A case for clean-needle programs

by Brent Whitteker and Dawn Day

Whitteker is executive director of the San Diego Harm Reduction
Center. Day is the director of the Dogwood Center, a research
organization in Princeton, N.J.

The North American Syringe Exchange Conference meeting here this
week is offering the citizens of San Diego an opportunity to
learn about how a clean-needle program of an appropriate size
here in San Diego could, in the next few years, save hundreds of
lives and hundreds of millions of health-care dollars.

Dr. Scott Holmberg of the Centers for Disease Control estimates
that, in just the next 12 months, over 100 drug-injecting users
in the San Diego metropolitan area will become HIV positive
because they do not have access to sterile needles. An effective
clean-needle program would both save these individualsÌ lives and
also save the $133 million that their medical treatment will
otherwise cost.

And that is just the cost in lives and dollars for one year.
Each subsequent year that we delay, a similar loss in lives and
dollars will follow. There is a tremendous need for the San
Diego County Board of Supervisors to act now to declare a health
emergency and permit the establishment of clean-needle programs
that will reach all those in need.

Right now the courageous volunteers of the San Diego Clean Needle
Exchange are doing all they can to make clean needles available
to those in need. But with the possibility of arrest an
ever-present threat, the volunteers are limited in the numbers
they can reach.

With hundreds of lives and hundreds of millions of dollars to be
saved by implementing of clean-needle programs on a scale
commensurate with the need in San Diego County, let us consider
the reservations raised about clean-needle programs.

Some have expressed a concern that clean-needle programs increase
drug use. To them we say, this question has been examined. In
the last seven years, eight major studies funded by the federal
government have concluded that clean-needle programs reduce HIV
transmission and do not increase the use of injected drugs.

Some who oppose clean-needle programs say they do not believe the
research. To them we answer, researchers can make mistakes, but
the evidence in the case of clean-needle programs is massive. In
the face of a spreading and deadly epidemic, we need to act on
the information available.

Some who oppose clean-needle programs say that they are concerned
that when we give out sterile needles, we are giving out a double
message. To them we answer, we have many policies that inform
persons who inject drugs that their behavior is antisocial and
self-destructive -- everything from public service announcements
to prison sentences.

And even without clean-needle programs, we send double messages
about drug use. When a person who injects drugs has an overdose
or suffers a severe reaction to a substance used to cut the drug,
we rush that person to a hospital and give him or her the best
medical care we can. We do not want that person to die.

We do not say to the drug userÌs family and friends, Sorry, we
cannot give your family member life-saving medical care because
it would send the wrong message. Getting sterile needles to
persons who inject drugs is also about medical care and saving lives.

Americans are an intelligent people. They understand both that
injecting drugs is a really bad idea and that persons in need of
preventive medical intervention should receive it. A national
survey conducted in early 1996 found that two-thirds of all
Americans favor clean-needle programs as a way of saving lives
and stopping the spread of HIV/AIDS. A scientific survey of 1000
residents of San Diego county last August found even greater
support here, with over 85 percent of San Diego residents
favoring clean-needle programs as a way of slowing the spread of HIV.

Given the medical consensus that has emerged on the effectiveness
of sterile needles as a way of avoiding the spread of
drug-related HIV/AIDS, it is difficult to see the denial of
access to sterile needles as anything other than the denial of
access to a lifesaving medical intervention.

In the history of modern medicine in the United States, we are
aware of only one other instance where a life-saving medical
intervention involving a deadly infectious disease was
deliberately denied to a group of people. That instance is the
now infamous case of the Tuskegee syphilis experiment. The
unfortunate victims of this study were 400 black men in Macon
County, Alabama, who were denied medical treatment for their
syphilis from 1932 when the study began until they died or, if
they lived, until 1972, when the ÏexperimentÓ was exposed and
stopped. In the age of AIDS, people who advocate the denial of
access to sterile needles should give careful thought to what
they are saying and the company they are keeping.

Right now, when there is no cure, clean-needle programs are the
only effective intervention we have to protect people who inject
drugs from getting HIV from infected needles. A number of young
adults experiment with injecting drugs for a while and then stop
forever. Consider the difference access to sterile needles
makes. The uninfected person who stops using illicit drugs has a
lifetime before him or her. The HIV-infected person who stops
using illicit drugs almost surely must face serious, painful
illnesses and perhaps premature death.

We urge the San Diego County Board of Supervisors to declare a
public health emergency so that San Diego can have a clean-needle
program commensurate with the size of the problem.

With sterile-needle programs that reach substantial numbers of
drug users, we can slow this horrible AIDS epidemic among
injecting drug users in San Diego before it is widespread. The
best medical advice in our country says we need clean-needle
programs to slow the spread of HIV. If the County Board of
Supervisors acts now San Diego county can save hundreds of lives
and hundreds of millions of dollars. What are we waiting for?

Brent Whitteker and Dawn Day