NEEDLE EXCHANGE PROGRAMS STRUGGLE WITH FUNDING

NEW HAVEN, Conn. -- With her grayish hair and pink sweater, retired
teacher Joanne Iannotti looks like a typical grandmother as she
emerges slowly from her home with a little bag of dirty hypodermic needles.

She shuffles to a van and exchanges her bag for clean needles for her
adult sons, who she says shoot heroin with their friends.

"They tend to want to share," Iannotti said. "I say, 'No, wait. I
have clean needles for everybody."'

Iannotti participates in one of nearly 200 needle exchange programs
in the United States. A growing body of research has found that
needle exchange programs reduce the spread of AIDS without increasing drug use.

But local budget cuts and a federal ban on funding such programs in
the U.S. and abroad are hurting the programs at a time when injection
drug use is fueling a global AIDS epidemic, advocates say.

"Funding for needle exchange programs in the United States has always
been difficult because the governmental bodies have never wanted to
support what they see as a morally slippery intervention," said Dr.
Peter Havens of the Medical College of Wisconsin.

Physicians for Human Rights held congressional briefings last week to
build support for needle exchange and other programs to prevent the
spread of AIDS among drug users. The group also wants the U.S. to
lift constraints on programs that receive U.S. funding so they can
collaborate with needle exchange programs funded by other donors.

About one-fourth of the nearly 950,000 AIDS cases in the U.S. through
2005 involved injection drug use, according to the Centers for
Disease Control and Prevention. The rate is even higher in many other
countries, experts say.

Critics say needle exchange programs encourage risky behavior and
work against efforts to fight drug abuse.

But countries in Europe and Asia have increasingly recognized the
benefits of needle exchange programs, Havens said.

After several studies, then-Health and Human Services Secretary Donna
Shalala determined in 1998 that such programs reduce the transmission
of HIV and do not encourage the use of illegal drugs.

"They work," said Ricky Bluthenthal, senior social scientist at Rand
Corp., who has studied the programs in Connecticut and other states.
"The evidence in support of them is quite strong."

The New Haven program was touted as a national model after a Yale
University professor in the early 1990s was among the first to
document the effectiveness of providing clean needles to slow the
spread of the HIV virus that causes AIDS.

George Ducheli and Ambritt Lytell-Myers, who drive the program's van,
are convinced they are saving lives. Both are recovering drug addicts.

"They're going to get high anyway," Ducheli said. "We're just keeping
them from getting infected or infecting others if they are already infected."

In addition to proving clean syringes, they try to connect drug users
with treatment.

Iannotti said one of her sons was getting violent, had wrecked cars
and even stole her funeral money. But Ducheli arranged for him to get
into treatment last week.

"His mood is completely different," Iannotti said. "He wants to stay longer."

A proposed state budget would cut about $100,000 from the $500,000
spent on needle exchange programs in New Haven, Hartford, Danbury,
Stamford and Bridgeport. That cut would make it difficult to operate
the New Haven program and could lead to elimination of some of the
other programs, officials said.

"You're talking about trading lives for $100,000," said David
Purchase, chairman of the North American Syringe Exchange Network.

The money was cut because Gov. M. Jodi Rell wants to increase
spending for programs that help children with asthma, obesity and
other health issues, Rell spokesman Rich Harris said.

"What the governor has had to do is make some choices about where she
is going to spend limited state resources," Harris said.

The New Haven program is already struggling with limited money.
Ducheli and Lytell-Myers drive a van that is nearly 20 years old and
has 170,000 miles.

"They break down all the time," Ducheli said of the vans. "We run out
of syringes all the time."

Needle exchange programs have grown slowly around the country,
relying on private and state funding.

New Jersey, the only state without either a needle exchange program
or one that allows syringes to be sold without a prescription,
recently legalized needle exchange programs after a long struggle.

In Chicago, a cut in funding this year will mean 800,000 fewer dirty
needles will be taken off the streets, according to Dan Bigg, program director.

The funding was cut from about $1.1 million to $870,000 because of a
decrease of HIV cases involving injection drugs, said Christopher
Brown, a Chicago health official. He credited the needle exchange
program with causing the decline, but said officials try to match
limited funds with the type of transmission that accounts for the
most new cases.

Ducheli and Lytell-Myers say businesses sometimes chase them away and
police arrest their clients. But Lytell-Myers is driven by the loss
of her husband and sister to AIDS.

"I want to save the world," she said. "The ones closest to me I
couldn't save. I want everyone to get a feel of what recovery is."

Iannotti said the program kept her sons from getting infected with
the AIDS virus.

"I think it's fabulous," Iannotti said. "I think it saves a lot of lives."