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D.C. to Use Needles in AIDS Fight

By Amy Goldstein
Washington Post Staff Writer
Monday, September 23, 1996; Page B01

The District is beginning a major initiative to hand out clean hypodermic needles to intravenous drug users, adopting the strategy to slow the spread of AIDS in one of its main breeding grounds.

D.C. health officials on Friday awarded a contract for a "needle exchange" to a consortium that will distribute more than 100,000 sterile syringes over the next year in several Northeast and Southeast Washington neighborhoods where drug use is rampant and AIDS is increasingly common.

The $200,000 initiative will be the first large-scale needle exchange in the Washington area. City health officials and AIDS activists hope it will become their best tool in curbing the epidemic, which has been spreading more quickly in the District than in most other cities, making particular inroads among drug users who share tainted syringes.

The needle exchange is scheduled to begin next month, four years after the District conducted a brief and tightly restricted experiment in giving out syringes. It was widely judged a failure. In a city with an estimated 16,000 intravenous drug users, 33 people took part.

By moving to a broader strategy, D.C. officials reflect the extent to which mounting concern over acquired immune deficiency syndrome has overwhelmed resistance to a highly divisive public health technique that critics say condones the use of illegal drugs.

The District's handling of the exchange also shows how long it can take to launch an initiative in the city, even one defined as a critical response to a public health emergency. The contract is being awarded nearly two years after the D.C. Council directed officials to create the exchange and 10 months after the Department of Human Services said it was ready to accept bids.

The contract was held up for two months because Human Services officials realized that they had not checked adequately to find out whether the two bidders they were considering had the financial stability to run the program. When they checked, they had enough qualms about both groups that they were on the verge of throwing out both bids and starting the contracting process over again, according to several city officials familiar with the process.

Instead, they chose a consortium that is led by the KOBA Institute, a nonprofit group that holds other city contracts for drug treatment and AIDS-prevention work. The consortium includes the Whitman-Walker Clinic, the largest provider of AIDS services in the Washington area.

"It's been very frustrating. There have been many infections that have occurred in the years it took to get this program off the ground," said Jim Graham, Whitman-Walker's executive director. ". . . This is the single most important thing we can do. It is inexpensive. It works."

Since the epidemic started in the early 1980s, nearly 8,700 District residents have developed AIDS, 5,000 of whom have died. As many as 17,000 residents are infected with the human immunodeficiency virus, and more new infections are occurring among intravenous drug users, their sexual partners and their children than among gay and bisexual men, originally the epidemic's most common targets.

The trend in the District is a more pronounced version of a national pattern. The proportion of AIDS cases related to intravenous drug use has grown to more than 25 percent, while the proportion attributable to sexual contact among gay and bisexual men has been falling for six years.

Across the nation, there are now 86 needle exchange programs, according to the North American Syringe Exchange Network. A variety of studies has found no evidence that they increase drug use. Nor have they found increases in needle-sharing, which appears to decrease or remain the same.

A study estimated that a New Haven, Conn., program lowered the rate of HIV infection among participants by one-third, while other studies have found significant decreases in the spread of other blood-borne infections, such as hepatitis B.

Exchanges largely have been shunned in the Washington area, however. Alexandria has been the only Washington suburb to consider an exchange. The idea was broached by the Health Department four years ago but was dropped after it failed to attract enough community support to encourage city officials to seek permission from the Virginia General Assembly.

Baltimore has the nation's largest government-run needle exchange, operating out of two vans that stop regularly in several neighborhoods. When the program began in 1994, health officials expected to attract 500 participants the first year. Instead, they were deluged by nearly 3,000 and exchanged 600,000 needles. The participants tend to be older drug addicts, most of whom use drugs daily.

The popularity of Baltimore's program contrasts with the District's 1992 experiment, which proponents of needle exchanges say was hampered by many restrictions. It required participants to sign up for drug treatment first and to submit to a physical exam and a long questionnaire. Instead of taking needles to the places where drug users gather, the program required users to pick up needles at the main office of the District's drug treatment agency.

Under the exchange, KOBA and Whitman-Walker will use a van to visit six or seven neighborhoods near drug markets day and night. Participants will be given two needles at a time as long as they turn in their old needles. They will not be required to enter drug treatment, although workers will help them get treatment, AIDS tests and help with AIDS prevention.

The D.C. Council imposed the 1992 restrictions as a compromise in light of intense community opposition. Today, critics are more muted, torn between concern over appearing to condone drug use and the growing inroads that AIDS is making.

"You don't save lives by saying: 'I know you are addicted. We are going to give you a needle to continue your practice,' " said the Rev. Herbert B. Chambers, senior pastor of Young's Memorial Church of Christ Holiness in Southeast Washington, which sponsors a group home for HIV-in\fected parents and children. But, Chambers said, "I understand the concept [for the exchange] to stop the infection rate."

© Copyright 1996 The Washington Post Company

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