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Houston physician Richard Evans is convinced that it is good medicine to collect used syringes from junkies and provide clean ones, to prevent the spread of AIDS. At a recent international conference on drug policy held at Rice University, Evans saw an opportunity to sound out Lee Brown on the issue. The mayor had just delivered a speech touting education and prevention as keys to winning the "drug war." When he was done, Evans pounced.
Why doesn't Houston have a needle-exchange program like most other major cities, the doctor wanted to know.
"I think you are aware that AIDS is decimating our community, particularly the African-American community," Evans said.
"The policy we had at the federal level was that if [a needle-exchange program] reduces the use of drugs, or doesn't in-crease the use of drugs, there's nothing wrong with it," he said. "In fact, you could use federal monies for the needle-exchange programs if the surgeon general would make that determination -- that it would not increase the drug use and would help reduce the drug use."
Brown jumbled his facts in a way that some found disconcerting for a former drug czar. To begin with, says Kevin Zeese, president of Washington, D.C.-based Common Sense for Drug Policy, it was the role of the Department of Health and Human Services -- not the surgeon general -- to determine whether needle-exchange programs met funding requirements. And Donna Shalala, the former health and human services secretary, concluded that such programs did meet the key criteria: reducing the transmission of HIV without increasing illegal drug use.
Shalala was not alone in her support of needle-exchange programs. Zeese says that it costs more than $100,000 to treat a person with AIDS and only pennies to supply a clean syringe. The American Medical Association, the Centers for Disease Control and Prevention, and ex-surgeon general David Satcher, among others, have endorsed needle exchanges. Despite widespread support, the Clinton administration ultimately blocked funding in the face of an angry backlash led by General Barry McCaffrey, Brown's replacement as drug czar.
Funding is not the only problem faced by needle-exchange advocates in Texas. State law makes it illegal to provide syringes knowing that they will be used to inject an illegal drug. That has not stopped AIDS-prevention advocates in Dallas, Austin and El Paso from testing the waters for the sake of public health.
"The state law applies equally here," says Dr. Marty Krepcho, the founder of the Dallas Area Needle/Syringe Exchange. Operating a needle exchange "is really a matter of choice and conviction."
Krepcho, a psychologist, saw the need for a needle program when he was director of Dallas County's AIDS education program. He found pockets of addicts throughout the city and knew they were at risk of contracting HIV, hepatitis C and other diseases. He launched his needle-exchange program in June 1992, running it on his own time and independently from his other work. Today, he and three volunteers operate openly out of his pickup in predominantly African-American neighborhoods. Their goal is to provide one clean syringe for every used one turned in. In 2001 they distributed about 250,000 needles, he says.
They also dispense condoms, provide screenings for HIV and other diseases, and make numerous referrals to drug treatment facilities.
"Our primary purpose is to take the used syringes out of the community," he says. "What we're really trying to do is get the message out there of how they can reduce harm to themselves in any number of ways."
Krepcho discussed the purpose of his needle exchange with police officials before he launched it, and has found local law enforcement "more protective than divisive." One of his regular stops is a street corner that's 50 yards from a police storefront, he says. But being tolerated is one thing; being actively supported is another. The program receives no public funding. Nearly all of its $15,000 annual budget comes from the North American Syringe Exchange Network, a Tacoma, Washington-based organization that supports many of the more than 200 needle exchanges across the country.
Austin has two needle exchanges that operate less openly than their Dallas counterpart. Brad Lindgren, a volunteer at Austin Is Reducing Risk, says he and his fellow volunteers take to the streets with knapsacks full of needles and condoms. He makes sure that addicts turn in dirty syringes before he hands out clean ones. A former addict himself, Lindgren doesn't preach to junkies. But he feels his steady presence has made an impact.
"I've gotten a lot of people into treatment and off the streets," he says.
As of January, Harris County had 19,223 reported AIDS cases -- 57 percent more than Dallas. More than 20 percent were linked to injecting drugs, according to Texas Department of Health data. The need for a needle-exchange program is evident, says Eric Roland, director of education at the Montrose Clinic, a health care center that focuses on HIV prevention and care. Visitors frequently come looking for clean needles, he says, but the clinic does not provide them.