Scotland's elegant capital deals calmly, quietly with sudden outbreak of AIDS

December 01, 1993|By Carl Schoettler | Carl Schoettler,London Bureau

EDINBURGH, Scotland -- Drug abuse, prostitution, HIV and AIDS fall outside the tourist vision of a Scotland of kilts and bagpipes, shepherds and crofters, Harris tweeds and plaid woolens, fine whisky and golf at St. Andrews.

Edinburgh, Scotland's capital, is a stately city of gray and red stone, pinnacles and turrets and crenelations. It is a cultured city renowned for its theater festival.

It is not the sort of place you'd expect to find a rampant AIDS problem and some of the world's most progressive programs for the prevention and treatment of AIDS.

But with about 750,000 residents, Edinburgh and the Lothian governmental region that surrounds it account for 52 percent to 58 percent of Scotland's 2,000 infections of human immunodeficiency virus.

Scotland is about three times as large as Maryland, but has a comparable population of about 4.9 million. (Maryland's is 4.8 million.

The latest figures from the end of March show that in Edinburgh and its Lothian suburbs, 1,099 people were HIV positive, 206 had AIDS, 127 had died. The figures are small compared with Maryland and Baltimore, where the numbers in each category are about 15 times as high.

In Edinburgh, city and regional health authorities recognized the AIDS danger early and moved quickly. Inventive ideas flourished and resulted in a range of far-reaching HIV/AIDS programs virtually unmatched in Europe and often rare in the United States.

Edinburgh provides services for people with HIV or AIDS literally from infection to the grave.

The programs start with preventive innovations like the C-Card. Just put down your date of birth and your neighborhood and you've got your credit card good at any participating pharmacy for a virtually unlimited supply of condoms. About 4,000 residents of the area are carry C-Cards.

Needle exchange programs for drug users, just now struggling to get under way in Baltimore and still rare in the United States, have been operating here since 1986. Shared needle use among intravenous drug users had been by far the leading source of HIV infection, followed by homosexual and then by heterosexual partners. There were, of course, other causes.

Needles, syringes and condoms in a wide variety of sizes, shapes and strengths are displayed like household gadgets in a hardware store at the Spittal Street Centre here.

No-fuss approach

Edinburgh seems to be able to provide such HIV and AIDS services without undue fuss, ostentation, sensation or self-congratulation. Practically everyone working with HIV/AIDS people seems remarkably non-judgmental.

"We don't tell people not to use drugs," says Frank Gough, a 30-year-old member of the center's Harm Reduction Team. "Our main thing is to try to get a clean set of works [injection paraphernalia] to the clients who are using."

At the center, users can get up to 10 sets a visit. About 300 dropped in for their works last month. The center also sends a bus out to neighborhoods with heavy drug use. And it provides a "prescription" form users can take to 20 pharmacies, which will then provide syringes and needles.

"We encourage users to return their old works," Mr. Gough says. His voice is as soft and low as his demeanor is gentle. "Some don't. We don't insist. But if someone continues to not bring back works, we do get pretty strong about it."

Unhappily, the AIDS epidemic and widespread drug use by injection, mostly of heroin, arrived more or less simultaneously in the early 1980s in Scotland, most severely in Edinburgh.

"The Scots went straight to injecting," says Roger Lewis, director of the city's HIV/AIDS and drug study center.

Testing blood samples from drug users in the mid-1980s, researchers found one-third to one-half were HIV positive.

"Overnight Edinburgh acquired itself an HIV problem," says Dr. George Bath, AIDS coordinator for Edinburgh and its outlying region.

But preventive measures such as the needle exchange and condom programs are credited with helping to reduce the high HIV infection rate substantially among injecting drug users.

"In terms of new people coming to drug treatment services, well below 50 percent have ever injected," Mr. Lewis says. "Very, very small numbers have shared over the last six months. It's gone down like that."

Trouble with sex

Bringing about change in sexual patterns has been more intractable.

"If we talk about sexual transmission," says Dr. Bath, "the risk is ahead."

In one area of sexual activity, the Scottish Prostitutes Education Project (ScotPEP), a 4-year-old self-help group, encourages safer sex and safer drug use by men and women working in "the sex industry."

According to Ruth Morgan-Jones, the ex-prostitute and university-trained social scientist who is a director of ScotPEP, 500 to 700 women and 150 to 200 men work in Edinburgh's sex industry.

ScotPEP provides information and advice, education and support services -- and distributes thousands and thousands of condoms.

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