Plan to Slow AIDS Spread by Drug Users Is Proposed

In the first broad-based attempt to slow the spread of AIDS among intravenous drug users in Los Angeles County, health officials are proposing that the county begin distributing condoms and bleach and making drug treatment available on demand.

The program would rely in part on former addicts and community workers who would meet with intravenous drug users, dispensing vouchers for free drug treatment, as well as kits containing bleach and explicit instructions on how to use it to disinfect needles.

The proposal, which is likely to be controversial, aims to reach the estimated 80,000 to 120,000 intravenous drug users in the county, a group that is considered the primary route through which the AIDS virus is spreading to heterosexuals and their children.

“What this proposal is doing is clearly and realistically dealing with a massive problem,” said Rabbi Allen Freehling, chairman of the county Commission on AIDS. “Those who wish to turn their backs on the proposal are living in a fantasy world.”

Concept Opposed

The proposal will be presented in detail to the AIDS Commission next month. Before it could be implemented, it would have to be approved by the Board of Supervisors, several of whom have already opposed the concept of the county encouraging safe needle use.

A spokesman for Supervisor Mike Antonovich said late Friday that Antonovich would oppose any plan to distribute bleach, because to do so would encourage drug abuse. Supervisor Deane Dana, who could not be reached, has taken a similar position in the past.

Supervisor Ed Edelman, however, embraced the health department plan.

“This is a health problem,” he said. “We shouldn’t let politics or morality stand in the way of saving human lives. (The proposal) is based upon health department recommendations and studies. It’s not someone who doesn’t know what they’re talking about.”

The acquired immune deficiency syndrome virus is spread through sexual contact and the exchange of blood, often through dirty syringes. The rising percentage of AIDS cases among intravenous drug users nationwide has been traced to the widespread practice of addicts sharing syringes.

Needle Users

In Los Angeles County, 3% of all AIDS cases have occurred among heterosexual needle users; another 7.9% have occurred among homosexuals and bisexuals who also use drugs. Surveys estimate that 5% of all needle users are infected and have not yet come down with AIDS.

But the rate of increase in cases among heterosexual needle users has outstripped the rate of increase among gay and bisexual men. The number of new cases reported in January was nearly three times the figure reported one year earlier, new county statistics show.

“We realize that the educational system in our treatment programs is not doing the trick,” Irma Strantz, head of drug abuse programs for the county, said Friday, referring to the county’s policy of educating users in treatment about the risks of AIDS.

The proposed program, based on existing programs in other cities nationwide, emphasizes the importance of providing drug treatment to any user who wants it--while at the same time enabling the rest to use needles without contracting or spreading the virus.

So-called outreach workers would be dispatched to all parts of the county with high concentrations of needle users. They would hand out educational materials written “in the vernacular,” as well as “risk reduction kits” for those users unwilling to quit, according to the health department proposal.

The kits would include bleach, condoms and “clear instructional material for their proper use,” according to the Department of Health Services proposal. They would also hand out drug treatment vouchers designed to encourage users to get off drugs.

Some Success

Both approaches appear to have had some success elsewhere.

In San Francisco, where outreach workers have plied the streets for two years, nearly 70% of drug users polled said they clean their needles with bleach. Some also reported reducing their needle-sharing.

In New Jersey, more than 80% of vouchers distributed were used by addicts.

The health department’s proposal also recommends that drug treatment programs be expanded to make possible immediate treatment for anyone who wants it. The wait for admission to subsidized treatment currently ranges from three to eight months.

The long waiting lists are the result of a steady drop in federal and state funding since 1982. Noting that it would take $14 million to restore the capacity that has been lost, the department’s proposal states, “This gap must be closed.”

‘Need Help’

“When you are talking about the intravenous drug user population, education alone is not enough,” commented Judy Spiegel of AIDS Project Los Angeles. “People who have drug habits don’t stop their habits by education alone. They really need help.”

Freehling, the AIDS Commission chairman, welcomed the proposal.

“I’m delighted that the AIDS Commission is now being given an opportunity to clearly focus on one of the more troublesome aspects of the AIDS epidemic,” he said in an interview. “It’s my belief that we have been almost totally lacking in our ability to communicate with intravenous drug users.”

Freehling predicted, nevertheless, that the plan would be fought by people who believe that to hand out bleach and condoms is to encourage crime and promiscuous sex, and that the use of explicit language in educational materials is tantamount to pornography.

“Nothing is farther from the truth,” he said. “However, that’s their perception. Because of that, much of the AIDS educational material on the federal, state and county level has been less than effective.”