Pubdate: Mon, 25 Oct 2004
Source: New York Times (NY)
Column: Editorial Observer
Copyright: 2004 The New York Times Company
Author: Brent Staples
Bookmark: (Harm Reduction)
Bookmark: (Needle Exchange)


Gentrification has sent middle-class pioneers streaming into New York City 
neighborhoods once known for abandoned buildings and open-air drug markets. 
This has done wonders for property values and improved police protection. 
But it has a downside for Daliah Heller, who directs an AIDS prevention 
program called CitiWide Harm Reduction in the Bronx.

Ms. Heller, an early advocate of syringe exchange programs as a method of 
preventing AIDS among drug users, has seen tolerance for drug programs 
decline as neighborhoods get fancier. Local police officers who once viewed 
addicts as a low priority come down hard, herding them to distant 
neighborhoods where they quickly lose touch with caseworkers.

CitiWide Harm Reduction is one of nine city syringe exchange programs 
sanctioned by the state under a law passed in 1992. The New York City 
program is the largest and most successful in the country. When New York 
passed its law, about half the city's addicts were infected with H.I.V., 
and were regularly passing on those infections to others. Since the syringe 
exchanges were legalized and expanded, however, the infection rate among 
addicts has dropped from about 50 percent to a little more than 15 percent.

Many states lack exchange programs. Where the programs exist, they are 
often hampered by laws that make it illegal to possess syringes. But 
impressive statistics from exchanges in New York and several foreign 
nations recently prompted California to make it easier for addicts to buy 
syringes without a prescription. New Jersey is entertaining a similar 
proposal. Even so, the New York example shows that passing a law may be the 
simplest step in a long and tortuous process. AIDS prevention advocates 
here have had to contend with suspicious neighborhoods, sluggish 
bureaucracies and hostile police officers.

This problem was on full display recently when I visited CitiWide's modest 
storefront offices in the Bronx, where the drop-in center was alive with 
chatter about the latest encounters between clients and the police, who are 
said to harass addicts even when they carry ID cards showing that they are 
registered participants in a state-sanctioned program.

Even so, CitiWide was doing a brisk business that afternoon, as addicts 
trooped in to exchange dirty syringes for new ones. A young Latino man who 
came in looking for new syringes without old ones to trade explained that 
his used syringes had been confiscated by a police officer he encountered 
on the street.

Dicey encounters between addicts and the police are to be expected, given 
that addicted people often commit crimes to support their habits.

In 2002, the courts put an end to the practice of arresting addicts as they 
approached the exchanges with used syringes. The Police Department issued a 
directive explaining the ruling. But continued reports of harassment 
suggest that officers on the street still may not have fully accepted the 

The fear of being arrested is helping to drive the AIDS epidemic among 
blacks and Latinos, who are far more likely than whites to be stopped and 
frisked. Minority addicts respond by failing to carry clean syringes, which 
leads them to borrow dirty ones, which in turn exposes them to disease.

The picture is substantially different in Britain and Canada. The two 
countries embraced syringe programs as far back as the 1980's, getting an 
early jump on the epidemic.

By contrast, the debate in America has been driven not by science or public 
health concerns but by an ideology that sees syringe exchange programs as 
inherently "evil." This view has persisted in Congress, which has barred 
syringe programs from receiving federal funds, despite clear evidence 
showing that they slow the spread of disease without creating new addicts. 
Narrow-mindedness at the federal level has cost lives, leaving the country 
20 years behind where it could be in the battle against AIDS. 
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MAP posted-by: Richard Lake