San Diego Union Tribune, San Diego, CA
Copyright 1997: San Diego Union Tribune

April 25, 1997, page B-9

Brent Whitteker and Dawn Day

The North American Syringe Exchange Conference meeting here this week is offering the citizens of San Diego an opportunity to learn about how a clean-needle program of an appropriate size here in San Diego could, in the next few years, save hundreds of lives and hundreds of millions of health-care dollars.

Dr. Scott Holmberg of the Centers for Disease Control estimates that, in just the next 12 months, over 100 drug-injecting users in the San Diego metropolitan area will become HIV positive because they do not have access to sterile needles.  An effective clean-needle program would both save these individuals' lives and also save the $133 million that their medical treatment will otherwise cost.

And that is just the cost in lives and dollars for one year.  Each subsequent year that we delay, a similar loss in lives and dollars will follow.  There is a tremendous need for the San Diego County Board of Supervisors to act now to declare a health emergency and permit the establishment of clean-needle programs that will reach all those in need.

Right now the courageous volunteers of the San Diego Clean Needle Exchange are doing all they can to make clean needles available to those in need.  But with the possibility of arrest an ever-present threat, the volunteers are limited in the numbers they can reach. 

With hundreds of lives and hundreds of millions of dollars to be saved by implementing of clean-needle programs on a scale commensurate with the need in San Diego County, let us consider the reservations raised about clean-needle programs. 

Some have expressed a concern that clean-needle programs increase drug use. To them we say, this question has been examined.  In the last seven years, eight major studies funded by the federal government have concluded that clean-needle programs reduce HIV transmission and do not increase the use of injected drugs. 

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

Some who oppose clean-needle programs say that they are concerned that when we give out sterile needles, we are giving out a double message.  To them we 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 clean-needle programs, 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 him or her the best medical care we can.  We do not want that person 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.

Americans are an intelligent people.  They understand both that injecting drugs is a really bad idea and that persons in need of  preventive medical intervention should receive it.  A national survey conducted in early 1996 found that two-thirds of all Americans favor clean-needle programs as a way of saving lives and stopping the spread of HIV/AIDS.  A scientific survey of 1000 residents of San Diego county last August found even greater support here, with over 85 percent of San Diego residents favoring clean-needle programs as a way of slowing the spread of HIV.

Given the medical consensus that has emerged on the effectiveness of sterile needles as a way of avoiding the spread of drug-related HIV/AIDS, it is difficult to see the denial of access to sterile needles as anything other than the denial of access to a lifesaving medical intervention. 

In the history of modern medicine in the United States, we are aware of only one other instance where a life-saving medical intervention involving a deadly infectious disease was deliberately denied to a group of people.  That instance is the now infamous case of the Tuskegee syphilis "experiment."  The unfortunate victims of this study were 400 black men in Macon County, Alabama, who were denied medical treatment for their syphilis from 1932 when the study began until they died or, if they lived, until 1972, when the "experiment" was exposed and stopped.  In the age of AIDS, people who advocate the denial of access to sterile needles should give careful thought to what they are saying and the company they are keeping.

Right now, when there is no cure, clean-needle programs are the only effective intervention we have to protect people who inject drugs from getting HIV 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 illicit drugs has a lifetime before him or her.  The HIV-infected person who stops using illicit drugs almost surely must face serious, painful illnesses and perhaps premature death. 

We urge the San Diego County Board of Supervisors to declare a public health emergency so that San Diego can have a clean-needle program commensurate with the size of the problem.  

With sterile-needle programs that reach substantial numbers of drug users, we can slow this horrible AIDS epidemic among injecting drug users in San Diego before it is widespread.  The best medical advice in our country says we need clean-needle programs to slow the spread of HIV.  If the County Board of Supervisors acts now San Diego county can save hundreds of lives and hundreds of millions of dollars.  What are we waiting for?

Whitteker is executive director of the San Diego Harm Reduction Center.  Day is the director of the Dogwood Center, a research organization in Princeton, N.J.