Pointed Warnings : Health Agency, Police Step Up War on AIDS

Beginning next Tuesday, whenever Santa Ana vice officers arrest someone for soliciting a prostitute, they will give him a bluntly worded flyer developed by county health officials.

“When you buy sex, you may get more than you paid for,” it warns. “The extras you might get from a prostitute are: AIDS, syphilis, gonorrhea, herpes, lice, warts and there are others.”

And in the next few weeks, four AIDS educators--some of whom may be former heroin addicts--from the Orange County Health Care Agency will hit the streets, seeking intravenous drug users to offer them free AIDS testing, free condoms and information on how to avoid contracting a virus that can kill them, their sexual partners and their children.

In sharp contrast to Los Angeles County where supervisors have balked at an aggressive effort aimed at educating IV drug users about AIDS, officials from Orange County and the city of Santa Ana are pressing ahead with AIDS programs.

These tandem outreach efforts, by county health officials and Santa Ana police, are critically needed in Orange County, state and local drug abuse officials said.

Orange County--with 6,965 IV drug users who entered treatment in the 1986-87 fiscal year--has the second highest population of junkies in California, according to the California Drug Abuse Data System.

The new programs are necessary because drug addicts with their habit of sharing needles are believed to be a “bridge” by which the AIDS virus can spread from the homosexual community to heterosexuals, county officials said.

In Orange County as around the nation, a minority of heterosexuals are infected with AIDS. About 11% of Orange County’s 620 reported AIDS cases through the end of January involved heterosexuals.

Though the county’s IV drug-using population is large, to date the incidence of AIDS among addicts has remained low; only about 7% of Orange County residents who inject heroin or cocaine are now infected, health officials say.

So county health officials believe they can stop the disease before it reaches the epidemic proportions that East Coast cities have experienced. (In New York, for instance, at least 60% of the city’s 200,000 addicts are infected with the AIDS virus.)

“We’re at the right time,” said county outreach program director Rick Greenwood. “The number of infected people in Orange County is fairly low. . . . Intervention at this time is a lot better than discovering that 30% to 40% of the IV population is infected.”

William L. Edelman, director of county drug abuse services who with Greenwood is administering the federal grant, agreed: Without intervention now, Orange County could follow the trend of East Coast cities, and “you’ll see a doubling” of “this hideous virus” among IV drug users in just a few years.

When, in 1985, an Orange County nurse began counseling prostitutes in the women’s jail and offering them testing for AIDS, it was the first such action by a public agency in California.

In the last eight months, the Orange County Health Care Agency has expanded its AIDS testing and education effort to the men’s jail and to all six public and private methadone clinics in the county.

The latest actions are part of a $508,662 federally funded outreach program.

Expanded Services

Besides educating drug abusers that sharing needles or having sex with an infected partner can spread the virus, the yearlong program--part of a $5-million federal anti-drug abuse project--encourages addicts to give up their illegal habit. It also offers expanded methadone services to heroin and cocaine addicts as well as prenatal care for female IV drug users, housing for addicts infected with the AIDS virus and an ombudsman to make sure addicts infected with the AIDS virus are not discriminated against.

In addition to the health agency effort which county supervisors endorsed Jan. 19, the Santa Ana Police Department recently started its own pilot program to educate prostitutes and their clients on the dangers of AIDS.

At least 90% of the city’s 500 prostitutes are IV drug users, some of whom are already infected with the AIDS virus, Lt. Michael B. Foote said.

Since early February, Santa Ana vice officers have alerted county health officials whenever they expect to make prostitution sweeps. As local prostitutes were cited and released, county health educators have been waiting nearby to dispense information about AIDS. (They keep their distance, however; public health workers are barred by law from sharing confidential health records with police.)

Foote, who is commander of vice and criminal intelligence, said the job of police officers is to alert citizens to a community danger--a deadly disease like AIDS--as well as make arrests.

“Enforcement efforts to control prostitution have not been effective for more than 200 years,” he said, so if educational efforts by police officers can slow or halt some of that illegal activity, “we can accomplish the same end through a different means.”

Added Lt. Joseph E. Brann, a section commander in charge of narcotics who helped Foote develop the pilot program: “Prostitutes are far more afraid of AIDS than they are of going to jail.

For all the excitement about these efforts, plans for both programs are still evolving, and there is still some internal controversy about just how they will work.

One issue is just how closely county health care officials will work with Santa Ana police and eventually other county police agencies.

County AIDS coordinator Penny Weissmuller noted that at one point, police officers invited the county to introduce outreach workers to the county’s IV drug scene by letting them ride in police cars for several weeks.

Weissmuller said that idea was rejected out of hand. “It would mark them (health educators) with a red X,” she said, forever preventing them from building trust with a community of illegal drug users.

Outreach project director Greenwood said he would ask Lt. Foote and probably police officers from other agencies to map locations in the county--alleys, laundry rooms or gas station restrooms--which are frequented by IV drug users.

Solitary ‘Shooting’

Unlike New York or Newark where 50 to 100 addicts meet in “shooting galleries” to deal drugs and shoot up, Orange County’s IV drug users are said to pursue their habit in a more solitary fashion, injecting themselves alone or with several other addicts in secluded parts of Santa Ana, Stanton, Anaheim or Garden Grove, Foote and Edelman said.

Greenwood stressed that his outreach workers will not work directly with police. “The last thing we want is for people to think that we’re linked with the Police Department. People will think they (health workers) are some sort of undercover cops,” he said.

Still, Santa Ana police will be helping the health care agency in another way, Lt. Foote said. His vice officers are about to start gathering health data on prostitutes for the agency.

Since June, Foote said, some of his officers have been informally questioning prostitutes, asking them if they are concerned about sexually transmitted diseases and if they had been tested for AIDS.

That effort began, he said, after a concerned patrolman noted that as he took “the girls” to jail, they often discussed their fears about AIDS and asked questions about the disease. Foote said he is interested in gauging what percent of Santa Ana prostitutes are infected with AIDS but hadn’t been able to get good data from the Health Care Agency.

Questionnaire Developed

So at his request, county health officials recently developed a questionnaire which vice officers will soon be using after a prostitute is cited.

A prostitute’s participation in the “sexually transmitted disease questionnaire” will be voluntary, Foote emphasized. Among the questions: Has she ever been tested for antibodies to the AIDS virus? Because of AIDS, does she ask her client to use a condom? If she has injected drugs, does she believe that her needle was previously used by someone else?

Another issue of controversy in the outreach program is whether health educators will carry bottles of bleach and show IV drug users how to clean their “works” (their needle and syringe) with this solution to prevent transmission of the AIDS virus.

When Weissmuller explained the outreach program to the county’s AIDS advisory committee last November, she said that the four health educators would definitely carry bleach.

Weissmuller said that county health officials wanted to target IV drug users who might not at the time wish to begin methadone treatment and thus protect them from contracting AIDS while they continued to inject themselves.

But Greenwood now says he is not sure if outreach workers will carry bleach. It is possible the agency will begin a pilot program of issuing bleach in a few areas of the county, he said.

But “our concern is that we don’t want to give them the wrong message. Obviously we don’t condone IV drug-use behavior,” he said, and so it might not be a good idea to show addicts how to use their needles and syringes more safely.

Also, Greenwood said, although outreach workers in New York and San Francisco carry small bottles of bleach, he isn’t sure if the strategy is effective in protecting IV users from AIDS.

George Erska, a federal official who is monitoring a related Orange County demonstration project of services to AIDS victims, agreed: “A heroin addict in a severe phase of needing his next fix is not about to wait to clean his needle.”

Greenwood stressed that his program is still in a preliminary stage, and he is still developing outreach strategies. One issue that he has decided, however, is that none of his outreach workers will follow the example of New York City and pass out needles to IV users.

Handing out needles to someone who doesn’t have a prescription to own them is “illegal in the state of California, and we don’t intend to do it.” Greenwood said.

In getting the county program under way, Greenwood recently hired a former Peace Corps worker and a county AIDS educator to be his first two outreach workers, but he still needs to find two more health educators who can build trust with IV drug users.

As he weighs the options, Greenwood said he is excited about the prospect of having an impact on the triple problems of AIDS, IV drug use and prostitution in Orange County.

“It’s a different approach, “ Edelman said. “But we have a desperate situation, and it calls for unusual and creative measures.”

INTRAVENOUS DRUG USERS

Intravenous drug users reported in treatment centers for fiscal 1986-87, by county.

County Users Population Los Angeles 24,982 8,403,500 Orange 6,965 2,193,600 San Diego 5,889 2,240,700 San Francisco 5,229 742,700 Alameda 3,218 1,214,100 Fresno 3,117 588,300 Riverside 2,503 886,200 San Bernardino 2,256 1,167,200 Sacramento 1,985 928,700 San Joaquin 1,040 435,700

Source: California Department of Alcohol and Drug Programs.