AVOIDING THE TRUTH OF WHAT'S NEEDED TO FIGHT AIDS:

NEEDLE PROGRAMS

The glittering vision of Atlantic City that gamblers experience at night -
with the streets jammed with limousines and the casinos ablaze with light -
melts away with the rising sun. In the cruel light of day, the casino strip
is dotted with homeless people, tapped-out gamblers and garishly dressed
prostitutes, staring into the windows of passing cars. Move onto the side
streets and you encounter young men holding down proprietary street corners
and people who are clearly addicts, skittering nervously along in search of
drugs.

Drugs and prostitution - always birds of a feather - have turned Atlantic
City, the gambling capital of the East Coast, into the scene of an AIDS
epidemic and the backdrop for a public health emergency. City health
officials estimate that 1 in 40 residents is infected with H.I.V. Many of
the infected are prostitutes who turn tricks to earn money for drugs. The
largest single group appears to be intravenous drug users, who may make up
as much as 15 percent of the population. They become infected while sharing
dirty needles with other addicts, then pass on the disease to lovers and
unborn children.

The addicts need treatment and counseling. But treatment programs are in
short supply, and the community can't wait to slow the spread of infection.
A critical part of the solution is to supply addicts with clean needles.
Most states have permitted these programs, prompted by studies showing that
needle exchanges cut down the transmission of H.I.V. without spreading drug
addiction. But five states, including New Jersey, still have laws on the
books that make it a crime to possess needles without a prescription.

The City Council of Atlantic City voted to create a needle exchange program
despite the law, hoping that officials would look the other way given the
emergency circumstances. The county prosecutor, however, has sued to stop
the program, setting up a court battle that is being closely watched by
public health advocates across the country and abroad.

Gov. James McGreevey has danced around the issue while claiming that he
supports needle exchanges in principle. But he couches his support in vague
terms, saying he could endorse only a program that was somehow "hospital
based." The problem, AIDS researchers say, is that needle exchange programs
set in hospitals fail. Addicts are afraid to present themselves at medical
centers - where they walk through metal detectors, encounter people who
know them and meet the police. The best way to reach this population is
through neighborhood storefronts or roving vans that seek out addicts where
they live and congregate. I recently spent time with one of those vans,
which have become fixtures in the city's roughest neighborhoods. It was
parked not far from a homeless shelter and just opposite the Stanley Holmes
housing, a public development that the state attorney general recently
described as the home base of a drug cartel.

The van's driver, a middle-aged man named Tug, has a booming voice and an
imposing physique that naturally keeps troublemakers at bay. The van's
medical staff consists of two formidable women: Scherri Rucker-Graves, a
veteran nurse, and Rosemary McMenamin, a nurse practitioner who once worked
in the state prison system. The neighborhood was naturally suspicious when
the van began to show up about a year ago. But after the nurses reassured
people, the outreach team developed a rapport with the neighborhood -
thanks in part to a large supply of modest gifts, like condoms, lanyards
and white T-shirts promoting the testing program.

The small park near the housing project was teeming with ill fed and poorly
dressed women from the nearby homeless shelter. "We just hang out where
they hang out," Ms. Rucker-Graves said, "close to the housing projects,
close to the supermarket, close to the rescue mission." People who are most
at risk know frighteningly little about the disease, the nurses say. Some
young women were under the impression that condoms weren't necessary for
oral sex because, they thought, oral sex was not really sex. Others
believed that even if they were infected, they might magically be protected
from AIDS.

Working within the current constraints has been painfully difficult. About
480 people have been tested in the last year; roughly 6 percent were found
to be H.I.V.-positive. But the test that is currently allowed on the van
requires a two-week waiting period, and about one-fifth of those tested do
not come back to hear the results.

Approximately 30 percent of the people tested in the van are addicts, but
if they turn out to be infected, the team's options are limited to
counseling and medical referrals. Every time the van hits the street
without clean needles, an opportunity is lost and new lives are placed at risk.