Their job: Needle exchange.
Their mission: To reduce transmission of the AIDS virus among intravenous
drug users. Many become HIV-infected by sharing needles, then transmit the virus to others through sex and pregnancy.
The increasing connection between drug use and AIDS is alarming. In Philadelphia, as of January, 1991, at least 30 percent of all reported AIDS cases involved drug users. It is estimated that one-third of all drug users in the U.S. are HIV positive. I-V drug use (or sex with a user) is the leading cause of HIV transmission from mothers to children.
Last Saturday, I joined the Prevention Point volunteers, who have been quietly operating the only needle exchange project in Philadelphia since November.
These are no ordinary folks. They are AIDS activists, health prevention specialists and others who believe offering clean needles to addicts and taking dirty ones off the streets is a public health measure so desperately needed that they are willing to risk arrest to see that it happens.
Snow and cold weather did not deter them Saturday. Bad weather also made no difference to the people who approached the group - men and women of all races, some shaking, some lucid, some amazingly healthy-looking.
A few came to ask questions or to get free condoms. But most came to turn in used hypodermic needles, in exchange for ones they knew were clean and wouldn't kill them.
The volunteers count the needles coming in and keep track of those handed out. "Two of bleach, two of water, don't share with anybody," David Acosta reminds everyone.
Many addicts come back week after week, Acosta says. "They are consistent, they spread the word about us. They know we genuinely care about their condition and they trust us. Nobody stands out here every Saturday morning in the cold unless they truly care about these people's health, and their issues."
"Rob," a muscular white male, came up, turned in two needles and got four.
"I found out about this from a friend," he said. "At first, I couldn't find it because I was looking for a building, not an empty lot. I'm glad they're here."
Rob used to share needles, but no more. "Before, I didn't care if I died. But now I don't want to die, and I know I don't have to."
"Frank" read about Prevention Point in the newspaper. He disagrees with the notion that if given the opportunity, addicts won't protect themselves and others against AIDS.
"Addicts know how to clean their works," Frank said. "They come and get clean needles because they care about AIDS and about their families."
Prevention Point members are well aware that needle exchange is not a solution to drug use; treatment and rehabilitation are. This is why their long-term strategy includes pressing for drug treatment on demand and health care for everyone.
In the short run, however, they want the city's Health Department to support community-based needle exchange programs by funding them and incorporating them into the city's public health strategy.
Needle exchange programs are successful in New York, San Francisco, Seattle, Hawaii and some European cities. A government-supported needle exchange program in New Haven, according to a study done by Yale University researchers, reduced HIV infection among IV drug users by 33 percent.
Needle exchange is important to taxpayers too. For each AIDS transmission that is prevented, $60,000 to $80,000 is saved in health care costs.
Philadelphia's policy-makers and political leaders are dragging their feet on laying the groundwork for establishment of this life-saving initiative citywide.
Although a Pennsylvania law makes possession or exchange of syringes without a prescription a misdemeanor, that's little reason for inaction. Connecticut authorized its needle exchange program by special legislation.
Only 11 states still criminalize the sale or possession of needles. Our City Council may be able to authorize a needle exchange program by local ordinance.
Whatever the strategy, it's time our city government got serious about slowing the spread of AIDS. Under present circumstances, assuming that anything other than distribution of clean needles can stop the spread of AIDS among addicts is a grave mistake. Until we are ready to offer addicts drug treatment on demand, we must offer them clean needles so they can protect their lives and the lives of those around them.
Needle exchange is an intelligent, compassionate and cost-effective response to the AIDS epidemic.