Counselors Take AIDS Battle to the Streets : Health: The county recently approved the distribution of condoms and syringe-cleaning bleach. Some agency workers say they had been doing it secretly for years.
As Drew Walters strolls through Skid Row, drug addicts swarm toward him as if drawn to a magnet. “You got some for me today?” one man asks in a raspy voice, his eyes struggling to focus.
The junkies are not looking to Walters, a former cocaine and heroin user, for a fix. He is a health worker now and they want the miniature bleach bottles and packets of condoms he carries to help them ward off AIDS.
“That’s the stuff!” the addict said.
After nearly four years of refusing to allow distribution of bleach and condoms through county-funded programs, the Los Angeles County Board of Supervisors recently agreed to spend up to $100,000 on it this year.
Yet, Walters and others who work for three of the seven nonprofit agencies the county uses for sidewalk AIDS counseling say they secretly have been handing out bleach--to clean syringes--and packets of condoms for up to two years.
By using county-funded workers to distribute the AIDS prevention kits, the agencies were acting in defiance of a county edict. They said they were willing to risk losing county financial support for one reason: They believed they were saving lives.
“It just got to the point where it was ridiculous and cumbersome not to do it,” said John L. Brown, Walters’ boss at the Los Angeles Centers for Alcohol and Drug Abuse. “When you have people actually asking you for bleach and condoms, you know they’re using it.”
Being told to give advice about precautions without providing the tools was like “being sent to Vietnam without a gun,” said John Palomo, AIDS program coordinator at El Proyecto del Barrio in the northeastern San Fernando Valley.
Although El Proyecto was careful to use employees paid through a state grant to hand out the bleach and condom kits, Palomo said he sometimes slipped addicts money for bleach.
At El Centro del Pueblo Inc., only volunteers were allowed to hand out bleach and condoms at first, but staff members started doing it about two years ago, said AIDS coordinator Gilbert Fernandez. “We said, ‘Just don’t tell us,’ ” said Fernandez.
John Schunhoff, assistant director of the county AIDS program, said he was not aware that county-funded agencies had taken matters into their own hands. He added that the matter is “basically moot” now that bleach and condoms have the official backing of the Board of Supervisors.
The trend toward including bleach and condoms in AIDS prevention programs began about three years ago and is common practice at some level in most U.S. cities, said Barry Brown, chief of the community research branch at the National Institute on Drug Abuse. A handful of cities and counties also have endorsed the even more controversial needle exchanges, where addicts may trade dirty syringes for clean ones.
“You’ve got to do essentially a marketing campaign,” said Doug Longshore, whose study for the UCLA Drug Abuse Research Group helped persuade the Los Angeles County supervisors to approve the program March 26. “Instead of marketing Reeboks or Coca-Cola, you’re marketing risk reduction and to market anything you’ve got to hand out free samples.”
Last April, the Los Angeles City Council voted to buy 60,000 AIDS prevention kits, providing the agencies with bleach and condoms, but not the manpower to distribute them.
New York City last year withdrew its financial support for the purchase of bleach and ended the needle exchange, although it continues to allow city-funded agencies to give out bleach. Mayor David N. Dinkins ordered the policy change because minority leaders said the programs were government support for drug use.
Random curbside distribution of bleach and condoms by former drug users also is in vogue, although Leslie Dutton, who heads the American Assn. of Women in Los Angeles, a conservative activist group, questioned that approach.
“In the past, we supported distribution of condoms through the Sheriff’s Department to known drug addicts when they were released from jail. We knew those individuals were high risk,” she said. “But calling on outreach workers to go out and distribute bleach kits and condoms willy-nilly is not efficient.”
The street counselors defend the program, insisting that the response has been astonishing everywhere--from gay bars in North Hollywood to gang corners in East Los Angeles and cardboard shacks on Skid Row. Because the distribution has been largely clandestine until now, there are few facts and figures to support their perceptions.
Of 1,200 women contacted by counselors with the Women at Risk Network in 1990, more than one-third entered drug treatment programs, said program director Ruth Slaughter. She said she believes that was partly because providing the bleach and condoms enabled them to gain the trust of drug users, prostitutes and their partners.
“By being there, giving the women some tools, some options, it shows that we care about their health, we care about them. It’s not giving lip service,” Slaughter said.
An informal survey about AIDS conducted by the county-sponsored agencies indicates that nearly all people contacted by the street counselors understand that bleach and condoms can stop the spread of the disease.
Now, counselors said, cleaning needles has become part of the ritual of getting high for many drug addicts who share their needles. Drug users interviewed last week said a black market for bleach has emerged, with one-ounce bottles being sold for up to $5.
In a homeless encampment downtown, Walters watched three men use the same syringe to inject heroin into their tattooed arms. As one heated the heroin in a bottle cap, another rinsed the syringe twice with bleach and water between each hit. It was a bittersweet moment for Walters.
“I’d rather see them in treatment, but we know from working out here that these people won’t get clean until they’re ready to,” he said. “We’re just trying to keep them alive until then.”
In Los Angeles, the incidence of the virus that causes AIDS is relatively low here among intravenous drug users when compared to East Coast cities. In New York, more than half test positive for the human immunodeficiency virus, while fewer than 15% of the estimated 125,000 users in Los Angeles are affected.
Reasons for the discrepancy have little to do with prevention efforts, researchers say. The better public transportation system in New York sends addicts venturing far from their neighborhoods in search of drugs. That, combined with a higher population density, has bred massive New York “shooting galleries,” still rare in Los Angeles.
The nation’s top authorities on AIDS prevention say that there is no evidence that providing bleach and condoms works any better than only demonstrating how to use them.
Research and surveys do seem to support the theories that addicts’ attitudes are changing toward using bleach and condoms and that the handouts may build a relationship between counselors and drug users, leading more users to enter treatment programs:
* In San Francisco, one study of intravenous drug users showed that 86% were using bleach in 1989, compared to 3% in 1986, the year before bleach distribution began there.
* A survey of 98 users in the San Fernando Valley in 1988-89, before distribution formally began there, found only one-quarter reported ever using condoms and nearly half had never used bleach. But 95% said they would use bleach and 80% said they would use condoms if they were given out free.
* In Long Beach, half the addicts who participated in a federal AIDS prevention program for at least six months had either stopped sharing their needles or were cleaning them with bleach.
“I wouldn’t have wanted to be doing our program without bleach,” said Fen Rhodes, the program’s monitor and a psychology professor at Cal State Long Beach. “What are you going to tell people, ‘Go buy bleach?’ It’s a visible sign of what you’re talking about.”
After nearly four years of rejecting similar measures, the L.A. County Board of Supervisors agreed to begin distribution of condoms and hypodermic needle-cleaning kits to drug addicts and others at high risk of contracting AIDS. Here are some other programs:
ATLANTIC CITY, N.J.: In March, 1987, city health department officials hire a prostitute to educate streetwalkers, passing out condoms attached to business cards.
WASHINGTON, D.C.: In February, 1988, District of Columbia health officials decide to distribute vials of bleach for cleaning hypodermic needles to drug addicts to impede the spread of AIDS.
PHILADELPHIA: In August, 1988, Mayor W. Wilson Goode circumvents the prison board and orders condoms be distributed to inmates as part of an AIDS prevention program in city jails.
TACOMA, WASH.: In January, 1989, Tacoma-Pierce County Board of Health approves nation’s first full-scale, government-sponsored hypodermic needle exchange program to combat spread of AIDS.
SAN FRANCISCO: In August, 1989, as part of the county’s AIDS prevention program, the city begins distributing condoms to county jail inmates despite questions about the action’s legality.
OHIO: In February, 1990, state health department officials distribute free condoms in the lobbies of family-planning clinics in an effort to halt the spread of AIDS.
CITY OF LOS ANGELES: On April 2, 1990, the Los Angeles City Council votes unanimously to begin a pilot program to distribute AIDS prevention kits. Kits include condoms and hypodermic needle-cleaning bleach kits. In October, the council increases its efforts to combat the disease by adopting one of the nation’s most comprehensive AIDS prevention programs. It includes special training for city employees and the distribution of AIDS prevention kits to people being released from jail.
MASSACHUSETTS: In June, 1990, state health officials begin distribution of condoms to community health centers as part of a campaign to promote their use in fighting the spread of AIDS and other sexually transmitted diseases.
NEW YORK CITY: In February, 1991, the New York City School Board, in a 4-3 vote, decides to begin distributing condoms at its 120 schools in an effort to fight the spread of AIDS.
COUNTY OF LOS ANGELES: On March 26, 1991, the Board of Supervisors on a 3-2 vote allows county-funded organizations to distribute bleach, condoms and AIDS prevention literature.
Source: Los Angeles Times, Associated Press, United Press International