The New York Times - Wednesday, March 3, 2004
Lynda Richardson

ALLAN CLEAR, the executive director of the Harm Reduction Coalition, has spiky graying hair that suggests it came into contact with an electric socket. At age 44, with pierced earrings and lace-up Doc Martens, Mr. Clear looks as if he has not quite gotten over his English youth as a working-class punk rocker.

Yet Mr. Clear has a calm and reasoned manner, not that of a hardened rabble-rouser, as he gives a tour of the coalition's garment district offices, where the literature and posters leap out from the moment you enter.

There is the safety manual for injection-drug users, called "Getting Off Right." And the new hepatitis C prevention campaign, "It's All About the Blood." There is a poster urging, "Fix With a Friend," to prevent heroin overdose. "Taking Drug Users Seriously," another poster states.

Mr. Clear, who heads a national coalition that develops public policy and trains social service workers, is used to operating as a maverick. He promotes the exchange of drug users' dirty needles with clean ones to curb the harms associated with drug use, especially the spread of H.I.V. And over the years, he has become accustomed to working without much support from the city. "The door was closed," he says.

But now Mr. Clear has found an ally at the highest levels of city government in ways the coalition never had before.

Dr. Thomas R. Frieden, the city's health commissioner, is aggressively and publicly pressing the case for needle exchange programs as an H.I.V. prevention strategy in several neighborhoods in Queens, a borough without any such programs and with some resistance to them. Dr. Frieden has noted that in the early 1990's, when needle exchanges were relatively few, 50 percent of injecting drug users were H.I.V. positive. Today, he says, that figure is about 12 percent.

"This administration is like night and day from administrations in the past," Mr. Clear says. "There's a willingness to take on a difficult issue, certainly to address the public health point of view as opposed to the political point of view. It's been marginalized for a long time."

To start a needle exchange program in New York State, community groups must go through an often cumbersome process to obtain a waiver from the state's Health Department.

Mr. Clear's coalition, which was started in San Francisco in 1994, serves as a lead agency on the issue between the city and community groups. It is working on plans to help establish needle exchange efforts in Queens, which would be run by the AIDS Center of Queens County. The coalition is coaching the staff on regulatory matters and on how to operate an exchange if it wins community board approval.

"Allan has been an effective and dedicated advocate for harm reduction for more than a decade," Dr. Frieden says of Mr. Clear in an e-mail. "He's an important resource to helping improve the health of the hard to reach New Yorkers in need."

Mr. Clear is a quiet sort, but quietly passionate, too. Still, there has always been a bit of the outlaw in him.

On his office walls are black-and-white photographs that he shot of demonstrations in support of needle exchange, some taken when he was one of the shock troopers for the militant AIDS activist group Act Up. (He was arrested three times, but concedes that his is a lightweight rap sheet when it comes to Act Up.) There also are pictures from his travels in Croatia and the Gaza Strip, where Mr. Clear covered civil strife as a freelance photographer.

He says he cannot remember a time when he was not concerned about social justice. He grew up in Portsmouth, England, where his father held jobs as a mechanic and a bus driver. His mother was a telephone operator.

MR. CLEAR arrived in New York at age 22. He worked as a bartender but mostly became immersed in the drug culture. His cocaine addiction grew. He is a veteran of Alcoholics and Narcotics Anonymous.

Throughout the 1980's, working as a bartender and a waiter, Mr. Clear was struck by the number of colleagues who were H.I.V.-infected.

"Being surrounded by so many people dying of H.I.V., it was too painful for me to sit back and not do anything," he says. "It was clear to me that I should be working with drug users; that was my community. I couldn't sit by and watch what was going on without doing something when there was a solution to it."

He became involved in underground needle exchanges years before the state, in 1992, provided waivers to some community groups to do it legally. In 1992, he went above ground to head the Lower East Side Harm Reduction Center, which had official state authorization.

"Harm reduction is not making drug use solely acceptable, but it's accepting that people use," he says.

He was hired to run the coalition in 1995, and moved its base from San Francisco to New York because he lives here, in TriBeCa, with his wife, Cynthia Springer, a holistic medicine practitioner, and his 13-year-old stepson, Zachary.

Mr. Clear looks forward to the day when needle exchange programs are completely normalized in society, when advertisements for them become as common as, say, subway campaigns promoting safe sex and condom use.

"Being an advocate for the health of drug users is not a popular thing," he says. "But I wouldn't do this if I wasn't overly optimistic."

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