Needling Clinton.

ON APRIL 23 PRESIDENT CLINTON ALLOWED BAD POLITICS to override good science in our battle against AIDS. On the same day that his secretary of Health and Human Services declared, finally, that science had proved that needle-exchange programs reduce HIV infections without encouraging drug use, our president ordered that federal funds could not be used for this purpose. It was the kind of "split the baby" mentality that has haunted this administration since its earliest days.

In political life it is difficult to publicly challenge the decisions of allies who stray into unacceptable territory, part the president has been our friend on AIDS. Funding levels for AIDS programs and research have increased dramatically, even when overall discretionary spending has stagnated. Drug approvals come faster, research is better coordinated, services are expanding. All of this deserves our praise. Unfortunately, good is not good enough in the fight against AIDS. Until a cure and a vaccine are found, the HIV epidemic must be treated as the health crisis that it is.

Since dirty needles are the cause of more than half of all new HIV infections, needle exchange is needed now. Annually more than 20,000 people in this nation alone contract HIV directly or indirectly through dirty needles. Without funds to effectively combat this mode of transmission, thousands will continue to be infected, and many will die.

In 1995 Clinton articulated his goal of "[reducing] the number of new [HIV] infections each year until there are no more new infections." His decision to withhold federal funds for needle exchange will make it impossible to achieve his stated goal.

This issue requires political courage and, most important, leadership to educate people about the lives that could be saved. Fifteen years ago, then-surgeon general C. Everett Koop refused to be politically intimidated and insisted that this nation follow the science with respect to HIV. Koop set the standard for political courage. The Administration could have done the same, allowing individual communities the choice as to how best to use their federal prevention money, including funding the exchange of clean needles to injection-drug users. But instead the president stepped in and, ignoring the unanimous advice of AIDS czar Thurman, Health and Human Services secretary Shalala, National Institutes of Health director Varmus, and Surgeon General Satcher, said that no federal dollars could be used by local communities to implement these lifesaving programs.

So to whom did the president listen? Remarkably, he followed the biased, conventional, and conservative advice of Gen. Barry McCaffrey, a drug policy czar with no public health or medical experience. All McCaffrey could say was, "It sends the wrong message." The general could be a major force in coordinating HIV-prevention programs, but his prejudice and narrow-mindedness have proved to be major stumbling blocks. Clinton and Congress must rise above political rhetoric, respect good science, and communicate the facts directly to the nation. Any needle-exchange policy would likely face an uphill battle on Capitol Hill, with Republicans eager to cast Clinton as a " soft on drugs" demagogue by distorting this vital health care issue. But the chance of wasting some political currency by fighting for a program whose benefits are so clear should not deter the Administration. Until such leadership comes from a president or a Congress, the epidemic will rage on, fueled as much by political expedience as by HIV.

Hitt is chairman of the Presidential Advisory Council on HIV/AIDS, which is March gave a unanimous vote of no confidence regarding the Administration's ability to carry out Clinton's stated goals on HIV prevention.