TIME: Almanac 1993/TIME Almanac 1993.iso/time/052592/0525130.000

Text File | 1992-09-10 | 9.1 KB | 180 lines

                                                                                HEALTH, Page 55

Getting the Point In New Haven


The city's clean needle program has cut the spread of AIDS. Now
other towns are seeing the light

DICK THOMPSON/NEW HAVEN


    The van, painted with vivid stripes and a rising sun,
plies the drearier streets of New Haven, Conn., drawing eager
throngs like some dark version of the Good Humor truck. Four
times a week, the "dope fiends," as they call themselves, line
up to enter the vehicle. They identify themselves to city
workers by their code names ("Carol Burnett," "Streetcat,"
"Wizard") and, in exchange for used needles, receive survival
kits: bottles of bleach, bottles of water, clean needles, and
condoms. They do this because they are terrified of the epidemic
that is raging through their city. "Just because I shoot drugs
doesn't mean I don't care about AIDS. I care a lot," says a
petite white woman, 45, who works as an executive assistant.
That's right, says a dope dealer known as "Philip Morris":
"Heroin don't make you retarded."

    No, it doesn't, but for years the acrimonious debate over
how to protect heroin users has impeded efforts by health
authorities to control the spread of AIDS. Civic leaders have
been caught up in moralistic arguments over whether providing
clean needles to addicts would only accelerate inner-city drug
abuse. In minority communities, opponents insisted that needle
handouts were akin to genocide. Meanwhile, AIDS raced through
intravenous-drug-using populations. Today one-third of the
nation's AIDS cases originate from IV drug use. More
specifically, 71% of all females with AIDS are linked directly
or indirectly to IV drug use, as are 70% of all pediatric AIDS
cases. Still, health experts wrangled over what to do.

    Suddenly that has changed. In a dramatic turnabout, New
York City last week announced that it would support a
needle-exchange effort, two years after Mayor David Dinkins
halted such a program. The mayor of Washington also called last
week for needle exchange for addicts, as well as the
distribution of free condoms in city schools and jails. Rhode
Island, New Hampshire and Connecticut will probably soon take
the even more dramatic step of decriminalizing the possession
of hypodermics. Movements are under way in New Jersey,
California and Massachusetts to remove legal barriers and begin
officially sanctioned needle programs. Even in the U.S.
Congress, Charles Rangel, who has led opposition to needle
exchange on the ground that it threatens blacks, has asked the
General Accounting Office to reevaluate the effects of such
programs.

    The most important catalyst for this change has been the
experiment conducted in New Haven. The two-year-old program has
demonstrated that needle exchange dramatically slows the rate
of infection without encouraging new IV drug use. Some
indicators even suggest that the program has been responsible
for a decrease in both crime and the amount of drugs used
illegally. The city's new police chief, Nicholas Pastore, claims
that crime actually dropped 20% over the past two years, perhaps
because of the improved relationship between city workers and
the community. Meanwhile, referrals to drug-treatment centers
increased. These results have enabled policymakers elsewhere to
break the logjam. Says New York City's health commissioner
Margaret Hamburg: "It all came together in the New Haven
experiment."

    New Haven, unfortunately, had all the right ingredients.
The city of 130,000 surrounding Yale University is the seventh
poorest in America. The community is 45% black, 15% Hispanic and
40% white, and with 2,000 heroin addicts, it has roughly the
same proportion of addicts as New York City.

    But unlike New York and most other urban centers, New
Haven had a group of public-health workers who, when faced with
the AIDS epidemic, pulled together to confront a politically
dicey issue. "It was a very methodical process," says Elaine
O'Keefe, director of the AIDS division for New Haven's health
department. The New Haven workers spoke out about the value of
needle exchange at civic meetings, classrooms and churches.
Then, after building support from the ground up, they forced the
issue into local elections. A special act of the state
legislature was required to lift the ban on possession of
hypodermics. After lobbying by health workers, the measure
passed easily. Their efforts also helped defuse the race issue.
"One thing was surely true," says black state representative
William Dyson. "To do nothing was to ensure genocide."

    One of the last converts to the cause was John Daniels,
the city's first black mayor. Concerned at first that the
program would promote drug abuse, Daniels changed his mind after
seeing AIDS-infected newborns in the city's hospitals. Today he
says he was wrong to impose his own moral standards on a
community so desperately in need of help: "If giving needles
saves a life, I support it. If giving a youngster a condom
prevents AIDS or a baby with AIDS, I support it."

    Support from the police has also been essential to the
success of the experiment. Police chief Pastore, who has worked
hard to reduce friction between cops and city residents, sees
to it that his officers cooperate with the needle-exchange van.
If, for instance, a police car patrols too close to an exchange
site, a quick call to the chief will trigger a radioed
instruction sending the car in another direction. Ultimately,
Pastore hopes to restore trust between police and addicts who
may need their help.

    Gaining trust was a major hurdle for workers manning the
needle van. Robert, a 36-year-old convicted armed robber,
remembers thinking the van was part of a police sting operation.
"You're not used to nobody helping you and wanting nothing in
return," he says. Eventually, outreach workers in the van helped
him apply to a treatment program to end his 16-year addiction
to heroin. To date, more than 200 addicts have been funneled
through the van and into drug-treatment programs. Nonaddicts
have also turned to the van for help. Teenagers flag it down and
ask for condoms. It has, in a sense, become one of the few
visible expressions of the city's desire to help poor residents.
"The people here are so used to being treated bad, they
internalize that and think they're bad," says outreach worker
Dominick Maldonado.

    A major goal of the program has been to get contaminated
needles out of heroin shooting galleries, where, according to
one New Haven study, more than 90% of needles are contaminated
with the AIDS virus. Addicts in these galleries can "rent"
recycled needles either for money or for an exchange of drugs.
After each use, addicts clean the needles in a pail of water set
out every morning by the operator. The water starts out clear,
but it is bloodred by afternoon. "We don't know who all got the
virus," admits the proprietor of one such establishment. By
exchanging needles, the project also reduces the number of
contaminated needles that find their way into the city's parks,
playgrounds and schools. "We used to find needles scattered
throughout the building," says Edith Rawls, resident director
of the downtown Y.M.C.A., which houses 131 men and women (75%
are addicts). "There were dirty needles in the hallways and the
bathrooms. Children would see them outside and pick them up."

    What has made the New Haven experiment so compelling is
that researchers independent of the program did the analysis.
In fact, since the state provided no money for the evaluation
of the program, Yale scientists donated their time and
equipment. Using the advanced techniques of molecular biology,
they were able to "interview the needles" to track the spread
of the virus. All needles provided by the van are coded. When
the needles are distributed to addicts, the numbers and
participants' code names are fed into a computer along with the
date and location. When the numbered needles are returned, they
are tested for HIV, and the results are run through the
computer. Such studies confirm that the program has shortened
the length of time needles are in circulation. "This means the
number of sharing opportunities is going down," says Yale's
Edward Kaplan.

    The researchers were also able to put to rest the concern
that free needles would entice youngsters into IV drug use. The
average participant in the program is 35 and has been shooting
drugs for seven years. "We are not encouraging kids from the
local high school," says Kaplan. Most important, researchers
established that within six months of the program's start, the
rate of new infections had dropped one-third.

    While these lessons have impressed lawmakers from New York
to California, they have failed to budge the Bush Administration,
which continues to maintain that needle programs promote drug
abuse. "When you use drugs intravenously, that clearly shows
you're not concerned about your health," says Bob Martinez, the
nation's "drug czar." The lines snaking out of New Haven's van
would seem to prove him wrong.