AEGiS-SC: Vancouver's Needle Exchange: AIDS prevention program depends on trust of drug users

Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.

Vancouver's Needle Exchange: AIDS prevention program depends on trust of drug users

San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Thursday, July 11, 1996 - Page A6
David Perlman, Chronicle Science Editor

Vancouver, British Columbia: Few of the 15,000 delegates to the 11th International AIDS Conference here are aware of what goes on in the dark and ugly corners of this lovely Pacific Rim city. But to the handful of delegates advocating needle exchange programs, Vancouver's project is a model that demonstrates an effective way to curb the spread of AIDS. The program has much of its action out on Vancouver's grimy West Hastings Street, where you can buy almost anything -- cocaine, heroin, uppers, downers, sex of any kind. But bleach, swabs and clean needles are free from a province- sponsored program that this year will distribute in the city an estimated 2 million clean needles, plus condoms and swabs, at a cost of $1.1 million. And West Hastings late one night is where a health worker named Manny shows how the program works. He drives his white van slowly along the street, snaking through a seamy network of alleys where furtive young men and women bend over the played- out veins in arms and legs to shoot up. To them, Manny is a kind of benign Pied Piper.

STREET-NAME BASIS

An easy rapport links Manny and his clients, whose names and preferred alleys he knows, and who trust him completely. "Hey Joe, hey Schutz, hey Gloria," Manny greets three clients in an alley where, knowing the van's schedule to the minute, they are waiting for him. Joe drops five used needles into Manny's white plastic box. Manny dumps them gingerly, untouched, into a large yellow plastic "sharps" bin safely inside the van. Then he hands Joe five clean syringes, a package of condoms, a clean water bottle in which Joe can mix his drugs, and a friendly word: "Keep well, man," Manny calls out the open window of his van. "Be safe, don't share." Schutz steps up to the van. "Hey Manny," he says, "I left my rig at home, and I found this one on the street, but it's got blood on it, so I didn't know what to do with it and I need a new one." Manny questions him. Tomorrow night, same place, same time? Will he bring his own rig? Schutz promises, dumps the bloody syringe into Manny's white box, and Manny says:

`DON'T SHARE, AND KEEP WELL'

"OK, Schutz. Here's the rig, but you promised, so don't forget, you owe me your own. So be safe, don't share, and keep well." Gloria steps up to the van window. Thin, young, pretty but wan, and in the dim light of a distant open window her eyes look weary. "I got three, and I need some rubbers," she says, dropping her used syringes into Manny's box. She gets what she wants. It goes year-round. Manny and one other van driver will exchange needles with some 700 clients each night, and hand out some 4,000 clean "rigs." Judy McGuire, program manager for the needle exchange project, said the program's success "is all dependent on the total trust of our clients." "They know us, they rely on us, and it's the best way we know to limit AIDS among drug users." McGuire's office is directly across the street from a Vancouver police station and the provincial courthouse. She and her drivers carry letters from the chief of police authorizing their efforts.

DELEGATES SHARE NEEDLE DATA

Meanwhile, at the AIDS conference, delegates from several nations including Nepal, the Netherlands, Australia and several European cities shared data on the value of their needle exchange programs. The effects were dramatically underscored by a report from Dr. Peter Lurie of the University of California at San Francisco's Center for AIDS Prevention Studies and Dr. Ernest Drucker, an epidemiologist at New York's Albert Einstein College of Medicine. Sharing needles, they noted, inevitably risks sharing HIV-infected blood, spreading the deadly disease itself.

The two researchers analyzed injection rates of illicit drugs throughout the United States and the number of drug users reached by needle exchange programs -- most of them still illegal in most states. They estimated that if the programs had been widely available in the period 1987-1995, as many as 10,000 cases of AIDS could have been prevented in drug users, their sex partners and children. And looking to the future, between 5,000 and 11,000 more "preventable" AIDS cases will occur in the United States before the end of the decade unless the United States ends its national policy that refuses all government funds for needle exchange programs, Lurie and Drucker said.

$500 MILLION ESTIMATE

Refusal to implement legal needle exchange programs has already cost more than $500 million in needless AIDS care, Lurie estimated. That total, he said, is bound to rise. The American Foundation for AIDS Research held a cocktail party for delegates in Vancouver this week, and the star of the event was Elizabeth Taylor, long a genuine activist as the organization's major public supporter and fund raiser. "The federal ban on clean needle exchange," she exclaimed, "is a glaring example of politics and social squeamishness standing in the way of sound public health practice. It is a measured act of premeditated murder!"
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