Public Lives

FROM PUNK ROCK AND DRUGS TO THE WAR ON H.I.V.

ALLAN CLEAR, the executive director of the Harm Reduction Coalition,
has spiky graying hair that suggests it came into contact with an
electric socket. At age 44, with pierced earrings and lace-up Doc
Martens, Mr. Clear looks as if he has not quite gotten over his
English youth as a working-class punk rocker.

Yet Mr. Clear has a calm and reasoned manner, not that of a hardened
rabble-rouser, as he gives a tour of the coalition's garment district
offices, where the literature and posters leap out from the moment you
enter.

There is the safety manual for injection-drug users, called "Getting
Off Right." And the new hepatitis C prevention campaign, "It's All
About the Blood." There is a poster urging, "Fix With a Friend," to
prevent heroin overdose. "Taking Drug Users Seriously," another poster
states.

Mr. Clear, who heads a national coalition that develops public policy
and trains social service workers, is used to operating as a maverick.
He promotes the exchange of drug users' dirty needles with clean ones
to curb the harms associated with drug use, especially the spread of
H.I.V. And over the years, he has become accustomed to working without
much support from the city. "The door was closed," he says.

But now Mr. Clear has found an ally at the highest levels of city
government in ways the coalition never had before.

Dr. Thomas R. Frieden, the city's health commissioner, is aggressively
and publicly pressing the case for needle exchange programs as an
H.I.V. prevention strategy in several neighborhoods in Queens, a
borough without any such programs and with some resistance to them.
Dr. Frieden has noted that in the early 1990's, when needle exchanges
were relatively few, 50 percent of injecting drug users were H.I.V.
positive. Today, he says, that figure is about 12 percent.

"This administration is like night and day from administrations in the
past," Mr. Clear says. "There's a willingness to take on a difficult
issue, certainly to address the public health point of view as opposed
to the political point of view. It's been marginalized for a long time."

To start a needle exchange program in New York State, community groups
must go through an often cumbersome process to obtain a waiver from
the state's Health Department.

Mr. Clear's coalition, which was started in San Francisco in 1994,
serves as a lead agency on the issue between the city and community
groups. It is working on plans to help establish needle exchange
efforts in Queens, which would be run by the AIDS Center of Queens
County. The coalition is coaching the staff on regulatory matters and
on how to operate an exchange if it wins community board approval.

"Allan has been an effective and dedicated advocate for harm reduction
for more than a decade," Dr. Frieden says of Mr. Clear in an e-mail.
"He's an important resource to helping improve the health of the hard
to reach New Yorkers in need."

Mr. Clear is a quiet sort, but quietly passionate, too. Still, there
has always been a bit of the outlaw in him.

On his office walls are black-and-white photographs that he shot of
demonstrations in support of needle exchange, some taken when he was
one of the shock troopers for the militant AIDS activist group Act Up.
(He was arrested three times, but concedes that his is a lightweight
rap sheet when it comes to Act Up.) There also are pictures from his
travels in Croatia and the Gaza Strip, where Mr. Clear covered civil
strife as a freelance photographer.

He says he cannot remember a time when he was not concerned about
social justice. He grew up in Portsmouth, England, where his father
held jobs as a mechanic and a bus driver. His mother was a telephone
operator.

MR. CLEAR arrived in New York at age 22. He worked as a bartender but
mostly became immersed in the drug culture. His cocaine addiction
grew. He is a veteran of Alcoholics and Narcotics Anonymous.

Throughout the 1980's, working as a bartender and a waiter, Mr. Clear
was struck by the number of colleagues who were H.I.V.-infected.

"Being surrounded by so many people dying of H.I.V., it was too
painful for me to sit back and not do anything," he says. "It was
clear to me that I should be working with drug users; that was my
community. I couldn't sit by and watch what was going on without doing
something when there was a solution to it."

He became involved in underground needle exchanges years before the
state, in 1992, provided waivers to some community groups to do it
legally. In 1992, he went above ground to head the Lower East Side
Harm Reduction Center, which had official state authorization.

"Harm reduction is not making drug use solely acceptable, but it's
accepting that people use," he says.

He was hired to run the coalition in 1995, and moved its base from San
Francisco to New York because he lives here, in TriBeCa, with his
wife, Cynthia Springer, a holistic medicine practitioner, and his
13-year-old stepson, Zachary.

Mr. Clear looks forward to the day when needle exchange programs are
completely normalized in society, when advertisements for them become
as common as, say, subway campaigns promoting safe sex and condom use.

"Being an advocate for the health of drug users is not a popular
thing," he says. "But I wouldn't do this if I wasn't overly
optimistic."