BILL WOULD LIMIT NEEDLE EXCHANGES

BANGOR, Me. -- For years, the location of this city's needle exchange
program, in a nondescript strip mall close to highways and bus lines,
was seen as a major asset.

But now, AIDS activists say, that very location could undermine what
happens inside the exchange.

A bill working its way through Congress would lift a ban of more than
20 years on using federal money for needle exchange programs. But the
bill would also ban federally financed exchanges from being within
1,000 feet of a school, park, library, college, video arcade or any
place children might gather -- a provision that would apply to a
majority of the country's approximately 200 exchanges.

"This 1,000-foot rule is simply instituting the ban in a different
form," said Rebecca Haag, executive director of the AIDS Action
Council, an advocacy group based in Washington. "Clearly the intent
of this rule is to nullify the lifting of the ban."

Under a separate bill, all exchanges in Washington within the
1,000-foot perimeter would be barred from receiving city money as
well as federal money.

"Let's protect these kids," said Representative Jack Kingston,
Republican of Georgia, who introduced the Washington bill. "They
don't need to be playing kickball in the playground and seeing people
lined up for needle exchange."

Both bills have passed the House and a Senate subcommittee and await
Senate action.

Advocates and organizations including the N.A.A.C.P. are lobbying
Congress to kill the 1,000-foot provisions. The promise of federal
money could not come at a better time, these officials say, as states
are cutting their health and human services budgets and private
donations are dropping precipitously. At least four needle exchanges
have closed this year because of a lack of financing.

Many exchanges are run by organizations that provide broad-based
health services like testing for the AIDS virus and hepatitis C,
mental health counseling, medical referrals and condom distribution.
Advocates worry that if needle exchanges disappear, drug users will
lose access to those other services.

The rule "is going to kill us," said Ellis Poole, executive director
of the Harm Reduction Center of Southern Oregon, which is 997 feet
from a high school in Roseburg. The center runs a needle exchange and
offers antidrug programs to high schools in the area. With donations
plummeting, it has a $374,000 budget deficit for 2009. Mr. Poole said
he worried that the center's programs would be threatened if the bill passed.

"We could move a few feet down, but the building is more expensive at
the other end," Mr. Poole said. "I have to beg for money for
computers. I have to ask people to come clean the carpet at no charge."

Officials at exchanges in cities like Chicago, New York and
Washington say there are few, if any, places that could house a
needle exchange under the rule.

"I was thinking, 'A thousand feet, how much is that?' " said Raquel
Algarin, executive director of the Lower East Side Harm Reduction
Center in Manhattan. "And then I found myself thinking, 'We'd
probably be doing syringe exchange in the middle of the East River,
and any exchange on the West Side would be in the Hudson River.' How
do you work that out?"

Many advocates also worry that smaller, rural exchanges, which lack
the fund-raising abilities and infrastructure of many larger, urban
exchanges, will be affected by the 1,000-foot rule.

In Maine, which officials say has one of the highest rates of
prescription drug abuse per capita in the country and is grappling
with a recent influx of heroin, AIDS activists worry that they will
receive less money just as their client base is growing. The state's
four exchanges -- in Augusta, Bangor, Ellsworth and Portland -- would
be ineligible for federal money.

"The federal funding would be key for us," said Patricia A. Murphy,
executive director of the Eastern Maine AIDS Network in downtown Bangor.

Upon entering the office, squeezed between a veterans center and a
music store, drug users are escorted into a small room, where a
trained staff member checks them in, using only first names and case
numbers, and carefully counts their needles.

Under Maine law, drug users may receive one clean needle for every
dirty one they turn in. The exchange offers users a variety of needle
sizes, along with tourniquets, antiseptic ointment, condoms and
information on safe needle use, and helps refer clients to clinics
and treatment centers that deal with sexually transmitted diseases.
The center also has a food bank, which clients are urged to use.

Those who have built a level of trust with Ms. Murphy and her staff
send fellow drug users to the office. The number of users enrolled in
the needle exchange here has doubled in the past year, while funding
fell by about 15 percent.

The federal money, Ms. Murphy said, would allow the exchange to grow
with the number of clients, many of whom come from rural northern and
eastern Maine, and set up mobile needle exchange units in communities
more than 100 miles from Bangor.

"This is a critical piece of harm reduction," Ms. Murphy said.

According to the Centers for Disease Control and Prevention,
intravenous drug use directly or indirectly accounts for about
one-fifth of the nation's 1.1 million H.I.V. cases, and needle
exchanges are an effective way to stem the spread of infection. The
World Health Organization said in a 2004 report that there was
"compelling evidence" that increasing needle exchanges reduced H.I.V.
transmission. It cited studies showing that the rate of infection
dropped up to 18 percent in cities with an exchange.

Luke, a 30-year-old Bangor resident who did not want to give his last
name, said he exchanged his needles, and sometimes those of his
friends, about once a week. He said he had become addicted to
Suboxone, a drug intended to treat opiate addiction that officials
say more people are starting to abuse.

In a black hooded sweatshirt and red sneakers, Luke said he often
also picked up condoms and guides on how to inject drugs more safely.
He said he came to the facility because its location made it discreet
and few people knew what it was.

A 23-year-old man who is addicted to heroin and exchanges needles at
the Down East AIDS Network in Ellsworth called the 1,000-foot limit
"ridiculous." The man, who did not want to give his name because of
his addiction, said he started using heroin eight years ago and
exchanging needles four years ago. He said he often picked up needles
he saw on the ground and brought them in for safe disposal.

"It's a dangerous thing to do," the man said of his heroin use, "but
it's best to take every precaution you can. If you're going to do
this stuff, you should do it right."