Pubdate: Fri, 21 Mar 2003
Source: The Week Online with DRCNet (US Web)
Author: Phillip S. Smith, Editor
Bookmark: (Needle Exchange)


But Where's the Money?

In a move that caught health workers and harm reduction advocates by
surprise, New York City Mayor Michael Bloomberg (R) announced on March
13 that he supports needle exchange programs (NEPs) in the city to
help reduce the spread of HIV/AIDS and other infectious diseases. But
with both the city and the state of New York in deep financial crisis,
it remains unclear whether Bloomberg's comments will result in any
expansion of the city's existing NEPs. Even as Bloomberg embraced
needle exchanges, his Health Commissioner, Dr. Thomas Frieden, was
wrangling with city council members over proposed cuts in funding for
groups that operate those and other AIDS prevention-related programs.

Bloomberg's comments came as he addressed a national HIV/AIDS
conference at the midtown Manhattan Sheraton Hotel and Towers. During
his speech, Bloomberg announced that the city will reorganize its
programs to deliver HIV/AIDS services and that the city will support
needle exchange programs. Bloomberg's commitment marks a sharp
contrast with his predecessor, Rudolph Giuliani, who ignored NEPs
despite their proven record of effectiveness.

Noting that more than 100,000 New York City residents are HIV
positive, with half of them diagnosed with AIDS, Bloomberg called the
situation "unacceptable" and vowed "to do better." Bloomberg said his
administration will try to make the city a national model for meeting
the Centers for Disease Control and Prevention's goal of reducing US
HIV infections by 50% by 2005, and that NEPs will be part of that push.

"These programs have been operating in New York City for over 10
years," said Bloomberg. "The sky has not fallen. Drug use and
drug-related crime have not gone up. In fact, they've gone down."

Harm reductionists and AIDS workers welcomed Bloomberg's remarks, but
wondered aloud whether his words would be backed up with hard cash.
"After years of struggling to have needle exchange recognized in the
city, one of the centers of HIV and intravenous drug use in the US, it
is very gratifying to have the mayor acknowledge that it works," said
Allan Clear, executive director of the New York-based Harm Reduction
Coalition ( "We have been working on the
mayor with a coalition of NEPs, and that is partially why this
happened," Clear told DRCNet. "We've been showing people what we are
able to do in New York City, and this is one of the fruits of our work."

But lack of government funding raises serious questions, said Clear.
"The budget crises in the state and here in the city make the future
unclear. We are pushing for a meeting with the mayor so we can discuss
this further."

Dr. Don Des Jarlais of Beth Israel Medical Center has tracked HIV
among injection drug users since the 1980s. "We have tested injectors
for HIV all over the city over time, and the rates of infection have
dropped by at least half since these programs became legal, so the
mayor's comments are a very positive sign," he told DRCNet. "At a time
when NEPs are under some political and financial pressure, this is an
important source of public support."

Des Jarlais was also worried about the future of NEPs given the city's
and the state's perilous financial situation. "The financial crisis
certainly isn't going to help," said Des Jarlais. "We will have to see
how that plays out. But having the mayor take this stand at this time
is very reassuring."

Nine NEPs currently operate in New York City, and they have played a
critical role in stemming HIV/AIDS infections, said Des Jarlais. "NEPs
have been absolutely critical," he said. "The mayor cited data we
provided showing that NEPs cut the rate of new infections by more than
half, and that is very impressive. There would be tens of thousands
more people with HIV/AIDS in New York City if not for syringe exchanges."

Daliah Heller is the executive director of Citiwide Harm Reduction, a
needle exchange operating in the Bronx and Manhattan. Heller's program
is part of a coalition of HIV organizations that have been working
with the city on needle exchange since Mayor Bloomberg came into
office. "Needle exchange is the most successful prevention strategy in
the history of the epidemic. When injectors use these programs, they
don't just protect themselves. They protect their families and their

"These programs don't just fight HIV. They are a crucial bridge to
drug treatment and health care," added Amu Ptah, the Harm Reduction
Coalition's national policy director. "For eleven years these programs
have been working with the people that everyone else has shut out or
forgotten about. They've gotten thousands of people into drug
treatment, housing, family services and AIDS care. The majority of
drug related HIV and hepatitis is happening in communities of color,
and it's hitting women worst of all. These infections are preventable,
and they always were preventable. Allowing deadly viruses to spread is
an attack on our communities."

But even as Bloomberg praised NEPs and harm reductionists praised the
mayor, Health Commissioner Frieden was warning of layoffs and health
clinic closings, leaving in doubt whether NEPs could expect any new
support and even raising questions about whether they could expect
support at current levels. Between state cutbacks and Bloomberg's
demands that city agencies retrench to help close a looming budget gap
in the city, the situation is grim, Frieden told the city council in a
Tuesday session.

"Proposals currently being considered in Albany to reduce the state's
matching funds for public health activities, coming on top of the cuts
we have already sustained, would have a devastating effect on the
department's ability to protect the public health," he said. Frieden
warned that many programs could be eliminated, including HIV testing,
and that dozens of HIV/AIDS prevention groups would be forced to seek
funding from other sources.

Of particular concern to council members was $5 million in HIV/AIDS
assistance from the state, a sum that Frieden said would now not be
available. At least one member, Councilwoman Christine Quinn of
Manhattan, chair of the Health Committee, accused the Bloomberg
administration of cutting the funds.

But Frieden insisted that he had few options. "I would respectfully
ask the Council to tell me where you'd like me to cut," he said. "If
you want me to put back $12, $13 million in programs. Should I stop
issuing birth and death certificates? Should I not investigate severe
acute respiratory syndrome? Should I close a TB clinic somewhere?
Should I stop treating STDs? Should I stop doing HIV prevention? I'm
all ears."

So, New York's mayor now supports NEPs, but there's no money. "I guess
that means we have some moral support," said HRC's Clear.
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MAP posted-by: Richard Lake