NEEDLE SWAPS

TO BE REVIVED

TO CURB AIDS

NEEDLE EXCHANGE PROGRAMS

TO BEGIN IN NEW YORK CITY

by MIREYA NAVARRO

The Dinkins administration will permit drug addicts in New York City to receive clean hypodermic needles under an ambitious research effort announced yesterday intended to measure whether such an approach will slow the spread of AIDS.

The needle-exhange programs, which will begin June I, will be financed by a private organization and the New York State Department of Health. But they were made possible by a policy shift on the part of Mayor David N. Dinkins last November, who had previously opposed needle-exchange programs as encouraging illegal drug use.

The programs are expected to exchange 2.5 million to 3 million clean needles for used needles a year. The programs are expected to attract about 6.000 of the city's estimated 200,000 intravenous drug users to seven to pine sites in Manhattan and the Bronx, most of them out on the street.

MONTHS OF MEETINGS

The announcement, made by the American Foundation for AIDS Research at its New York City offices, capped months of meetings among city and state health officials and AIDS advocates to address the Mayor's concerns, particularly that the effectiveness of the programs be monitored.

Cities like Seattle and Tacoma in Washington, and Portland, Ore, have needle-exchange programs. But experts say the New York City program will be the first in a large inner-city area with one of the highest rates of infection among drug users. City health officials estimate that at least half of the city's intravenous drug users have H.I.V., the virus that causes AIDS.

The city has the highest number of reported AIDS cases in the nation.

Yesterday, Mayor Dinkins said in a prepared statement that he hoped the programs would help efforts "to stop the pread of AIDS, to educate people and to provide a bridge to treatment, primary health care and support services, for drug abusers".

And the New York City Health Commissioner, Margaret A. Hamburg, said the city would be involved in the evaluation of the programs.

The Mayor's shift stems from the results of smail studies, conducted elsewhere in the country, that indicated needle exchanges worked. Last year, he responded positively to a similar exchange program in New Haven after Yale University researchers estimated that, in eight months, it had reduced new H.I.V. infections by 33 percent.

Sharing contaminated needles is a major way the AIDS virus is transmitted in New York City and other urban areas, and those infected often infect others through sez and pregnancy. Of 39,452 reported AIDS cases in New York City as of March, 61 percent of the cases among women and 37 percent among men stemmed from needle-sharing, figures from the city's Health Department show. Most of the drug-related cases, which are rising at a faster rate than those stemming from sex, were among black and Hispanic people.

The programs will differ markedly from the city's first legal program, which the Mayor canceled in 1990. Then, addicts had to come to the city Health Department's office - near City Hall in the heart of the businnes and government disctict. In less than two uears of operation, that program attracted only about 300 participants, although it succeeded in enrolling many of them in drug-treatment programs.

The new programs will rely on community workers to distribute clean needles to addicts on the street and in the "shooting galleries" where drugs are used, and in one or two indoor sites that have not yet been designated. They will also teach addicts how to protect themselves from infection and offer access to social services and drug treatment.

$590,000 IN GRANTS.

Three nonprofit organizations - the Minority Task Force on AIDS, the Bronx-Harlem Needle Exchange Program and the Lower East Side Needle Exchange Program - will run the programs with $140,000 in grants from the American Foundation for AIDS Research - a private organization known as Amfar and $450,000 from the New York State Department of Health.

Official from Amfar said that they expect to finance three other needle-exchange programs in New York City this summer.

The Bronx-Harlem Needle Exchange Program and the Lower East Side Needle Exchange Program have been distributing clean needles illegally for more than two years, an act of defiance their operators said saved lives. New York is one of 11 states in the country where it is a crime to sell or possess nypodermic needles without a prescription.

To allow the programs to run legally, the New York State Departiment of Healt has exempted the groups from the law for two years. But the new programs will have to meet stringent reporting and evaluation requirements.

The needles must bear an identifying mark and records of all exchanges - one clean needle for one used one - must be kept and submitted to the department in quarterly reports. The groups are required to properly dispose of the needles. More important, the programs must provide counseling to reduce risk and referrals to health and social services, including drug treatment for those who want it.

Dr. Don Des Jarlais, director of Beth Israel Medical Center's Chemical Dependency Institute and a member of the National Commission on AIDS, will evaluate how successful the programs are in changing risky behavior and in preventing new infections among participants who test negative for H.I.V. He said the evaluation, through interviews and testing of returned needles and saliva samples to track new infections, will also look at whether exchanges on the street work better than those performed in an storefront setting.

Rod Sorge, a member of Act Up who runs the Bronx-Harlem Needle-Exchange Program, said the grants and new legitimacy would also allow his program to expand to two days a week at four sites in the Bronx - three on the street, one indoors. Currently, his program has volunteers distributing condoms and kits to disinfect needles, referring addicts to treatment and exchanging needles from plastic buckets on street corners once a week.

Mr. Sorge will run now the exchange with the Minority Task Force on AIDS, a social-service organization serving primarily black and Hispanic clients.

Representative Charles B. Rangel of New York said yesterday that while he opposes government involvement in the needle exchanges, he does not oppose efforts by community groups "to do something to minimize terminal diseases like AIDS."

AROUND THE COUNTRY

PROGRAMS

* Legal # Underground

CALIFORNIA

# Marin County

# Oakland

# Sacramento

# San Francisco

# San Mateo

# Santa Clara

# Santa Cruz

NORTHEAST

# Baltimore

# Boston

* New Haven

# New York (^)

# Philadelphia

WASHINGTON

* Seattle

* Spokane

* Tacoma

* Vancouver

OTHER

* Boulder, Colo.

# Chicago

* Honolulu

* Portlande, Ore.

(^) Pending Legalization