BEXAR TO GET TEXAS' FIRST LEGAL SYRINGE EXCHANGE PROGRAM

Sidling through a crowded, narrow hallway at El Divino Salvador
United Methodist Church on the near West Side, where dozens line up
for groceries from the twice-monthly food bank, Bill Day smiles and
asks, again and again: "Do you need any syringes?"

Most shake their heads or stare blankly. The few who say yes claim
that they or family members are diabetic. Day believes at least some
of the needles will be diverted for illegal drug use. And that's fine with him.

"I found that some low-income diabetics use the same needles
repeatedly," Day said. "They're not drug addicts — they just use the
same needle over and over again. Sometimes they share their needle
with family members, and sometimes with addicts."

In September, Bexar County could have the first legally authorized
syringe exchange program for drug addicts in Texas — the only
remaining U.S. state without some form of one, proponents say. An
amendment creating the local pilot program was attached to Medicaid
legislation by state Rep. Ruth Jones McClendon after a bill that
would have allowed syringe exchange programs throughout the state
died in committee.

But until then, Day and other volunteers in most major Texas cities
skirt the law by handing out clean syringes on their own — despite
the fact that Texas bans the sale and distribution of drug paraphernalia.

Day co-founded the Bexar Area Harm Reduction Center, a tax-exempt
nonprofit group with grant funding from local churches, particularly
St. Mark's Episcopal, and national organizations. The idea is to
limit the spread of HIV and hepatitis C.

Until recently, the program has struggled to get off the ground — a
result of skittish board members, unreliable volunteers and a change
of police administration that drove addicts underground, Day said.

"We started out with three (volunteers) in January 2003," said Day, a
retired commercial real estate appraiser and lay minister at St.
Mark's. "We had a lot of people show up initially. Then when they
found out about the state law regarding drug paraphernalia, they'd disappear."

The risk of disease

Perhaps half of new HIV infections in the United States are among
intravenous drug users, their sex partners and their kids. Such drug
users account for 60 percent of new hepatitis C infections. Many are
uninsured, and the public cost of treating them is huge.

"The amount of money that you spend with (a syringe exchange) program
is so small compared with the cost of treatment for hepatitis and
HIV," said McClendon, D-San Antonio.

Her original legislation, House Bill 856, would have allowed local
health departments in Texas to run syringe exchange programs in-house
or through contractors. Sen. Leticia Van De Putte, D-San Antonio, a
pharmacist, co-authored the Senate version with Sen. Bob Deuell,
R-Greenville, a family physician.

In past years, Deuell had opposed syringe exchange programs on moral
grounds — "the 'ick' factor," as an aide described it — but changed
his mind after researching the issue. The state's medical community,
including the Texas Medical Association, backed the bill.

The Senate version passed easily. In the House, the bill was blocked
by Public Health Committee Chairwoman Dianne Delisi, R-Temple.

"The members of the committee wanted the bill to be voted out,"
McClendon said. "But the chair has to recognize a member to make the
motion to call the bill up. And the chair would not recognize a
member to make the motion to call the bill up. So we never got the
bill out of committee."

Delisi said at the time, "I have not been persuaded that the public
health benefits outweigh the concerns of many members, myself
included, of providing needles for those that are using illegal drugs."

But McClendon managed to get authorization for a Bexar County pilot
program attached to the Medicaid bill. She's working with local
health officials to design the program, bringing in outside experts for advice.

"It's really important for us to succeed in Bexar County, so that we
can have documentation and evidence as to how it would be implemented
on a statewide basis," McClendon said.

Out of the shadows

Proponents say exchange programs not only reduce the spread of
disease but can draw addicts out of the shadows to offer them help
overcoming their addiction.

"Syringe exchange is just a little piece of what the program can be,"
said La Juana Lamb, who ran New Mexico's statewide program in the
mid-1990s and now works for the National Native American AIDS
Prevention Center in Denver.

"Because once you start making connections with folks and start
talking to them, offering them other services, start supporting them
as a human being again, it starts rebuilding that person's confidence
in themselves. It might be the first time in a long time that
anybody's looked at them as a human being, as opposed to a druggie.

"If you're seeing somebody every week, you also have a chance to talk
to them about, how's your health? How are your arms? Are you eating
and drinking water? Where are you sleeping? We always ask them, do
you want to get off this stuff? A lot of times the answer was no, but
sometimes the answer was yes."

Sheriff Ralph Lopez, who supports the program, thinks it might also
reduce the risk of his officers accidentally getting stuck with an
infected needle while searching a suspect.

Still, Lopez thinks the organizers of the program have their work cut
out for them.

"If you look into the (local drug) culture, if you've got a place
where these guys are shooting up and you don't share, they'll either
think you're undercover, or if you bring your own needle that's an
insult to them and they might initiate violence."

Studies have drawn mixed conclusions about how effectively syringe
exchange programs reduce disease. While most have shown benefit, some
have shown no effect, and a few have even suggested HIV infection
increases after exchange programs are launched — although some
critics say those negative results have been in cities where addicts
have legal access to clean needles through multiple sources such as
pharmacies, skewing the data.

A 2001 overview of the studies, conducted by researchers at the
University of California, Davis, found that when those cities with
multiple sources were excluded, 28 of 29 remaining studies showed
exchange programs reduced the spread of HIV and/or needle sharing.
And another 2003 study of 99 cities worldwide found that HIV
prevalence decreased 19 percent a year in cities with exchange
programs and rose 8 percent a year in cities without them.

Also, a National Institutes of Health consensus panel on HIV
prevention estimated that exchange programs reduce needle sharing up
to 80 percent and can reduce HIV infection among drug users by almost a third.

"It's hard to prove something didn't happen and exactly why it didn't
happen. But in Europe and Australia and New Zealand particularly,
where they have these programs, they report unanimously that the
spread of diseases go down," said William Martin, a senior fellow in
religion and public policy at Rice University's Baker Institute who
has studied and written about exchange programs and testified in
favor of them during the past two legislative sessions.