Bay Windows - Local News, December 2, 1999
Scott A. Giordano, Bay Windows staff

Needle-exchange programs allow the distribution of clean syringes to IV drug users. AIDS advocates say such programs -- now up and going in Boston, Cambridge, Northampton and Provincetown -- have saved thousands of lives in the Commonwealth. Meanwhile, activists and physicians who treat people with HIV agree that local politics are standing in the way of saving thousands of other lives in places like New Bedford, Springfield and Worcester -- where programs are yet to be enacted despite high rates of HIV infection among IV drug users.

Opponents argue that such programs indirectly encourage drug use and bring increased taxes and health care costs, in addition to increased crime rates to local neighborhoods. But a range of activists and physicians countered all those claims on Nov. 30 and said there are no valid reasons to block life-saving programs from being put into place.

"I come here as a primary care doctor and a physician to homeless people in Worcester ... who are being infected with [HIV] in disproportionate numbers," said Erik Garcia, from the Homeless Outreach and Advocacy Project in Worcester. "I have seen what is the right solution to [the HIV/AIDS] epidemic, and I find that local politics have overwhelmed the public health issue [t]here.

"For those who would say it is unreasonable to use the taxpayers to pay for such a program, they don't understand that we are already paying for not having the program. The health care costs for even one person infected with [HIV] would more than cover the cost for a year of a needle-exchange program," he added. "For those fortunate enough not to have been touched by this disease, who may not know even one person who has been infected, I would say to them, 'Look at this as a way to keep it that way.'"

John Rich, medical director of the Boston Public Health Commission (BPHC), spoke about the opposition faced by Boston AIDS advocates when they first established Boston's needle-exchange program in 1994.

"When we established this, we heard all of the reasons that we shouldn't: There will be increased crime; there will increased drug use; neighborhoods will be unsafe. But our evaluations have shown that this is not the case," Rich said. "In fact, these programs were put together with the help of the police and neighborhoods themselves, and they have worked. ... We believe [the programs are] a critical tool in addressing [the AIDS epidemic] across the state"

Robert Greenwald, director of public policy and legal affairs for the AIDS Action Committee, the state's largest AIDS-service organization, cited statistics from the Massachusetts Department of Public Health (DPH) as evidence that needle-exchange programs are needed.

"In Boston, where needle exchange is successfully up and running, intravenous drug use represents the mode of transmission in 29 percent of people living with AIDS. In Worcester, Springfield and New Bedford, where needle exchange does not exist, needle exchange represents 53 percent, 57 percent and 58 percent of people living with AIDS. It is now time for the governor to act," Greenwald said.

"The governor must place science over politics and show that he is a bold and caring leader. He cannot yield to the fear or complacency of other elected officials," Greenwald added. "When state legislators or local politicians are too slow to respond, and the public health is threatened, the governor has the authority to act. The governor has the power to declare a public health emergency. Our governor has done many good things in the fight to end this epidemic. The lives of Massachusetts residents depend on his willingness to show bold leadership once again."

Representing more than 500 physicians who support needle-exchange programs, Catholic priest and physician Jon Fuller from the Boston Medical Center, countered claims that such programs send the wrong message to citizens in the commonwealth.

"The most frequently voiced objections to these programs ... is that they ... send the wrong message that drug use is permissible or can be made safe. Gov. Cellucci, there is not indication that the wrong message is being communicated by needle-exchange programs. If it were, we would see non-addicts beginning to inject drugs and [we would see] increasing drug use by chronically addicted persons, but we do not," Fuller said. "You have the responsibility to recognize this ... not as a political issue, but as a public health emergency. ... We ask you to have the political courage to move beyond a non-substantiated objection about sending the wrong message to communicating the right message that the lives of all Massachusetts citizens are valuable, even those on the margins of society whose lives have become trapped in the vicious cycle of addiction."

Following the Nov. 30 press conference, Cellucci spokesman Jason Kauppi said the same day that the governor is committed to the battle against HIV/AIDS but has no plans to declare a public health emergency at this time.

"The success of a program like that depends, in large part, on the willingness of the community. If more communities want to have them, DPH is ready to assist them," Kauppi said. "That is not to say that there isn't a serious public health problem, but it's a problem that is being addressed on many levels by state government. Needle-exchange is only a portion of any effort to battle AIDS and HIV."

But Garcia said the governor now needs to take proactive steps to curb new HIV infections,

"I come here as a person who is morally concerned that we are permitting people to become infected when we have the means to prevent it, when people become infected simply by the virtue of where they live in Massachusetts," he said. "For those of us who work in this field, we work with some of the most disenfranchised, people who have the least voice. ... We see needle-exchange as a hope to ... keep people from needlessly being infected."

"We at the [BPHC] recognize that we are at the midst of a critical public health emergency. As a physician, I can't understand why we would take something we know could work and deny it to people simply because they have an addiction," Rich added. "In the city of Boston, we have delivered needle-exchange programs since 1994, and we know that it works."

Among the organizations that have endorsed access to clean needles: the American Academy of Pediatrics, the American Medical Association, the American Public Health Association, the Centers for Disease Control and Prevention in Atlanta and the National Institutes of Health.
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