Clean Needles Put Into War on AIDS : Health: L.A. group serves about 150 heroin addicts weekly, swapping new syringes for dirty ones in controversial approach to fighting disease.

Last June, AIDS activists handing out free hypodermic syringes to heroin addicts in South-Central Los Angeles were confronted by an angry group of community leaders who believed the giveaway promoted drug use.

Undaunted, the distributors--a committee of the militant ACT-UP LA group that calls itself Clean Needles Now--temporarily shifted their focus to a drug-inundated neighborhood closer to downtown.

From curbside posts, the group claims it now serves about 150 addicts weekly, swapping one new needle for every dirty one users turn in.

“We’ve kind of been forced underground . . . but we’re not going away,” said Renee Edgington, an organizer of the effort.

Los Angeles’ first concerted effort to provide syringes to discourage needle sharing--a controversial approach to preventing the fastest-growing form of AIDS transmission--has arrived late compared to many other large U.S. cities. Elsewhere, programs have been supported, or at least ignored, by government and law enforcement for up to four years.

AIDS and needle-exchange activists from more receptive parts of the country attribute the slow pace of acceptance in Los Angeles to a variety of obstacles: health agencies’ fear of losing local government funding, health workers’ fear of being arrested and the spread-out geography of the city, where most residents rarely come face-to-face with addicts.

“I came down there to talk to people in health offices--outreach workers--and found they were very, very receptive, but very scared,” said Spero Saridakis, a San Francisco needle-exchange advocate, who joined the movement after serving as jury foreman at the trial of two men charged with illegally distributing needles.

In California and nine other states, only pharmacists have authority to distribute needles and then only to those with prescriptions. Still, the largest volunteer needle exchange in the country is operating in San Francisco, where it has been embraced by the last two mayors and generally tolerated by police.

The absence of needle exchanges in Los Angeles does not reflect a lack of demand for free syringes. The most recent estimates by the UCLA Drug Abuse Research Center show there could be as many as 190,000 injection drug users in this county. At least 6% of them are thought to be infected with HIV, the virus that causes AIDS.

Los Angeles County government has consistently opposed the practice, although the Board of Supervisors’ political composition is changing and so is its view of needle exchanges. The fledgling effort by Clean Needles Now is one of several indicators that this most controversial of AIDS-prevention efforts is taking hold in Los Angeles.

* State legislation that would legalize pilot needle exchanges has been approved and awaits Gov. Pete Wilson’s consideration. The state Department of Health Services has advised Wilson that needle exchanges have no known negative side-effects.

“There does not appear to be a credible scientific reason to not allow needle exchange,” said Mike Hughes, chief of the epidemiologic surveillance branch for the state Office of AIDS.

The Los Angeles County Commission on AIDS unanimously voted in favor of the bill, although its members are divided on whether to institute a pilot program.

* One of the bill’s authors--Sen. Diane Watson--is running for county supervisor and says inaugurating a pilot exchange program here would be one of her top goals if she is elected. Her opponent, former Supervisor Yvonne Brathwaite Burke, said she too would support such a program if it were coupled with adequate drug rehabilitation.

* Needle exchange supporters are hopeful that the new police chief, Willie L. Williams, will implement the kind of hands-off law enforcement policy that exists in San Francisco and New York. In Philadelphia, Williams’ policy reportedly was to respond only if there were complaints.

Williams was out of town Friday and his spokesman, Cmdr. Bob Gil, said the issue was “not important enough to bother him with” during his trip.

* Even if none of the other efforts materialize, the nation’s largest renegade needle distribution group--the National AIDS Brigade--has chosen Los Angeles as its next target, promising to force the issue with aggressive needle handouts beginning Sept. 24.

“Los Angeles has been on my list for a long time,” said Jon Parker, brigade director, whose credentials include a public health degree and a past heroin addiction. “If we don’t get arrested, it’ll be a regular thing. If we do get arrested, it’ll go underground . . . until we can fight it in the courts.”

The concept behind needle exchanges is simple: allow addicts to trade their used syringes for new ones at no charge, thus lessening both the need and the opportunity for sharing and passing on HIV infection.

Opponents counter that needles are the tools that make injection drug abuse possible.

“Rather than give in and hand the needles out, we need to really concentrate on IV drug use by getting (addicts) off drugs,” said Kathryn Barger, health deputy to county Supervisor Mike Antonovich. “Especially in areas like South-Central, we need to concentrate on cleaning the area up . . . not giving out an instrument to do an illegal activity.”

Public health is governed in this county by the Board of Supervisors, which historically has taken conservative stands on AIDS-related issues.

It was not until March, 1991, that the board agreed to allow its health outreach workers to distribute bleach and condoms to addicts--several years after such practice had become common in most other large cities.

At that time, Kenneth Hahn, the supervisor who provided the swing vote, made it clear he would never approve of needles. But Hahn is retiring this year and either Watson or Burke will take his seat.

Supervisors Antonovich and Deane Dana remain opposed to needle exchanges, but Supervisor Gloria Molina supports them and Supervisor Ed Edelman said this week that, if the state bill is signed by the governor, he will ask the county health department to research the track record of exchanges elsewhere.

“It shouldn’t be our personal views, it should be based upon what public health people feel is appropriate action,” Edelman said. “We need to take it out of the political, morality area and make a public health decision.”

The most recent research supporting needle exchange also is considered by AIDS researchers to be the most conclusive.

The ongoing study, by Yale University Professor Edward Kaplan, tested used needles returned to a city-sponsored exchange program in New Haven, Conn. It found that the percentage of HIV-tainted syringes dropped from nearly 68% at the beginning of the program in November, 1990, to about 46% today. For comparison, Kaplan tested syringes gathered at a New Haven shooting gallery--where addicts gather to inject themselves--and found that nearly 92% carried HIV.

Coding on the needles gathered this year by the municipal program showed that they had been circulating for an average of a week, instead of the three weeks documented at the beginning of the program. Tracking of participants showed that one in six entered drug treatment programs and one in four would have if there had been spaces for them.

Kaplan was particularly excited about some of the seemingly minor findings, which he believes prove that no new users were attracted by the free handouts: there were no declines in either the average age of participants--35--or their average length of addiction: seven years.

In Los Angeles, much of the controversy has been focused on the way in which the activist group Clean Needles Now has been carrying out its efforts--the subject of a flurry of memos circulating among county supervisors and AIDS and health officials.

Even some opponents who support exchanges charge that the ACT-UP operation lacks the organization and research necessary to make a case for a county-sanctioned program. They say it has led to nasty confrontations between addicts and the county’s own health outreach workers, who have only bleach and condoms at their disposal.

“Addicts are getting irritated with the workers when they don’t have needles for them and, in some cases, law enforcement has had to get involved,” said Christy Cowell, staff analyst for the county AIDS Commission. “It’s been a colossal mess.”

Even Watson said that any misstep at this junction could hinder efforts to gain public and political acceptance of an official pilot program. She recently asked Clean Needles Now to discontinue its effort, angering the group’s leaders.

Edgington, of Clean Needles Now, said the negative impact of the group’s activities has been greatly exaggerated. She also said the group does plan to conduct research into the effectiveness of its exchange and has been storing the used needles it has collected so far to be tested for HIV.

The National AIDS Brigade dismisses the opposition to Clean Needles Now as ridiculous and totally expected. In the end, director Parker said, the controversy will lead to public acceptance.

“When it’s happening, even unofficially, that takes the shock away from it,” he said. “The public says, ‘How can we do it better?’ instead of ‘Should we do it?,’ because it’s already happening.”