The New York Needle Trial: the politics of public health in the age of AIDS.
During the past 5 years, the exchange of sterile needles and syringes for dirty injecting equipment has gained increasing acceptance outside the United States as a potential means of reducing the transmission of the human immunodeficiency virus (HIV) among intravenous drug users. This article describes the controversy over attempts to establish a needle and syringe exchange scheme in New York City between 1985 and 1991. The response to a health crisis is used as an indicator of patterns of social and institutional practice. Advocates of needle exchanges had reached a stalemate with the promoters of law enforcement, and the strategic reformulation of the policy problem in terms of the research process seemed to offer a solution. The article discusses the practical limitations on designing and carrying out a controversial health promotion policy; the use (under constraint) of a restrictive research process to constitute--rather than simply to guide or monitor--public policy; and the potential ethical hazards of health professionals' seeking a polemical recourse to the clinical trial. The efforts to establish a needle exchange in New York thus illustrate more general problems for AIDS prevention.
Anderson
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History and Sociology of Science Department of the University of Pennsylvania, Philadelphia 19104-6310.
D000163:Acquired Immunodeficiency Syndrome / Q000266:history / Q000517:prevention & control*; D002986:Clinical Trials as Topic / Q000266:history; D003140:Communicable Disease Control / Q000266:history*; D006291:Health Policy / Q000266:history; D049673:History, 20th Century; D006801:Humans; D038622:Internationality; D035846:Law Enforcement; D009339:Needles / Q000600:supply & distribution*; D009519:New York City; D010865:Pilot Projects; D011057:Politics; D011634:Public Health / Q000266:history; D018570:Risk Assessment; D015819:Substance Abuse, Intravenous