HEALTHY POINTS WELL TAKEN

New Jersey may be getting a new weapon to help fight the spread of
HIV/AIDS among addicts.

The auburn-haired, green-eyed slip of a woman, looking older than her
20 years, says she started shooting heroin two months ago.

The woman, who gave her name as Dana Nelson, talks about getting
clean for her 2-year-old son, but she's not ready. For now, she just
tries to be careful as she walks Camden's streets, trading sex for money.

"I don't use other people's needles. I reuse my own," she said,
sitting inside a mobile home converted for on-the-street outreach by
the Camden Area Health Education Center.

She flagged down the health van one day last week for condoms and a
bleach kit, which she needed to clean her needles. If the workers had
new, free needles, she said, she would have taken some. But there are
no needle-exchange programs in New Jersey.

There are signs in Trenton, though, that change is on the way. If
state legislators approve the Bloodborne Disease Harm Reduction Act,
which they could in the next few weeks, anyone who uses hypodermic
syringes - whether intravenous-drug users or diabetics - would be
able to trade old needles for new.

The law's passage would end a public policy debate in New Jersey that
extends back to at least 1993, when then-Gov. Christie Whitman
declared that she opposed needle exchange, saying it was tantamount
to telling children to "just say maybe."

It's hard to pinpoint, but surveys put the number of states where
needle-exchange programs exist between 33 and 39. Some states,
including Pennsylvania, operate exchanges under gubernatorial
executive orders, not laws. New Jersey would join the states that
have statutes regulating the programs. Proponents say the bill is
long overdue and will reduce the number of people contracting
HIV/AIDS and other diseases.

"As a state and as policymakers, New Jersey has been reluctant to
take on the issue," said State Sen. Joseph Vitale (D., Middlesex), a
sponsor of the bill. "Intravenous-drug users, the homeless, etc., are
not a bloc of voters like other groups that get heard in Trenton. If
this were a wealthy suburban public-health crisis and this was a way
to mitigate this, we would have done this long ago."

Under New Jersey's plan, six cities would enter a pilot program. They
also would be required to provide other support, such as
mental-health and substance-abuse treatment, housing, and employment
counseling.

The recent activity on needle exchange came after underground
exchanges surfaced and municipalities started pushing for them. State
Sen. Nia Gill (D., Essex) tried to get the bill on the legislative
agenda in 2005, but it did not get out of the Senate Health Committee
before the session ended. It did, however, pass the Assembly. When
Gov. Corzine entered office, he said he was in favor of the bill,
reigniting Gill's efforts as its primary sponsor. Last month, after
heated committee debates, the bill moved forward.

"This is the first time it's gotten out of committee in 13 years, so
she is very excited it's gotten this far," said Vince Matthews,
legislative director for Gill. "She knows there is still a lot of
work. But, she's optimistic that it can get through."

The bill now has to go before the Senate budget committee to get
approval for a $10 million amendment for more drug-treatment
resources. The money was added to appease exchange opponents, such as
Sens. Ronald Rice (D., Essex) and Thomas Kean Jr. (R., Union), who
argue that more prevention and intervention are needed.

"All the indicators say that HIV/AIDS numbers are going down and we
haven't given out one needle yet," said Rice, his voice tinged with
irritation as he drove by several men hanging out on a street corner
in Irvington, a city in his district. "There should be facilities for
these guys I'm looking at on that corner to get treatment and help."

Proponents say treatment is not enough when there are about 33,000
documented adults living with HIV/AIDS statewide - the fifth-highest
number in the nation. More than half of them are black or Hispanic
and more than a third are women.

And a little under 10,000 contracted the disease by sharing a needle
while getting high, according to the state Health Department's 2005
report on HIV/AIDS. The number getting the disease through needles is
dropping annually, but advocates say it could fall faster with needle exchange.

"There have been extensive investigations done over the last 15 years
by many organizations and results show that they work," said Scott
Burris, a law professor at Temple University Beasley School of Law,
who has examined syringe-access laws throughout the country.

Burris also points to the 2004 World Health Organization's report on
the effectiveness of exchange programs on reducing HIV/AIDS among
injecting drug users that shows there is "compellingly consistent"
evidence that they work, he said.

For now the region's only needle-exchange program is in Philadelphia,
where about 30,000 people live with HIV/AIDS.

Prevention Point Philadelphia, a nonprofit, city-funded outreach
agency, provides almost a million clean needles a year to its 10,000 clients.

Nicole Leighton, coordinator of the exchange program, estimates it is
reaching only 10 percent of the city's intravenous-drug users with
the 15-year-old program. That's because the program needs more
resources, including more than one van to service the entire city.

On a beautifully warm day in South Philadelphia, Leighton and about a
half-dozen other agency workers and volunteers recently crammed into
a mobile home with plastic-covered seats and kitchen cabinets filled
with everything from syringes to bleach kits to condoms and cotton
balls. Between handing out condoms and exchanging needles, they hand
out information about "harm reduction" - ways their clients can stay safe.

New and registered clients lined up outside holding everything from
small brown lunch bags to garbage bags full of used syringes.

"How many are you exchanging today?" asks worker Emily Gibble,
speaking to a man in his 40s who began unloading 300 syringes
contained in red needle dispenser cans provided by the program.

"How many people are you exchanging for," Gibble asks.

"Four," says the man, who has track marks on his arms. Leighton and
her crew put three boxes of 100 syringes in his bag. She adds
supplies such as alcohol swabs, bandages and cotton.

A 30ish woman who says she is a mother of four who gets high when her
children are not around comes to the steps. She did not have any
needles to exchange, but the program allows registering newcomers to
get 10 syringes even if they don't have any to trade.

Gibble asks her if she gets high alone.

"It's better to have someone with you in case something happens," she
tells the woman, and convinces her to get an AIDS test.

Drew Kramer, director of the program, acknowledged needle exchanges
are not a panacea, but he recalled a letter he got from a woman
living in Wisconsin.

She used to shoot up on the streets of New York, where Kramer worked
with a needle exchange before coming to Philadelphia. She now has a
job, two children and a decent life.

"She said the only reason she is alive and HIV-negative is because of
you guys," Kramer said. "It was my best day at work ever."

Dana Nelson says she wants to be straight someday, too. She said she
was waiting for a bed in a program in Washington Township, but when
offered the chance to get into a program that day, she turned it down.

Instead, she'll likely continue reusing the needles she buys on the
street, for $3 apiece, until she has a better option.