Few Needle Swaps Exist as HIV Spreads in L.A. County : Health: Studies find exchanges slow infection rates and don’t boost drug use. But opposition limits efforts.
By the time she was 16, Gretchen Adams was a veteran junkie, shooting up daily with amphetamines, getting so wired she often didn’t sleep for days, wandering the streets of Hollywood in a hallucinatory fog.
If her needle got dull, she sharpened it on a matchbook. If the plunger stuck, she lubricated it with earwax. If the needle broke or got lost, she’d share one with someone else--her boyfriend, other addicts, almost anyone--as long as dope flowed in her veins.
In those days--the early 1980s--few addicts knew that needle-sharing was a fast track to AIDS, that the virus could be spread on the tip of a contaminated spike. Adams shared thousands of times. And now, at 28, she is HIV-positive.
“If I had some drugs and you had a syringe, and I didn’t know you from Adam, I’m going to give you drugs so I can use your syringe,” said Adams, a North Hollywood social worker who no longer uses drugs.
Intravenous drug users are the second-largest group of people with the AIDS virus in Los Angeles County, and the main transmission route for the disease to heterosexuals, their sex partners and children. An estimated 14,000 county residents are infected with the human immunodeficiency virus as a result of contaminated needles.
Needle-related HIV infections have nearly doubled in five years in the county, and public health experts warn that local government is not doing enough to battle the virus among injection drug users.
One of the best ways to attack the problem, health specialists say, is by supplying sterile injection equipment to addicts through “needle exchanges.” But city and county officials have provided little or no support for such programs amid concerns that they violate state law and encourage drug abuse.
Operating outside the law, two private needle exchange groups have struggled to fill the vacuum, trading new needles for used ones with AIDS-conscious addicts at rundown motels, behind buildings and on street corners. But both programs run on shoestring budgets, and organizers say they reach only a fraction of those they should.
Health experts say that although the HIV infection rate is a relatively low at about 7.5% of the estimated 190,000 intravenous drug users in Los Angeles County, it will rise if government inaction continues. Specialists point to the New York City area as an example of how bad things can get. There the infection rate in this group is a horrific 50%, and an army of more than 100,000 people have contracted HIV through needles.
“On the East Coast, the horse is out of the barn. Here, (the infection rate) is still low enough that we can have an impact,” said Dr. Tom Horowitz, a longtime member of the county Commission on HIV and AIDS.
“Unless we have major intervention, (the infection rate) is going to go up. A certain percentage of people will share, and a certain percentage will get infected. . . . It’s going to go up until we stop it.”
There is remarkable consensus among health professionals that needle exchanges--giving addicts new needles for old ones on a one-for-one basis--are a cheap, effective way to reduce the spread of AIDS among drug injectors, and a number of medical studies support that conclusion.
For example, the U.S. Centers for Disease Control and Prevention found in 1993 that supplying clean needles to addicts protected them and their families from HIV and should be part of a broad assault on the disease. The CDC study examined 37 needle exchange programs in the United States, Canada and Europe.
Studies also have found that needle exchanges do not encourage existing addicts to use more drugs, or lure non-users into drug abuse.
Moreover, backers say, needle exchanges help keep dirty needles out of the hands of children and others in public parks, schoolyards and streets, where they are often discarded. By trading new needles for old ones, exchanges serve as recycling centers, giving addicts an incentive to pick up needles and turn them in.
And addicts are not the only ones who benefit from needle exchange, supporters say.
Many Los Angeles residents follow the Mexican folk practice of injecting vitamins and antibiotics, and family members often share needles. In addition, many athletes inject steroids and transsexuals commonly inject hormones, sometimes sharing needles within their own groups.
But despite their benefits, needle swaps have stirred sharp opposition in Los Angeles.
Detractors charge that drug users drawn to a controversial exchange in Hollywood have stolen property, defecated on sidewalks and strewn trash on streets.
Last fall, angry residents made citizen’s arrests of three volunteers working at the exchange sponsored by Clean Needles Now, a private group that has supplied addicts with more than 350,000 new syringes since 1991. The residents’ action forced police to accept the arrests despite a declaration by Los Angeles Mayor Richard Riordan that enforcing the needle law would be a low priority.
Linda Lockwood, a Hancock Park businesswoman who opposes the Hollywood exchange, said she has more than 700 signatures on a petition opposing use of city funds for needle exchanges.
Lockwood said she does not oppose public health measures aimed at stemming the spread of AIDS. But she wants needle exchanges to be done in medical facilities by trained professionals, not on the streets or in parking lots by untrained volunteers.
Residents are not alone in their opposition. Gov. Pete Wilson has twice vetoed legislation that would have established pilot programs allowing needles to be handed out without prescriptions.
In a message explaining one veto, Wilson said the legislation would undermine anti-drug campaigns aimed at young people and possibly trigger “an enormous increase in addicts.” He also bluntly questioned whether it was worth taking that chance for the sake of reducing HIV risks to people who already are addicts.
As word of its dangers has spread in recent years, the practice of sharing injection equipment has declined among Los Angeles County drug addicts. But sharing is still alarmingly common, according to a study by UCLA’s Drug Abuse Research Center that said 50% of intravenous drug users were still sharing in 1993.
Sharing is risky because HIV can be transmitted through blood. When shooting up, addicts commonly draw a small amount of blood into their needle to make sure they have hit a vein. Even after they push down the plunger to inject drugs, traces of blood can remain in the syringe cylinder or on the point.
Despite the danger, addicts continue to share for a variety of reasons.
It is illegal to possess hypodermic needles without a doctor’s prescription in California, and drug users caught with them are subject to arrest. Some drug users--especially those who take narcotics only occasionally--don’t want to store injection equipment at home, fearing that family members may learn of their habit.
As a result, users often share needles stashed at friends’ homes or “shooting galleries” in apartments, houses or abandoned buildings.
Also, addicts are, after all, addicts. When the craving hits them, they will use almost any needle within reach, whether or not it is sterile.
“When a person wakes up first thing in the morning and be sick, all your thoughts and reasoning . . . kind of be left behind,” said Richie Sims, a homeless South Los Angeles man who injects heroin--and a heroin-cocaine combination called a “Belushi” because it killed actor John Belushi.
Needing a fix yet wary of police, intravenous drug users sometimes find their way to shooting galleries, where many addicts can borrow injection equipment or rent it for a dollar or two. The galleries function as biological blenders for HIV, as addicts pass possibly contaminated needles to one another over and over, increasing their chances of infection each time they shoot up.
In New York City, shooting galleries are a major reason for the explosion in infection rates among addicts. Occupying abandoned buildings in rundown neighborhoods of Harlem, the Bronx and Brooklyn, the galleries often take in 200 to 300 addicts per day.
Although Los Angeles’ galleries are not as numerous as New York’s and do not draw as many customers, the UCLA study found that up to 50 drug users at a time gather at local galleries. Twenty-three percent of drug injectors in the county visit shooting galleries, and most share needles while there, the study said.
Despite the persistence of sharing, some intravenous drug users say needle exchanges have persuaded them to change their habits--and perhaps saved their lives.
“Needle exchange is the best thing that happened to all of us, because we don’t share anymore,” said Shirley Mitchell, who has used heroin and cocaine for 20 years.
Each week, she joins a line of addicts picking up needles at South Park, a longtime drug hangout in South-Central. The needles are distributed by Los Angeles’ other private needle exchange program, run by the Minority AIDS Project.
Project employees trade needles with addicts outside “the Cage,” a fenced-in portion of the park where drug users gather. After getting their new needles, the junkies quickly retire to the Cage, where they eagerly plunge drug-filled syringes into arms and necks.
“AIDS is nothing to play with,” said Mitchell. “I see too many of my brothers and sisters dying from it. And it ain’t nothing pretty.”
The HIV infection rate among intravenous drug users in Los Angeles County has escalated slowly but steadily over the past five years. In 1989, it was 3.8%; now it is between 7% and 7.5%.
Despite the county’s vast size and population, its infection rate in this category remains far below that of New York City. Experts attribute New York’s rate--the nation’s highest--to the city’s large number of shooting galleries, and the throngs of people who share needles in them.
Local health experts say now is the time to aggressively battle the virus in Los Angeles County’s population of intravenous drug users, before the infection rate rises further. In San Francisco, the rate in this group more than doubled in a year, to 13% in 1987 from 6% in 1986.
But Los Angeles city and county officials have long balked at supporting needle exchanges.
In 1988, a motion to explore the idea of a countywide needle exchange died for lack of a second before the Board of Supervisors. The supervisors waited four years before finally approving, in 1991, the distribution of bleach kits to disinfect dirty syringes. And although supervisors agreed in August to examine the feasibility of a countywide needle exchange, they have yet to vote on a program.
Since Mayor Riordan declared AIDS a local health emergency in September, police have made few arrests among exchange volunteers. But the city has shown little support for needle exchange.
City officials last year gave $130,000 to three private groups to carry out needle exchanges and other AIDS-prevention activities among intravenous drug users. However, city officials specified that no public funds could be used to actually buy needles, although the money could be used for administrative costs.
Moreover, one group has not yet started its exchange program, while another is spending the city money on anti-AIDS activities other than needle exchange.
By contrast, local government in San Francisco--with less than one-tenth as many intravenous drug users as Los Angeles County--has aggressively tackled the problem.
San Francisco’s health department gives about $235,000 a year to Prevention Point, a private group that since 1988 has exchanged more than 3.7 million needles with local addicts. The funds are used, among other things, to buy needles and the program operates with the active backing of Mayor Frank Jordan, the city’s former police chief.
AIDS activists and public health experts say Los Angeles politicians have dragged their feet partly because they fear being accused of using tax dollars to promote drug use.
“More than anything else, it’s because AIDS is looked at as a political issue, rather than a public health issue,” said Dr. Aliza Lifshitz, president of the California Hispanic-American Medical Assn. and a veteran member of the county Commission on HIV and AIDS.
Others charge that since most drug users are poor--and politically powerless--whites, blacks and Latinos, their needs can be safely ignored by local elected leaders.
“The bottom line is, it has always been about color,” said Carrie Broadus, who runs the Minority AIDS Program’s needle exchange. “It’s always been about economic and social class. It’s always been about haves and have-nots.”
The latest exchange proposal to come before the Board of Supervisors illustrates the conflicting political, medical and legal concerns that have blocked needle exchanges here.
The supervisors in August directed several county department heads to investigate the possibility of setting up a county-funded needle exchange. But department chiefs issued conflicting reports, and the proposal has bogged down.
County Department of Health Services chief Robert Gates noted that extensive studies have shown exchange programs to be effective, and he recommended that the county set one up.
But county counsel DeWitt Clinton later reported that the county “cannot take any measures” without breaking state law, and he argued that the county might be liable if an addict was injured with a county-supplied needle.
Meanwhile, those who run private needle exchanges say they reach only a small number of the drug users needing help.
Broadus, who oversees syringe exchanges at four sites in Central and South-Central Los Angeles, said needles should be available at a dozen locations or more--including the Westside and the San Fernando Valley.
“With the large size of Los Angeles County, it’s a shame we have not taken a leadership role,” she said.
“I believe that in the long run, people are going to view Los Angeles County, if we don’t move on this, as the county that buried its head in the sand and continued to let people get infected. And that’s a political and moral shame.”