THREAT OF THE NEEDLE

LAHORE, Pakistan - They crouch on sidewalks in the brief camaraderie of
drug users, small clusters of men in filthy pajamas fumbling with syringes
and plastic packets and tin foil. In a few moments they disperse, one
staggering off while another keels over in solitary oblivion.

Sometimes, the men stumble to the door of the Nai Zindagi (New Life)
drop-in and needle-exchange center. Inside, they are offered a shower and a
nap, a clean syringe and first aid for abscesses and stomach cramps. The
doctor, S.M. Sayeed, shows clients how to avoid injecting drugs into
arteries, which causes swelling and pain.

He also tells them about HIV and AIDS. It is a disease few Pakistani
addicts have heard of, although an increasing number risk exposure to it as
they switch from the traditional culture of smoking and inhaling heroin to
the fast-growing trend of injecting tranquilizers and painkillers.

"I always chased [inhaled heroin] before, but I've been injecting
[sedatives] for about 18 months now. It's cheaper, it works faster, and
everyone was pushing me to try it," said Sanaullah, 32, a bleary-eyed man
slumped on a straw mat in the shelter's nap room.

Sanaullah said he did not know about AIDS, but he and several other clients
said they had been told by counselors at Nai Zindagi (pronounced "nigh
ZIN-da-gee") that there was a serious "syringe sickness" and that they had
to stop sharing needles to avoid getting it.

"We don't preach, we just make them aware," said Jawad Akhtar, a staff
member. "We tell them, if they want to shoot drugs, don't take the extra
risk. If they start keeping needles for their own use, that's a big change
in itself."

Pakistan is a major outlet for heroin from next-door Afghanistan, the
world's largest producer of opium poppies from which heroin is made, and it
has developed a large population of addicts in the past 20 years. An
estimated 3 million people are habitual drug users, and about half are
addicted to heroin.

Until recently, most Pakistani addicts smoked heroin or heated it on tin
foil and inhaled the fumes, a method known as "chasing the dragon." Now,
according to a 1999 study by the U.N. Drug Control Program in Pakistan,
injecting pharmaceutical drugs is fast becoming the preferred method of
substance abuse.

The most popular drugs to inject are opiate painkillers, antihistamines and
tranquilizers. They cost about half the price of heroin, they are legal and
widely available because pharmacies do not require prescriptions, and
injecting them delivers a faster high.

But needles are also a major source of transmitting AIDS. The disease is
relatively unknown here, with less than 200,000 cases of HIV reported to
date. But the skyrocketing use of intravenous drugs, according to the
United Nations, is a "warning sign of the potential for an epidemic of HIV
infection" among Pakistani addicts.

One recent study of 200 injecting addicts by Nai Zindagi found that none
were HIV positive and most had been injecting for only a year. But an
alarming 89 percent were infected with hepatitis C, another illness spread
through needles.

"We still have a window of opportunity to reach people, but we have to act
fast before Pakistan becomes like Burma, Vietnam, India and other countries
where AIDS is growing rapidly," said Tariq Zafar, the director of Nai Zindagi.

The government is becoming alarmed, too, and officials acknowledged that
while Pakistan has worked hard to eliminate opium poppy cultivation and
drug smuggling, it has done far too little to treat addicts and educate the
public about the interlinked dangers of drugs and AIDS.

"Frankly, we know very little about it," said Mohammed Aziz Khan, an
anti-narcotics official at the Interior Ministry. "Rehabilitation and
reducing demand have been our areas of tremendous weakness. Now we see AIDS
coming, and we know we won't be immune if we have a lot of intravenous users."

There are 73 drug treatment centers in Pakistan, but most offer only
detoxification and serve only a tiny fraction of the country's addicts.
Pakistani jails are crammed with drug addicts - about 30 percent of all
inmates - who rarely receive treatment and report that drugs are widely
available behind bars.

Nai Zindagi, a private program founded 10 years ago, is one of the few
places that offer treatment, education and vocational training for addicts
in recovery. The 1999 U.N. study showed that half of Pakistani addicts are
unemployed and 73 percent have had no formal education.

In Angoori, a village in the hills above Islamabad, 30 recovering addicts
live in the Nai Zindagi retreat, crafting wood and metal art objects for
sale. For many, it is the first time they have breathed fresh air or known
life beyond the grimy, drug-infested streets of Lahore or Karachi.

Muzamil Hussain, a cheerful man of 37, spent three decades as a homeless
beggar and laborer, turning to drugs for solace. Injured in an accident and
never treated, he contracted gangrene and his legs were amputated. Now,
after several years of treatment at Nai Zindagi, he said he has finally
found a family and a purpose.

"I never got love from anyone, and I thought I was no good," he said as he
padded about the Angoori workshop on his knees, making coffee. "I miss the
streets, but I know I was in a bad society there. Now I hope it is not too
late to make some use of my life."

But Hussain is still a rarity in Pakistan, where most street drug users
live by their wits and many die of their addiction, bouncing in and out of
jail but never getting serious help. In Lahore, hundreds doze in a public
park where the Nai Zindagi drop-in center opened in August.

Each day, about 75 addicts stop by the shelter. Most are interested only in
a shower, a nap and a new syringe. Some hurry out to meet their suppliers
and hit the foil or the needle; others stay until closing time, swapping
street stories and vowing to stay clear of drugs for good.

"I lost everything because of drugs - my wife, my children, my house. I
weep for them, but I cannot stop," said Nasir Tirmazi, 32, a longtime
heroin addict who recently switched to injectable painkillers. Four days
ago he vowed to quit, but ever since he has been shaky and unable to sleep.
The chances of his remaining drug-free, said Nai Zindagi counselors, are slim.

But Tirmazi and other Nai Zindagi clients have one advantage over their
friends on the streets. They have access to medical treatment and advice
about the importance of not sharing needles, using condoms and maintaining
personal hygiene.

Sometimes, the advice comes too late. One day recently, three Nai Zindagi
employees carried in a severely emaciated teenager on their backs. He was
too weak to walk and his feet were grossly swollen, probably from injecting
drugs into his femoral artery.

As he slumped in a chair, the other addicts crowded around, clucking in
sympathy. It was almost closing time, and a dozen grimy men lined up for
their new syringes. Some had saved their old needles but others admitted
they had given theirs away.

One man drew a filthy needle from his pocket, and Sayeed gently took it
from him. He plunged it into a bottle of red dye, filled it up and then
squirted it out. The needle was still full of blood-red droplets. Each one,
the doctor explained, could kill.