by Bruce Lambert

(NEW YORK TIMES Sunday, April 14th 1991)

Two trials that opened last Monday on the East and West Coasts could mark a turning point in the debate over how to prevent AIDS among drug users, their sex partners and their unborn babies. The issue at stake in New York City and Redwood City, Calif., is whether the threat of Aids justifies giving away clean needles in violation of state laws.

Across the country, advocates for AIDS victims have openly defied authorities by giving out needles. At the same time, the campaign to legalize needle distribution has won victories in courts and legislatures as well as on streets.

"There's a real civil disobedience movement that's having an effect on public policy," said Dr. Don C. Des Jarlais, a member of the Federal Commission on AIDS. Eleven states outlaw the sale or possession of hypodermic needles without a prescription: New York, New Jersey, Connecticut, Pennsylvania, Delaware, Rhode Island, Massachusetts, New Hampshire, Maine, Illinois and California. In other 39 states needles are considered illicit if found with contraband drugs.

Legal needles that retail for less than 20 cents each fetch up to $5 on the black market.Addicts often borrow used needles, which may be contaminated with the AIDS virus. Once infected by sharing needles, addicts can transmit the virus through sex and pregnancy.

In the cases that went to trial last week, defendants staged public needle giveaways and invited arrest. Other test cases are pending in Newark and in the Massachusetts towns of Lowell, Roxbury and Worcester. Jon C. Parker, who founded the National AIDS Brigade, which gives away needles and collects dirty ones, was aquitted in Boston last year after arguing that he was saving lives. Later he was arrested in Rhode Island and Delaware but charges were dropped. A public health graduate student at Yale and ex-addict, he is one of eight defendants in the New York trial and was an organizer of the incident that led to the case in Redwood City.

There are signs that the campaign is having an effect. The Connecticut legislature authorized New Haven's health department to start providing needles last fall, with the endorsement of the mayor and police commissioner. Supporters of needle distribution programs include the mayors of Boston, Baltimore and San Francisco. Even states that already allow people to buy needles without a prescription are trying to make access easier. Hawaii's legislature approved needle distribution. Local projects have sprouted in Seattle, Portland, Ore., and Boulder, Colo. Tacoma, Wash., offers swift needle delivery to addicts who call in.

The nation's biggest needle program, Prevention Point in San Francisco, distributes nearly 8,000 needles a week. Last year San Francisco residents adopted a referendum asking the state to legalize the program, which was started in 1988. Te rate of infection with the AIDS virus among addicts there had doubled nearly 13 percent from the year before. Since then, the level has remained stable. Samplings of East Coast addicts show infection rates of 50 percent or more.

Official needle distribution programs are growing in Europe. "Internationally, the U.S. is the exception," Dr. Des Jarlais said. Although the National Academy of Sciences recommended researching the effects of needle distribution, the Bush administration has barred Federal funds to pay for needles or study programs sponsored outside the Government.

Treatment on Demand

Opponents also include some prosecutors, religious leaders, politicians, minority leaders and drug treatment experts who contend that giving away needles encourages drug abuse. Mayor David N. Dinkins and Dr. Woodrow A. Myers Jr., the New York City Health Commissioner, are opposed to the programs. After cancelling a small needle exchange program, Dr. Myers said he would prefer the city to work toward a policy of treatment on demand for any addict who wanted it.

Proponents of the programs argue that there is no evidence that the needle restrictions reduce drug abuse. Addicts intent on shooting up will find needles, they say, resorting to used ones if necessary. Studies show that recipients of free needles are less likely to share them. Sometimes the giveaway programs serve as bridges to encourage addicts to seek treatment. Proving that the programs reduce AIDS cases is hampered by the years-long lag between infection and symptoms. But cases of hepatitis B dropped among needle recipients in San Francisco and Amsterdam. Baltimore researchers found that addicts with diabetes, who have legal access to needles for insulin, were infected with AIDS virus at a rate less than half that for other drug users.

People on both sides of the debate agree that the ideal is to get addicts off drigs. But Dr. Stephen C. Joseph, a former New York City Health Commissioner, says that not all addicts are willing or able to quit. And those who seek treatment face monthslong waiting lists at underfunded clinics. He testified for the eight New York defendants last week, calling them courageous.

Strategists hope that winning more cases will enable needle distribution to flourish without fear of reprisal, and perhaps even to win government financing. But adverse court rulings could turn the test cases into setbacks rather than breakthroughs.

Giving needles to addicts "is not something we like to do, but if we don't, people are going to die for lack of a stupid needle," said Dr. Mathilde Krim, cofounder of the American Foundation for AIDS Research. Dr. Krim helped hand out needles in San Francisco last year during the international AIDS conference. "Laws should help people," she said, "not hurt them."