The United States of America has been contending with adverse social and
economic effects of the drug abuse, namely of heroin, since the foundation of
this country. Our initial attempt to outlaw heroin with the Harrison Narcotic
Act of 1914 resulted in the U.S. having the worst heroin problem in the world (Tooley
540). Although the legislative actions regarding heroin hitherto produced
ominous results that rarely affected any individuals other than the addict and
his or her family, the late twentieth century brings rise to the ever-infringing
AIDS epidemic in conjunction with heroin abuse. The distribution of clean
needles to intravenous (IV) drug users is being encouraged in an attempt to
prevent the transmission of human immunodeficiency virus (HIV) from sharing
"contaminated needles" (Glantz 1077). It is the contention of this
paper to advocate the establishment and support of needle exchange programs for
intravenous drug users because such programs reduce the spread of HIV and do not
cause an increase of drug use. This can be justified simply by examining the
towering evidence that undoubtedly supports needle exchange programs and the
effectiveness of their main objective to prevent the spread of the HIV.
Countries around the world have come to realize that prohibiting the
availability of clean needles will not prevent IV drug use; it will only prevent
safe IV drug use (Glantz 1078). Understanding that IV drug use is an inescapable
aspect of almost every modern society, Europeans have been taking advantage of
needle exchange programs in Amsterdam since the early 1980's (Fuller 9).
Established in 1988, Spain's first needle exchange program has since been joined
by 59 additional programs to advocate the use of clean injection equipment (Menoyo
410) in an attempt to slow the spread of HIV. Several needle exchange programs
sponsored by religious organizations in Australia have "reported no new HIV
infections resulting from needle sharing over the past three years" (Fuller
9). Public safety groups in the United States are rapidly beginning to accept
the effectiveness of needle exchange programs. The 113 needle exchange programs
that are currently operating throughout the United States (Bowdy 26) are a
result of this acceptance. These programs for the most part are established to
support "needle exchange" more so than "needle distribution"
(Fuller 10). Many needle exchange programs have been initiated by recovering
addicts who understand "the realities of addiction and the potential harm
of needle sharing" (Fuller 9). Perhaps addicts feel more comfortable taking
advice from some one whom has been there and knows what they are going through.
Social interaction between the addict and program is quite simple. Program
clients are asked to donate their old injection equipment in exchange for new
materials and identification cards issued by some programs, allowing the users
to carry their injection equipment anywhere (Loconte 20), reducing the need to
share needles. Volunteers keep track of old needles collected and sterile ones
given out with "a coding system that allows participants to remain
anonymous" (Green 15). Unlike some of their European counterparts, needle
exchange programs in the U.S. do not advocate the use of vending machines to
dispense hypodermic needles (Fuller 10). American programs understand the grave
importance of regular contact between the addict and caring members of society
who inform addicts about various avenues of health care and recovery during each
visit (Fuller 10). The assistant director of the Adult Clinical AIDS Program at
Boston Medical Center, Jon Fuller, feels that this intimate approach by American
programs conveys "a powerful message to addicts that their lives and
well-being are still valued by the community" despite their inability to
"break the cycle of addictive behavior" (10). Addicts who can not stay
clean or get admitted into a drug treatment program should be encouraged to take
the necessary precautions to perform safe injections and not put others at risk
as a result of their habit (Glantz 1078). From 1981 to 1997, drug related HIV
cases in the United States rose from 1 to 31 percent not including infants and
sexual partners infected by the user (Fuller 9). With contaminated needles
infecting 33 Americans with HIV daily (Fuller 11), it was only a matter of time
before an in-depth analysis of the drug related AIDS epidemic was made. More
comprehensive research in regards to the effectiveness of needle exchange
programs is necessary to provide the basis for making proper legislative
decisions. The ban currently preventing federal funds from being allocated to
support needle exchange programs in the U.S. greatly curtails the means
necessary to establish and operate an effective needle exchange program.
President Clinton initially planned to lift the ban (Bowdy 28) but, against the
advise of his health advisor and compelling scientific support for needle
exchange programs, he extended the ban forcing needle exchange programs to
operate within their already thin budgets (Schoofs 34). A bit of hypocrisy is
sensed by Joe Fuller because the Clinton Administration "refused to lift
the ban but encouraged local governments to use their own resources to fund
exchange programs" (8). The Administration claims that by supporting
something other than "zero tolerance" may give the "wrong
message" (Drucker 15). Political careers were obviously placed ahead of the
general safety of the American people (Green 15) possibly due to public opinion
surveys. The Family Research Council performed a public opinion survey in 1997 (Bowdy
28). Sixty-two percent of the 1,000 registered voters who where asked to voice
their opinion about needle exchange programs did not approve of them (Bowdy 28).
Some critics claim that needle exchange programs may increase drug use and
encourage promiscuity (Bowdy 27) while others fear contaminated needles will not
be disposed of properly creating a "public health hazard" (Bowdy 28).
These concerns are understandable but they must be properly weighed against the
benefits to society as a whole. An effective needle exchange program in Windham
Connecticut was shut down after a needle that was improperly disposed of pricked
a two-year-old girl (Connecticut 5). Researchers interviewed a number of clients
before and after the program was terminated to determine the number of
participants that secured their injection equipment from the street or
acquaintances (Connecticut 5). The number of participants using unreliable
equipment drastically increased from 14 percent while the program was still
operating, to 36 percent immediately after closing, to 51 percent in an
interview three months after closing (Connecticut 5). The status quo remained in
regards to the amount of debris after Windham's program had been terminated
(Connecticut 6). Advocates feel that taking the remote chance of dealing with an
improperly disposed needle is worth saving countless lives for sure. The
frustration of dealing with federal and public resistance is compounded by state
laws forbidding individuals from possessing or distributing hypodermic needles
and syringes that are enforced by all but four states in the U.S. (Glantz 1078).
As a result, needle exchange programs across the country must evade prosecution
regularly. The Chai project is a group of public safety advocates based in New
Brunswick, New Jersey that distributes sterile needles and syringes, condoms,
and valuable information about diseases such as HIV despite interference from
local authorities who are required to enforce laws with which they may or may
not agree (Green 15). Diana McCague, founder of the Chai project, was arrested
after giving an undercover detective a sterile pack of hypodermic needles (Green
15). The judge hearing the case, Terrill Brenner, praised McCague's undeniably
effective contribution to public safety but was forced by law to convict her of
illegally distributing drug paraphernalia (Green 15). McCague wonders "What
kind of society …we live in that people are arrested for saving lives?"
(Green 15). Recently conducted studies of various needle exchange programs
returned rather encouraging results. The number of HIV infections among drug
users decreased of 5.8 percent annually in 29 cities throughout the world where
needle exchange programs where implemented as opposed to a 5.9 percent increase
in 51 cities where they were not (Bowdy 27). The National Institute of Health
claims that needle exchange programs reduce their clients' rate of performing
dangerous injections as much as 80 percent (Fuller 11). From 1991 to 1996 New
York City's rate of drug related HIV cases dropped from 44 to 28 percent (Schoofs
36). Organizations nationwide such as the American Medical Association, the
American Bar Association, and the American Public Health Association have begun
to openly support needle exchange programs (Fuller 11). Donna E. Shalala,
secretary of the Department of Health and Human Services, was asked to
investigate the validity of needle exchange programs as a whole. She concluded,
"needle exchange programs can be an effective part of a comprehensive
strategy to reduce the incidence of HIV transmission and do not and do not
encourage the use of illegal drugs" (Bowdy 28). Needle exchange programs
encourage the participation of addicts in their program usually by giving out
more equipment than is received (Loconte 20). We can not ignore the possibility
that addicts are really motivated to participate in the programs because the
extra equipment received from the program could easily be sold to attain their
next bag of dope (Loconte 20). This will not do the addict any good but it could
possibly keep someone from being victimized to support such a habit. It should
be understood that needle exchange programs are not really concerned with the IV
drug users' reasons behind taking advantage of the services regularly, so long
as they do just that, take advantage of the services regularly. America can no
longer ignore the ominous consequences of its drug abusers and their addiction.
HIV has infringed our society in conjunction with the relentless forces of
addiction for which there is no cure. The perilous habits of a drug addict,
especially an IV drug user, are geared toward getting high (Loconte 15), not
personal health and public safety. However, habitual behavior is not
inalterable. It can be swayed by a little incitement from the brighter, more
intelligent members of society; incitement to support and make regular use of
local needle exchange programs. Although American society may not understand the
driving force behind heroin addiction, we all must understand that it"will
always be with us …[so] we had better learn how to live with [its] …in a way
that minimizes [its] …adverse health and social consequences" (Drucker
15)