Needles and Public Health

April 03, 1993

Mention a needle exchange program and many people envision syringes being flung helter-skelter to waiting addicts. But a one-for-one exchange conducted by officials as a public health measure is nothing like that. Sadly, suburban legislators failed to see the difference when Baltimore City's proposal for a needle-exchange program came before a committee of the House of Delegates last week. The proposal died -- depriving city officials of a promising way to help stem the rapid spread of AIDS among intravenous drug users.

At least legislators were honest that their votes were based on fear and discomfort, rather than facts and evidence. We suspect that if they were carefully educated, they would feel more confident about voting for such a program -- and more willing to defend such a vote to their constituents.

Needle exchange programs have been instituted in seven other states and eight foreign countries, and there is solid evidence that they work. In New Haven, Conn., for example, a needle-exchange program reduced HIV infection rates by one-third with no evidence of increased drug use. In fact, one out of seven drug users who participated in the needle exchange entered treatment programs. Residents of drug-ridden neighborhoods also liked the program, since the one-for-one exchange drastically reduced the number of syringes littering sidewalks, alleys, playgrounds and other public spaces.

What's at stake? In the United States, one-third of all AIDS cases stem from the injection of illegal drugs; in Baltimore City, that figure rises to 42 percent. Best estimates suggest that one-fourth of the city's 40,000 injection drug users are HIV positive, with four to five new infections occurring each day. Those figures should ring alarm bells for every public official.

Speaking Wednesday to newspaper editors gathered in Baltimore, Dr. John Bartlett, chief of infectious diseases at Johns Hopkins Hospital, said that by 1997, AIDS will have become the most deadly epidemic in human history, surpassing the toll of 25 million people killed by the 14th century plague known as the Black Death. Dr. Bartlett is pessimistic about prospects of finding a cure for the virus.

Given that prognosis, public health officials have a duty to do all they can to stop the spread of the AIDS virus. Well-designed, responsible programs to reach out to vulnerable populations like intravenous drug users are an important tool. The General Assembly missed an important opportunity to help slow the spread of AIDS in Maryland. But with a stronger effort to educate lawmakers -- as well as Gov. William Donald Schaefer, who also opposed the measure -- a similar effort might stand a better chance of success next year.

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