Injecting drug abuse with safe practices
One-third of all new AIDS cases in the United States can be traced to injection drug users who share infected needles, according to the Bethesda, Md.-based National Institute on Drug Abuse. For that reason, cities and states are working to stop the spread of the disease, in part, through needle exchange programs (NEPs) that allow injection drug users to legally exchange used syringes for sterile ones and to buy a limited number of syringes over the counter without a prescription.
“[NEPs] get people out of the shadows,” says Matthew Lopes, coordinator of AIDS services in New Haven, Conn., which established the first legal syringe exchange program on the eastern seaboard in 1990. The program combines the needle exchange with counseling and treatment programs. Lopes says every time injection drug users exchange used needles, they have an opportunity to receive treatment.
Despite a 12.3 percent decline of AIDS cases in New Haven since 1990, many people oppose NEPs and believe the programs condone drug use and contradict abstinence-based educational and treatment programs. For example, in April, the Westport, Mass., Board of Selectmen unanimously approved establishing a NEP but was forced by community opposition to reverse it just three days later.
Phillip Fiuty, harm reduction program coordinator for the New Mexico Health Department, says the key to establishing NEPs is getting everyone on board, including local health councils, law enforcement and the community. New Mexico has been slowly implementing NEPs in all 54 of its health offices.
Winning over individual communities is half the battle. Tucumcari, for instance, was a town with a high amount of drug activity but was not receptive to NEPs until recently. Fiuty says his team slowly moved in, distributing participant identification cards that allowed users to legally carry drug paraphernalia. They also began working through the local district attorney’s office to educate law enforcement about the programs and provided them with safety equipment, such as Kevlar gloves for protection against needle sticks during searches. In November 2004, the town passed a resolution to support a NEP.
Some states, however, remain reluctant. In New Jersey, which has the fifth highest HIV rate in the country, legislators have successfully fought NEPs. In October 2004, then-Gov. James McGreevey signed an executive order declaring a “state of emergency,” which allowed health departments in up to three cities to establish NEPs. In June of this year, four legislators filed a request for an injunction, which was granted. “It is my firm belief that you cannot separate drug use from its associated crimes,” says Republican Assemblyman Joseph Pennacchio, one of the legislators who filed suit. “I do not want to enable the state to become a part of that equation.”
Establishing NEPs in drug-riddled cities has been further hampered by the federal government, which has banned the use of federal dollars for the establishment or operation of NEPs since 1988. “You need to speak to the group in the middle,” says Edward Kaplan, an expert in HIV prevention program evaluation at the New Haven, Conn.-based Center for Interdisciplinary Research on AIDS at Yale University. “In the realm of values, religion and beliefs, if you can make clear the consequences and present things in stark terms, people can change their view.”
Annie Gentile is a Vernon, Conn.-based freelance writer.