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New Jersey Medicine
For want of clean needles: race and the spread of AIDS
Dr.
Day is the director of the Dogwood Center in Princeton. Dr. Day is a sociologist and activist scholar who writes on
issues of social justice and AIDS. By
the end of June 1996, 193,000 Americans were living with
injection-related AIDS or had already died from it.
AIDS spread through dirty needles accounts for about 45 percent
of all new AIDS cases nationally and over 50 percent in New Jersey.
In the face of a injection-related AIDS epidemic of this
magnitude, we suffer under government policies that, although not
intended to do so, actually cause spread of AIDS. To
see how certain policies affect the spread of AIDS, we need to look
first at the racial differences in
the spread of drug-related AIDS.
We have two methods available for looking at the relationship
between drug use and the spread of HIV/AIDS at the national level.
One utilizes information on new injection-related AIDS cases
published by the Centers for Disease Control (CDC) and information on
injecting drug use from the National Household Survey on Drug Abuse.
The other utilizes CDC information on the prevalence of HIV among
needle users in drug treatment centers across the United States.
Both data sets lead to the same conclusion: among persons who inject drugs, blacks are four times as
likely as whites to get AIDS.1,2 Using
FBI arrest data and looking at the relationship between injecting drug
use and arrests, we find that among persons who inject drugs, blacks are
at least twice as likely as whites to be arrested for possession of
heroin or cocaine. We now
can begin to see why the number of injection-related new AIDS cases is
so high among blacks. Arrests
for possession are higher. This means that the police are more likely to
confiscate the personal needles of blacks.
And, as has been documented elsewhere, users who believe that
they are vulnerable to arrest for possession of drug paraphernalia are
more likely to share needles instead of carrying their own, safe
needles.3-5 Spreading
HIV among African Americans who inject drugs is not the deliberate
policy of any police department. But,
by targeting black drug users for arrest, that has been the result. Discrimination
by pharmacies also plays a role. Some
states, like New Jersey, prohibit the sale of syringes without a
prescription. But in places where the sale of syringes through pharmacies
is legal, such as St. Louis, Missouri,
there is evidence that some pharmacies are willing to sell
syringes to whites but not to blacks. Because
we live in a society that is largely segregated by race, the racial
differentials in the prevalence of HIV, put in place by aggressive drug
law enforcement in black communities, are magnified.
As HIV spreads from person to person in segregated neighborhoods,
the young African American adult who borrows a needle from another black
is much more likely to borrow an infected needle than is the young white
adult, living in a white neighborhood, who borrows a needle from another
white. Because
the progression from HIV to AIDS is so slow, a good way to get an
understanding of the pattern of spread of the disease is to look at age
cohorts. The Figure
shows the rate of new injection-related AIDS cases per million
for whites and blacks. Both
groups start out at the same low point, with virtually no AIDS cases per
million among those under age 21. But
then there is an almost breathtaking upward movement in the rate of new
AIDS cases among blacks, so that by the time we reach the cohort age
41-45 in 1995, there are almost 18 times as many injection-related AIDS
cases among blacks as there are among whites. This
situation must not continue. Persons
of all races must have the opportunity to avoid getting AIDS through
dirty needles. Clean needles need
to be accessible to persons who inject drugs though clean needle
programs and over-the-counter sales of syringes.
Scientific study after scientific study has shown that these
changes are necessary to begin to bring this deadly, infectious epidemic
under control. To do otherwise is inhumane and costly. Sterile needles cost almost nothing; the new combination
drugs now being used to treat HIV cost between $10,000 and $16,000 per
year for each infected individual.
To treat one patient throughout the course of this illness is
estimated to cost at least $120,000. In
a national poll done in early 1996, two-thirds of Americans said they
favored clean needle programs to save lives.
It is the politicians who are out of step both with the common
sense of the American people and the scientific research of the United
States and international medical communities. Right
now the state of New Jersey is prosecuting Diana McCague and Thomas
Scozarre, two public health volunteers, because one cold night last
April, they were trying to stop the spread of AIDS by giving out clean
needles to persons who injected drugs.
Although the case is in the courts, the officials in New Jersey
who need to hear about the lifesaving character of clean needle programs
are Governor Christie Whitman, and the members of the New Jersey Senate
and Assembly committees holding the bills that would make clean needle
programs possible. At
the federal level, President Clinton needs to hear that we have an
out-of-control epidemic of an infectious, deadly disease that will only
begin to come under control when federal AIDS prevention funds can be
used to support clean needle programs, an enabling decision that
President Clinton, through his acting Surgeon General, has the power to
make. MSNJ, the New Jersey Public Health Association, Governor Whitman's Advisory Council on AIDS, and President Clinton's Advisory Council on AIDS have all taken positions favoring clean needle programs. Now, in the face of continuing inaction in this life-and-death situation, we, as citizens and knowledgeable professionals, must raise our voices.
References 1.
Day D, Cohen R: Race and
the Spread of HIV/AIDS Related to Injection Drug Use.
Paper, April 1996. 2.
Day D: Health Emergency 1997: The Spread of Drug-Related AIDS Among
African Americans and Latinos. Paper,
November 1996. 3.
Booth R, Koester S, Reichardt C, Brewster J:
Quantitative and qualitative methods to assess behavioral change
among injection drug users. Drugs Soc 7:161-183, 1993. 4.
Conviser R, Rutledge JH: Can public policies limit the spread of HIV
among IV drug users. Drug
Issues 19:113-128, 1989. 5.
Zule W: Risk and reciprocity: HIV and the injection drug user.
J Psychoactive Drugs. 24:253-249, 1992.
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