FRESNO-AREA NEEDLE EXCHANGE PROGRAM VITAL IN CURBING SPREAD OF DISEASES

On the edge of Roeding Park in May 1998, Audrey Alloro and Bobby Bowens of
the San Joaquin Valley Ex-change Works were being cited for a misdemeanor
as they exchanged sterile syringes for used ones to injection drug users
from the trunk of their car.

My car was backed up within 5 feet of theirs. I was dispensing medical care
from the hatchback of my car (the birth of the Fresno Free Clinic) as part
of the community project of my residency in Family Practice/Community
Health at University of California, San Francisco-Fresno/University Medical
Center.

Concerned about my welfare, I was joined by a former board member of Valley
Medical Center to observe this arrest. We watched Audrey and Bobby get
arrested for providing appropriate and recommended medical care to an
"at-need" and "high risk" population.

Touching many

So how does this war on drugs in Roeding Park come home to us? It beats
down our doors when a family member tells us of a date rape, a youthful
indiscretion or just poor judgment with at-risk behavior. Specifically,
these include unprotected sex, using the same straw for intranasal cocaine
use or sharing injection equipment. Approximately 50% of new HIV infections
occur among injection drug users, their sexual partners and offspring.

We all have a vested interest in lessening the suffering of individuals,
the spread of communicable diseases and the staggering costs for treating
each new additional person with AIDS. The lifetime cost of treating a
person with AIDS is well over $189,000. Preventing only six cases of AIDS
saves all of us more than $1 million to use on so many other needed services.

Scientific study after study points directly to syringe exchanges making
major reductions in injection drug users becoming infected with HIV.
Injection drug users in New York City using syringe exchanges were
two-thirds less likely to become HIV positive. This was repeated in Tacoma
and New Haven for HIV, hepatitis B and C.

In 1977, a Baltimore study showed decreases in improperly discarded
syringes. Reductions in law enforcement and corrections expenditures are
projected because of increased referrals for medical and drug treatment.

Dr. Peter Lurie's classic UCSF/Centers for Disease Control study says there
is "no evidence that needle exchange programs increase the amount of drug
use by its clients or change overall community levels of non-injection and
injection drug use." Eight other government studies conclude the same. No
reports contradict this finding.

Every major scientific/medical organization supports the use of syringe
exchange programs to reduce the spread of infectious diseases including:
National Academy of Sciences, American Medical Association, American
Academy of Family Physicians, National Institute of Health (NIH) Consensus
Panel, as well as the U.S. surgeon general.

The National Commission on AIDS says, "Legal sanctions on injection
equipment do not reduce illicit drug use, but they do increase the sharing
of injection equipment and hence the spread of AIDS." The Centers for
Disease Control and Prevention and NIH advise health care workers to
counsel those who are unable to stop injecting drugs to "use a new, sterile
syringe to prepare and inject drugs" and practice safe injection technique.
Here at home the Fresno-Madera Medical Society recently approved a motion
in support of syringe exchange for the Fresno area.

Assembly Bill 136 allows local governments the authority to declare health
emergencies and designate agents to exchange sterile syringes without being
charged with criminal violations. Currently, four cities in California have
declared health emergencies and operate syringe exchange programs.

Much-needed action

Our Board of Supervisors needs to act by allowing the volunteers of the
local, 5-year-old needle exchange to continue their important health
outreach of saving lives and stopping the spread of these deadly diseases
in our own back yard. This medical issue needs to be taken out of the
criminal jurisdiction and placed into the arena of community health.

The clear message needs to be given out in a medical model that injection
drug use is dangerous and risky, and if you can't stop then at least you
need to use sterile syringes to lessen harm to oneself and others.