NEEDLES TRADEIN FAILING

Program sees increase in HIV, study indicates

Is it worth spending taxpayers' dollars on free needles for drug
addicts, if so many of the people who use them get HIV and die anyway?

That question, so big in the United States where federal funding for
needleexchange programs is banned, has been raised again today.

The reason is a muchanticipated Montreal study that shows that far
from stemming the spread of the virus linked to AIDS, local exchange
programs actually have witnessed an increase in cases.

Published today as the lead report in the American Journal of
Epidemiology, the controversial St. Luc Hospital study says that
addicts who use exchanges like Montreal's CACTUS are more than twice
as likely to get HIV than those who don't.

Of the 974 addicts who were studied between September 1988 and January
1995, 5.1 per cent became infected with HIV each year. The rate was
highest for those in exchange programs 7.9 per cent, compared with
3.1 per cent for those who weren't in programs.

That finding of the St. Luc Hospital study goes against the
conventional wisdom that needleexchange programs are an effective way
of limiting the spread of HIV because they eliminate the need to share
syringes that could be infected.

Indeed, studies this year and last in New York and Baltimore have
shown decreases in new HIV cases as high as 70 per cent thanks to the
exchange programs.

The reasons for Montreal's exception to the general rule are many,
according to the journal and the study's authors, as well as Montreal
publichealth officials and the people who run CACTUS:

n The most important reason is the much higher use of cocaine over
heroin. Cocaine has long been the drug of choice for twothirds of
addicts here. More and more often, and in groups, they are
``bingeing'' on coke, sometimes injecting as many as 50 times a night.
In the process, they are more likely to use each other's HIVinfected
syringes when their supply of clean ones runs out or they get too
stoned to care.

Montreal is not alone in its explosion of cocaine and HIV. In
Vancouver, where 2.3 million syringes a year are handed out free, the
HIV infection rate among needleprogram users is 12 per cent. Like
here, the unquenchable demand for syringes for cocaine use has been
cited as a principal cause of the nearepidemic.

n CACTUS is in the heart of Montreal's redlight district, where drug
use among prostitutes and street kids is high, as is HIV. The centre,
which is inside a neighbourhood CLSC, is popular with the most severe
addicts, who are at high risk anyway for HIV infection.

n In the period studied by the St. Luc researchers, before 1995,
Montreal's programs only supplied a limited number of syringes a
maximum of 15 a night. That was far below demand, and so sharing
outside the program and the use of infected needles was
inevitable. Since 1995, there has been no maximum.

This year, as many as one million syringes have been distributed free
in Montreal by needle programs and pharmacies.That's almost double the
number in 1996 and four times what was distributed before the maximum
was lifted in 1995.

The syringes don't come cheap to Quebec taxpayers. This year, the
program, coordinated by Montreal publichealth officials working for
the province's Health Department, cost $500,000. CACTUS alone operates
on a $200,000 budget, not including the syringes.

Costs like that have added to the debate over exchange centres in the
United States, where critics fear that free syringes lead to more drug
use, not less.

Some have even cited earlier versions of the Montreal research to back
them up; the study was first presented as a workinprogress in 1994
at an international AIDS conference in Japan.

But now that it is out in full, there is no question what the Montreal
study proves, says an American Journal of Epidemiology editorial that
accompanies the St. Luc Hospital research.

``What is needed to reduce the terrible toll of HIV among Montreal
intravenousdrug users is not less needle exchange, but more,'' the
editorial says.

The study's authors agree. However, at a press briefing last week,
they cautioned that even with increases in supply, needleexchange
centres aren't a panacea far from it.

The study's finding ``certainly doesn't mean we should close the
needleexchange programs,'' said principal author Julie Bruneau, a
psychiatrist in St. Luc's detox centre. ``But by not doing enough''
by not expanding the program earlier ``we may have created problems
as well.''

For example, there is the ``networking'' effect. Special centres like
CACTUS can become meeting grounds for addicts who otherwise might not
have met, she said. Without enough needles to go around, those friends
could end up sharing needles.

CACTUS director Mario Bilodeau disagrees. Most of his clientele
already know each other from the street, and they don't stop to talk
with other visitors when they come to get fresh needles.

``We're not a dropin centre,'' Bilodeau said in an interview last
week at his office, where shelves are lined with boxes of new
syringes. ``And it's not because you visit here that you get AIDS.
When I hear that, it makes me really upset.''

Every night (the centre is open from 8 p.m. to 3 a.m., seven days a
week) when the regular public is no longer allowed in, dozens of
addicts come up to the second floor of the Sanguinet St. CLSC where
CACTUS operates.

Thirtyseven thousand times a year they come, and most are repeat
visits. The traffic is heaviest in summer, ``when the tourists are in
town,'' Bilodeau said.

They bring their old syringes. Some have stuffed them into special
plastic containers supplied by the centre. ``The most we've had
someone bring in at one time is 600,'' Bilodeau said.

Others have improvised their disposal. They bring needles in packets
of 15, wrapped with elastic bands. Others have dropped them into
softdrink or bleach bottles, Bilodeau said.

To get a fresh supply, they fill out a brief questionnaire date of
birth, sex and two initials, to help track them statistically.

They can take away as many syringes as they bring in.

The centre supplies plastic bottles, for fresh water to prepare their
injection, and new cigarette filters, for drawing the drug solution
through when they take it off their heated spoon. Condoms and alcohol
swabs are also free.