Praise for needle exchange

Convert: Miss America once took a stand against the program for drug
addicts. A visit to Baltimore has changed her mind.

By Diana K. Sugg
Sun Staff

They were homeless and drugaddicted, high on alcohol and hungry, waiting
in line to swap their dirty needles for clean ones through a city program
that aims to reduce the spread of HIV. Yesterday afternoon, staffers told
them they were in for a beautiful surprise.

Minutes later, the newly crowned Miss America, Kate Shindle, swept out of a
car in a long black wool skirt and bulky turtleneck sweater pinned with a
sparkly tiara brooch. She came to one of Baltimore's toughest neighborhoods
to praise the needle exchange program that she had condemned just weeks ago.

"It seemed to work against common sense to give drug addicts needles," said
Shindle, echoingthe concerns of many private citizens and politicians in
what has become a longrunning national debate. After hearing her comments,
Baltimore Mayor Kurt L. Schmoke and others helped change her mind, quoting
studies that show Baltimore's effort significantly reduces the spread of
HIV and doesn't encourage drug use.

Congress has recently been wrangling over needle exchanges and whether
federal dollars should pay for them. At the same time, some members of the
Presidential Advisory Council on AIDS have said they may quit, angered that
the administration won't buy clean needles when evidence shows that such an
effort curtails the spread of the human immunodeficiency virus which causes
AIDS.

Meanwhile, the Baltimore exchange, one of the country's largest, is
emerging as a national model. Rep. Elijah E. Cummings, a Baltimore
Democrat, is touting it to his congressional colleagues and pushing a bill
that would direct the creation of federally funded needle exchanges.
Baltimore officials plan to expand distribution to two westside
pharmacies, and researchers have completed studies showing drops in drug
use and crime among hardcore addicts.

Shindle, 20, has stepped in the middle of it all.

"It may seem like it doesn't coincide with Miss America, but if she's going
to be relevant, she has to tackle tough issues," said the Northwestern
University senior, admitting that her viewpoints have caused some
controversy. She launched her reign with a pledge to promote HIV prevention.

"Controversy gets people talking. In this disease, silence is one of our
biggest enemies," she said.

Yesterday, at the corner of Mount and Westwood streets in West Baltimore,
Shindle explained her change of heart to a crowd of neighbors and addicts
and complimented the program for "not passing judgment on the lifestyle or
behaviors of anyone," but focusing on saving lives.

"Hey, all right!" shouted people in the audience, applauding her.

Michele Brown, the program's director, said getting Miss America's stamp of
approval may open others' minds to the idea of exchanges. "I definitely
didn't know what to expect," said Brown. "But she definitely did her
homework. She knew what she was talking about."

Others who stood nearby took little comfort.

"They need more programs to help those trying to get off drugs," said
Joseph Lyle, 42. Clothed in a dirty jean jacket and old navy sweat pants,
he lives in vacant houses and shoots heroin and cocaine. He said he's tried
for years to get into treatment, even faking suicide attempts and going to
local emergency rooms.

He comes to the needle exchange because the program, besides swapping
needles and giving HIV tests, refers addicts to treatment about 600 so
far. Lyle is hoping to get a slot soon.

Nationally, experts estimate that over the life of the epidemic,
contaminated needles have led to the infections or deaths of 200,000
Americans. In Baltimore, where 80 percent of all acquired immune deficiency
syndrome cases in the past two years are linked to intravenous drug users,
their partners or their children, the needle exchange program is key to
saving lives and money.

Participants can swap needles on a oneforone basis. About 1.2 million
needles have been turned in since August 1994, and about 6,100 addicts are
tracked by computer.

Johns Hopkins University researchers have found that hardcore addicts
using needle exchange cut their risk of HIV by 40 percent. Two new studies,
to be presented at coming meetings, add to the evidence.

In one study, scientists looked at addicts using the needle exchange who
were referred into treatment, before admission and then three months later.
Their days of illegal activity dropped from 13 days a month to two. Their
illegal income dropped from $800 to less than $10 a month. Their daily drug
use dropped to less than two days a month.

This group of about 100 hardcore addicts also posted a retention rate in
treatment of 80 percent to 85 percent, said Dr. Peter Beilenson, city
health commissioner. A second Hopkins study found that crime in the
vicinity of the needle exchange sites dropped about 20 percent, comparable
to an overall drop in the city.

There are 115 needle exchange programs in 29 states, the District of
Columbia, Puerto Rico and U.S. territories. They are funded by city, state
and private money. Several major organizations, from the Institute of
Medicine to the U.S. Conference of Mayors, have endorsed the concept.

But critics like Bob Maginnis of the Family Research Council in Washington
argue that the programs promote drug use and crime in depressed
neighborhoods. He also said that the exchanges are a gateway to legalizing
illicit drugs such as heroin.

"These people are killing themselves slowly," said Maginnis. He said they
need help to kick their habits.

Cummings, whose district includes neighborhoods with some of the state's
highest rates of AIDS cases and deaths, understands that thinking. But he
stressed that Baltimore residents asked for the program, which operates at
six sites.

"I was talking to a mortician the other day. He said it gets so bad, he
can't order the caskets fast enough," Cummings said. "My aim is to stop the
deaths, stop the spread of AIDS."

Back on the Baltimore corner, Miss America thanked her hosts. She eagerly
accepted a black sweat shirt emblazoned with the program's name and logo.
Then she began calling all the staff to be photographed with her.

"Where's Michele? Michele!" Shindle said. "Come on everybody, get in the
picture."

Together, they posed, all shouting at the same time: "Needle!"