PRINCE GEORGE'S WEIGHS ILLNESS PREVENTION VS. DRUG PROMOTION

The father leaves his two-story white house in Prince George's County, the
one with the picnic table in the back yard, and drives his pickup truck a
mile into the District to the ragtag corner of Central and Southern avenues
SE.

He's there to meet an unmarked white truck that distributes clean syringes
he uses to pump heroin into his arms every day.

The truck and the needles are the stairway to his life within a life, the
secret he keeps from his wife and children and the neighbors who know him
as Earl. It's also how he hopes to spare himself the one fate he fears more
than a day without dope: catching HIV.

"There'd be a lot of people out here dying from using dirty needles if it
wasn't for that truck," says Earl, who declines to reveal his full name
after exchanging 18 dirty syringes for 18 clean ones. He excuses himself to
buy a pack of cigarettes, then returns in a cloud of blue smoke, his eyes a
glassy mix of brown and yellow. "I know too many people who got AIDS. I
know too many people who are gone."

For the past four years, intravenous drug users in the Washington area have
relied on a single program that distributes clean syringes in the District,
a program that is legally barred from crossing into Maryland or Virginia.
Now a proposal to create a needle exchange program in Prince George's
County would bring the service to a county that is home to Maryland's
second-highest number of AIDS cases, after Baltimore.

The proposal, recently introduced in legislation by County Council member
Thomas R. Hendershot (D-New Carrollton), has provoked passionate debate
among lawmakers, pastors and residents, a debate echoing those that have
riled communities nationwide when similar programs have been proposed.

Proponents rest their case solely on public health concerns: Distributing
clean syringes, they argue, is a proven way to curtail the spread of AIDS.
Opponents cannot fathom handing junkies the very tool they need to indulge
their addiction. At the very least, they contend, it is tantamount to the
government sanctioning drug use.

Yet the Prince George's debate also has taken on a distinct shape, as the
county seeks to tout itself as a suburban enclave of prosperous homeowners
and upscale development. County leaders would rather talk about Opryland,
the focal point of the proposed National Harbor development on the Potomac
River, than HIV prevention or anything else that conjures up images of
urban-style afflictions that dog the county's less affluent communities.

"We'll have to change the gateway signs to read, 'Welcome to Prince
George's County, home of National Harbor and clean needles,' " said County
Council member Walter H. Maloney (D-Beltsville), a leading opponent of the
proposal. "In the face of our efforts to become upscale, we're also saying
we're not above putting needle wagons out there and attracting drug users
to come in and swap needles. I think it's a very downscale thing to be doing."

But the proposal's supporters contend that the issue is far more profound
than how the county may be perceived by families or corporations looking
for a new home. "It's about saving lives," said council member Peter A.
Shapiro (D-Brentwood). "If we can do it, we should."

The number of intravenous drug users in Prince George's County is unknown,
but state health officials can measure an element of the population by
tracking AIDS cases. In Baltimore, for example, 62 percent of the 4,689
people living with AIDS inject drugs or have had sex with a man who injects
drugs, according to the state Department of Health and Mental Hygiene's
AIDS Administration.

In Prince George's County, nearly 33 percent of the 1,444 AIDS patients are
intravenous drug users. That's far higher, say, than in Montgomery County,
where 23 percent of the 763 people with AIDS use needles.

"Prince George's County is a county clearly with a population needing
services," said Liza Solomon, director of the AIDS Administration.

Skeptics need only check out the addicts who visit Prevention Works, the
organization that operates the District's only needle exchange program.
Four days a week, a Prevention Works truck brings syringes to mostly
eastern neighborhoods. Prince George's residents account for 8 percent 96
or about 300 96 of the 3,758 addicts who have registered with the program
since 1996. And some are picking up the needles for others.

They include Nikki, a 34-year-old Largo resident who was among the wilting
cluster of addicts who met the truck as it was parked in front of Sargent
Memorial Presbyterian Church on Nanny H. Burroughs Avenue NE on a recent day.

The group of a dozen or so addicts consisted mostly of black men in their
thirties and forties. The average age of Prevention Works clients is 45,
and 22 percent are women. They are disheveled and thin and apparently have
nowhere else to be at 2:45 p.m. on a Thursday. One paced back and forth in
a nearby field, his head down, squinting into the grass. He was looking for
discarded needles to turn in.

Theirs is a language all their own. "The works" is their term for the
package the program distributes 96 needles, cotton swabs and a small metal
tin in which they cook their heroin; "blue heads" is the most popular kind
of needle, five-eighths of an inch long and able to find hard-to-reach veins.

Nikki climbed aboard the truck and showed Francis Walker, a Prevention
Works HIV counselor, her palm-sized yellow registration card. She dropped
100 needles into a red plastic bin, slowly so Walker knew how many she was
turning in. Moments later, she walked away with a brown paper bag filled
with 100 new syringes.

"For me and friends," Nikki said, climbing into a friend's car.

Another day, another corner, this one Central and Southern, at the Prince
George's border.

Here's Dominique, 50 years old, eyes glowering, cheeks hollow, a black
stocking pulled down to her eyebrows. She said she's from Capitol Heights
and slept last night in a 24-hour laundromat.

"Dope is my man, my lover, my friend and my food," she said, lips as hard
as rails as she spits out each word. "It's the last thing I do before I go
to sleep and the first thing I do when I wake up."

Even if it means using a dirty needle. "Whatever it takes to get the dope
in me," she said.

Here's Dee, 47, a Riverdale construction worker waiting while his friend
picks up new syringes. Like the other addicts interviewed, he didn't want
to reveal his full name. Otherwise, he said, his wife and his children
would know about his drug use, which began more than two decades ago, then
stopped for 15 years before starting again.

"Why? That's a good question," he said, smiling and folding his arms across
his chest. He was dressed in a neat brown V-neck sweater and black jeans.
His hair and goatee were speckled with gray. "I guess I'd stop if I could,
but it's an illness. Anything that makes someone act so irrational,
anything that makes you so uncomfortable, it's an illness."

More than 150 needle exchange programs have cropped up in the United States
and Puerto Rico over the last decade. About half benefit from some form of
public funding, while the rest receive private donations or are underground
operations. The American Medical Association and the National Academy of
Sciences are among the high-profile institutions that have endorsed needle
exchange programs.

But the issue also has proven politically radioactive. In 1998, President
Clinton extended the ban on federal funding for needle exchanges after his
chief drug policy adviser argued that the programs send a message to
children that the government tolerates drug abuse. At the same time,
though, Health and Human Services Secretary Donna E. Shalala publicly
acknowledged that needle exchange programs are effective for curtailing HIV.

Baltimore began a needle exchange program in 1994, distributing more than 2
million needles to about 100,000 addicts. Health officials there say that
the program has helped reduce the city's HIV cases by 35 percent.

"From my point of view, I don't see any down side," said Steven Huettner, a
Johns Hopkins University research coordinator who monitors the program.
"The needle exchange is building a bridge to people who are so far out
there that they have no formal contact with the health establishment.

Baltimore's success helped prompt the Maryland General Assembly to pass
legislation in 1998 allowing Prince George's to start a needle exchange
program.

Last fall, County Executive Wayne K. Curry (D) asked Health Officer Arthur
G. Thacher to brief the council about the issue. Thacher included in his
lengthy presentation testimony from experts who detailed the successes of
Baltimore's program.

Yet Curry also has been careful not to embrace the idea publicly. Instead,
he has asked the council to review the proposal and forward a
recommendation. "The real issue here is what are the pros and cons of
trying to avoid a public health catastrophe," Curry said.

Many, though, view the program as a kind of white flag in the struggle to
stamp out drugs. One pastor has compared it to allowing gun owners to trade
in used pistols for new ones.

"It's a dreadful accommodation to the people who are using drugs," said
Monsignor Richard Hughes, of St. Mary of the Assumption Church in Upper
Marlboro and the former chair of the county's Addictions Advisory
Committee. "We ought to hope to cure them, not just let them continue. This
just facilitates the habit."

Walker, 44, the Prevention Works counselor, said that in the last year he
has handed out dozens of drug treatment referrals to addicts he encounters
on his rounds.

"I guess three have made it out," he said. "Three in 10 months. That's not
too many."

His latest dreamer is James, a 58-year-old Prince George's truck driver.
His wife doesn't know he shoots dope. Nor his children. Nor his girlfriend.

"No one," James insisted, his left hand fingering his belt buckle. He never
shoots up at home. Refuses even to bring dope or syringes in the house.
Instead, he travels into Washington to shoot up with a friend.

He wants to stop. Even tried. Made it two days, then he got stomach cramps
and diarrhea and his heart was beating so fast he thought he was having a
heart attack.

Walker wrote down the phone number of a drug treatment clinic he can call.

"Maybe they can help," Walker said. Then he and his partner, Alphonso
White, 49, watched James limp away.

"Just another one we'll have to pray for," White said, shaking his head
before climbing back on the truck to head for another neighborhood.