N.Y. Begins Giving Needles to Addicts in AIDS Battle

Two heroin addicts denied immediate entrance into an overcrowded drug-abuse treatment program became the first recipients of sterile needles provided by the New York City Health Department on Monday as the city launched the nation’s first government-sponsored needle exchange program for drug addicts.

The extraordinary experiment, which is being watched closely by public health officials around the country, seeks to determine whether distributing clean needles to as many as 200 intravenous drug abusers can slow the spread of the human immunodeficiency virus that causes AIDS.

Needle exchange programs and other measures to promote the use of sterile needles by addicts have become the focus of intense and bitter debate here and elsewhere.

Proponents, pointing to similar successful programs in Europe, argue that providing clean needles to drug users will save the lives of addicts and their sex partners and babies. Opponents contend that the programs will not slow the spread of HIV but will encourage drug abuse and symbolize a retreat in the battle against addiction.

New York’s controversial program is intended to serve as a “bridge” to drug-abuse treatment in a city that has only 35,000 drug treatment slots and more than 200,000 drug addicts, more than half of whom are already infected with HIV. On any given day, between 1,000 and 2,000 New York City addicts are on waiting lists for admission into treatment programs.

The two heroin addicts who were enrolled in the needle exchange program Monday will leave that program to begin treatment with methadone on Nov. 16, said Marvin Bogner, New York’s assistant health commissioner for public information. “At least between now and then, they will have clean needles,” he said.

City officials said they were not disappointed by the two-person turnout, noting that addicts were not likely to run a gauntlet of TV cameras and reporters.

Opponents of the program, which has taken on great symbolic importance in a city wrestling with the twin plagues of AIDS and drug addiction, remained adamant.

Though the needles will come with a large dose of AIDS-prevention education, Sterling Johnson Jr., New York’s special narcotics prosecutor, said addicts cannot be trusted to avoid sharing their city-issued needles.

Official’s Arrest Advocated

“This program is inhumane, criminal and racist,” said Hilton Clark, a city councilman from Harlem, noting that most of New York’s IV drug abusers are black and Latino. New York City Health Commissioner Stephen C. Joseph, he said, “should be arrested.”

Black and Latino political leaders here insist on a more comprehensive solution to the city’s drug problem, including treatment on demand for addicts and stepped-up law enforcement.

But, “even if you had unlimited money, it would be a 10-year program to set up enough programs and to find and train new staff,” said Don C. Des Jarlais of New York state’s Division of Substance Abuse Control and an expert on AIDS and drug abuse.

“All the European data indicate that legal access to sterile injection equipment does not lead to any increase in drug use,” Des Jarlais said.

Two dozen supporters of needle exchange demonstrated outside the Health Department’s Worth Street headquarters on New York’s Courthouse Square.

‘Dying in Our Parks’

“The opponents of this program call it genocide,” said Yolanda Serrano, executive director of the Assn. for Drug Abuse Prevention and Treatment. “Well, genocide is what is happening now. People are dying in our parks, in our hospitals, on our streets” from using HIV-contaminated needles, she charged.

“To say that this limited, carefully controlled program promotes drug abuse is absurd,” Joseph said. “There are neighborhoods in this city that are awash in cocaine and heroin, neighborhoods where you can find discarded syringes and needles in the parks.”

Joseph acknowledged that the program is unpopular among black and Latino politicians and law enforcement officers. But, he said, “we must not lose sight of the fact that New York City is still in the early stages of the worst epidemic in modern memory.

“Neither the mayor nor I will allow ourselves to be in the position, 5 or 10 or 20 years from now, of having to justify to ourselves why we didn’t try by every means possible to lessen the terrible toll of AIDS,” Joseph said.

In addition to the addicts who will receive needles and counseling on AIDS, up to another 200 addicts will receive only counseling. Over time, the rates of infection in the two groups will be compared.

Talks Tabled in L.A. County

Los Angeles County supervisors have twice tabled discussion of a needle exchange program and in August rejected the less drastic step of providing addicts with bleach kits to clean dirty needles.

A private needle exchange program in Portland, Ore., financed by a grant from the American Foundation for AIDS Research, has been delayed since July because of problems in securing liability insurance.

The New York City program required 2 1/2 years to overcome obstacles thrown up by state and law enforcement officials, and, more recently, by black and Latino politicians.

“The 2 1/2-year delay has been responsible for the loss of many lives,” Joseph said. Perhaps 15,000 New Yorkers have been infected with HIV during that time, statistics show. “That is a consequence of the social choice we have made,” he said.

“(The delay) is one of the most graphic commentaries about the dynamics of social unconcern in this epidemic. People don’t want to see it. People don’t want to hear it. People don’t want to know about it.”

Retreat From Other Sites

Opposition from community members and school officials forced Joseph to pull back from four proposed neighborhood sites to start the program at Health Department headquarters downtown.

“We’ve circled the wagons,” Joseph said. Noting that hundreds of IV drug users a day come to the neighborhood for court appearances, he said that “nobody can charge us with polluting a pristine environment.”

Some advocates of needle exchange elsewhere in the country feel so strongly that the programs will save lives that they have taken matters into their own hands. In downtown Tacoma, Wash., drug abuse counselor David Purchase has operated an informal needle exchange program from a pair of TV trays on a seedy stretch of Pacific Avenue.

His action has the tacit approval of Tacoma’s mayor, its chief of police and its Health Department, said Tacoma-Pierce County Health Department AIDS officer Terry Reid.

Objections ‘Political or Moral’

“I got tired of watching the junkies die,” Purchase said. “There is no scientific or epidemiological reason why needle exchange shouldn’t exist. The objections are political or moral.

“The virus has been later in coming here.” Purchase, who has spent more than $2,000 of his own money on the program, said: “We still have a chance.” Tacoma will consider starting a formal needle exchange program next month, Reid said.

In Boston, “AIDS Brigade” founder Jon Parker was arrested in August for handing out needles to addicts. Charged with violating state law against possessing and distributing syringes and needles without a prescription, he is scheduled to go on trial next month.

Needle exchange advocates here point to European programs, mainly in Holland and the United Kingdom, that appear to have slowed if not stopped HIV transmission among addicts in those countries.

“We find spread of the illness has been stopped” among the 7,000 addicts of Amsterdam, said Lo Breemer, chief of staff to the Dutch city’s mayor.

“But I don’t know if you can copy our program in the U.S., because our situations are not comparable,” Breemer said.

“New York is different from Amsterdam,” Joseph acknowledged. “Maybe it won’t work here. But if it does, we have lost a lot of time.”