Trenton Times
Copyright 1996: Trenton Times

June 16, 1996, section CC, page 1

Dawn Day
Special to The Times, Trenton, NJ

By the end of 1995, over 15,500 New Jersey citizens had injection-related AIDS or had died from it.  Over 9,600 of those people were African Americans. 

New Jersey ranks first among all the states in terms of the proportion of AIDS cases among adults and adolescents that are related to injection drug use.  Every day five more New Jersey citizens get injection-related AIDS. 

What can we do?  All the independent medical experts who have studied the problem tell us that in their considered scientific opinion, making sterile needles available to persons who inject drugs slows the spread of HIV/AIDS.

The American Medical Association, the American Public Health Association, and their New Jersey counterparts all favor needle exchange programs, as does the former surgeon general, Dr. Joycelyn Elders. 

Such programs, in which persons who inject drugs turn in their dirty needles in exchange for sterile ones, also include drug counseling.

In the last five years, six major studies funded by the federal government have concluded that needle-exchange programs reduce HIV transmission and do not increase the use of injected drugs.

Some who oppose needle exchange programs say they do not believe the research.  To them I answer, researchers can make mistakes, but the evidence in this case is massive, and in the face of a deadly epidemic, we need to act at once on the information available.

Some who oppose needle exchange, including Governor Whitman, say that they are concerned that when we give out sterile needles we are giving out a double message.  To them I answer, we have many policies that inform persons who inject drugs that their behavior is antisocial and self-destructive -- everything from public service announcements to prison sentences.  

And even without needle exchange, we send double messages about drug use.

When a person who injects drugs has an overdose or suffers a severe reaction to a substance used to cut the drug, we rush that person to a hospital and give them the best medical care we can.  We do not want them to die.  We do not say to the drug user’s family and friends, “Sorry, we cannot give your family member life-saving medical care because it would send the wrong message.”  Getting sterile needles to persons who inject drugs is also about medical care and saving lives.

The question is, do our New Jersey laws that prevent persons who inject drugs from getting sterile needles constitute the denial of medical care -- not only to drug users but to those they infect?  

In our society, medical interventions go way beyond pills, bandages, and surgery.  In the name of public health we remove asbestos, cover over lead-based paint, and purify water.

In anger and frustration some may cry out that persons who inject drugs and get AIDS are getting what they deserve.  But are they?  In New Jersey our laws say an appropriate punishment for drug possession is imprisonment for a maximum of five years, not the death penalty. 

It is a tragic irony that the laws prohibiting access to sterile needles, laws meant to protect people, are now the cause of people dying from AIDS.

Americans are an intelligent people.  It is not really asking too much of us to have us understand both that injecting drugs is a really bad idea and also that persons in need of  preventive medical intervention should receive it.  In fact, Americans do understand that.  A recent national survey found that two thirds of all Americans favored needle exchanges as a way of saving lives and stopping the spread of HIV/AIDS. 

Addiction is a medical problem.  In cities where they have been allowed to operate, needle exchange workers are the people showing they care about the health of drug users.  And their efforts have been rewarded.  Needle exchange workers are often the first people drug users turn to when they want help in finding drug treatment.  And when drug treatment is not available, needle exchange workers have been effective in pointing out to policy makers the urgent need for more drug treatment.

Needle exchanges help protect the police who are in danger of a needle stick when they are frisking someone.  A needle exchange takes infected needles out of circulation.  A sterile needle with its protective cap is no danger to a police officer.

Needle exchanges help reduce the problems with discarded needles.  In a Portland, Oregon, neighborhood where discarded needles had been a problem, fewer discarded needles were found after the exchange opened than before because drug users had an incentive to keep their dirty needles and trade them in for sterile ones at the exchange.

In this time of limited government funds, it is worth noting that changing the laws that prohibit access to sterile needles involves no government expenditures at all.   And the $140,000 it costs for the medical care of one AIDS patient until he dies could cover the cost of running a large needle exchange that could save many lives and eliminate much suffering.    

Right now, when there is no cure, needle exchange is the only effective intervention we have to protect people who inject drugs from getting AIDS from infected needles.

A number of young adults experiment with injecting drugs for a while and then stop forever.  Consider the difference access to sterile needles makes.  The uninfected person who stops using drugs has a whole life before him or her.  The HIV-infected person who stops using drugs almost surely must face serious, painful illnesses and premature death. 

Do we have a moral obligation to protect people who take dangerous risks?  

Are we our brother’s keepers?  Let us consider an example unrelated to drugs.  There is a dangerous curve in the road.  One speeding driver dies.  Then another.  Then another.  Then another  They should not be speeding.  They are responsible for their own behavior.  Perhaps there is a wife or husband along, or perhaps a newborn child.  We know the curve is dangerous.  Don’t we have an obligation to post a warning sign?  Put in a stop light?  Change the traffic pattern?  Perhaps even straighten the road?

And so it is with injecting drugs in the age of AIDS.  People who inject drugs know they are taking a risk.  But we know too. 

As a religious person who believes in the worth of all human beings, I believe we have a moral obligation to make sterile needles available to the injecting drug user for his or her own sake.  And like the reckless driver in the example above, persons who inject drugs have wives, husbands, and babies. 

When we abandon the person who injects drugs to HIV/AIDS, we are abandoning their non-drug-injecting partners and babies as well. 

Let us lobby Gov. Whitman and our legislators in support of needle exchange, the policy recommended by the New Jersey Governor’s Advisory Council on AIDS under its chairman, David W. Troast.  Let us find ways to support Diana McCabe and Thomas Scozzare, the two leaders of the New Brunswick Chai needle exchange who were recently arrested for trying to save lives.  Let us follow the lead of Bill Franklin as he organizes community support for needle exchange in Newark.

With sterile needles we can slow this horrible AIDS epidemic among injecting drug users in New Jersey.  Let us do it.

Dawn Day is the Director of the Dogwood Center in Princeton, New Jersey.  Dr. Day a sociologist and activist scholar who writes on issues of social justice and AIDS.