Needle Exchanges Battle AIDS and the Law : Public health: Addicts spread HIV by sharing contaminated syringes.
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 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 has the deadly affliction.
“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.
She is among the estimated 14,000 Los Angeles County residents infected with the human immunodeficiency virus as a result of using contaminated needles. Intravenous drug users are the second-largest group of AIDS sufferers in the county, and the main transmission route for the disease to heterosexuals, their sex partners and children.
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.” However, 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 warn that while the infection rate is a relatively low 7.5% among the estimated 190,000 injection drug users in Los Angeles County, it will rise in the face of government inaction. Specialists point to the New York City area as an example of how bad things can get. There the infection rate is a horrific 50% and an army of more than 100,000 people has 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 (needles), and a certain percentage will get infected. . . . It’s going to go up until we stop it.”
As a portable klieg light shone down harshly on her green-tinted hair, the young addict stood in the Hollywood parking lot, pleading for more needles.
Her face was half-hidden in the hood of a dirty sweat shirt. A small metal ring pierced her left eyebrow. She was about 20.
Before her stood another young woman, a volunteer for Clean Needles Now, a private group that supplies addicts with new syringes in exchange for used ones. The week before, the young junkie had received 17 needles. But this night she wanted more.
“I need 30 needles,” she said, seeming unsure whether to beg or demand. “Seventeen last week sucked. And my friends took them.”
Each Wednesday night, a group of young volunteers--artists, social workers, graduate students--knowingly breaks state law by distributing sterile needles in the parking lot behind the Los Angeles Gay and Lesbian Community Services Center in Hollywood.
Nervous junkies--many in their teens and 20s--materialize out of the night and turn in dirty needles for new ones on a one-for-one basis. They stuff their old needles into a red plastic bin labeled “Infectious Waste--Biohazard.” Then they slip back into the shadows.
Since it was formed in 1991, Clean Needles Now has exchanged more than 350,000 sterile needles with IV drug users in Los Angeles. Rene Edgington, a Clean Needles Now founder, said the group was formed because she and other early members were appalled that no public or private agency was taking such a simple step to fight the virus.
Beyond the simple moral imperative of trying to save lives, she said, needle exchange is highly cost-effective. While it costs $180,000 or more to care for someone dying of AIDS, a new needle costs 7.4 cents.
There is remarkable consensus among health professionals that needle exchange is 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-exchange programs do not encourage existing addicts to use more drugs or lure non-users into drug abuse.
Supporters argue that needle exchange is one of the few effective vehicles for providing a difficult-to-reach subculture with health services like HIV testing and referrals to drug treatment programs.
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 needles are shared by family members, placing them at risk if one person is infected.
In addition, many athletes inject steroids and transsexuals commonly inject hormones; members of both groups sometimes share needles as well.
But despite the benefits, needle swaps have stirred sharp opposition in Los Angeles.
Detractors charge that drug users drawn to the Hollywood exchange have stolen property, defecated on sidewalks and strewn trash on streets.
Last fall, angry Hollywood-area residents made citizens arrests on three Clean Needles Now workers, forcing 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 gathered more than 700 signatures on a petition opposing the 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 performed in hospitals and other medical facilities by trained professionals, not on the streets or in parking lots by untrained volunteers.
Gwen Johnson, a longtime resident of the Imperial Courts housing project in South-Central, also opposes needle exchanges, arguing that it promotes addiction in low-income communities where drugs already are a scourge.
“A dope fiend gets a needle, a dope fiend’s going to overdose,” she said. “And (needle exchange workers) are to blame, because they put the needles out there.”
Local 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 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 that risk, addicts continue to share for a variety of reasons.
It is illegal to possess needles without a doctor’s prescription in California, and drug users caught with them on the street are subject to arrest. Some intravenous 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, they often share needles stashed at friends’ homes or “shooting galleries” in apartments, houses or abandoned buildings.
Also, addicts are, after all, addicts. And 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 “Belushis"--a heroin-cocaine combination that killed actor John Belushi.
“I don’t want to catch AIDS or nothing like that; I’m not crazy,” said Sims, who recently broke up with his wife and nearly died in a hospital from heavy heroin and crack use. “But to be honest with you, it’s kind of like I’ve stopped caring.”
Needing a fix yet wary of police, intravenous drug users sometimes find their way to shooting galleries, where many addicts may 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 sections 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, nor do they draw as many customers, the UCLA study found that up to 50 drug users at a time gathered 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, a South-Central Los Angeles woman who has used heroin and cocaine for 20 years.
Each week, Mitchell joins a line of addicts picking up needles at South Park, a longtime drug hangout near her home. The needles are distributed by Los Angeles’ other private needle-exchange program, run by the Minority AIDS Project.
Working out of a van, MAP workers trade needles with addicts outside “the Cage,” a fenced-in portion of the park where drug users gather. After collecting new needles, the junkies quickly retire inside the Cage, where they eagerly plunge syringes into arms or necks.
“AIDS is nothing to play with,” said Mitchell, who sometimes sells new needles for $1 apiece. “I see too many of my brothers and sisters dying from it. And it ain’t nothing pretty.”
Uninfected addicts are not the only exchange customers.
Lamont Hanks, a homosexual ex-nurse and longtime drug injector, collects needles from the Clean Needles Now site in Hollywood even though he already has full-blown AIDS.
For 10 years, he has injected amphetamines--a “sex drug” that allows the user to maintain an intense level of sexual desire. Because he was a nurse, he said, he always had access to clean needles in hospitals and doctors’ offices.
Since he no longer works, he now gets needles from Clean Needles Now. Using clean needles keeps him from contracting another strain of AIDS or another disease, such as hepatitis or endocarditis, an infection of the heart’s lining. He got AIDS, he said, from unprotected sex.
On a chilly night recently, Hanks picked up 120 needles. Some were for him, and some were for friends--also drug injectors with AIDS--with whom he has sex-and-drugs parties at his house on weekends, he said.
“None of my friends share now,” said Hanks. “They did in the past. Fortunately, I’ve changed all that.”
California is among only 11 states that still prohibit needle sales without a prescription, and some health activists argue the law should be repealed to give addicts easier access to clean needles.
Activists say the needle ban is one reason Los Angeles County’s infection rate is creeping upward. While the county’s infection rate is 7.5%, the rate in Seattle and surrounding King County--where needles can be purchased without a prescription--is about 4%.
But many law enforcement agencies want the ban left in place, saying it helps to suppress drug abuse.
“Police and sheriff’s departments say they believe that (repealing the law) would lead to an increase in drug use,” said Dave Puglia, a spokesman for state Atty. Gen. Daniel E. Lungren.
“They always get laughed at by people on the other side, but law enforcement people who deal with the problem every day say the law shouldn’t be repealed, and that shouldn’t be dismissed out of hand.”
In a small apartment in Lancaster, on the edge of the Mojave Desert, Teresa Roberson and Gary Brickman live day to day with HIV.
Both once injected drugs, and both believe they got the disease from dirty needles. Roberson has not worked since she was diagnosed in 1990; Brickman was recently laid off his job with a small lighting firm.
They met last year at an HIV support group in Pacoima. Since she developed the AIDS virus, Roberson’s health has declined swiftly; Brickman shows no outward signs of illness. They are both 33.
“Teresa is the girl I wish I had met my whole life,” Brickman said. “I guess it took AIDS to bring us together.”
Over the past five years, the HIV infection rate among current and former injection drug users in Los Angeles County has escalated slowly but steadily. In 1989, it was 3.8%; now it is 7.5%.
Despite the county’s vast size and population, its infection rate remains far below that of New York City. Experts attribute New York’s rate--the nation’s highest--to the large number of shooting galleries there, 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 intravenous-using population, before the infection rate rises further. In San Francisco, the rate 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 exchange programs.
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. While the supervisors agreed in August to examine the feasibility of a countywide needle exchange program, they have yet to vote on a program.
Since Riordan declared AIDS a local health emergency in September, police have arrested few exchange volunteers. But the city has show little other 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 they could be spent on salaries, rent and similar expenses.
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 needle exchange that since 1988 has exchanged more than 3.7 million needles with local addicts. The funds are used to, among other things, buy needles. 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 taking.
“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 traditionally 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 Health Services chief Robert C. Gates noted that extensive studies have shown exchange programs to be effective. He recommended that the county set up a needle exchange, as long as it was linked to HIV testing and counseling, access to drug treatment and AIDS prevention literature and materials such as bleach and condoms.
But County Counsel De Witt W. Clinton said in an October report that the county “cannot take any measures” without breaking state law, and argued that the county might be held liable if an addict was injured with a county-supplied needle. Anyone distributing needles, he noted, could be arrested and prosecuted.
Meanwhile, those who run private needle exchange operations say they reach only a fraction of the addicts 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 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.”