County Weighs Giving AIDS Safety Tips to Drug Abusers

Orange County health officials are considering a controversial plan that would teach intravenous drug abusers to use their illegal drugs more safely, and without contracting AIDS.

But the idea of educating addicts about safer drug use, rather than enrolling them in a treatment program, poses an ethical dilemma for Timothy P. Mullins, who is in charge of Orange County’s drug-abuse programs.

“As a treatment person, I can’t condone that. . . . My whole program is based on abstinence,” Mullins said Wednesday. Such an approach, however, is already being used in New York and San Francisco and appears to be necessary if the spread of the deadly AIDS virus is to be slowed or stopped, he added.

Under the plan, expected to be presented to the Board of Supervisors Nov. 9, county health workers or private counselors under contract with the county would seek out some of Orange County’s estimated 8,000 intravenous drug users. In bars, city parks or barrio streets, caseworkers will spread this message: “If you are going to use, here are ways to use safely,” Mullins said.

These workers will try to enroll addicts in a drug-treatment program, but if the drug user has no interest in treatment, workers will continue to offer information on AIDS and safer drug use, Mullins and other health care agency officials said.

Modeling their efforts on similar outreach programs to youth gangs, health-care workers may also try to talk to drug dealers and the sexual partners of intravenous drug users. Although case workers may initially work with law enforcement agencies to locate hangouts for drug users, they will not report addicts to those agencies, county AIDS coordinator Penny C. Weismuller said.

“The word has to be ‘strictly confidential.’ We’re interested in drug users staying healthy,” she said.

The outreach effort would include free condoms, free testing for the AIDS virus, and information about the transmission of AIDS, including instruction on how drug users can keep their hypodermic needles and syringes clean, Weismuller said.

The AIDS virus is spread in an exchange of blood or bodily fluids, either through intimate sexual contact, shared hypodermic needles or from a mother to her unborn child, federal health officials have said.

Intravenous drug abusers account for 34% of about 43,000 AIDS cases nationally, health authorities have said, and about 70% of all addicts in New York City have AIDS. By contrast, only 2.6% of Orange County’s 538 AIDS cases have involved intravenous drug users, so authorities still have the chance to slow the spread of the disease here, Weismuller said.

Orange County’s outreach effort, budgeted at $473,000, is part of a $5-million federal program to treat intravenous drug users and educate them about AIDS.

Most of the county’s federal money will be used for treatment, Mullins said, but $154,000 is targeted for education, including the hiring of four or five “street-wise” caseworkers and a public health nurse to instruct drug users on safer drug use. Another $75,000 will be used to provide residential care for drug abusers who are sick with AIDS or AIDS-related illnesses, Mullins said.

Already, San Francisco and San Joaquin counties have begun similar outreach programs to intravenous drug users, and another 30 California counties now are studying how to use their share of the federal funds, Mullins said.

Although county health officials emphasized that the outreach effort was needed, they also termed it “controversial” and “sensitive” Tuesday at a meeting of the county’s AIDS advisory committee to the Board of Supervisors.

“Should we attempt to teach people to use these illegal drugs safely? That’s the $64,000 question,” Mullins said.

Three years ago, Los Angeles County’s Department of Health Services drew fire from two supervisors for distributing a pamphlet called “Shooting Up and Your Health,” which advised intravenous drug users to “clean your works” and “clean your skin with alcohol before injecting.” Supervisors Kenneth Hahn and Michael Antonovich demanded that distribution of the brochure be halted because it implied that the county and city government approved of illegal drug use.

But Orange County health officials stressed that they needed to send out two messages to drug addicts. “We need to educate people to get to clinics, to get off drugs,” Dr. L. Rex Ehling, the county’s public health director, said. “But while they’re waiting to get in--or in case they don’t get there--we want them to use clean needles.”

According to Mullins, an estimated 8,000 Orange County residents are intravenous drug users. since money for treatment is limited, however, only a fraction of those can be enrolled in county methadone programs. Each day, addicts seeking treatment line up at 3 a.m. outside two detoxification centers in Stanton and Fullerton, and each day, about 100 of those addicts must be turned away, Mullins said.

Testifying in Los Angeles Tuesday morning, Weismuller told two state Senate committees investigating AIDS and substance abuse that addicts who have received education about the virus have “modified certain risk behaviors, with increasing demand for ‘clean works.’ ”

For several years, Orange County health workers have provided education about AIDS at the women’s jail to prostitutes who were also intravenous drug users, she said. “Those women are reporting more condom use and less sharing of ‘works’ (hypodermic needles and syringes) when they are on the street,” Weismuller testified.

But education about AIDS came too late to help nine female addicts from the Buena Clinton section of Garden Grove, Weismuller said. All shared needles and syringes, she said, and all now test positive for the AIDS virus.