AIDS Calamity Is Lurking in Needles : Prevention: Getting control of the epidemic among intravenous drug users demands immediate action on several fronts.

The prevalence of the AIDS virus among intravenous drug users appears to be low in San Diego right now: 2% to 5% of the drug injectors, according to county figures. But, once the virus gets into a drug-abusing population, it can spread silently and swiftly in the absence of aggressive intervention efforts. Increases of more than 10% per year in the prevalence of HIV antibodies--a precursor to AIDS--have been reported among IV drug users in New York City, parts of Italy, Edinburgh and Bangkok.

Although the current prevalence of the AIDS virus among drug injectors in Southern California is lower than in New York, complacency would be a serious mistake. We must not forget that infected drug injectors spread the virus not only through contaminated needle sharing but also sexually and through childbearing, with particularly devastating consequences.

Sexual promiscuity and drug abuse were viewed as major social problems long before the appearance of the AIDS virus. And the standard prescription for both has been abstinence or safer, controlled use.

We may argue about whether abstinence or controlled use, or both, are acceptable objectives for society. But, while we argue, transmission of the deadly AIDS virus continues--through unprotected sex, childbirth and use of contaminated needles.

A socially and medically pragmatic view would argue for using several strategies to interrupt the spread of this fatal disease. Trusting that drug injectors will be abstinent or practice safe sex could have devastating consequences--not only for the drug users addicts, but also for their sexual partners and the children of both. (Not to mention for subsequent sexual partners of the drug injectors’--lovers and their children.)

Education and admonitions about risky behaviors are not enough.

What other strategies are available?

The basic ones that have been used are criminal sanctions for users and suppliers, drug treatment programs aimed at ultimate abstinence, substitution therapy with methadone for opiate addicts and safer injection methods.

Safer injection methods include not sharing needles and syringes (referred to as “works” among injection drug users), the use of bleach to sterilize potentially contaminated works, and easier access to clean syringes and needles.

This last one is controversial.

It means allowing drug injectors to purchase clean works through pharmacists, physicians, or even vending machines; or to exchange a used needle for a clean one. A needle exchange is preferable because it does not add to the total reservoir of needles in circulation, and the prevalence of HIV infection can be monitored. Needle exchange programs are often linked to other HIV prevention strategies, including HIV testing and counseling, bleach and condom distribution, and can serve as a bridge to drug treatment.

Certainly, it is far less desirable to pass out clean needles than to get users to stop using drugs by entering treatment programs or by going on methadone maintenance.

But consider the vast chasm between the availability of drug treatment and methadone maintenance and the demand.

In San Diego County, Drug Abuse Services estimated that it would cost $30 million to provide drug treatment on demand for the year 1988-89. The entire county budget for drug abuse treatment was $6 million.

There are an estimated 15,000-22,000 opiate addicts, but only 1,250 methadone maintenance slots, almost all of which require private sources of payment.

Waiting times for treatment are appallingly long. Until and unless we as a society are willing to put resources into drug treatment, it is foolish to categorically proscribe an effective prevention program, such as needle exchanges.

Needle-exchange programs have been implemented in Holland, the United Kingdom, Australia, and more recently in the United States. Critics argue that increasing the availability of clean “works” will increase drug abuse.

However, the available evidence, from European studies and more limited evaluations in the United States, is that such programs have not increased drug use among their clients nor have they resulted in measurable recruitment of new users. Studies of the Amsterdam syringe exchange program, begun in 1984, have suggested that “the syringe exchange program might actually be associated with reductions in IV drug use rather than increases.”

Although continued research and evaluation of needle distribution and exchange programs is mandatory, getting control of the AIDS epidemic among injection drug users demands immediate action on several fronts:

* Greatly expand publicly funded drug treatment and methadone maintenance programs so that the goal of treatment on request is achieved.

* Greatly expand outreach to users not in treatment with access to HIV testing, counseling, bleach and condoms.

* Institute a properly monitored program of needle exchange.

If communities, like San Diego, with low rates of infection among drug injectors wait to deploy adequate resources until hospitals are filled with AIDS patients, the social and medical burdens will be akin to mounting an Operation Desert Shield after the invasion took place.