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To stop AIDS 'breeding ground' needle exchange a must, many say

While politicians bicker, more intravenous drug-related infections occur

Posted Saturday, June 10, 2006
Basha Closic, a drug prevention specialist, searches for needles in a Wilmington "shooting gallery." (Buy photo) The News Journal/FRED COMEGYS

Empty bags of heroin, orange syringe caps, needle plungers, spent lighters, stainless steel cooking spoons, bloody clothes and used condoms -- all surround a tattered bed in an abandoned Wilmington row house.

The second-floor bedroom, stinking of urine and feces, has long been a hideaway for drug addicts and prostitutes. Earlier that day, a worker clearing out the property had thrown out more than a half-dozen dirty hypodermic needles. In a nearby alley, a rusting needle lay in the wet dirt.

Basha Closic, a drug prevention specialist, winced as she tiptoed through the house in the city's Hilltop neighborhood, calling the mess a biological hazard and "breeding ground" for HIV/AIDS, hepatitis C and other infectious diseases.

"There's a bed for sex, needle sharing going on, and probably contaminated fluid all over the place," said Closic, program director at Brandywine Counseling in Wilmington.

To Closic, the decadence at the West Fourth Street "shooting gallery" is a textbook illustration of why Delaware needs a needle-exchange program for intravenous drug users.

Delaware remains one of only two states that does not have a program that allows drug users to swap used needles for sterile ones or to buy syringes in pharmacies without a prescription. The other is New Jersey, where Gov. Jon Corzine is trying to start a program.

HIV/AIDS infections from dirty needles is a major problem in Delaware. Through 2004, 48 percent of the state's AIDS patients were intravenous drug users or people who had sex with them -- fourth highest in the nation -- according to the Kaiser Family Foundation, which studies U.S. health issues. The national average is 31 percent.

In 2004, Delaware had the nation's sixth-highest AIDS infection rate from all causes, the foundation reported.

Closic and other advocates of needle exchange argue that if more addicts had access to clean needles, fewer people would contract HIV, the virus that causes AIDS. They also point to studies showing that infection rates drop and injection rates do not rise when addicts have ready access to clean needles.

Said Closic: "A stack of sound scientific data proves this works."

Police chief criticized

For nearly a decade, proponents of such a program in Delaware, led by state Sen. Margaret Rose Henry, have pleaded with lawmakers to approve one. Last May, Henry achieved a victory of sorts when her bill to start a pilot program in Wilmington, where heroin and cocaine are sold openly in some areas, passed the Senate 16-4. The bill is supported by Gov. Ruth Ann Minner, the state Division of Public Health and Wilmington Mayor James M. Baker.

But in the year since Senate passage, the bill has languished in the state House of Representatives, prevented from a hearing before the entire body by powerful foes such as Majority Leader Wayne A. Smith, R-Clair Manor.

Smith said needle exchange would condone and possibly increase intravenous drug use. "It totally defeats the message we have in trying to get young people not to use drugs anytime, anyhow, anywhere," he said.

But Smith may be losing his grip on the bill. On Friday, Speaker of the House Terry Spence, R-Stratford, guaranteed the bill will be debated on the House floor later this month.

Even though the program could reduce the spread of AIDS, which costs as much as $190,000 to treat one patient, Smith said he could not "excuse some behavior that is illegal under our code because there might be a health benefit."

Smith points to opposition by Wilmington police Chief Michael J. Szczerba as a key reason for his objection. Szczerba's position, however, differs from Baker and City Council, which passed a resolution supporting Henry's bill.

"He's in the dark ages about it," Henry said of Szczerba.

Szczerba, who said he is simply trying to save lives and stem the use of needles, bristled at the senator's characterization.

"If that puts me in the dark ages, I'll stay in the dark ages. This proposal would condone or facilitate illegal and dangerous activity but now you can add deadly to that," said the chief of Delaware's largest city.

Szczerba was referring to recent batches of heroin laced with the powerful sedative fentanyl, which is suspected in at least seven Delaware deaths.

Closic countered that the fentanyl cases demonstrate that users are going to inject heroin, methamphetamine and cocaine -- no matter the consequences -- and only strengthened the argument to provide clean needles.

"They are not stopping," Closic said. "They are addicts, and they are going to shoot up and we need to offer them a safe way."

'A ridiculous argument'

Aaron DeMaris, a recovering heroin addict who has used dirty syringes and is now in a methadone treatment program in Wilmington, agreed with Closic and many experts about the merits of needle exchange. A few years ago, DeMaris was in such a program in Rochester, N.Y.

Officials there gave users 12 clean needles, DeMaris said. "For each one you turn in you get two back," he said. "If you don't return them you don't get more needles. They are not laying on the streets for kids to find. It reduces the transfer of the disease."

DeMaris, 33, was astounded by the suggestion that needle exchange could lead more people to inject drugs.

"Nobody is going to say, 'Just because I can get a syringe, I'm going to start shooting dope,' " DeMaris said. "It's asinine, just a ridiculous argument."

Jon Willis, 56, a heroin addict who has used dirty needles, said he has seen friends die from AIDS after contracting the disease from shooting up.

"It's very important to be able to trade in needles, especially with the AIDS going around," he said. "Most people just throw them on the ground."

One addict and former prostitute, who spoke on the condition that she be identified only as Sally, said she has used old needles "but by the grace of God" has not contracted HIV.

"If you buy needles [on the black market], you don't know for sure that they are clean," she said. An exchange program would assure users "they won't get HIV or spread it around."

The three-year pilot program, which would be overseen by the Division of Public Health, also would offer counseling and treatment programs. "It can be a gateway to other services," said Paul Silverman, deputy public health director.

Baker understands Szczerba's concerns, but added, "Every effort we can make to save lives we should take."

Minner, in a written statement, also touted economic benefits of the program, which would cost $315,000 the first year for a specially equipped van, supplies and salaries for social workers and counselors.

"Drug users who contract HIV/AIDS ultimately end up needing expensive medical care at taxpayer expense," the governor said. "It is important that Delaware implement this program for the safety and benefit of our residents."

'Got to do something'

President Bush, whose administration will not fund such programs, has said they "signal nothing but abdication."

But advocates such as Bill Piper, director of national affairs for the nonprofit Drug Policy Alliance, said numerous studies have shown such programs are proven winners, noting that the American Medical Association and federal Centers for Disease Control and Prevention support improved access to clean syringes.

One report, by the National Institutes of Health Consensus Panel on HIV Prevention, said "an impressive body of evidence suggests powerful effects" from exchange programs. Those benefits include a reduction in risky behavior as high as 80 percent, and estimates of at least 30 percent reduction in HIV cases in intravenous drug users, the report said.

Those who think otherwise are misinformed, Piper said. "They are like people who think the Earth is flat despite all the science," Piper said. "A lot of things in drug policy are debatable, but needle exchange is not one of them. It reduces the spread of AIDS without increasing drug use."

A May report by the alliance said 185 programs are operating in 36 states as well as Washington, D.C., Puerto Rico and American Indian lands.

Henry, who represents some of Wilmington's hardest-hit areas, said the program would be a savior for the city, especially the black community.

In Delaware, where 19 percent of residents are black, 66 percent of AIDS patients through 2004 were black, sixth highest in America. Nationwide, blacks comprise 12 percent of the population but 40 percent of AIDS patients. The AIDS figures are from the Kaiser Family Foundation.

"I am desperate for this to pass the House," said Henry, D-Wilmington East. "People are going to use dirty needles. And so much of the AIDS women have is from sexual relations [with needle users]. It will save unborn babies from getting AIDS. And it's not just an issue in Wilmington, but in Greenville and everywhere. AIDS doesn't discriminate."

Needle exchange has won the support of traditional legislative hardliners like Sen. Robert Venables, D-Laurel, and Rep. Dennis Williams, D-Wilmington North, a former city police detective.

"If it's going to reduce the spread of AIDS, we've got to do something," Williams said. "I'm sure guys are lying and saying they are not having sex with anybody else. I have no recourse but to support it."

Venables, who called Smith "hardheaded," said common sense told him to vote for needle exchange. "I don't know what else you can do," Venables said. "It's certainly not working the way we're doing it."

Contact senior reporter Cris Barrish at 324-2785 or cbarrish@delawareonline.com.
THE FACTS

Through 2004, 48 percent of Delaware's AIDS patients were intravenous drug users or people who had sex with intravenous drug users.

THE DEBATE

Opponents, like state House Majority Leader Wayne A. Smith, say needle exchange would condone and possibly increase intravenous drug use.

Proponents, like drug prevention specialist Basha Closic, point to studies showing HIV infection rates drop and injection rates do not rise when addicts have ready access to clean needles.

DELAWARE HIV/AIDS CASES

Group Through 1993 1994-2004

(954 cases) (3,389 cases)

Men who inject drugs: 25% 27%

Men who inject drugs and have sex with men: 7% 4%

Women who inject drugs: 11% 13%

Women whose male sex partners inject drugs, are HIV positive or bisexual: 5% 16%

TOTAL: 48% 60%

Source: Delaware Division of Public Health

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