"Jane" doesn't sleep Friday nights so she's sure to be awake to meet ACT UP on Saturday mornings. The 33-year-old social worker and active cocaine user has come to rely on the activists to provide her with clean needles. "I can't stop using," Jane says, matter-of-factly. "But at least I'm safe from HIV. I never have to share."
Though needle distribution is illegal in New York, ACT UP and the National AIDS Brigades have been providing sterile syringes - along with bleach, condoms, and HIV prevention tips - to addicts in drug-saturated areas of Manhattan, Brooklyn, and the Bronx since February. In the early months of the campaign, the activists gave out about 100 needles per week and few were returned, fueling charges that they were simply adding to the number of needles on the street and providing addicts with something to sell. But the program has grown. Now they hand out about 2000 "works" each week, all color-coded by neighborhood. They say in some neighborhoods the return rate is nearly 100%.
Officially the Dinkins administration remains firmly opposed. "The mayor believes that drug treatment is the only way to reduce infection among addicts," says his spokesperson, Lee Jones. But while officials estimate there are at least 200,000 IV-drug addicts in New York, the city has treatment slots for only 50,000. Shortly after taking office, Dinkins killed a needle-exchange study run by the Department of Health that had been opposed by the Black Leadership Commission on AIDS on grounds that distribution of needles and bleach to clean them does more to encourage drug abuse than to prevent HIV infection. BLCA has called programs like ACT UP's "genocide".
Yet the reaction in the streets has been favorable. "Even neighborhood people who thought what we were doing was wrong have come around," says activist Gay Wachman. "And the addicts have really responded. In a way, needles being illegal really helped us. That we were willing to risk arrest made them pay attention." Wachman says that many addicts, like Jane, have established friendship with the activists, and that for some, needle exchange has proved the way into drug abuse programs and early treatment for HIV.
Unofficially, the city tolerates ACT UP's initiative. A spokesperson at police headquarters says: Unless someone complained, we probably wouldn't take any action." Some activists involved in the exchange were arrested last March, but only after they provoked the cops with phone calls announcing their plans; the trial of "the Needle 10" is scheduled to begin this week. The activists hope the case will follow the precedent set in Boston, where needle hygiene activist Jon Parker was acquitted on similar charges.
Meanwhile, barriers to funding needle exchange seem to be crumbling in Washington. Senator Jesse Helms had won a stipulation in last year's budget banning the use of federal funds for needle exchange, or for study of its possible benefits. While some restrictions remain, this comprehensive ban fell by the wayside in the pitched battle over this year's budget. Now all that stands in the way of federal funding for such programs is a nod from the surgeon general.
That won't happen until researchers make a formal presentation of the newest data. Dave Purchase, who organized a conference attended by 11 of the 12 North American needle exchange programs two weeks ago in Tacoma, Washington, reports, "Universally, the programs have found essentially the same thing: sharing is reduced, sterile injection practices increase, infection rates stabilize, and there is no increase in drug use."
These other needle exchanges - in San Francisco, Seattle, and other cities - all have the blessing of the local government. ACT UP insists that only a government-sanctioned program could hope to put a dent in the crisis in New York, the IV-drug-use capital of the world. First, there's the weekly scramble for funds to pay for the needles hygiene kits and the subterfuge involved in importing needles from states where they aren't illegal. Then, the used needles have to be discarded. After a demo, the activists persuaded Gouverneur Hospital to accept the over 7000 syringes they had collected in the first nine months of operation. But citing the cost of disposal, the hospital has now refused to take anymore.
And there's the danger of needlesticks. One activist was pricked by a dirty needle during an exchange a few weeks ago and was rushed to New York Hospital where, following an experimental procedure for health care workers accidentally exposed, she was given a massive dose of AZT in hopes it would prevent infection.
A few DOH staffers along with staff from city hospitals and the state Narcotic and Drug Research Institute have formed an informal committee with ACT UP to address these problems and to seek ways to pressure the city to legalize needle exchange.
New York's failure to provide more aggressive AIDS prevention for addicts also has sparked wave of criticism from abroad. Last week, Emma Bonino of the Italian Parliament and Marco Taradash of the European Parliament were arrested on the steps of City Hall, in a civil disobedience to protest the city's needle policy.
The International Anti-Prohibitionist League, which organized the demo, argues that the city's inaction is helping to spread HIV to the rest of the world. A study from Los Angeles and preliminary data from other cities show that the highest risk factor for HIV infection among addicts in those cities is having a shot up in New York.
