Pubdate: Mon, 23 Jul 2007
Source: San Antonio Express-News (TX)
Copyright: 2007 San Antonio Express-News
Author: Don Finley, Medical Writer
Bookmark: (Harm Reduction)
Bookmark: (Needle Exchange)


Sidling through a crowded, narrow hallway at El Divino Salvador 
United Methodist Church on the near West Side, where dozens line up 
for groceries from the twice-monthly food bank, Bill Day smiles and 
asks, again and again: "Do you need any syringes?"

Most shake their heads or stare blankly. The few who say yes claim 
that they or family members are diabetic. Day believes at least some 
of the needles will be diverted for illegal drug use. And that's fine with him.

"I found that some low-income diabetics use the same needles 
repeatedly," Day said. "They're not drug addicts  they just use the 
same needle over and over again. Sometimes they share their needle 
with family members, and sometimes with addicts."

In September, Bexar County could have the first legally authorized 
syringe exchange program for drug addicts in Texas  the only 
remaining U.S. state without some form of one, proponents say. An 
amendment creating the local pilot program was attached to Medicaid 
legislation by state Rep. Ruth Jones McClendon after a bill that 
would have allowed syringe exchange programs throughout the state 
died in committee.

But until then, Day and other volunteers in most major Texas cities 
skirt the law by handing out clean syringes on their own  despite 
the fact that Texas bans the sale and distribution of drug paraphernalia.

Day co-founded the Bexar Area Harm Reduction Center, a tax-exempt 
nonprofit group with grant funding from local churches, particularly 
St. Mark's Episcopal, and national organizations. The idea is to 
limit the spread of HIV and hepatitis C.

Until recently, the program has struggled to get off the ground  a 
result of skittish board members, unreliable volunteers and a change 
of police administration that drove addicts underground, Day said.

"We started out with three (volunteers) in January 2003," said Day, a 
retired commercial real estate appraiser and lay minister at St. 
Mark's. "We had a lot of people show up initially. Then when they 
found out about the state law regarding drug paraphernalia, they'd disappear."

The risk of disease

Perhaps half of new HIV infections in the United States are among 
intravenous drug users, their sex partners and their kids. Such drug 
users account for 60 percent of new hepatitis C infections. Many are 
uninsured, and the public cost of treating them is huge.

"The amount of money that you spend with (a syringe exchange) program 
is so small compared with the cost of treatment for hepatitis and 
HIV," said McClendon, D-San Antonio.

Her original legislation, House Bill 856, would have allowed local 
health departments in Texas to run syringe exchange programs in-house 
or through contractors. Sen. Leticia Van De Putte, D-San Antonio, a 
pharmacist, co-authored the Senate version with Sen. Bob Deuell, 
R-Greenville, a family physician.

In past years, Deuell had opposed syringe exchange programs on moral 
grounds  "the 'ick' factor," as an aide described it  but changed 
his mind after researching the issue. The state's medical community, 
including the Texas Medical Association, backed the bill.

The Senate version passed easily. In the House, the bill was blocked 
by Public Health Committee Chairwoman Dianne Delisi, R-Temple.

"The members of the committee wanted the bill to be voted out," 
McClendon said. "But the chair has to recognize a member to make the 
motion to call the bill up. And the chair would not recognize a 
member to make the motion to call the bill up. So we never got the 
bill out of committee."

Delisi said at the time, "I have not been persuaded that the public 
health benefits outweigh the concerns of many members, myself 
included, of providing needles for those that are using illegal drugs."

But McClendon managed to get authorization for a Bexar County pilot 
program attached to the Medicaid bill. She's working with local 
health officials to design the program, bringing in outside experts for advice.

"It's really important for us to succeed in Bexar County, so that we 
can have documentation and evidence as to how it would be implemented 
on a statewide basis," McClendon said.

Out of the shadows

Proponents say exchange programs not only reduce the spread of 
disease but can draw addicts out of the shadows to offer them help 
overcoming their addiction.

"Syringe exchange is just a little piece of what the program can be," 
said La Juana Lamb, who ran New Mexico's statewide program in the 
mid-1990s and now works for the National Native American AIDS 
Prevention Center in Denver.

"Because once you start making connections with folks and start 
talking to them, offering them other services, start supporting them 
as a human being again, it starts rebuilding that person's confidence 
in themselves. It might be the first time in a long time that 
anybody's looked at them as a human being, as opposed to a druggie.

"If you're seeing somebody every week, you also have a chance to talk 
to them about, how's your health? How are your arms? Are you eating 
and drinking water? Where are you sleeping? We always ask them, do 
you want to get off this stuff? A lot of times the answer was no, but 
sometimes the answer was yes."

Sheriff Ralph Lopez, who supports the program, thinks it might also 
reduce the risk of his officers accidentally getting stuck with an 
infected needle while searching a suspect.

Still, Lopez thinks the organizers of the program have their work cut 
out for them.

"If you look into the (local drug) culture, if you've got a place 
where these guys are shooting up and you don't share, they'll either 
think you're undercover, or if you bring your own needle that's an 
insult to them and they might initiate violence."

Studies have drawn mixed conclusions about how effectively syringe 
exchange programs reduce disease. While most have shown benefit, some 
have shown no effect, and a few have even suggested HIV infection 
increases after exchange programs are launched  although some 
critics say those negative results have been in cities where addicts 
have legal access to clean needles through multiple sources such as 
pharmacies, skewing the data.

A 2001 overview of the studies, conducted by researchers at the 
University of California, Davis, found that when those cities with 
multiple sources were excluded, 28 of 29 remaining studies showed 
exchange programs reduced the spread of HIV and/or needle sharing. 
And another 2003 study of 99 cities worldwide found that HIV 
prevalence decreased 19 percent a year in cities with exchange 
programs and rose 8 percent a year in cities without them.

Also, a National Institutes of Health consensus panel on HIV 
prevention estimated that exchange programs reduce needle sharing up 
to 80 percent and can reduce HIV infection among drug users by almost a third.

"It's hard to prove something didn't happen and exactly why it didn't 
happen. But in Europe and Australia and New Zealand particularly, 
where they have these programs, they report unanimously that the 
spread of diseases go down," said William Martin, a senior fellow in 
religion and public policy at Rice University's Baker Institute who 
has studied and written about exchange programs and testified in 
favor of them during the past two legislative sessions.
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MAP posted-by: Beth Wehrman