NEEDLE EXCHANGES, AGAINST THE ODDS

To the Editor:

Re "Needle-Trading Programs Have Few Inroads in U.S." (news article, June 23):

While we are dismayed by the laws and attitudes that hinder this pragmatic
response to the problem of H.I.V. transmission, we're pleased that there
is, at least, a debate.

Underground needle exchanges are less effective than legal ones because of
the threat of arrest and a diminished ability to raise money. Hence we find
it ironic that even as the Centers for Disease Control and Prevention
affirms the utility of needle exchange programs, in its home city of
Atlanta neither the press nor the politicians are talking about making them
legal.

SUSAN ZIONY LOGAN SPECTOR Atlanta, June 25, 2001

The writers are, respectively, president and vice president, Atlanta Harm
Reduction Center.

To the Editor:

"Needle-Trading Programs Have Few Inroads in U.S." (news article, June 23)
effectively portrays the sources of local resistance to needle exchange
programs: baseless claims and demagoguery pitted against the mass of
scientific evidence on the effectiveness of exchange programs in combating
H.I.V. and related diseases without increasing rates of drug abuse.

Such resistance led to the closing of a state-sponsored needle exchange in
Windham, Conn. A scientific study that a team of us has conducted since
1994, based on follow-up interviews with hundreds of drug injectors in the
Windham area, found that contrary to the outlandish claims of the program's
opponents, closing the needle exchange produced no reductions in the
robustness of Windham's drug scene. It resulted only in significant
increases in drug injectors' H.I.V. risk behaviors, especially reusing and
sharing dirty syringes, and in obtaining new syringes from unsafe sources.

ROBERT S. BROADHEAD Storrs, Conn., June 24, 2001

The writer is a professor of sociology, University of Connecticut.

To the Editor:

Another area in which needle exchange (news article, June 23) appears to
making an impact is a reduction in the spread of hepatitis C.

Approximately 60 percent of new cases of hepatitis C are attributed to
injection drug use. Because the infection is spread very efficiently by
blood, hepatitis C has traditionally been acquired rapidly in this
population. A pattern of rapid early acquisition has been replaced by a
much more gradual increase, probably due in part to the promotion and
distribution of sterile injection equipment by needle exchange programs.

Such programs should also be credited with aggressive educational practices
that provide this high-risk population with the information they need to
prevent disease transmission. Until a vaccine becomes available, needle
exchange programs will be central to the containment of this epidemic.

DIANA L. SYLVESTRE, M.D. San Francisco, June 24, 2001

The writer is clinical assistant professor of medicine, University of
California, San Francisco.