Pubdate: Fri, 29 Jun 2001
Source: New York Times (NY)
Section: Section A; Pg 22; Column 6; Editorial Desk
Copyright: 2001 The New York Times Company
Authors: Susan Ziony, Logan Spector, Robert S. Broadhead, Diana L. 
Sylvestre, M.D.


To the Editor:

Re "Needle-Trading Programs Have Few Inroads in U.S." (news article, June 23):

While we are dismayed by the laws and attitudes that hinder this pragmatic 
response to the problem of H.I.V. transmission, we're pleased that there 
is, at least, a debate.

Underground needle exchanges are less effective than legal ones because of 
the threat of arrest and a diminished ability to raise money.  Hence we 
find it ironic that even as the Centers for Disease Control and Prevention 
affirms the utility of needle exchange programs, in its home city of 
Atlanta neither the press nor the politicians are talking about making them 

Susan Ziony
Logan Spector
Atlanta, June 25, 2001
The writers are, respectively, president and vice president, Atlanta Harm 
Reduction Center

To the Editor:

"Needle-Trading Programs Have Few Inroads in U.S." (news article, June 23) 
effectively portrays the sources of local resistance to needle exchange 
programs: baseless claims and demagoguery pitted against the mass of 
scientific evidence on the effectiveness of exchange programs in combating 
H.I.V. and related diseases without increasing rates of drug abuse.

Such resistance led to the closing of a state-sponsored needle exchange in 
Windham, Conn. A scientific study that a team of us has conducted since 
1994, based on follow-up interviews with hundreds of drug injectors in the 
Windham area, found that contrary to the outlandish claims of the program's 
opponents, closing the needle exchange produced no reductions in the 
robustness of Windham's drug scene. It resulted only in significant 
increases in drug injectors' H.I.V. risk behaviors, especially reusing and 
sharing dirty syringes, and in obtaining new syringes from unsafe sources.

Robert S. Broadhead
Storrs, Conn., June 24, 2001
Professor of sociology, University of Connecticut

To the Editor:

Another area in which needle exchange (news article, June 23) appears to 
making an impact is a reduction in the spread of hepatitis C.

Approximately 60 percent of new cases of hepatitis C are attributed to 
injection drug use. Because the infection is spread very efficiently by 
blood, hepatitis C has traditionally been acquired rapidly in this 
population. A pattern of rapid early acquisition has been replaced by a 
much more gradual increase, probably due in part to the promotion and 
distribution of sterile injection equipment by needle exchange programs.

Such programs should also be credited with aggressive educational practices 
that provide this high-risk population with the information they need to 
prevent disease transmission. Until a vaccine becomes available, needle 
exchange programs will be central to the containment of this epidemic.

Diana L. Sylvestre, M.D.
San Francisco, June 24, 2001
Clinical assistant professor of medicine, University of California, San 
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