The Times, Trenton, NJ 
Copyright 1998: The Times

December 25, 1998, page A13

Dawn Day

In a courtroom crowded with her supporters, Diana McCague, New Jersey's courageous public health leader, was recently fined $780 and sentenced to the loss of her driver's license for six months (she earns her living as a taxi driver) and 100 hours of community service. Her "crime" was slowing the spread of HIV among injecting drug users in New Jersey, by exchanging sterile needles for used ones. 

Diana pleaded guilty in court and promised never again to do needle exchange in New Jersey (unless the law changes) in order to avoid serving time in jail, to get the charges dismissed against her co-defendant, Derik Moore (who had been holding a clipboard, not syringes) and to get back the Chai Project's van. Confiscated by the police at the time of the arrests, the van is essential to the Chai Project's other outreach programs.

If Diana had been doing needle exchange in New York City or Philadelphia, instead of New Brunswick, she would be the respected head of an organization providing a legal and very much needed public service, not a criminal subject to arrest and possible imprisonment.

This trial concerned Diana's second and most recent arrest for saving lives with needle exchange. Her conviction in her first arrest is being appealed to the U.S. Supreme Court. If she (and all of us living in New Jersey who are concerned about public health and the expanding AIDS epidemic) win on appeal, Diana will be permitted to change her plea in this recent case to innocent. In that case, the fine money will be returned to her, but she will in no way be compensated for the six months employment she will have lost from her occupation as a taxi driver or her 100 hours of community service. 

At the sentencing, Judge Ralph F. Stanzione, Jr. imposed a three-month suspended jail sentence, so that if Diana ever engages in needle exchange in New Jersey, unless the law is changed, she will be sent to prison for three months. After her first conviction last year, Diana and the Chai project had continued their lifesaving needle exchange activities. But no more. One must respect Diana's decision that the personal price of three months in jail is too high.

So the Chai Project will continue its mission to reduce the harm associated with drug use. Staff members will continue to distribute safer sex and LEGAL safer drug using materials. They will continue to support program participants as they seek out other services, including drug treatment. But they will not utilize the approach, recognized worldwide, that could have an immediate impact on slowing the injection-related HIV/AIDS epidemic in the Middlesex area: needle exchange.

The ending of needle exchange in Middlesex is very unfortunate, since there is great need there. In 1997, the Middlesex metropolitan area ranked seventeenth in the nation with regard to injection-related AIDS, among the 99 metropolitan areas with populations of 500,000 or more.

New Jersey's injection-related AIDS epidemic is not confined to Middlesex however. In 1997, New Jersey had FIVE of the top twenty metropolitan areas of 500,000 or more population in the country with regard to injection-related AIDS. In 1996, New Jersey ranked third in the United States in the rate of injection-related AIDS.

So Diana's arrest and punative sentencing is not just about government's failure to permit needle exchange in Middlesex, it is about the New Jersey's failure to protect the lives of its citizens everywhere in the state. The number of persons in New Jersey living with injection-related HIV or AIDS or had already died from it increased by 5 percent in the year ending June 30, 1998. 

New Jersey's minorities are being especially hard hit with the injection-related AIDS epidemic. Over 12,900 African Americans and 3,200 Latinos living in New Jersey have injection-related AIDS or have already died from it.

New Jersey's AIDS epidemic has created 9,100 orphans. Even with our best medical care, about 10 percent of all babies born to HIV positive mothers are also HIV positive. 

New Jersey law needs to be changed so that sterile syringes can be sold over the counter without prescription and so that organizations like the Chai Project can legally exchange needles, removing HIV-infected needles from circulation before they infect others.

New Jersey is paying a high price in dollars as well as lives for ignoring the advice of the Centers for Disease Control, the American Medical Association and the other public health groups that recommend needle exchange. Using a sophisticated mathematical model, a University of California team estimated that, over a five-year period, it costs between $4,000 and $12,000 in needle exchange program expenses for each HIV infection averted. The cost of medicine for combination therapy for a comparable five-year period is $60,000. Adding in doctors' fees and hospitalization costs, the cost difference between HIV prevention and HIV/AIDS treatment is even greater. From a financial point of view, there is no question that needle exchange programs are a tremendous bargain compared with the cost of treating HIV/AIDS.

In this holiday season, we focus on the power of new beginnings. Drug users too can turn their lives around. But what a tragedy for them and their families if, when they do, they find that what they have before them is a life a chronic illness and perhaps a painful death. 

New Jersey can do better. We need better drug education. We need more drug treatment. And we need needle exchange to slow the spread of HIV. 

In this season when we look for messages of love and forgiveness, let us consider instituting a policy that sends the message that even the lives of people who inject drugs have value.

Dawn Day, Ph.D., is a sociologist and activist scholar who writes on issues of social justice and AIDS. She is the author of Health Emergency 1999: The Spread of Drug-Related AIDS Among African Americans and Latinos.