The first day of April could have been a turning point in ending the AIDS epidemic. That was when Congress’s freeze on secretary of health Donna Shalala’s power to lift the ban on needle exchange ended. In the week prior to the deadline, it looked like she and President Clinton would finally do what scientists, researchers, public health experts and activists had long pleaded for: Lift the ban. Shalala scheduled a press conference for a big-news Monday, and her office leaked word of the long-overdue announcement. White House staffer Marcia Scott excitedly told F.O.B.-with-AIDS Bob Hattoy, at a chance grocery-store meeting, that “the president’s going to do the right thing!”

On the weekend before the planned announcement, General Barry McCaffrey, the U.S. drug czar, sat next to the president on a plane back from Chile, and had his ear for several hours. McCaffrey has had a Svengali-like hold on the president’s drug policy for years. He adamantly opposes needle exchange. Sources report that he threatened to resign if the ban was lifted or to denounce Clinton, accusing him of promoting drug use. Unbelievably, McCaffrey, a Clinton appointee, had already alerted anti-Clinton members of Congress to mobilize their forces to maintain the ban.

On Sunday, after Clinton and McCaffrey’s return, word spreads that Shalala’s press conference is canceled. At noon on Monday, AIDS Policy Office staffer Daniel Montoya, San Francisco AIDS Foundation’s Regina Aragon, Bob Hattoy and others hunker down in AIDS czar Sandra Thurman’s office to strategize. They fear that Clinton’s AIDS legacy will be defined by his refusal to take this simple, cheap, lifesaving step. Thurman gets a call from senior Clinton advisor Rahm Emmanuel. He tells her that the White House has decided to keep the ban in place. Frustrated, Thurman urges more consideration. Former ballet dancer Emmanuel turns a nasty pirouette: “Fuck you!” he yells at Thurman. “I didn’t call to argue with you! I called to tell you what to say to the press!”

Thurman, refusing to toe the administration line, goes home. Shalala has her press conference, first affirming that needle exchanges save lives while not increasing drug use, and then defending the ban, with NIH head Harold Varmus and new surgeon general David Satcher looking on. The New York Times reports that both doctors “shifted uncomfortably in their seats as reporters peppered Dr. Shalala with questions, although none publicly disagreed about it.” But Scott Hitt, Clinton’s defender-in-chief as head of his AIDS advisory panel, has had enough. He tells the Times: “At best this is hypocrisy. At worst, it’s a lie. And no matter what, it’s immoral.” Thurman declines comment.


I strongly disagree with General McCaffrey’s position on needle exchange and, for that matter, the entire failed approach to the so-called war on drugs. But one thing no one can disagree with: McCaffrey knows the power of a high-level appointee’s threatened resignation or public denouncement. And he was bold enough to play that card. Sadly, on the issue of needle exchange, the most powerful players on our side never showed that level of courage or effectiveness.

For better or worse, history will likely remember Bill Clinton as good for the gay lobby. Yet in terms of HIV prevention right now there is no issue more urgent than needle exchange. Not gay marriage. Not gays in the military. Not the employment nondiscrimination bill. Decisions made today about whether to lift the ban on needle exchange and to end content restrictions on public AIDS education literally determine if people live or die. Let’s hope that Clinton’s modestly supportive (albeit failed) initiatives on gay issues are never confused with his record on AIDS, which is one of cowardice, opportunism, callous disregard and cynical dismissal. It is a record of shame, and indefensible.

Everyone in politics with a conscience has a limit beyond which they cannot rationalize actions counter to their own personal morality. For those who care deeply about AIDS, this latest knife in the heart of HIV prevention must surely be the last straw.

In the end Shalala did urge Clinton to lift the ban. Yet her 11th-hour support is too little, too late. Donna, for six years, we’ve reasoned, begged and screamed for you to exercise leadership on this issue.  Instead, most of that time, you took a walk. Now that your boss has barred you from doing what you know is right, you should resign. Go run for governor; go write your book and get rich. You’ll do less harm to PWAs or people at risk that way.

A final irony. On the evening of the announcement, Shalala attended a New York City gala for the International Women’s Health Coalition, a leading advocate for sexual and reproductive rights in developing countries. Chatting and toasting with the elite of the feminist health movement, Shalala gave no sign that earlier in the day she had selected thousands of women and children for death from dirty needles. Neither did anyone else in the room.