Rapid Increase of AIDS in Users of IV Drugs Feared

The recent surge of the AIDS virus among intravenous drug users in San Francisco has led the newly created state Office of AIDS to predict that such drug-related infections will spread rapidly throughout the state, causing 12,500 to 25,000 new cases of AIDS, unless strong preventive programs are begun at once.

In San Francisco, the rate of IV-induced AIDS infection last year rose from 8% to between 16% and 20%, and health experts fear that Los Angeles will also experience a sharp increase within six to 12 months. In Los Angeles, only about 1.8% of addicts are infected.

Threat to Heterosexuals

Failure to head off such a new round of infection poses an unparalleled threat to the heterosexual population because most IV drug users are heterosexuals who may well transmit the virus to their partners.

But despite the urgency of the problem, state attempts to head off a new rise in acquired immune deficiency syndrome cases have been largely ineffective, partly because drug-treatment agencies generally have shown little interest in helping out, according to public health officials and AIDS researchers.

They say this is so because, by emphasizing AIDS prevention, with its inherent message of using clean needles, drug-abuse prevention workers would find themselves in the ironic position of seeming to promote drug use.

“Drug-abuse people are not primarily interested in (AIDS) education for addicts but in making them non-addicts,” said William Schwied, a Los Angeles physician who works in a drug-treatment program.

$280-Million Funding

But such reluctance may soon erode, with an expected infusion of $260 million in federal funding for AIDS-prevention programs, including ones that would teach addicts how to avoid acquiring and spreading the disease. Drug-treatment agencies throughout California are preparing grant proposals to set up programs similar to those already existing in San Francisco, the city that again is out in front of the pack.

Drug-treatment officials concede that they generally have not tried to mount a massive anti-AIDS campaign aimed at IV drug users, although some have attempted to do so.

Chauncey Veatch III, director of California’s Department of Alcohol and Drug Abuse, said educating addicts about AIDS has not been a top priority in his department because “state law made the Department of Health Services the involved department” and other concerns were higher on his priority list.

But, Veatch added, his department will be involved in disbursing the state’s share of new federal money, which for the next fiscal year will be as much as $18.9 million. Veatch said he expects to announce in the next 30 to 60 days new AIDS-prevention projects directed at IV drug users.

“There is no funding,” said Dr. Irma Stranz, director of Los Angeles County’s Drug Abuse Program. She cited two instances in which the county’s application for state funds for such programs were turned down.

The first request--for a $240,000 program--was nearly 18 months ago. And last June, the county Department of Health Services, in cooperation with the Sheriff’s Department, asked the state Office of AIDS for $250,000 for an educational project aimed at reducing AIDS-related behavior among black and Latino IV drug users, including jail inmates. The Sheriff’s Department estimated that 60% to 80% of the 21,000 inmates jailed monthly in the county system are substance abusers.

The $240,000 grant went to a proposal from San Francisco.

Bad in San Francisco

“Educating addicts was terrible in San Francisco too, until about a year ago,” said Patrick Biernacki, co-director of the Mid-City Consortium to Combat AIDS, a nonprofit organization funded by state money.

“All we used to hear from the drug-treatment centers was that AIDS is a gay disease and not their problem,” he said. “But now many of those programs are in a panic because they find that many of their patients are developing AIDS.”

San Francisco today has an extensive AIDS-prevention program for drug abusers, including offering street addicts free condoms and bottles of bleach with which to sterilize their needles. The program has met with some opposition but nevertheless has been approved by the city health commission.

Dr. Donald O. Lyman, chief of the state Office of AIDS, estimates that half of the state’s current IV drug users, estimated at 200,000 to 500,000, may become infected if no prevention programs around the state are begun.

The spread of the AIDS virus can be unusually swift among IV drug users because they tend to share needles, which become quickly contaminated if there is an infected person.

In New York City, for example, 70% of all addicts are believed to be infected by the AIDS virus, and IV drug users account for 34% of all AIDS cases, according to health authorities. In Los Angeles, IV drug users account for only 2% of all AIDS cases.

And in New Jersey, half of the more than 1,800 AIDS cases reported are due to IV drug use. If the sexual partners of IV drug users and their children who got AIDS are included, the total accounts for 60% of all of New Jersey’s cases, according to Dr. Ronald Altman of the state’s AIDS activities and drug abuse program.

Free Needles Abandoned

New York City’s Health Department also proposed giving addicts free needles in order to discourage needle sharing, but the idea was abandoned, at least for now, as a result of strong public outcry.

According to Altman, New Jersey’s most effective program is one in which outreach workers mix with street addicts and persuade them to seek drug abuse treatment. In such settings, AIDS education already is provided.

“Eighty-five percent accept,” he said in a telephone interview. “But the problem is that the treatment centers become overwhelmed” and waiting time lengthens.

So far, in most of California except San Francisco, relatively few IV drug users have been found to be infected by the virus.

However, Lyman said, “unless intervention is begun, the high prevalence of virus infection now seen among gay and bisexual men will soon be present in the IV drug users also.”

Surveys show that at least 50% of San Francisco gays carry the AIDS virus, and it is predicted that up to 30% contract the disease.

The Office of AIDS is a part of the state Department of Health Services. One of its first mandates was to check the spread of the virus. Lyman chose to target IV drug users, the second-largest risk group.

“We went to drug-abuse (agencies) and all the other experts and found that they were all oriented toward treating addicts. But our need was for somebody to help prevent the transmission of a lethal agent by educating addicts,” he said.

Four Options Considered

Lyman and his staff considered four options for achieving their goal. They ended up discarding three of them as being politically or ethically impractical or as likely to have no effect on controlling the transmission of AIDS. These included stepped-up police action against drug users, providing addicts with free needles and encouraging police not to enforce the law that makes possession of drug paraphernalia a crime. The latter law is said to be one reason why addicts share needles.

“The fourth option, health education, is the one that we selected, even though we are well aware that it is difficult to educate a junkie,” Lyman said. “Education is the only approach that we see as being feasible, and we can’t even promise that even that will do the job.”

Nationally, IV drug users account for 17% of the 30,632 AIDS cases reported as of Feb. 9. About 80% of all heterosexual AIDS cases in the United States can be traced to drug users, according to authorities.

One of the most discouraging aspects of trying to control the transmission of the virus among addicts is their tendency to be uncooperative and unreliable, experts say.

In an attempt to get a maximum result from their preventive efforts, Lyman and his staff have divided drug users into several categories according to their likelihood to respond to education.

One of the most highly motivated groups consists of addicts who are already in methadone and other drug-treatment programs where they can receive counseling on how to avoid AIDS. Another motivated group, according to Lyman, are so-called recreational users, who account for about half of all IV drug users in the state.

Hard-Core Users a Problem

The biggest problem group, everybody agrees, consists of the hard-core users who have little or no contact with any mainstream social structure. To what extent any educational program would affect their behavior remains to be seen.

In Los Angeles, where the county Drug Abuse Program will distribute $22 million this year to 52 local agencies that treat addicts, only $70,000 is earmarked for AIDS-related projects, according to program director Stranz.

AIDS Project Los Angeles, a major focal point for education on the disease, is spending no money this year for addict education, but it will receive $700,000 from the state for that purpose next year, according to Judy Spiegel, director of education and training.

In addition, the Office of AIDS would like to spend the $900,000 initially earmarked to operate AIDS blood testing centers for addict education. The testing centers are being funded by federal money. To date, however, the office has not received authorization to do so from the Department of Health Services, the governor and the Legislature, according to Lyman.

His office currently spends $1.2 million to inform and educate addicts out of an annual budget of $19.1 million, which is aimed chiefly at the gay and bisexual populations.