NEEDLE EXCHANGE STEMS SPREAD OF DEADLY DISEASE

Dr. Howard Koh, commissioner of the state Department of Public
Health, is one of many top health care professionals persuaded by
scientific data that needle exchange programs for intravenous drug
users prevent the spread of the HIV/AIDS epidemic. "I have come from
not-so-sure to being absolutely certain," he told me during a recent
interview.

"This epidemic is preventable," he said. "Yet we have not made
progress in years because the debate has been emotional rather than
data-based. We have between 700 and 800 new cases each year in the
state, traceable to intravenous drug use. That is a failure of the
system."

"We haven't seen anything yet about what the effect (of dirty
needles) on hepatitis C may be," Jean McGuire, assistant commissioner
and director of the department's HIV-AIDS bureau, added. "With about
110,000 people already infected in the state, that disease is
spreading."

"Whether needle exchange is effective is no longer an issue.

That question has long been answered," said Joseph D. McKee, director
of client services at AIDS Project Worcester Inc. A native of
Northern Ireland and a practicing Roman Catholic, he moved to this
country with his family after hatemongers burned down his father's
business.

"I know what bigotry and prejudice can do," he said. Indeed, the
evidence in favor of needle exchange is overwhelming. Among the
organizations supporting the program are the National Academy of
Science, American Medical Association, American Public Health
Association, American Bar Association, American Pharmaceutical
Association and the U.S. Conference of Mayors.

The list of leading experts backing the clean-syringe program is a
virtual "Who's Who" of medicine and science.

The U.S. Surgeon General and the Department of Health and Human
Services declared there is conclusive evidence that needle exchange
reduces the spread of HIV while it does not increase illicit drug use
or crime.

Claims that the so-called "Vancouver and Montreal studies" detected
an increase in HIV transmission among participants in needle exchange
programs have been soundly rebuffed by the studies' original authors
and by subsequent data.

Having watched the devastating effect of intravenous drug abuse in
Worcester, Mr. McKee spearheaded an effort in 1995 to persuade the
City Council to authorize needle exchange.

When the advocates were turned down, Mr. McKee joined the Harm and
Risk Reduction Coalition that developed a new, clinic-based
rehabilitation program.

The council rejected that model in 1998. Mr. McKee then decided to
work with the Massachusetts AIDS Policy Task Force. "We tried to
accomplish our goal at the state level rather than fighting the issue
town-by-town," he said.

The task force backed a bill by state Sen. James P. Jajuga,
D-Methuen, that would allow the DPH to actively prevent the
transmission of HIV/AIDS and hepatitis C. The Legislature's Joint
Health Committee approved the measure, but former Gov. Paul Cellucci
vetoed a budget provision for the program because he was concerned
about the lack of local consensus.

However, the bill provides for a local advisory committee "to solicit
community input" and report to the commissioner before a final
decision is made on implementation of needle exchange programs.

The Jajuga bill, now co-sponsored by state Sens. Harriette L.
Chandler and Richard T. Moore, has been resubmitted and will be
considered at a legislative hearing on June 11. Meanwhile the DPH has
launched a statewide education program, complete with radio ads and
billboards, to inform the public. "The balance between local control
and state involvement is delicate," Dr. Koh noted. "I always prefer
the route where people are educated."

"This program is not just walking in and getting clean needles.
Syringe exchange is part of a comprehensive HIV prevention strategy,"
Mr. McKee explained. "It entails substance abuse counseling and
treatment at community health centers already involved in the fight
against drug and alcohol addiction." Services include medical
screening and psychiatric evaluation, detoxification, HIV testing and
counseling, testing for sexually transmitted infection, medical care
and long-term follow-up.

"Addicts can and do recover.

And preventing AIDS or hepatitis is far less expensive than the
treatment," Mr. McKee stressed.

Said Dr. Koh, a physician, "People with addictions should not be
viewed as criminals. Addiction is a disease, and all humans are
susceptible to it. The enemy is not human beings.

It's contaminated needles."

Unprotected sex among gays is not the leading cause of new HIV and
AIDS cases in Massachusetts; injection drug use is. The DPH has the
power to actively prevent the transmission of every communicable
disease, except the deadliest one: HIV and AIDS. It does not have the
authority to organize clean needle exchange programs.

A poll by the McCormack Institute of the University of Massachusetts
last year showed that 64 percent of registered voters in the state
favor needle exchange. The Society of Christian Ethics declared,
"Needle exchange programs are ethical and should be fostered."In
Boston, Cambridge, Northampton and Provincetown needle exchange has
reduced the transmission of the HIV virus that causes AIDS and
hepatitis C without encouraging illegal drug use. But in cities that
have no needle exchanges, the epidemic has spread.

In Lowell, 60 percent of new AIDS cases are attributed to intravenous
drug use; in New Bedford, 58 percent, and in Worcester, 53 percent.
The situation is particularly troubling in Worcester. More than 52
percent of substance abuse in Central Massachusetts is
heroin-related, with 49 percent traced to the use of syringes.

This is nearly double the rate in most communities. While nationwide
27 percent of women diagnosed with HIV/AIDS are injection drug users,
the percentage in Massachusetts is 40 percent -- and in Worcester 49
percent. "I find it unconscionable that we allow people to get
infected with a disease for which there is no cure when the epidemic
could be curtailed," Ms. McGuire said. "If we adopted needle exchange
in Worcester, we could curtail the spread of the disease by one-third
within 18 months," Mr. McKee pledged.

I, too, have traveled the road from skeptic to believer with Dr. Koh
and others.

I'm persuaded there is nothing to lose and much to gain from a
well-organized needle exchange program in Worcester.