WINNING THE WAR; BUT QUEENS, SI NEED TO HELP IN HIV BATTLE, EXPERTS SAY

Atlanta - New York City is on the verge of further reducing the spread of
HIV between drug users through needle-exchange programs, with only Queens
and Staten Island standing in the way, experts are expected to announce here
today.

The needle-exchange programs, permitted under New York State law since 1992
and implemented aggressively in Manhattan, Brooklyn and the Bronx throughout
the late 1990s, have been the key to success, said Dr. Don DesJarlais of
Beth Israel Medical Center in Manhattan. Before these programs began,
DesJarlais said, about half of the city's estimated 200,000 IV drug users
were HIV positive, and their ranks were being replenished annually as about
4 to 5 percent of the remaining IV drug users acquired HIV each year.

Representing a research coalition of New York City, state and academic
scientists, DesJarlais will announce these findings today at the second
National HIV Prevention Conference. DesJarlais will report that New York
City may execute the most dramatic reduction in HIV transmission seen in the
world - but only if the whole city cooperates.

Since the widespread implementation of programs in which drug users can swap
used syringes for clean ones and are encouraged not to share the devices
with others, "what has gone way down is the rate of new infections
replacement ... so that the number of new infections no longer matches the
number of AIDS deaths," DesJarlais said.

As of 2000, DesJarlais said, New York City's drug users are getting infected
annually at a rate of 1 percent, and the pool of HIV-positive IV drug users
is down to about 30 percent of the drug-using population. These findings are
based on six studies, involving 11,000 drug-using participants in the five
boroughs.

"There is still a considerable possibility of doing more," DesJarlais said
in an interview. "We estimate that we could reduce that new infection rate
down to about 0.5 percent here in New York City if there was broader access
to needle exchange.

"And then the transmission would be down to just sexually acquired
infections."

In interviews with thousands of New York IV drugs users, 80 percent said
they would regularly use safe, sterile syringes if a needle exchange site
was within 10 minutes travel distance of their homes, DesJarlais said. When
the exchange site was more than 10 minutes away by foot or subway use, that
response dropped to 50 percent. "Most of our Queens respondents said it was
just unrealistic to think they would come into Manhattan to get syringes,"
he said.

Asked to respond to the report, Queens borough President Claire Schulman
said, "I'm in favor of a clean needle exchange program in Queens. Anything
that can help lower the number of people infected with HIV should be done."

"These stunning statistics will undoubtedly increase support in Congress for
needle exchange programs," added U.S. Sen. Charles Schumer (D-N.Y.).

During the 1980s and early '90s nearly one out of every 11 Americans
infected with HIV were New York City residents who injected drugs and
acquired their infections through sharing needles.

"It was one of the biggest local epidemics in the developed world,"
DesJarlais said in a news conference yesterday. By 1990, about 50,000 New
York IV drug users had AIDS, and another 50,000 were in earlier stages of
HIV infection, giving "numbers of AIDS cases that were more than the totals
for all risk groups combined in any country in Europe," he said. Bringing
those figures down from half of the drug-using population to less than a
third would constitute a significant victory in the war against HIV. If the
rate at which IV drug users become infected can drop below 1 percent, the
pool of HIV and AIDS patients in the city will eventually shrink to people
who acquire the disease sexually.

Already, needle-exchange programs have saved thousands of lives in New York,
ranking the achievement above the 600 American babies annually protected
from HIV through treatment of their infected mothers, according to the
Centers for Disease Control and Prevention.

On Staten Island and in Queens, community resistance has blocked creation of
needle-exchange sites. Staten Island's IV drug population is fairly small,
but in Queens, DesJarlais said, "There are tens of thousands of IV drug
users that aren't getting reached right now."

Over-the-counter sale of syringes without a prescription has been permitted
at drug stores in the state since Jan. 1. The largest drug store chains in
the tristate region have agreed to sell consumers up to 10 syringes a day,
at a cost ranging from $2 to $6 per 10-pack. As the program expands, experts
anticipate spread of HIV among drug users will fall further. DesJarlais
predicts that doubling spending on aggressive outreach and needle exchange
to $4 million a year, along with the drug store sales program, could push
new infection rates citywide to below 0.5 percent.

Currently, New York's needle exchange programs operate on a collective
budget of about $2 million a year, and receive no federal funds. Congress
has repeatedly voted to deny federal funding for such programs, despite
countless studies and a National Academy of Sciences report demonstrating
their efficacy in saving lives. Congressional opposition has generally cited
claims that needle distribution encourages drug use.

For fiscal year 2002, the estimated federal budget calls for National
Institutes of Health spending on prevention research of $1 billion, $357
million of which is directed toward vaccine development. The remainder is
directed to research on behaviors that put people at risk for HIV, effective
ways to change sexual behaviors and about $40 million for discovering an
effective vaginal microbicide. Another $755 million is budgeted for CDC
spending on HIV efforts nationally, about 40 percent of which will be passed
on the local health agencies for their AIDS prevention efforts. None of the
CDC or NIH funds may legally be used for needles exchange efforts.

According to Dr. Helene Gayle, the CDC's combined HIV prevention efforts
have failed to reduce the numbers of Americans newly infected with the
virus. Since 1998, said Gayle, who heads all of the CDC's HIV-related
efforts, the numbers have remained stable with 40,000 becoming newly
infected annually and 12,000 dying of AIDS each year. Worse yet, she said in
a conference speech yesterday, "We fear infections may again be rising" and
progress thus far may be in jeopardy.

Gayle warned that disturbing behavioral and new infection trends show HIV
has shifted into the African-American heterosexual population, and is
resurging among gay men. Yet, she said, "the sense of urgency in the United
States seems to have vanished."