EXPANDING NEEDLE EXCHANGES

In most big US cities, the sharing of syringes by drug users has overtaken
unprotected sex among gays as the leading cause of AIDS transmission. This
is not the case, though, in Boston, one of four Massachusetts communities
with a needle-exchange program that trades sterile needles for the used ones
addicts bring in.

The programs in Boston, Cambridge, Northampton, and Provincetown have been a
great public-health success in reducing transmission of both the HIV virus
that causes AIDS and hepatitis C. Moreover, the experience of Massachusetts
mirrors what national studies have shown - that needle exchanges do not
encourage illegal drug use.

Unfortunately, AIDS incidence is growing among IV drug users in other cities
that have not set up needle exchanges. In Lowell, 60 percent of AIDS cases
are attributed to intravenous drug use; in New Bedford, 58 percent; and in
Worcester, 53 percent.

The state Department of Public Health is ready to assist officials in these
cities to set up needle exchanges, but state law requires local approval,
which none of the cities has granted. Recognizing the urgent need to reduce
HIV and hepatitis C transmission, the state Senate has included language in
its budget that would permit the DPH to set up programs without a local OK,
as long as it works with a local community advisory committee. While this
page generally opposes the use of budget outside sections for nonfiscal
measures, the tactic is justified by the health crisis that needle sharing
presents.

Typically, opponents of exchanges worry that they would make their community
a magnet for drug users, and that they send a mixed message to children.
There is also concern about the effect on neighborhoods of needle-exchange
sites.

In reply, operators of existing programs say that they have been sensitive
to neighborhoods in setting up their sites and that there is no evidence of
addicts traveling significant distances to take advantage of free needles.
And whatever risk there is that some children might see a needle exchange as
sanctioning drug use, it is far outweighed by the advantage of getting IV
drug users into a therapeutic situation that is often the first step to
kicking the habit.

This is one of the great pluses of exchange programs. In Boston, 20 percent
of participants in needle exchanges enroll in drug-treatment programs. In
addition, the addicts get crucial information about treatment for HIV and
hepatitis C and avoiding transmission of the diseases.

The provision in the Senate measure requiring a local advisory committee,
with representatives of the police and health board, would ensure that local
officials still have a voice in running their needle exchange program.

A poll last month by the McCormack Institute of the University of
Massachusetts showed that 64 percent of registered voters in the state favor
needle exchanges. The Legislature should second the voters' good sense by
approving the Senate outside section.