Drug, AIDS Tear City's Social Fabric : Twin Epidemics in N.Y. Linked by Addict's Needle

By JOHN J. GOLDMAN

Feb. 16, 1989 12 AM PT

Times Staff Writer

NEW YORK —

Thread by thread, the stark scenes of suffering are being woven together by drugs and AIDS into a gigantic tapestry of tragedy.

One recent evening, after her daily rounds, a visiting nurse sipped coffee and described just two of her cases as New York City grapples with the nation’s biggest AIDS epidemic:

--In a ninth-floor apartment of a housing development in lower Manhattan, a 51-year-old grandmother lies curled in the fetal position on a gray couch, an AIDs patient who contracted the disease from her boy friend, a needle-using addict. As her two grandchildren play nearby, the emaciated woman and her family debate how soon she should return to the hospital.

--Uptown, in a third-floor walk-up of a Harlem tenement, on a street where drugs routinely are sold, a woman in a navy blue dress also lies dying. She is an intravenous drug abuser and has AIDS, tuberculosis and a history of not taking her medicines. On the bed with her is an infant, and in the apartment are five other children. The woman is acting as a baby-sitter, potentially exposing all the youngsters to tuberculosis.

“It’s worse than a war,” the nurse said in frustration. “You feel helpless.”

The effects of the twin epidemics on the social fabric of New York are profound.

Hospitals are overburdened, medical staff burnout is accelerated, municipal budgets are strained, badly needed social services are stretched almost to the breaking point.

The violence associated with drugs eradicates innocent lives, threatens to destroy entire neighborhoods, touches children in their cribs, even causes Mayor Edward I. Koch to be protected by police bodyguards armed with Uzi submachine guns.

For untold numbers of ghetto youth, the dream of success has been corrupted, often shattered. Big-time drug dealers become role models for teen-age recruits nicknamed “wanna-bes,” because they want to be narcotics kingpins.

To an increasing degree, New York City’s twin epidemics of AIDS and drugs are being joined together at the point of the addict’s needle.

The number of AIDS cases being detected has slowed in the gay community, but the disease continues to spread virtually unabated among intravenous drug users. The city Health Department estimates that about 60% of the city’s 200,000 intravenous drug users are infected with the AIDS virus.

“In this city, looking into the future, the bottom line of the AIDS epidemic has to do with how successful we are going to be in dealing with the drug epidemic,” said Dr. Stephen C. Joseph, New York’s health commissioner.

” . . . It is an exaggeration, but a useful exaggeration, to say that probably, from this point on, cocaine will . . . be a more important driving force in the epidemic than heroin,” Joseph said. “The heroin addicts are all infected already . . . . That is why we must do something about cocaine.

‘The Hell Beat Out of Us’

“Is AIDS going to sink the city? My response is the city will not collapse. The health care system will not collapse. But we are going to get the hell beat out of us in the process,” Joseph said frankly.

New York City, with 18,518 cases, leads the nation in AIDS victims as well as in narcotics abusers.

The New York State Division of Substance Abuse Services estimates that at least 200,000 intravenous drug abusers live in the city, fully half the heroin addicts in the nation. Cocaine users are harder to count, but estimates range from at least 200,000 to more than 400,000. If the maximum figures are correct, New York has a drug-using population of 600,000, greater than the entire population of Boston.

Epidemiologists estimate that more than 43,000 people in New York City will develop AIDS and 32,000 of these will die by 1991. So far, about 10,112 New Yorkers have died from AIDS, which has become the leading cause of death in the city among men 25 to 44 years old and women 25 to 34.

“When you look at the statistics, they are startling and frightening,” said Sterling Johnson Jr., New York City’s special narcotics prosecutor. “There is more heroin out there than ever before. We have been so inundated with cocaine and crack, the heroin dealers have become sleepers. They are doing their thing quietly. They are not being touched.”

“The criminal justice system can’t cope with the problem of drugs in this city,” said Robert M. Stutman, who heads the New York office of the federal Drug Enforcement Administration. “The numbers are absolutely overwhelming.”

“Crack is cheap, highly addictive and leads to great violence,” said Manhattan Dist. Atty. Robert M. Morgenthau. “The violence is just escalating.”

Horror stories abound to such a degree that their frequency threatens to become social Novocain--numbing public outrage.

A 16-year-old boy stabs his mother to death and tries to make it look like a rape because she refuses to give him $200 to pay his crack dealer. A 34-year-old South Bronx junkie, desperate to get into an overcrowded drug treatment program, throws a chair through a police station window in an effort to be arrested. A playground referee is beaten and dies after making a controversial call in a high-stakes basketball game sponsored by drug dealers.

Just three blocks from the house where this writer grew up in Brooklyn, a 12-year-old girl inadvertently walked into an argument over drugs recently and was shot to death with a machine pistol.

Drug gunmen nickname such people who stray into their line of fire “mushrooms” because they pop up unexpectedly. Perhaps as many as 19 people were killed by stray bullets in New York last year. Most were mushrooms.

Veteran law enforcement officers fear that the drug violence will escalate. Six policemen, a record number, including a rookie cop who was assassinated by drug dealers, were killed in drug-related incidents in 1988.

Within the short span of two months, two Federal Drug Enforcement agents were shot. One, who was struck in the face by a bullet from a .357 magnum revolver at close range, will require two years of reconstructive surgery. The other was grazed on the forehead during a gunfight in Brooklyn during which 52 shots were fired.

Behind a door protected by an alarm system at the DEA’s headquarters in Manhattan, a red-carpeted room is chock full of weapons seized from drug dealers. Piles of pistols rest side by side with submachine guns, rifles, shotguns, machetes--even a crossbow with arrows.

Mayor Koch Threatened

The DEA’s Stutman and Mayor Koch have been threatened by Colombia’s Medellin cocaine cartel--threats that are being taken seriously. The mayor is now protected by Uzi-toting bodyguards.

In poor and marginal neighborhoods, the problems that drugs cause can seem overwhelming.

“Drug sales and drug addicts doing cocaine are seen 24 hours a day in at least six buildings in our block and in the street,” a Manhattan woman wrote Morgenthau. “There have been muggings and other violence. Master keys to our buildings are being sold on the street corner. We are under siege. Please help us.”

Throughout New York City, cars are parked with “No radio” signs in their windows.

Thousands upon thousands of autos are broken into each year by addicts, who rip out the radios and sell them for drug money. Car thefts in New York have risen dramatically. In the first 11 months of 1988, thieves stole 88,140 autos, compared to 70,123 for the same period last year--a 25.7% increase.

Addicts Cannibalize Cars

“An addict needing money to support a habit not only will steal a vehicle but cannibalize it and sell the parts,” said Stanford Tice, former director of insurance fraud prevention for the state of New Jersey, where some cars from New York are taken for demolition.

A recent study showed that 78% of people arrested for felonies in New York City tested positive for illegal drugs. For those booked for robbery, the figure was 90%.

Cases of child abuse linked to drugs are up dramatically.

Although New York City seemed riveted by the televised trial of Joel Steinberg, a disbarred lawyer accused of killing his illegally adopted 6-year-old daughter in a case that received national attention, 127 other children died of suspected child abuse or neglect in 1988.

When Steinberg’s home was searched, paraphernalia for free-basing cocaine was found. During the trial, there was testimony that he and his live-in girlfriend free-based cocaine for hours while the child lay dying on the bathroom floor.

The New York City Human Resource Administration, already hard pressed to provide home care for some AIDS patients, is facing an additional crisis in identifying and providing help for victims of child abuse. The agency’s statistics show that drugs are implicated in 80% of child abuse cases.

New York has suffered through great epidemics before. In 1727, when there were only about 9,000 residents, smallpox killed about 500 of them within weeks. Yellow fever struck in 1792 and 1822. Thousands died.

During the great Asiatic cholera epidemic of 1832, 94 people died during just one day and many of the rich fled in panic. Cornelius Vanderbilt profited by running a fleet of steamboats on Long Island Sound, shuttling frightened people to Connecticut, where they were sometimes repulsed by residents brandishing rifles and pitchforks.

In 1918, it was flu. So many doctors fell ill that people even suggested that Bellevue Hospital be closed. The final death toll was 12,562.

But those were relatively short outbreaks. Health officials say that duration is the basic difference between past epidemics and today’s twin plagues of AIDS and drugs.

“Virtually all the people who are infected (with the HIV virus) will come down with severe illness,” Dr. Joseph said. “We now think the mean time between infection and illness may be as long as eight years. We won’t see the crest of the wave in this city until the mid 1990s, and then it will start to diminish.”

The toll among intravenous drug users, who are predominantly blacks and Latinos, is especially devastating.

“If we counted the addicts who are sick and dying from tuberculosis and other diseases related to HIV infection but not officially classified as AIDS, projections would be as much as 150% higher for addicts,” Joseph said.

Among intravenous drug users, cocaine injection is becoming a major route of transmission. Prostitution to buy crack, a highly addictive form of cocaine, which is smoked, also is spreading AIDS through sex-for-drugs transactions.

“You can get AIDS through crack,” Johnson said. “It’s so seductive and addictive. Young girls will sell their bodies to get crack.”

Some drug counselors report that they have been unable to persuade some male and female prostitutes to practice safer sex because some clients will pay more for unprotected sex.

Municipal officials believe New York City is entering the second phase of its AIDS epidemic.

” . . . The critical . . . need (is) for services. The real crisis in AIDS now is no longer getting people to say ‘anal sex’ on television or to accept condom ads but to get the services developed that people need, whether they are preventive services or clinical services,” Joseph said. “The problem has been defined, and to some extent engaged, and now the scope of response has got to be scaled up very rapidly and effectively.”

Health professionals say the epidemic’s second phase is bringing a new realism.

The AIDS hot line operated by the Health Department receives about 60,000 calls a year from worried New Yorkers. But professionals manning the phones have noticed a difference recently.

“Nowadays, we don’t get so many AIDS 101-type calls, that is, ‘How do you get AIDS? How do you not get AIDS?’ We get a lot of calls from people who have AIDS or from their care partners or from people who know someone who has AIDS, or from people who are HIV infected,” Donald Troise, the hot line’s director, said.

Critically ill AIDS patients occupy more than 1,700 hospital beds in New York each day. There are estimates that the number will rise

to at least 2,700 beds by 1991.

Emergency rooms are badly overcrowded with medical and psychiatric cases. New York, like the rest of the nation, faces a severe nursing shortage, worsened by the reluctance of some medical personnel to treat AIDS on a regular basis. One symptom of the nursing shortage: Posters in the lobby of a Manhattan hospital offer a $500 reward to any staff member who can recruit a new nurse.

The problems of long-term AIDS care are even more difficult. Nursing homes in New York City refuse to accept AIDS patients. And fewer than 100 beds in the municipal hospital system are set aside for long-term care of people with AIDS. Planners estimate at least 264 long-term care beds will be needed by 1991.

The economics of the epidemic still are coming into focus. But Empire Blue Cross and Blue Shield estimate that it costs $55,000 to $65,000 to care for the average AIDS patient.

Because of the severe shortage of low-income housing, many AIDS victims spend some of their last days alone in cheap hotel rooms. The Partnership for the Homeless, in a recent report, estimated that 5,000 to 8,000 people with acquired immune deficiency syndrome live in shelters or on the streets.

Homeless Figure Disputed

William J. Grinker, the city’s Human Resources Administration commissioner, disputes the estimate. “I don’t think those numbers are real,” he said. “ . . . We’re seeing maybe 400 of our caseload need some kind of housing assistance.”

“The city has made no serious attempt to estimate the numbers because it would be clear that what they are providing would not be enough,” countered Peter Smith, president of the Partnership for the Homeless. He argues that New York artificially depresses the number of homeless applying for housing by ignoring people with lesser AIDS-related symptoms.

The Human Resources Administration has set up a special AIDS case management unit, which now serves 2,200 clients. More than 80 case managers visit the sick at home and can authorize special funds to pay rent to prevent evictions when victims can’t work. Counseling and home health care attendants are provided.

Within the Human Resources Administration, another unit seeks to find foster homes for children with AIDS. About 180 youngsters have been placed. But others are destined to remain most of their lives in hospital pediatric wards.

Must Watch Infants Die

“You take a baby, you see that child die in a year usually, and you take another one and see that infant die,” Grinker said. “That is as much as anyone can take usually. You don’t stay in that business very long.”

As increasing numbers of narcotics addicts become infected, finding home care attendants has become a serious problem. Attendants are reluctant to enter high-crime neighborhoods where drugs are sold.

In an experiment with implications for other communities, Manhattan’s Beth Israel Medical Center, with a $293,000 grant from the Robert Wood Johnson Foundation, is training 25 methadone patients to act as “buddies” for socially isolated, homebound methadone patients with AIDS. The “buddies” not only will provide companionship and help in cooking and paying bills but are being taught when to notify health care professionals in case of an emergency.

“These people are surrogate friends,” said Nina P. Peyser, Beth Israel’s director of substance abuse planning. Doctors and law enforcement officials agree that additional methadone treatment programs are desperately needed for New York’s 200,000 heroin addicts. Taken daily, methadone blocks the withdrawal effects of heroin. (No such blocking agent exists for cocaine.) But current methadone programs can accommodate only 40,000 people.

“You could easily accommodate 80,000,” said Don Des Jarlais, coordinator of AIDS research at the New York State Division of Substance Abuse.

Des Jarlais noted one positive trend: Drug users have been cutting down on sharing needles.

“The market in terms of illegal street sales of sterile needles has gone up. Drug users are changing their needle use pattern,” he said.

In an effort to stem the tide of heroin and cocaine, some old municipal laws are being given new meaning.

Several months ago, a drug dealer paid a tenant $10,000 to take over his apartment in upper Manhattan so it could be used as a crack den. The landlord was so incensed that he padlocked the apartment’s door. The drug dealer then put a gun to the landlord’s head and forced him to open the lock.

Drug Dealer Evicted

But the landlord didn’t give up. He complained to the Manhattan district attorney’s office, which used a 100-year-old statute reserved for bawdy houses to void the lease and evict the drug dealer. About 25 similar eviction cases are pending.

Drug enforcement agents and police officers have made some spectacular arrests, and the number of tactical narcotics teams designed to saturate drug-infested neighborhoods has been increased. Just last month, $19 million in neatly stacked $20 and $100 bills--the largest cash haul in the nation’s fight against drugs--was seized in a van at a Queens furniture warehouse. Eleven people, charged with being members of a Colombian drug cartel controlling cocaine distribution in the New York area, were arrested.

In 1988, from January through September, 31,381 people were arrested in New York on felony drug charges--a 19% increase from the same period in 1987. Thousands received local jail sentences, and 3,680 New York City drug offenders were sent to state prisons--a 24% increase.

But, with the potential for enormous profits, there are other dealers to take their places.

Sometimes, when he considers New York’s AIDS epidemic, Dr. Joseph realizes that he is living health history.

“Nobody expects in his professional life to live in the center of a millennial event,” the health commissioner said. “AIDS is a millennial event. I am living in the center of it. It’s hard to describe that . . . Do I really comprehend the magnitude of what’s going on around us in this? No. Maybe better than most people. But you do the best you can and try to understand where you are in this. I don’t think any of us really understands the total picture of this.”

Joseph paused to consider further. “I do feel less swept along by it than two years ago. I think we’re, speaking collectively, we’re a little more in control of our own destinies than we were two years ago in this epidemic. There are more things we can do that make a difference. We are more effective in education. We are more effective in testing. We are getting more effective in early diagnosis and some palliative therapy . . . . We are not nearly as helpless as we were two years ago--none of us.”

NEW YORK’S EPIDEMIC OF AIDS AND DRUGS

The annual increase in AIDS cases. . . 1981: 143

1982: 462

1983: 995

1984: 1738

1985: 2572

1986: 3486

1987: 4542

1988: 5614*

1989: 6687*

1990: 7760*

1991: 8833*