HOW NEEDLE EXCHANGE PROGRAMS FIGHT THE AIDS EPIDEMIC

Gentrification has sent middle-class pioneers streaming into New York City
neighborhoods once known for abandoned buildings and open-air drug markets.
This has done wonders for property values and improved police protection.
But it has a downside for Daliah Heller, who directs an AIDS prevention
program called CitiWide Harm Reduction in the Bronx.

Ms. Heller, an early advocate of syringe exchange programs as a method of
preventing AIDS among drug users, has seen tolerance for drug programs
decline as neighborhoods get fancier. Local police officers who once viewed
addicts as a low priority come down hard, herding them to distant
neighborhoods where they quickly lose touch with caseworkers.

CitiWide Harm Reduction is one of nine city syringe exchange programs
sanctioned by the state under a law passed in 1992. The New York City
program is the largest and most successful in the country. When New York
passed its law, about half the city's addicts were infected with H.I.V.,
and were regularly passing on those infections to others. Since the syringe
exchanges were legalized and expanded, however, the infection rate among
addicts has dropped from about 50 percent to a little more than 15 percent.

Many states lack exchange programs. Where the programs exist, they are
often hampered by laws that make it illegal to possess syringes. But
impressive statistics from exchanges in New York and several foreign
nations recently prompted California to make it easier for addicts to buy
syringes without a prescription. New Jersey is entertaining a similar
proposal. Even so, the New York example shows that passing a law may be the
simplest step in a long and tortuous process. AIDS prevention advocates
here have had to contend with suspicious neighborhoods, sluggish
bureaucracies and hostile police officers.

This problem was on full display recently when I visited CitiWide's modest
storefront offices in the Bronx, where the drop-in center was alive with
chatter about the latest encounters between clients and the police, who are
said to harass addicts even when they carry ID cards showing that they are
registered participants in a state-sanctioned program.

Even so, CitiWide was doing a brisk business that afternoon, as addicts
trooped in to exchange dirty syringes for new ones. A young Latino man who
came in looking for new syringes without old ones to trade explained that
his used syringes had been confiscated by a police officer he encountered
on the street.

Dicey encounters between addicts and the police are to be expected, given
that addicted people often commit crimes to support their habits.

In 2002, the courts put an end to the practice of arresting addicts as they
approached the exchanges with used syringes. The Police Department issued a
directive explaining the ruling. But continued reports of harassment
suggest that officers on the street still may not have fully accepted the
program.

The fear of being arrested is helping to drive the AIDS epidemic among
blacks and Latinos, who are far more likely than whites to be stopped and
frisked. Minority addicts respond by failing to carry clean syringes, which
leads them to borrow dirty ones, which in turn exposes them to disease.

The picture is substantially different in Britain and Canada. The two
countries embraced syringe programs as far back as the 1980's, getting an
early jump on the epidemic.

By contrast, the debate in America has been driven not by science or public
health concerns but by an ideology that sees syringe exchange programs as
inherently "evil." This view has persisted in Congress, which has barred
syringe programs from receiving federal funds, despite clear evidence
showing that they slow the spread of disease without creating new addicts.
Narrow-mindedness at the federal level has cost lives, leaving the country
20 years behind where it could be in the battle against AIDS.