FRESNO COUNTY CONSIDERS NEEDLE EXCHANGE

A group of doctors and drug-treatment workers asked Fresno County Tuesday
to start a needle-exchange program.

The answer: We'll look into it.

The county's Board of Supervisors wants staff members to explore the legal
and liability issues involved in starting such a program -- the practice of
giving clean syringes to drug users in exchange for dirty needles. The goal
is to lower the risks of users contracting HIV and other diseases.

"When this issue does come back, I intend to look into the science of it
and not the politics," Supervisor Juan Arambula said.

Dr. Marc Lasher, the Fresno Free Medical Clinic medical director who took
the proposal to the supervisors at their regular meeting, called it a step
forward.

"We're out of the closet, and the county's willing to learn," Lasher said.
"Obviously, we hope they do the right thing."

The San Joaquin Valley Exchange Works -- which illegally distributes
needles to drug users at a Fresno park on the weekends -- and the
Fresno-Madera Medical Society also backed a needle-exchange program.

"This is not a political or moral issue," said Dr. Anna Marie Gonzalez, the
society's president. "This is a public health issue."

Federal law prohibits anyone -- including counties -- from distributing
drug paraphernalia.

But California passed a law in 1999 that allows for needle exchanges if a
governing body declares a health emergency.

So far, 13 cities and counties have made the declarations and distribute
the needles. The federal government has not stopped those programs,
Gonzalez said.

"There have been greater people than myself that have said bad laws are
made to be broken, and maybe that's the reason why the feds are not
enforcing it," Gonzalez said.

The number of AIDS patients in Fresno County has remained fairly stable
over the past few years, said Gary Carroza, the county's director of
community health.

According to a January report from the department, 1,180 people in Fresno
County have AIDS. Out of that group, 282 were intravenous drug users and 96
others were drug users who were homosexuals or bisexuals -- other groups at
higher risk of contracting AIDS.

But Dr. John Zweifler of University Medical Center argued that AIDS is not
the only disease spread through needles. He said hepatitis B and C also can
be spread through shared needles and that nearly 40 new cases of hepatitis
C have been reported every week this year to the Fresno County Health
Department.

"The continuing scourge of AIDS, coupled with the growing epidemic of
hepatitis C in our community, constitutes a health crisis," Zweifler said.

He also said that the more the health community interacts with drug users
- -- such as with needle-exchange programs -- the more chances there are to
get them into drug-treatment facilities.

To start a needle-exchange program under state law, Fresno County would
need to declare an emergency and then designate either the Health
Department or another group such as the San Joaquin Valley Exchange Works
to run it, Lasher said.

The supervisors' first reaction was mixed. Supervisor Judy Case said she's
willing to explore the issue but didn't think the numbers constitute an
emergency.

"It would take a huge epidemic for this board member to declare an
emergency," said Case, saying Fresno County would be the only county in the
central San Joaquin Valley to take that stance.

Chairman Bob Waterston worried about whether a program would be legal under
federal law and the liability to the county if someone were stuck with a
dirty needle.

"If we did this and we handed out needles, then we become responsible if
someone's little kid sits on one of these," Waterston said.

Supervisor Susan B. Anderson said there is a risk of liability, but she
believed the risk to be small.

"I'm a supporter of needle exchanges, and I see this as a public health
issue," Anderson said. "It's a matter of life and death -- people will die
if we don't do the right thing."