in memory of Rod Sorge...
among the FIRST 1990 syringe exchange activists ARRESTED
and taken thru the judical SYSTEM
in New Jersey to challange and CHANGE the laws...
charges were DISMISSED by the Court one year later
under the NECESSITY DEFENSE.
____The 'necessity defense' applies to the following circumstances (all must be true):
- 'the conduct was necessary to avoid eminent harm to a person or the public,
- 'there was no adequate alternative for avoiding the harm,
- 'the harm caused by the act was not disproportionate to the harm avoided,
- 'the defendant had a good-faith belief that the act was necessary to prevent harm,
- 'the defendant believed his or her behavior to be reasonable.'
by Sharon Lerner
February 3, 1999
Rod Sorge 1968-1999
Rod Sorge, one of New York's most articulate, knowledgeable, and empathic voices on harm reduction for drug users, died last Thursday from complications of AIDS. Only 30, Rod had already had an enormous influence on how people think about drug use and AIDS, taking the groundbreaking position that addicts have rights. "The message to drug users cannot be 'abstain or die,' " he explained in one of his many articles on the subject. Users, he said and wrote and tirelessly chanted at demos, should be helped without judgment.
Though providing IV drug users with clean needles has been shown to decrease the spread of AIDS, it was illegal to do so in New York until 1992. Rod helped bring that change about. He cofounded the ACT UP needle exchange, the first in New York, ran the then underground needle exchange programs in Harlem and the Bronx, and later headed the first state-authorized needle exchange program. Rod was also arrested for handing out clean needles in Jersey City (he was the first to do this in the state).
As a gay man who came to New York expressly to devote himself to AIDS activism, Rod was involved in countless demonstrations on behalf of people with AIDS. He was one of those jailed during ACT UP's famed Stop the Church action on Saint Patrick's cathedral. When singer Diamanda Galas testified to his character at the trial, she dubbed him Saint Rod.
Rod, who dropped out of college and read constantly, was known for his sharp intellect and follow-through. "He led in terms of doing the work," says close friend and former ACT UP colleague Lei Chou. "If we needed a press release, he was the one to write it. If research needed to be done, he did it." His intellectual precision earned Rod respect at all levels of the AIDS world. After he testified in support of a law that would have allowed pharmacies to sell hypodermic needles without prescriptions, state assemblymember Richard Gottfried commented, "There are probably several state agencies it would be useful to turn over to you."
Yet Rod didn't bow to- or even seem to recognize- the world's hierarchy. He had little interest in self-promotion, refusing raises and eschewing material possessions. "His pants were so old, the street kids used to make fun of him," remembers Edith Springer, a friend who, with Rod, coordinated HIV prevention with youth involved in crack use and prostitution. Despite his own humble style, Rod was accepting of all who shared his goals. "He even had compassion for us poor bureaucrats," says Diane Rudnick, director of the substance abuse section of the AIDS Institute.
Still, Rod's passion was for helping people directly, so whatever he gleaned from the intellectual world was quickly put into action. When AIDS researchers suggested tagging needles so that they could be tracked, Rod immediately bought enamel paint and began what became a Friday night ritual of painting needles and assembling bleach kits at his apartment. (The event would sometimes run right into Saturday morning distribution with no sleep in between.)
In his journey to the heart of the problem, Rod also began the "walkabout" program at the Lower East Side needle exchange. "He would fill his shopping cart with needles and just walk through the neighborhood," says friend and coworker Angela Echevarria. "Being that he was Caucasian, everybody was like, 'Police! Police!' But he would explain to them with like 50 different ID cards that he wasn't police and then he would show them how to clean their works."
Rod was a private person. Only a few of his friends had heard him make even a passing reference to his childhood in Chicago, an unhappy time spent as a sensitive, gay boy growing up in an unaccepting and poor family. And few of his friends were aware, at least at first, of his own drug use or his illness. But gradually Rod became more public about both shooting heroin and having AIDS, which in his case was diagnosed at a late stage and didn't respond to combination therapy.
In an article in the zine Junkphood, Rod declared that he planned to deliberately overdose rather than die the object of someone else's pity. His suicide, he predicted, would "be the act of an empowered, purposeful human being committed to gaining ultimate control over his life and death."
But Rod did not take his life. Instead he struggled in his final years to find doctors who would treat his pneumonia, TB meningitis, and other infections while accepting his drug use, which he believed helped him to manage his depression. The medical response was profoundly disappointing to him. As he detailed in a painful article, called "one junky's odyssey," his doctors often treated him as a "dysfunctional fuck-up." They refused to see AIDS--rather than drugs--as his problem.
"All those years I spent advocating for other drug users...did not prepare me for the treatment I would also receive as a heroin injector with AIDS," he wrote. Because he was taking rifampin for his TB, a drug that made him process methadone quickly, he regularly went into withdrawal even while taking doses of methadone that would stabilize others. And he repeatedly checked out of the hospital against medical advice.
True to his principles, Rod did not use the connections he had made as an advocate to get special treatment, even during this last period, when it might have saved his life- or made it more bearable. "He had so many friends and admirers throughout the AIDS system. If he had used his contacts, he would have gotten the best care," says Chou. "But he detested privilege. He wanted to be treated like everybody else."
A memorial for Rod Sorge will be held at Housing Works, 743 East 9th Street (at Avenue D) on Saturday, February 20, at 4:30.
The Village Voice February 3, 1999
EDUCATION SERIES NUMBER 2
Drug Policy in the Age of AIDS:
The Philosophy of Harm Reduction
by Rod Sorge
We have understood HIV transmission for years. The routes are obvious, limited, and modifiable, yet HIV seroprevalence has steadily increased around the world. There have been only limited medical advances in the treatment of HIV-related illness. Because of a lack of federal leadership on all fronts, from funding to discrimination, misguided research priorities at the National Institutes of Health (NIH) and the Food and Drug Administration (FDA)(1), and because the virus continues to confound researchers the more it is studied (2), the dream of making AIDS a chronic but manageable condition remains mostly a dream as we start to live through its second decade.
Instead of producing safer sex education for men who have sex with men, the government still demands as end to such sexuality; and instead of producing safer drug use education, the government demands an end to drug use by force rather than treatment. Many of our laws and cultural mores regarding sexuality (like prostitution and sodomy laws) and drug use (such as hypodermic possession and drug paraphernalia statutes) only create a climate that promotes silence, secrecy, hate, and shame at a time when we need to be talking openly about sex and drug use. It is not surprising, then, that most of the AIDS prevention education that has been effective has been developed outside of government agencies and in the communities at which it is aimed.
As the "second wave" of the epidemic crests, and seroprevalence reaches staggering levels among intravenous drug users (IVDU's) there is a growing movement among providers, AIDS activists, researchers, and policymakers toward a drug policy paradigm aimed not a incarcerating and punishing users, or at positing abstinence as the only alternative to drug taking, but at educating users about how to reduce drug-related harm. AIDS activists across the country are establishing, often illegally, programs in which drug users learn how to clean their works with bleach to help limit the transmission of HIV from the sharing of contaminated needles. Once again the prevention debates -- quagmires of personal anti-drug morality and local politics -- and have taken public health into their own hands. This article, ...attempts to articulate to articulate some of the arguments and developments in the U.S. movement for harm reduction.
The Needle Exchange Controversy in New York
Nowhere has the debate about needle exchange and safer injection education been as intense as in New York City. The complex racial realities and politics that dominate many aspects of New York life have likewise influenced this discussion. Where three socio-epidemics -- homelessness, drug addiction , and AIDS -- intertwine to devastate communities of color, some argue that needle exchange or bleach distribution programs are merely a way of ignoring the scope and gravity of these epidemics, paltry interventions that mock the realities of many people's lives. Most opponents of needle exchange programs believe that drug treatment should be given top priority, and that anything less is a non-solution. Some contend, despite much evidence to the contrary, that needle distribution would add to the problem by encouraging drug use or, at the very least, by sending "mixed messages" about drug use.
In their search for a single and immediate solution, opponents of harm-reduction measures simplify the complex phenomenon of drug taking and the complex lives and motivations of drug users. Their arguments reflect a lack of knowledge about addiction as it currently exists in New York City, the realities of the services that are needed, how much they will cost, and how long it will take for them to be actualized.
What may seem like an inadequate response to AIDS and drug-related harm from the vantage point of a policymaker or church leader can nevertheless be a life-saving strategy from a drug user's viewpoint. Proponents of needle exchange and distribution programs do not support such programs as solutions to the AIDS epidemic or drug-related harm. But that these programs can help prevent HIV infection, and help prevent those already immunosuppressed or HIV infected from contracting life-threatening infections, is undeniable.
The issue of risk-reduction education has been largely portrayed as a controversy between black church and political leaders on the one hand and white health officials on the other. However, such a generalization eclipses the fact that many Latino and African-American AIDS advocates and services providers have spoken out in support of the immediate implementation of needle exchange programs and do so with input from drug users themselves and from those who live in neighborhoods affected by AIDS and drug-related harm. Debra
Fraser-Howze, director of the Black Leadership Commission on AIDS, an organization that is one of the most outspoken opponents of needle exchange, admitted that needle exchange, bleach distribution, and safer injection education "are not about AIDS, but about power and control" (3). But in the struggle over who will determine drug and AIDS policy, those who most require empowerment and control are continually left out: active and former drug users themselves.
Just Say No to "Just Say No"
Drug use as it exists in the United States is largely the result of diverse forms of socio-economic coercion, but the sources of that coercion are made diffuse and indirect shifting the focus away from the physical considerations and the origins of addiction to the presumed recalcitrance of the individuals user. The "just say no" approach to drug "education" typifies this attitude: the recalcitrant individual is the one who won't or can't say no. The "choices" are clearly set forth. What type of person are you/will you be? The life conditions that often lead to drug-related problems are seldom raised in the mainstream discourse about drug addiction. Rather, the addict is solely accountable for her or his addiction, while racism, classism, poverty, and heterosexism almost never enter the picture. Each addict is viewed as a separate case, a separate individual having made a personal choice to use drugs. In the age of AIDS, the logic goes, choosing to become addicted and choosing not to end one's addiction make HIV a self inflicted condition. The just-say-no approach also denies the fact that drugs can be used more safely than they often are, and stablishes the equation drug use = drug abuse. Our culture hypocritically calls those who use heroin and cocaine "drug abusers" while "social drinkers" and cigarette smokers escape even the label of "drug user."
"Just say no" introduces the appearance of a choice when in actuality often no choice exists, thereby establishing a structure through which blame and accountability can be meted out. Drug-related harm prevention programs aimed at intravenous drug users and their sexual partners and families are essentially non-existent in New York, except for the work of ADAPT (the Association for Drug Abuse Prevention and Treatment) and a few other community-based organizations that distribute bleach kits and show addicts how to clean their needles. Drug addicts must be given realistic choices if they are to avoid health problems and change their drug-taking behavior. There must be immediate implementation of community-based needle exchange programs and the decriminalization of hypodermic needles and drug paraphernalia to prevent further HIV infection among this population. Such measures must be seen as components of a larger effort that includes drug treatment and health care for users. U.S. drug policy must be reworked to acknowledge and confront the AIDS crisis and the realities of addiction. HIV will continue to spread unchecked until effective needle exchange programs and safer drug use education are standards of preventive care for drug users.
Drug users will not be given choices -- of treatment, needles, or safer injection education -- if, as is currently the case, they are considered to have relinquished some of their rights merely by using drugs. In the United States, as addicted person is expendable. That intravenous drug users are prohibited from obtaining life-saving clean needles and unable to obtain drug treatment constitutes a government-sanctioned violation of their human and constitutional rights. The user's right to the pursuit of life has been abandoned.
Drug Use and AIDS in New York
Intravenous drug users constitute the second largest but fastest-growing AIDS caseload in New York State. Compared to the rest of the United States, people with AIDS in New York are three times as likely to be IVDU's. For 1988 and 1989, heterosexual drug users made up a larger proportion of AIDS cases in New York City than gay men (43 percent versus 41 percent in 1988, and 43 percent versus 40 percent in 1989). Findings from studies of patients in methadone programs and detoxification units estimate 50 to 60 percent seropositivity among these patients (4). The New York City Department of Health estimates that by 1993, 50 percent of New York City's AIDS cases will be among IVDU's (5).
Just as drug addiction has devastated communities of color, so HIV infection among IVDU's disproportionately affects Latinas, Latinos, and African-Americans. However, a large proportion of deaths among New York City's HIV infected IV drug users is not classified by the Centers for Disease Control (CDC) as AIDS (6); similarly, HIV manifestations in women--especially gynecological symptoms--do not fit the CDC's definition of AIDS (7). Thus, there is a relative under counting reflected in the statistics that purport to show the impact of AIDS on drug users. (Figure 1) The number of births to women who use narcotics cotinues to increase, in some areas dramatically. In northern Brooklyn, for instance, a 75 percent increase in such births occurred in just one year (1985-86) (9). IV drug use is a factor in at least 80 percent of New York City's pediatric AIDS cases (10).
Statistics on drug addiction and treatment reflect city and state attitudes and are, therefore, difficult to obtain. Most of the widely used numbers relating to drug use in New York--the ones that appear in the media and that the state uses for budgetary purposes come from the Statewide Comprehensive Five-Year Plan of the New York State Division of Substance Abuse Services (DSAS). DSAS is the arm of the state bureaucracy charged with all drug treatment and prevention services for New York State. It conducts needs assessment studies and statistical research, which is often outdated by the time it is available, but almost no research into treatment modalities. The most recent Five-Year Plan, an outline of what has been done and what is proposed regarding drug treatment services in the state over a five-year period, covers 1984-85 through 1988-89, and most of the statistics it gives are completely outdated. The annual updates to this larger report lag behind so that they, too, are outdated by the time they reach the public.
DSAS calls heroin use a "stabilizing problem," estimating the heroin-using population to be around 200,000 for New York City and 60,000 for the rest of New York State (11). These numbers represent what the state calls "primary heroin addiction." The most widespread secondary drug used by heroin addicts is cocaine, with 71 percent of users administering it intravenously (12). New York also has an estimated 350,000 cocaine and crack addicts (13). There is some substantial overlap between the heroin and cocaine using populations (as well as alcohol users), as polyaddiction becomes more prevalent that addiction to a single drug.
There are currently about 43,000 drug treatment slots in New York State for all addictions, including alcohol. About 35,000 of these slots are for heroin users, and most of them are methadone based and thus useless to those who inject cocaine, amphetamines, or other non-opiates. Methadone maintenance programs continue to operate at 105 percent utilization, according to DSAS's Five-Year Report. However, those who work in drug treatment tell us that because there is no centralized referral services that monitors drug treatment openings, many slots remain empty for weeks because people elsewhere do not know they are available. The treatment capacity for New York City's cocaine users is even more inadequate: there are only 97 publicly funded cocaine-specific treatment slots in the entire city--a truly astounding statistic for a city with an estimated 350,000 cocaine and crack user. Only 30 residential treatment slots exist in the entire state for women with dependent children--5 in Rochester and 25 in New York City--even though a majority of intravenous drug users have children, most of whom are in the custody of their mothers. Nationwide, as estimated 80 percent of active intravenous drug users are not in any kind of treatment.
Accessibility of Health Care
Most IV drug users lack any firm connections to even the most basic health care. Their most accessible option is emergency room treatment in one of New York City's public hospitals where, due to severe shortages of staff, beds, supplies, and money, decent and immediate care is almost impossible to get. The hospitals are so over-utilized and under funded that even easily administered Medicaidaccepted treatments and prophylaxes for HIV-related conditions are unavailable. This is the case with aerosolized pentamidine, for example, which serves as a prophylaxis for pneumocystis carinii pneumonia. Even though this illness can be successfully prevented, it is by far the most common "indicator disease" of AIDS diagnosis in New York State.
As of June 1990, only about 8.9 percent of all those enrolled in ACTG trials had reported some prior drug use, and 0.5 percent of trial participants were active ("illicit") drug users. Currently, there is only one trail designed specifically with recovering drug users in mind, ACTG 055, which intends to study the pharmacokinetics of AZT in people taking methadone. ACTG 082 will enroll a small group of pregnant women in their third trimester who have a history of drug use to evaluate the pharmacokinetics, safety, and urinary excretion of intravenous and oral AZT. There have been no trials that offer drug treatment in conjunction with treatment for AIDS-related conditions.
Besides entry criteria, there are numerous other problems that make clinical trials inaccessible to most IV drug users: no childcare is provided; trials are often not located near sick people (there are no ACTG center in Texas or Puerto Rico, for instance), and no travel reimbursements is provided to participants; no housing is provided for those who may need it; no meals are provided; and no option to obtain treatment for drug addiction is offered. ACTG researchers might dismiss the lack of such "amenities" as the fault of the health care system, which they cannot change but rather must work around. Provision of such services by the ACTG system would of course call the entire nature of clinical trials into question by suggesting that research should simultaneously be a form of treatment.
Most IVDU's with HIV disease lack basic, everyday physical and social supports. With this community, like most poor communities, we must keep in mind the entire health care picture. Comparatively speaking, clinical trials are far down on the list of priorities, even though they could be life-preserving, unless earlier obstacles to care are addressed. As one advocate for African-Americans points out, "AIDS research is not a basic means of survival in our community--it is an extraordinary means". This describes the situation of IVDU's. It is impossible for those who need experimental treatments to use (or want to use) the current system if their basic life necessities remain unmet.
Needles: A Health Issue
Intravenous drug users commonly contract bloodborne infections and diseases like hepatitis, encephalitis, endocarditis, and sexually transmitted diseases, develop abscesses that promote infections; and suffer from other conditions that are a direct result of using unclean injection equipment. Though HIV-related illness may be the most well-known, it is only one of many health problems an injecting drug users faces. This fact was recognized early in the Netherlands, where needle exchange programs were originally developed to help prevent the spread of hepatitis B.
Clean injection equipment for drug users is a form of preventive health care. In the United States and other "first world" countries, it would be unthinkable for a person to visit a hospital or doctor's office and be injected with a needle that was previously used on another patient. But receiving an injection in a hospital and injecting "illicit" drugs, while they entail the same physical act and thus the same physical risks, are perceived as moral worlds apart and therefore are judged differently. Although sterile needles and syringes could prevent drug users from contracting HIV and a host of other infections, users are denied access to such instruments and can even be arrested for having them. While clean needles should be a public health issue, they remain a drug policy issue. But U.S. drug policy, of course, is synonymous with law enforcement. Not only is access to medical treatment for drug users non-existent, but simple, cost-effective preventive health care measures like needle exchange are actively disallowed and criminalized. With AIDS, this prohibition means legally sanctioning a public health disaster.
Members of the AIDS activist community of New York City, most visibly embodied in the organization ACT UP (the AIDS Coalition to Unleash Power), have taken control of their lives in many ways despite AIDS. They often know more about treatments for HIV-related conditions than doctors do. They have created clinical drug trials separate from those of the government, tested drugs the government would not test, found ways to get drugs to those who couldn't afford them, and found ways to care for their sick when no one else would. They have struggled against the ghastly media depictions of people with AIDS and provided alternative representations. And they have cast off the smothering label of "AIDS victim": they are people living with AIDS. This change was much more tan a linguistic one.
New York City's IV drug users who have AIDS or are HIV positive are not living with AIDS. For them, HIV is a death sentence. Their day-to-day struggles for basic necessities preclude any possibility of mobilization or political action or community building to demand access to drug and medical treatment. Needle exchanges can be a departure point for a user's process of empowerment and can even serve therapeutic purposes for active and former users involved in needle distribution.
In countries with a national health plan, adequate housing, and other services--in short, where the quality of life for drug users is much better--addicts have successfully organized themselves to fight for their human rights and against stereotypic and degrading images of drug users. Groups like the Junkiebonden (junky unions) of Amsterdam, the Western Australian Intravenous Equity (WAIVE), and Queensland Intravenous A.I.D.S. Association (QuIVAA) of Queensland, Australia, have done for addicts many of the things ACT UP and other AIDS organizations have done for and as people with AIDS. In Amsterdam, the first syringe exchange established to prevent HIV transmission was initiated by a user-based organization called MDHG in 1984. And the Rotterdam Junky Union was distributing clean syringes in high-drug use areas of Rotterdam as early as 1981. The IV drug user's condition in New York City and the United States is situational, not necessary.
Needle Exchange: One Model
The terms "needle exchange" and "needle distribution" do not do justice to the concepts that they try to name. The words refer to only a small part of the event that needle exchange is. "Harm reduction" is the term most often used to describe the drug policy paradigm upon which needle exchange is predicated. The First International Conference on the Reduction of Drug Related Harm was held in April 1990 in Liverpool--a new force on the drug policy scene. The term "risk reduction" rather than "harm reduction" might sound better to ears in the United States, where it has become a staple in the discourse of AIDS education, particularly when talking about safer sex. The analogue to "safer sex" is "safer drug use." The fact that the latter phrase is never uttered is telling.
ACT UP/New York's Needle Exchange Committee is currently operating the only needle exchange programs in New York City, with four "permanent" sites in three of the city's boroughs--as permanent as they can be considering that the possession and distribution of needles are criminal activities in this state.1 Along with needles, ACT UP outreach volunteers hand out kits that contain bleach, clean water, cotton, cookers, condoms, referral information, and illustrated instructions on how to wear condoms and how to clean works. Alcohol pads, medicine for abscesses, and lubricant to use with condoms, especially for sex workers who use the service are provided.
ACT UP runs a very user-friendly project. Addicts are not required to give a needle in order to get one. Because the group's resources are currently limited and because the program is completely run by volunteers, it operates only two days a week. A 24 hour, seven-day-a-week program might have stricter return criteria. In addition, many of those who use the exchange re homeless, so it is unrealistic to demand that addicts save their works from one exchange to the next, when exchanges happen only twice a week. In fact, a majority of New York's addicts--whether homeless or not--do not carry works with them unless they intend to use them immediately, for fear of getting arrested. Despite this situation, at the six-month mark of ACT UP's project in August 1990, many needles are being collected. At the oldest site, an almost one-for-one exchange occurs each week. It is clear that many users are willing to risk arrest to use this program. What is often overlooked or ignored by critics of needle distribution is the interaction that takes place during the encounter. It is this interaction between the giver and receiver of the needle that is the significant component of needle exchange, especially when encounters are repeated, and trust--maybe even friendship--is established.
Along with getting needles and bleach kits, drug users get counseling sessions where they can ask questions--sometimes for the first time--about HIV transmission, receive advice on how to care for their abscesses, or simply have an opportunity to talk to someone who will listen to what they have to say. The exchange comes to encompass more than the needle.
ACT UP's Needle Exchange Committee has ironed out most of the practical problems it faces in order to operate viable programs: obtaining needles, which is, of course, illegal in New York State; having enough supplies; maintaining a consistent exchange schedule; and setting up pro bono legal support and a bail fund for addicts or outreach volunteers who are arrested during an exchange. The group is now trying to set up opportunities for users to receive more far-reaching care by connecting them with medical services, drug treatment, and other services from community-based organizations (the "bridge" concept). These services should all be a part of needle exchange. In Australia, where needle exchanges are located in the same building as drug treatment facilities, the connection between AIDS prevention and other services is difficult to ignore.
But while the concept of needle exchange as a "bridge" to drug treatment is important, needle exchanges must be viewed as helpful and life-saving independent of further linkages. In a place like New York City or Newark, New Jersey, where very little drug treatment exists and primary care for drug users is extremely limited, needle exchange can be a bridge to other services only insofar as those services exist. The drug treatment that is available in New York and New Jersey is mostly methadone based, so that many methadone patients who are addicted to more than one drug are shooting cocaine or other non-opiates while "in treatment." In addition, recovery from drug addiction is usually a long process with much recidivism. And, finally, there are many people who will use a needle exchange program who do not wish to stop using drugs at that point in their lives. While needle exchange can and should be viewed as one step in a continuum of care, an addict must be able to use it to the extent she or he wishes. If that means going no further than obtaining needles to shoot up more safely, this must be respected.
Because the personal interaction that occurs during a needle exchange is so important, decrimininalization of needle possession in itself would not be a sufficient AIDS prevention measure for IVDU's. Even if the needle possession statue were removed, deeper-rooted cultural stereotypes about drug users and drug use would persist as barriers to easy access to needles and syringes. Members of ACT UP's Needle exchane travel to states without paraphernalia laws to purchase needles, but are often perceived as drug users and thus refused service. In England, where syringes have long been legally available from pharmacies and where the philosophy of harm reduction is much more widely accepted, many drug users have traditionally been turned away, and thus do not consider this a viable route for obtaining injection equipment. Finally, although needles are less expensive in pharmacies than on the street, all economic restrictions are lifted in free needle exchanges. The street price of a needle in New York City is currently two to three dollars.
Reflecting back on the years of the AIDS epidemic we have live through so far, it is clear that the most effective prevention methods and system of care have been community-initiated and based. Needle exchange programs will not be helpful if they are inconveniently located, staffed by judgmental people, or coercive in any way. They must be located in neighborhoods where people buy and use drugs, be staffed by people who know the language spoken there (both the ethnic and street language), and offer points of identification and support to a user of the exchange. This means having active and former addicts and HIV-positive people involved, as well as residents of the neighborhood in which the exchange site is located. Needle exchange on a significant scale cannot take place without the removal of hypodermic and paraphernalia statues, but the repeal of such laws would not make needle exchange unnecessary.
There must be a shift in drug policy from the punitive, law enforcement philosophy that now serves as its base to an understanding that drug use is a socio-medical phenomenon that cannot be "treated" by jailing people. It is this mindset that is responsible for keeping needle exchange interventions so limited in the United States. Needle exchange must be viewed as a medical intervention against infection that results from the fact that people use drugs, and must be recognized as providing real, life saving options to users. These advances will come, however, only when drug users gain their rights, and are treated as people rather than criminals.
1. The NIH has spent most of its time and money looking at antivirals, specifically nucleoside analogues such as AZT, while ignoring other drugs designed to treat the opportunistic infections of which most people with HIV/AIDS die. This state of affairs has continued even though AZT has shown only limited efficacy, is extremely toxic, and is not tolerated by many with HIV/AIDS. Harrington, M. A critique of the AIDS Clinical Trials Group. Report prepared by the Treatment and Data Committee of Act Up/New York, May 1, 1990. Treatment Agenda 1990. Presented at the Sixth International Conference on AIDS. San Francisco: June 1990. Prepared by the Treatment and Data Committee of ACT UP/New York. [NAMA Note: Some problems regarding AZT toxicity can be reduced with an adjustment of dose.]
2. Levy, J. A. Changing concepts in HIV infection: Challenges for the 1990s. Presented at the Sixth International Conference on AIDS. San Francisco: June 20, 1990.
3. Meeting of members from the ACT UP Needle Exchange Committee and ADAPT with Debra Fraser-Howze. San Francisco: June 23, 1990.
4. 1987 Update to the Statewide Comprehensive Five-Year Plan, 1984-85 Through 1988-89. Albany: New York State Division of Substance Abuse Services, 1987. p. 22.
5. Frank, B. and Hopkins, W. Current drug use trends in New
York City. New York: New York State Division of Substance Abuse
Services, June 1989. p.
6. Sufian, M. et al. Impact of AIDS on Puerto Rican intravenous drug users. Hispanic Journal of Behavioral Sciences May 1990 12(2): 125.
7. Anastos, K. and Marte, C. Women-The missing persons in the AIDS epidemic. Health/PAC Bulletin Winter 1989 19(4).
8. 1987 Update to the Statewide Comprehensive Five-Year Plan, and Frank and Hopkins, op. cit. Note: These statistics show only cases of CDC-defined AIDS, not HIV seroprevalence.
9. Simeone, R. et al. The northern half of Brooklyn: An assessment of the drug abuse problem. New York: New York State Division of Substance Abuse Services, 1989. p. 2.
10. 1987 Update to the Statewide Comprehensive Five-Year Plan.
11. Ibid. p. 22.
12. Frank and Hopkins, op.cit.
13. Henneberger, M. City Drug Treatment System Can't Keep Up with Addicts. New York Newsday August 20, 1990. p.3.