The Dogwood Center, Princeton, NJ, USA

Twenty long years:
THE CONTINUING FAILURE TO ADDRESS DRUG-RELATED AIDS IN NEW JERSEY

June 2001

On this 20th anniversary of the discovery of HIV/AIDS,⁽¹⁾ New Jersey continues to ignore prevention for half the epidemic: HIV/AIDS among people who inject drugs.⁽²⁾

In 1981, when the first article about 5 mysterious deaths in Los Angeles was published, it is safe to speculate that New Jersey had few, if any AIDS cases.

By the end of 1990, AIDS, a blood-borne disease, had spread across the continent and out of the gay community affecting, among others, people who injected drugs. In the first decade of the epidemic, at least 4,500 New Jersey residents who injected drugs had contracted AIDS.

In the 1980s a test that could identify HIV infection before it had become AIDS was developed. With it, we could begin to measure the thousands being infected. In the second decade of the epidemic (ending December 2000) an additional 25,500 Jersey residents had contracted HIV/AIDS.⁽³⁾

It would be useful to know which New Jersey counties had the highest rates of injection-related AIDS. That information is not available. But we do know that half of all New Jersey HIV/AIDS cases involve injecting drug use. So looking at the overall HIV/AIDS rates by county can give us some sense of where the injection-related HIV/AIDS epidemic in New Jersey now stands. At the end of 2000, the New Jersey counties with the highest rates people living with AIDS per 100,000 population were Essex, Hudson, Atlantic, Passaic and Union, in that order. (Figure 1 gives the number of people living with HIV/AIDS and the AIDS rates for each of New Jersey's 21 counties as of December 31, 2000.)

A new study of New Jersey, recently published by the Centers for Disease Control and Prevention, indicates that injection drug use in New Jersey is expanding in new groups -- young adults living in suburban and rural areas.⁽⁴⁾

The new study looks at people entering drug treatment. Between 1993 and 1999, the number of urban residents of New Jersey entering treatment for injecting drug use increased 14 percent from 355 to 406. The number of suburban/rural residents of New Jersey entering treatment for injecting drug use in that same period rose almost 400 percent from 232 to 920.

According to the study, the greatest increase in injecting drug use for people entering treatment occurred among young adults aged 18 and 25. This occurred at a time when the number of young adults living in suburban and rural areas of New Jersey was declining.

With thousands of its citizens already infected and many more thousands at risk, is New Jersey doing enough to prevent the spread of injection-related HIV? There are two important ways to prevent HIV/AIDS among people who inject drugs:

In fact, instead of increasing access to sterile needles, New Jersey has continued policies that prevent access to sterile needles and cause the spread of HIV/AIDS.

The actions of the state governments of New York and New Jersey provide a stark contrast in their responses to the need for access to sterile needles.

New York has 14 needle exchange programs,⁽⁶⁾ permits pharmacy sale of syringes without a prescription and has recently changed its drug paraphernalia law so that possession of a sterile syringe is not a crime.⁽⁷⁾ These are all measures recommended by our national public health leaders including the American Medical Association, the Centers for Disease Control and Prevention, and the National Academy of Science and Institute of Medicine. (The important conclusion of all the major reviews of the evidence has been that needle access programs reduce the spread of HIV and do not increase drug use.)

New Jersey has taken a disastrously different path from New York. Through criminal prosecution, New Jersey shut down the state's one needle exchange program.⁽⁸⁾ New Jersey remains one of only six states that require a prescription to purchase syringes from a pharmacy.⁽⁹⁾ Possession of a sterile syringe is still a crime under New Jersey's drug paraphernalia law.

Racial profiling by New Jersey state police and other law enforcement officials has exacerbated the HIV/AIDS epidemic among New Jersey's residents who are African American. While white injecting drug users can travel to New York City or Philadelphia to get sterile needles without fear of being stopped, racial profiling in New Jersey continues to make that a risky alternative for black injecting drug users.⁽¹⁰⁾

New Jersey's failure to take steps to control the HIV/AIDS epidemic among injecting drug users can be seen in the high percentage of women living with HIV/AIDS in the state. New Jersey, in fact, leads the country in the percentage of AIDS cases among women. (Figure 2.) Women get HIV/AIDS either from injecting drugs themselves or from heterosexual sex, often with a current or former injecting drug user.

With thousands of women infected with HIV/AIDS, New Jersey has had remarkable success in preventing the spread of HIV/AIDS to newborn infants. But saving a child does not save a family.

An estimated 18,000 New Jersey children have lost their mothers to AIDS. With all the women infected with HIV/AIDS, we can expect many more orphans in future years.⁽¹¹⁾ After declining for three years, AIDS deaths in New Jersey increased by 6 percent between 1998 and 1999.⁽¹²⁾

Since women are often those thought to be most concerned about families, it is ironic that it was, in part, the aggressive opposition of a woman governor that has led to these thousands of AIDS orphans and the expanding HIV/AIDS epidemic among injecting drug users.⁽¹³⁾

But former Governor Whitman has now moved on to national environmental politics. And it is the challenge to those currently governing New Jersey to expand drug treatment programs and to find the political courage to change the laws preventing access to sterile needles in New Jersey.

It is the most basic duty of government to save the lives of its citizens and not create the circumstances that cause their illness and death. The time for action to prevent the further spread of HIV among injecting drug users is now!

(1) The first article on HIV/AIDS was published in 1981. At the time, of course, the disease had no name. Morbidity and Mortality Weekly Report. 1981. "Pneumocystis Pneumonia - Los Angeles." June 5. Reported by M.S. Gottlieb, H.M. Schanker, P.T. Fan, A. Saxon and J.D. Weisman.

(2) In New Jersey over half of all HIV/AIDS cases have been injection-related. This is true both if we look at all AIDS cases (table 5 cumulative) and if we look at all HIV cases (table 14). NJ Dept. of Health and Senior Services. 2000. New Jersey HIV/AIDS cases Reported as of December 31, 2000. 8 pages.

(3) In 1990, there was no HIV test and consequently we have no information on the number of HIV cases at that time. For the 2000 data, see tables 5(AIDS) and 14 (HIV) of NJ Dept. of Health and Senior Services. New Jersey HIV/AIDS cases Reported as of December 31, 2000. For the 1990 data, see Department of Health, State of New Jersey. AIDS cases state of New Jersey as of December 31, 1990. page 2.

(5) If a person is unable or unwilling to stop using drugs, the Centers for Disease Control and Prevention recommends that, as an HIV prevention measure, a sterile needle be used every time.

(10) According to New Jersey's Attorney General, John J. Farmer, Jr., racial profiling on the New Jersey turnpike is continuing. Iver Peterson, "Attorney General says better data led to admission that racial profiling continued." New York Times. April 5, 2001. page B5. The New Jersey racial profiling story has been well documented. For one overview, see Barbara Fitzgerald. 2001. "Imbalance of Power." New Jersey Reporter. April. pages 25-31.

(11) New Jersey AIDS Partnership. Orphans of AIDS Planning Committee. 1997. Issues affecting New Jersey's orphans of the HIV epidemic. June.

For other materials related to the 20th anniversary of HIV/AIDS, see the website of the federal government's Office of Minority Health