Pubdate: Sun, 13 May 2001
Source: Worcester Telegram & Gazette (MA)
Copyright: 2001 Worcester Telegram & Gazette
Author: Robert Z. Nemeth
Bookmark: (Needle Exchange)


Dr. Howard Koh, commissioner of the state Department of Public 
Health, is one of many top health care professionals persuaded by 
scientific data that needle exchange programs for intravenous drug 
users prevent the spread of the HIV/AIDS epidemic. "I have come from 
not-so-sure to being absolutely certain," he told me during a recent 

"This epidemic is preventable," he said. "Yet we have not made 
progress in years because the debate has been emotional rather than 
data-based. We have between 700 and 800 new cases each year in the 
state, traceable to intravenous drug use. That is a failure of the 

"We haven't seen anything yet about what the effect (of dirty 
needles) on hepatitis C may be," Jean McGuire, assistant commissioner 
and director of the department's HIV-AIDS bureau, added. "With about 
110,000 people already infected in the state, that disease is 

"Whether needle exchange is effective is no longer an issue.

That question has long been answered," said Joseph D. McKee, director 
of client services at AIDS Project Worcester Inc. A native of 
Northern Ireland and a practicing Roman Catholic, he moved to this 
country with his family after hatemongers burned down his father's 

"I know what bigotry and prejudice can do," he said. Indeed, the 
evidence in favor of needle exchange is overwhelming. Among the 
organizations supporting the program are the National Academy of 
Science, American Medical Association, American Public Health 
Association, American Bar Association, American Pharmaceutical 
Association and the U.S. Conference of Mayors.

The list of leading experts backing the clean-syringe program is a 
virtual "Who's Who" of medicine and science.

The U.S. Surgeon General and the Department of Health and Human 
Services declared there is conclusive evidence that needle exchange 
reduces the spread of HIV while it does not increase illicit drug use 
or crime.

Claims that the so-called "Vancouver and Montreal studies" detected 
an increase in HIV transmission among participants in needle exchange 
programs have been soundly rebuffed by the studies' original authors 
and by subsequent data.

Having watched the devastating effect of intravenous drug abuse in 
Worcester, Mr. McKee spearheaded an effort in 1995 to persuade the 
City Council to authorize needle exchange.

When the advocates were turned down, Mr. McKee joined the Harm and 
Risk Reduction Coalition that developed a new, clinic-based 
rehabilitation program.

The council rejected that model in 1998. Mr. McKee then decided to 
work with the Massachusetts AIDS Policy Task Force. "We tried to 
accomplish our goal at the state level rather than fighting the issue 
town-by-town," he said.

The task force backed a bill by state Sen. James P. Jajuga, 
D-Methuen, that would allow the DPH to actively prevent the 
transmission of HIV/AIDS and hepatitis C. The Legislature's Joint 
Health Committee approved the measure, but former Gov. Paul Cellucci 
vetoed a budget provision for the program because he was concerned 
about the lack of local consensus.

However, the bill provides for a local advisory committee "to solicit 
community input" and report to the commissioner before a final 
decision is made on implementation of needle exchange programs.

The Jajuga bill, now co-sponsored by state Sens. Harriette L. 
Chandler and Richard T. Moore, has been resubmitted and will be 
considered at a legislative hearing on June 11. Meanwhile the DPH has 
launched a statewide education program, complete with radio ads and 
billboards, to inform the public. "The balance between local control 
and state involvement is delicate," Dr. Koh noted. "I always prefer 
the route where people are educated."

"This program is not just walking in and getting clean needles. 
Syringe exchange is part of a comprehensive HIV prevention strategy," 
Mr. McKee explained. "It entails substance abuse counseling and 
treatment at community health centers already involved in the fight 
against drug and alcohol addiction." Services include medical 
screening and psychiatric evaluation, detoxification, HIV testing and 
counseling, testing for sexually transmitted infection, medical care 
and long-term follow-up.

"Addicts can and do recover.

And preventing AIDS or hepatitis is far less expensive than the 
treatment," Mr. McKee stressed.

Said Dr. Koh, a physician, "People with addictions should not be 
viewed as criminals. Addiction is a disease, and all humans are 
susceptible to it. The enemy is not human beings.

It's contaminated needles."

Unprotected sex among gays is not the leading cause of new HIV and 
AIDS cases in Massachusetts; injection drug use is. The DPH has the 
power to actively prevent the transmission of every communicable 
disease, except the deadliest one: HIV and AIDS. It does not have the 
authority to organize clean needle exchange programs.

A poll by the McCormack Institute of the University of Massachusetts 
last year showed that 64 percent of registered voters in the state 
favor needle exchange. The Society of Christian Ethics declared, 
"Needle exchange programs are ethical and should be fostered."In 
Boston, Cambridge, Northampton and Provincetown needle exchange has 
reduced the transmission of the HIV virus that causes AIDS and 
hepatitis C without encouraging illegal drug use. But in cities that 
have no needle exchanges, the epidemic has spread.

In Lowell, 60 percent of new AIDS cases are attributed to intravenous 
drug use; in New Bedford, 58 percent, and in Worcester, 53 percent. 
The situation is particularly troubling in Worcester. More than 52 
percent of substance abuse in Central Massachusetts is 
heroin-related, with 49 percent traced to the use of syringes.

This is nearly double the rate in most communities. While nationwide 
27 percent of women diagnosed with HIV/AIDS are injection drug users, 
the percentage in Massachusetts is 40 percent -- and in Worcester 49 
percent. "I find it unconscionable that we allow people to get 
infected with a disease for which there is no cure when the epidemic 
could be curtailed," Ms. McGuire said. "If we adopted needle exchange 
in Worcester, we could curtail the spread of the disease by one-third 
within 18 months," Mr. McKee pledged.

I, too, have traveled the road from skeptic to believer with Dr. Koh 
and others.

I'm persuaded there is nothing to lose and much to gain from a 
well-organized needle exchange program in Worcester.
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