ALONE IN A CITY'S AIDS BATTLE, HOPING FOR BACKUP

WASHINGTON - The nation's capital is the only city in the country
barred by federal law from using local tax money to finance needle
exchange programs. It is also the city with the fastest-growing
number of new AIDS cases.

These two facts keep Ron Daniels on the move, tirelessly driving his
rickety Winnebago from drug corner to drug corner across the rougher
parts of this city, counseling the addicted and swapping clean
needles for dirty ones.

Faced with an AIDS problem growing here at a rate 10 times the
national average, Mr. Daniels, the director of Prevention Works, the
city's only needle exchange program, is armed with a shoestring
budget of $385,000 in private donations, a small fraction of what
programs in other major cities receive in state and local money.

Since Washington is not part of a state, Congress controls the city's
local system of government, and for nearly a decade members of the
House, citing concerns about worsening drug abuse, have inserted
language into the bill approving the city's budget to prohibit
financing such programs.

That may soon change.

"This city's situation is totally improper," said Representative Jose
E. Serrano, Democrat of New York and chairman of the subcommittee
responsible for the District of Columbia appropriations bill. "It's
politically obscene to have Congress tell the District of Columbia
that it can't use local funds for something like needle exchange
programs, which have been proven to have a major effect on fighting a
deadly disease."

Calling the matter both a public health concern and a basic political
right of home rule, Mr. Serrano said he planned to make it a priority
to remove the language that prevents the city from financing such
programs. The city's mayor, Adrian M. Fenty, has said he will provide
city money as soon as Congress takes such action.

Washington was among the first cities nationally to create an AIDS
monitoring office after the virus first appeared in the United States
more than 20 years ago. But it has slid backward in its fight against
the disease, which is commonly spread by intravenous drug users
sharing needles.

"For every person I help, there're seven more I can't reach," said
Mr. Daniels, 49, who describes his program as providing a thin wall
between the city's drug and AIDS epidemics. "But I'd be reaching a
lot more if my hands weren't tied."

Critics of needle exchange programs argue that rather than reducing
the suffering of drug users and preventing them from spreading
diseases, the programs foster further drug use.

"We need to fight drugs, not show people that they can be used in a
safe manner," Representative Sam Graves, Republican of Missouri, said
last year during House floor debate about drug policy.

Mr. Daniels said fighting drugs was exactly what his program did.

"The needle is just an enticement, really," he said, looking through
the screen door of his van at a line of about 10 people who gathered
within minutes of his arrival at a corner on the city's grittier
Northeast side.

He said his program, which reaches about one third of Washington's
estimated 9,700 intravenous drug users, relied on clean syringes to
attract users so he and his staff of four could counsel them about
drug rehabilitation and testing for H.I.V., the virus that causes AIDS.

"Want ointment? Alcohol pads?" asks Mr. Daniels, running down his
checklist as he prepares supplies for a heroin addict who counts a
week's worth of used needles, dropping them in a plastic bucket.
"Need food? Condoms?" Mr. Daniels asks.

One by one, they file in: a security guard sick of hiding his
addiction from his wife, a carpenter looking for methadone, a
prostitute with a bad case of the shakes. Many are rail thin. Most have sores.

Teefari Mallory sits at the laptop entering data on each user. Three
other staff members go into the neighborhood to talk about safe sex
and AIDS prevention.

"Give me 5 apples, 10 blues and 2 groins," says a man named Bernard
after dropping 17 used syringes, a week's supply, into the bucket.

"Apples" and "blues" are syringes used by addicts who have been
taking drugs for shorter periods. "Groins are what you use when all
your other veins collapse," said Mr. Daniels, who used to be known on
the streets as Boo when he sold drugs and needed four hits of heroin
a day to get by.

In Washington, with just over half a million residents, one in 20 are
H.I.V. positive.

And the number of people with AIDS is growing. The city's rate of new
AIDS cases was 128.4 per 100,000 people in 2005, compared with a
national average of 13.7 per 100,000, according to the most recent
data available from the federal Centers for Disease Control and
Prevention, which compares the district with states rather than other cities.

Intravenous drug use is the second-most-common way H.I.V. is spread
among men in Washington, with unprotected sex being first, according
to city health officials. For women in the city, sharing needles is
the most common mode of H.I.V. transmission, city officials say.

There are more than 200 needle exchange programs in at least 36
states, about half financed by city or state money, according to the
North American Syringe Exchange Network. Needle exchange programs and
support services in New York City, for example, receive more than $3
million in state and local money, according to the Harm Reduction
Coalition, which works with 12 programs in the city.

Back at the Winnebago, Yvonne Zywusko, a 39-year-old prostitute,
climbed on board, shaking in withdrawal from not having used heroin
in over a day.

"Look at me," she said as she dropped two used needles in the bucket.
"I wasn't raised this way. I went to Catholic school. My family had a
lot to offer me, and I missed out."

Reaching out to prostitutes is an especially high priority of Mr.
Daniels's program, since they have great potential to spread H.I.V.

Seeming disgusted with herself, Ms. Zywusko described how she sold
her body and slept in stairwells, but she began shaking her head as
she added that she was still not ready or able to kick her addiction.

She added that the one line she was trying not to cross is sharing
needles. "I got checked in January. It was negative," she said about
her last H.I.V. test. "I'm lucky."

Financing for needle exchange programs is hardly Washington's only
problem in its fights against AIDS.

"D.C. is a city where a progressive local government wants to do the
right thing, but a lot of factors work against it," said A. Cornelius
Baker, a policy adviser in Washington and the former executive
director of the Whitman Walker Clinic, which ran its own needle
exchange program in the city until 1998, when Congress first blocked
local money from going toward such programs.

The city's AIDS prevention office is currently on its 12th director
in just over two decades, a turnover rate that has hampered its
focus, Mr. Baker said. The city is also predominantly black, and it
has a large gay population, and the infection rates for both
communities have historically been high, he said. Shame and stigma
have also hindered a willingness among blacks to confront the
problem, he added.

There are also broader prohibitions.

In 1988, Congress banned federal money from being used on needle
exchange programs, though it included an exception allowing the
president to waive the federal ban if review by the surgeon general
or secretary of Health and Human Services determined that syringe
exchange programs were proven effective and did not increase drug use.

A number of federal studies found that such programs did not increase
drug use, and in 1998 Donna Shalala, then the secretary of Health and
Human Services, concluded, "A meticulous scientific review has now
proven that needle exchange programs can reduce the transmission of
H.I.V. and save lives without losing ground in the battle against
illegal drugs."

However, President Bill Clinton did not remove the ban on syringe
exchange financing, and in 1998 Congress reinforced the ban by
removing the executive waiver.

The attention paid to the issue helped embolden critics in Congress,
who decided not only to tighten the federal ban but also to block
Washington's own financing of such programs. In recent years, Mr.
Clinton has said he regrets not having done more to lift the ban.

Across the Anacostia River and worlds away from the wealth and power
of Capitol Hill, Curtis Toney, 40, groans as he gently lowers himself
into the Winnebago's overstuffed chair. Mr. Toney unwraps a bandage
on his leg. The smell makes Mr. Daniels step back.

"We have got to do something about that," Mr. Daniels said, reaching
for gauze pads.

Mr. Daniels was infected with H.I.V. over 17 years ago after sharing
a needle. He said he began using hard drugs when he was a teenager
and became an addict in his early 20s while in the military. A
Washington native, he now parks his Winnebago near many of the
abandoned buildings and corners where he once bought and used his drugs.

A man arrives neatly dressed but with no needles to swap. He asks for
a referral to an outpatient drug rehabilitation program. "I got a
problem," he says, explaining that the city's in-patient drug
programs last too long and his employer will not give him that much
time off for "personal reasons" without asking questions. "I'd be
fired if I tried to explain."

Mr. Daniels estimates that he makes 50 referrals to drug treatment
programs per month.

"I got the guy you need to call," Mr. Daniels told the man. "But,
look," he added, looking him squarely in the eyes, "I will see you
next week, and I'm going to check up on what you're doing."