CHANGE ON NEEDLE EXCHANGE IS SLOW

Report disregarded

Although Massachusetts' dramatic shift in position on providing drug users
with clean needles in exchange for used ones has opened up the possibility
of local needle-exchange programs, action on the federal level remains
unlikely, despite a strongly worded favorable report on such programs
recently released by the U.S. surgeon general's office.

The state Senate last month added an amendment to its fiscal 2001 budget
that would allow the state Department of Public Health to establish local
needle exchanges.

The controversial proposal followed a poll commissioned by the McCormack
Institute at the University of Massachusetts at Boston that found that 62
percent of Massachusetts residents favor needle exchange, and that support
was across virtually all demographic groups. The amendment also followed an
analysis released by Surgeon General David Satcher emphasizing that recent
scientific evidence points to the effectiveness of existing needle-exchange
programs in the United States and Canada.

Two years ago Congress voted about 2-to-1 against funding one-for-one clean
needle-exchange programs.

U.S. Rep. James P. McGovern, D-Worcester, who supported the needle-exchange
plan, said he is not optimistic the issue will be revived anytime soon on
the federal level.

"Needle exchange is a controversial issue. That's no secret to anybody," Mr.
McGovern said in an interview. "It's controversial on the local level and
the federal level.

"It's a hard topic, much misunderstood," he added. "Politicians hate to talk
about it, because they get beat up during campaigns. I did during my last
campaign. But the reality is, we're confronting a very serious problem here.
And there really is not a comprehensive plan in place to deal with fact so
many people are addicted to drugs.

"I know people in my district who want to get treatment and can't get it
because there are waiting lines to get into some of these programs,"
McGovern said.

The surgeon general's report cites a 1999 study showing that HIV can survive
four weeks in a contaminated syringe. It also noted other studies showing
that 10.9 percent of used needles discarded in needle collection boxes at
community locations tested positive for the HIV antibody and that 27 percent
of contaminated syringes returned to a new needle-exchange program were
positive for HIV.

"The longevity of the HIV-1 virus, combined with its prevalence in used
equipment in some communities, is basic to the public health rationale for
removal of used syringes from the community environment," the report states.

According to Amy L. Rosenberg, senior public policy and legal specialist for
the Boston-based AIDS Action Committee, supporters of needle-exchange
programs are far more optimistic about their prospects in Massachusetts than
their prospects nationally, however.

"The feds have failed to put their money where their mouth is," she said.
"In the meantime, we have to keep working on the state level to get access
here."

"In some ways, the states are leading the nation on this," said Jane Silver,
vice president of public policy for the New York City-based American
Foundation for AIDS Research. "It's kind of hard to figure out what else can
be done to convince politicians to put public health before politics."

The needle-exchange proposal inserted in the state Senate's budget last
month received the endorsement of the Massachusetts HIV Prevention Planning
Group.

Established in 1994 by the U.S. Centers for Disease Control and Prevention,
the MPPG was charged with formulating a statewide HIV strategy and to make
recommendations to the DPH. Its endorsement of the Senate's needle-exchange
amendment comes as a legislative conference committee continues its budget
debate.

The Massachusetts Nurses Association and American Medical Association are
among a number of health-related organizations that have signed on to the
Senate initiative, according to Rosenberg. Suffolk County District Attorney
Ralph Martin also has come out in support of the amendment, she said.

The Senate amendment allows the state public health commissioner to identify
communities in which a needle-exchange program is needed to lower infection
rates. A seven-member commission of local residents then would be appointed
to advise the commissioner.

However some legislators have come out in opposition. They claim that
despite the provision for local input, the legislation cuts local
politicians out of the decision.

Explaining his vote against the amendment last month, state Sen. Robert A.
Bernstein, D-Worcester, said, "This essentially removes local control in the
decision-making process."

Four Massachusetts communities have adopted needle-exchange programs --
Boston, Cambridge, Northampton and Provincetown. Among the state's largest
cities, Boston and Cambridge have the lowest percentages of AIDS cases
associated with use of injection drugs.

In Boston, 29 percent of AIDS cases are linked to IV drug use. That figure
is lower than in communities such as Lowell (60 percent), Springfield (57
percent) and Worcester (53 percent), which do not have needle-exchange
programs.

In Worcester, an effort last year to combine a needle-exchange program with
drug treatment was defeated by a 7-4 City Council vote. The proposal had
been hailed by some national experts on the subject as one of the most
comprehensive needle-exchange programs ever devised.

Needle-exchange advocates say the program also would cut down on the number
of people who contract hepatitis C through sharing needles.

Hepatitis C cases in Massachusetts have risen in recent years. In the three
years before 1998, the number of cases of hepatitis C in Worcester rose from
eight to 152 to 224, according to information compiled by the city's
Department of Public Health and Code Enforcement. Those numbers were in
contrast to rates of other communicable diseases, which remained fairly
constant or decreased during the same period.