simple possession of a drug: Conviction for holding five grams of crack (three grams, if it's a
second offense) draws a required five-year term. Simple possession of any amount of cocaine, by
contrast, is a misdemeanor punishable by a year in jail.
Crack possession is rarely prosecuted on its own and accounts for less than 1 percent of crack
offenders sentenced in federal court. But former federal prosecutors say that having the option to
prosecute such an offense can provide them leverage in obtaining plea agreements.
Targeting the Labs
While lawmakers of today describe meth as a scourge as severe as crack, if not worse, there has been
no concerted legislative effort to create a mandatory minimum sentence for its possession. And this
winter, congressional negotiators rejected an effort to make the mandatory minimum sentence for
meth traffickers even stiffer than for crack traffickers ˜ at least five years for peddling as few as three
grams, and 10 years for selling as few as 30 grams.
Who Takes Speed
With almost no notice, Congress, in the omnibus appropriations package of 1998, lowered the drug
volume thresholds for applying the mandatory minimums to meth dealers to be the same as those for
crack dealers. But the law continues to treat the two drugs unequally in this sense: Measure for
measure, speed provides at least three times ˜ and perhaps 10 times ˜ as many "hits" as crack.
While the negotiators rebuffed proposals to make the sentences for meth traffickers the stiffest in the
federal system, they did include some anti-meth measures in the extension of the 2001 law known as
the Patriot Act that provides law enforcement with particularly broad powers to combat terrorism.
Principally, the language focused on limiting backyard "mom and pop" meth production.
The DEA estimates the operators of such small-time meth labs produce about one-fifth of the drug
distributed in the United States. But they are a disproportionately large concern to rural law
enforcement agents because the highly flammable toxic stews used to make the drug can injure
innocent bystanders and put police and firefighters at severe health risk.
Recipes for meth are readily available on the Internet, and the required equipment ˜ coffee filters, a
pressure cooker and gas cans ˜ can be purchased at the hardware store for about $50. The key
ingredient is pseudoephedrine, which is a principal ingredient of many cough and allergy medicines,
such as Sudafed, on the shelves of pharmacies and convenience stores. The new law seeks to limit
the supply of pseudoephedrine available to meth makers by limiting consumer purchases of
medicines containing that chemical and requiring sales of those medicines from behind the counter
as a means of curbing theft.
To address international production, the law authorizes funds to halt speed production in Mexico and
requires major exporters and importers of drugs containing pseudoephedrine report their
transactions. The rationale for focusing the campaign against meth on its ingredients is simple: It's
much easier to enlist the corporate manufacturers and retailers of its precursor chemicals than to shut
down the thousands of heroin poppy and coca fields spread all over the world.
Beyond Mandatory Minimums
In the two decades since the crack epidemic peaked, much has changed in Congress' view of how
best to fight drugs and punish those at the bottom of the supply chain.
In 1986, mandatory minimums and the entire federal sentencing guideline system were new
innovations. "It was still a moment in time that sentences were still relatively low and there was a
naive belief that severe sentences could be the solution to this problem," said Douglas Berman, a
criminal law professor at Ohio State University. "It's a radically different historical moment. We're
at a time that we've got a greater realization that severe sentences cannot alone be the answer."
Souder says this year's anti-meth law reflects that lesson. "We're not abandoning possession, but
we're being more sophisticated about the networks," he said. "Ultimately, we understand if we're
going to beat meth, it's going to be international, it's got to be along the borders, it's got to be at the
distribution systems. As long as they're there, you will have possession."
With the exception of child sex crimes, there is little enthusiasm in Congress for writing new
mandatory minimum sentences. This winter, for example, the chairman of the House Judiciary
Committee, Republican F. James Sensenbrenner Jr. of Wisconsin, stripped a collection of proposed
mandatory minimum sentences from legislation aimed at curbing both street gangs and violence
against judges. He did so, he said, to ease the bill's passage.
Rather than toughening punishment, Baucus says, "people are more concerned about prevention and
rehabilitation and getting the bad actors." And such a sentiment comes not only from Democrats.
"My focus has not been on punishing users," says Kennedy, who is the GOP candidate for the
Senate in Minnesota this year. "I'm focused on those who are preying on those who may ultimately
become meth users."
Souder, too, concluded that securing the new restrictions on pseudoephedrine was more important in
the fight against meth than toughening the sentencing of the dealers ˜ especially given the resistance
from pharmaceutical companies and retailers to the notion of restricting access to cough syrup. In
the end, Souder urged Sensenbrenner to drop the mandatory minimums in a bid to boost support for
the restrictions on the medicines. "We decided moving ahead in a bipartisan way was more
important than arguing over the minimums," he said. "For some Democrats, it was a non-starter. It
was simply not the most important thing we wanted to do."
The broader political context of the fight against crime has also changed significantly in the last two
decades. Polling during the 1986 and 1988 campaigns found that combating drugs was the nation's
top priority. President Ronald Reagan and Democrats in Congress competed to come up with the
most aggressive solutions.
"The Democrats were finally figuring out they couldn't afford to be portrayed as soft on crime, and
Republicans figured out running on crime and justice issues served their interests very well,"
Now, crime and drugs have clearly become second-tier issues; in their nationwide polls during the
past six weeks that sought to gauge which issues will matter the most to voters this fall, neither
CNN, CBS, Harris, Fox or NBC even suggested those issues as an option. Instead, they have been
supplanted as the principal political litmus test for judging lawmakers' toughness. "Terrorism has
sort of superseded it," Hatch said. "People are more concerned about terrorism now."
Ships in the Night
Another reason for the emerging double standard is that few lawmakers notice it. Those in Congress
most engaged in the fight against meth are almost completely different from the set of lawmakers
most concerned about crack. In general, members of each group focus on a drug problem that affects
their own constituents and ignore the one that doesn't.
Only five of the 44 members of the Congressional Black Caucus, which has taken the unofficial lead
at the Capitol on the crack issue, also belong to the Meth Caucus. Several members of the Black
Caucus describe themselves as not paying any attention to the meth issue.
Cummings stands out as an exception. But his interest has little to do with parochial concerns.
Instead, it has grown from his assignment as the top Democrat on a House Government Reform
subcommittee assigned to oversee federal criminal justice and drug policy. Cummings has
accompanied Souder, the panel's chairman, to field hearings on meth in rural Ohio, Kentucky and
With the area of intersection so small, few lawmakers are working to make federal policy treat
crimes connected to the two drugs more consistently. That could most readily be accomplished by
eliminating the unique mandatory minimum for crack possession and by increasing the quantity of
crack required to draw a mandatory minimum for trafficking, as the U.S. Sentencing Commission
recommended four years ago.
A bill by Roscoe G. Bartlett, a Maryland Republican, to narrow the sentencing differential has
drawn just three cosponsors. There is no companion bill in the Senate, where Hatch last proposed
similar legislation in 2001. Making punishments for crack crimes closer to that of other drug crimes
is a matter of "decency and fairness," Hatch says, but there is minimal interest in the idea among his
"Political realities make it too dangerous," Berman said, because advocates of lessening the crack
penalties would inevitably be portrayed by their opponents as soft on crime. "Nobody sees the
political benefits of this. It's very hard for anyone to see the political pros of this and extraordinarily
easy to see the cons."
With the law to limit access to meth ingredients on the books, members of the House Meth Caucus
and the Senate's leading voices against the drug, Democrat Dianne Feinstein of California and
Republican Jim Talent of Missouri, say their top priority is providing more money for treatment.
Law-and-order Republicans' experience with meth may lead them to rethink harsh prison sentences
for drug crimes across the board. Or they could buttress their contention that race plays no role in
their policy making by instituting mandatory minimums that sweep in as many users and low-level
dealers of meth as of crack.
Even supporters of this year's law acknowledge that, while putting cold medicines behind the
counter may help curb local meth labs, it's unlikely to significantly reduce meth use.
If the focus on interdiction and treatment fails, Congress could turn to tougher criminal sentences as
a way to show their constituents they are doing something about the problem. Or it might focus its
ire on Mexico, the main location of the "super labs" that will supply almost all meth to the United
States even if the mom and pop labs shut down.
In the coming years, said Daniel Richman, a Fordham University law professor and former federal
prosecutor, "I could imagine a legislative response to meth that wouldn't look much different than
the legislative response to crack."