COUNTY TO CONSIDER NEEDLE EXCHANGE PROGRAM TO STOP SPREAD OF AIDS DISEASE

Plan Would Be Aimed At Stopping Illegal Drug Users From Sharing Of
Contaminated Syringes

Faced with a worsening AIDS problem growing at the rate of about two cases
daily, the Board of Supervisors on Tuesday heard recommendations for
halting the spread of the disease in San Diego County that included
establishing a needle exchange program for illegal drug users.

The needle exchange proposal, the most controversial of the 83
recommendations included in a report from the county's Regional Task Force
on AIDS, was referred by the board to Chief Administrative Officer Norman
Hickey for more study.

With little debate, the board voted unanimously to direct Hickey to report
back in three months on the cost and feasibility of the recommendations in
the task force report.

Used in a handful of other Western cities, including Seattle, Tacoma and
Portland, government-sponsored clean-needle programs enable individuals who
use illegal intravenous drugs to exchange their hypodermics for new ones.

Noting that the sharing of intravenous needles among drug users spreads the
AIDS virus, supporters of needle exchange programs argue that the plans
prevent transmission of the disease and can also be a mechanism for
encouraging drug users to receive treatment.

Opponents, however, complain that, by dispensing the needles, the
government in essence condones illegal drug use and could even increase
addicts' usage by minimizing safety concerns.

"My concern is that, if we give away needles, addicts will use more drugs
than they do now, and we'll just be encouraging someone who might not
otherwise use drugs to try it," said Supervisor George Bailey. "I have
serious doubts about that idea."

The task force's chairman, lawyer Penn Lerblance, emphasized that the
needle exchange plan is only a backstop to the expanded drug treatment and
recovery programs recommended in the group's 39-page report.

"This clearly is a difficult issue for many people on the street to
understand," Lerblance said. "Our major objective is to stop the
transmission of the virus, and the best way to do that is to get people to
stop using drugs. But, until there's enough money for those programs, you
have to be realistic. If you can get people to stop using dirty needles,
that's a step in the right direction."

Sensitive to the political volatility of the needle-exchange idea, members
of the 31-member task force emphasized Tuesday that it is only a small part
of the group's overall strategy for battling a disease that has killed
about 1,400 San Diegans--a bleak statistic expected to grow dramatically.

An estimated 29,000 San Diegans are infected with HIV, the AIDS virus that
typically takes a decade to progress from infection to diagnosis of the
deadly disease. Of those individuals, about 2,300 have reached the final
stage of the disease and have been formally classified as AIDS cases.
However, because that number excludes AIDS patients living in San Diego who
were diagnosed elsewhere, the overall caseload probably is higher, the
report said.

"Our problem in San Diego is much larger than the mere count of diagnosed
cases of AIDS," Lerblance said. "The impact on hospitals, nursing homes and
the health system in general . . . is equally important."

Much of the report encourages the county to assume leadership in expanding
public awareness about the disease and in marshaling support from both the
public and private sectors to address the growing health problem.

That task is complicated, Lerblance and others acknowledge, by the fact
that AIDS today receives considerably less news coverage and public
attention than it did in the mid-to late-1980s, when concern over the
disease was at a peak.

"Getting less coverage is a mixed blessing," Lerblance explained. "You
don't get that intense, hysterical reaction that wasn't sound to begin
with. But you also get more people feeling that AIDS isn't their problem,
which it is, even if they don't have it, because of its (effect) on the
health system."

Recognizing that the county's severe fiscal constraints limit its ability
to fund ambitious new programs, however meritorious, the task force offered
many recommendations that would not significantly increase county costs.

For example, the advisory group urged the county to lobby aggressively for
state and federal legislation that would increase long-term health care
funding for AIDS patients and accelerate the approval of experimental drugs
to treat the disease.

It also recommended that the county work with education officials and
private employers to promote prevention and early detection, and press for
increased charitable donations for AIDS services, which lag behind more
established giving programs for other major diseases such as cancer and
heart disease.

However, other proposals, including the controversial needle-exchange plan
and a call for expanded hands-on oversight of AIDS cases, could increase
county expenses, forcing those ideas to compete for scarce county dollars
against other compelling needs both inside and outside the health-care field.

"Money's going to be a problem," conceded Dr. Donald Ramras, the county's
public health officer. "But I don't think there's any way that any
governmental agency could or, for that matter, should do the entire job in
an area like this. It's going to take a lot of cooperation on a lot of
levels to get the job done."