COUNTY BEGINS HEARINGS ON LEGAL NEEDLE EXCHANGE

With the number of HIV cases doubling in Allegheny County among intravenous
drug users during the past year, the Health Department for the first time
is considering creating a legal needle exchange program.

A series of public hearings begin on Saturday to collect community input on
a controversial practice that has been found to stem the spread of HIV
infection in other cities.

The incidence of HIV within the drug-shooting culture now rivals that of
gay men in the Pittsburgh area, said Guillermo Cole, spokesman for the
Allegheny County Health Deparment. An equally pressing concern is the
number of new hepatitis C cases coming from shared needles. Hepatitis C, a
blood-borne pathogen that can lead to liver disease or liver failure, may
affect as many as 79 percent of IV drug users nationwide, according to the
Centers for Disease Control and Prevention.

"Things are different than they were a year ago," Cole said. "The numbers
are very telling. They're prompting concerns."

On June 1, the numbers will start to tell more, as the county implements an
HIV reporting system 0that will track results of all tests, no matter where
they are done.

While confidentiality or anonymity will be maintained at the option of
those being tested, every incidence of HIV -- the virus that causes
acquired immune deficiency syndrome -- will be reported to the county,
which now gets its data only from publicly funded facilities such as the
health department clinics and the county jail.

The 8,700 tests the county processed last year revealed 59 cases of HIV,
including 21 among gay males and 18 among heterosexual IV drug users. The
year before, 8,738 tests found 48 cases of HIV, eight of whom were IV drug
users and 20 gay males.

The new reporting system will give the county more data, while a needle
exchange program would provide better access to an IV drug-use population
believed to number 13,000 to 20,000.

"A key component of any needle exchange program would be HIV testing and
drug treatment, especially getting people off drugs," said Cole. "But we're
not at the point where we've structured a program. We're just beginning the
information gathering stage."

A mostly volunteer group called Prevention Point Pittsburgh Inc. has been
operating an underground needle exchange program for six years. Without
much resistance from police and public officials, it delivers 310,000
syringes a year to heroin and cocaine users in areas such as the Hill
District and McKeesport. It also dispenses condoms.

Dr. Bruce Dixon, health department director, said the county would choose a
group to develop a pilot project and that the county would regulate, but
not fund, its work.

He refused to speculate about such a role for Prevention Point Pittsburgh,
though co-founder Stuart Fisk, a registered nurse and HIV/AIDS specialist,
said his organization would "demand" that the county enlist its help in
establishing a needle exchange program.

"We have the experience and the contacts," he said. "But our preference
would be to continue to operate on our own."

Fisk and Dixon agree that bringing needle exchange out of the shadows would
improve access to new funding sources, and provide the sort of health
screenings and treatment that people living on the fringe fail to receive.
And both say that needle exchange works.

A CDC study released last June showed that in 1997 there were 113 needle
exchange programs operating in more than 30 states, the District of
Columbia and in Puerto Rico. These programs were reducing the spread of HIV
by about 30 percent and were reducing risk behavior by as much as 80 percent.

Prevention Point Pittsburgh and other HIV/AIDS-related organizations plan
to testify at the health department hearings, and submit written
endorsements from the people they serve, Fisk said.

Fisk and others have lobbied the county for years to legitimize Prevention
Point Pittsburgh Inc., which operates on about $60,000 a year in private
donations. It hired its first paid employee in September.

Next month, the group will begin a $5,000 research project, underwritten by
the Beth Israel Institute for Chemical Dependency in New York, to determine
how needle exchange has altered injecting behavior among participants. The
funding would also allow the organization to offer HIV and hepatitis C
testing for those who agree to it, Fisk said.

Although county Chief Executive Jim Roddey said last summer that he
supports needle exchange and would ask the state legislature to amend laws
on possession of syringes, he has not taken action. He says he'll wait for
the findings of the health department hearings. In Pennsylvania, possessing
a non-prescribed syringe is a misdemeanor, punishable by up to a year in jail.

Mayor Tom Murphy believes needle exchange is good public policy as part of
an overall drug treatment program, said his spokesman Doug Root. "He'd like
to figure out a way to make the law more pliable when it comes to putting
policy into effect."

Legalizing needle exchange here does not require state action --just a
declaration of a health emergency by Dixon, something Philadelphia did
years ago.

"Involving the legislature would turn this into a long-term process," said
Dixon. "And rural communities don't have the HIV incidence we do. This is
an issue for the counties."

Dixon also predicted that it will probably take until November for the
nine-member county board of health to review the results of the hearings
and issue a decision about needle exchange. "We want information. And to
see the tenor of the community."

"You just wonder how there could be any kind of opposition," said Bob
Feikema, executive director of the Pittsburgh AIDS Task Force. "It's almost
a no-brainer, except that it raises emotional issues and not fact-based
issues. The concerns are that syringe exchange will increase drug abuse and
result in dirty needles laying around, but research shows the opposite is
true."

"It's an idea whose time has more than come," said Kenneth Walker, a
community outreach advocate for the Mental Health Association of Allegheny
County, a drug treatment referral and advocacy group.

"When the idea was first brought up seven, eight years ago, people said,
'Oh, no. Not here.' But, if you've ever been to 'shooting galleries,' you
see [shared] needles sitting in glasses of water or bleach. They're not
foolproof. They spread AIDS. Needle exchange is the right thing to do."