Hope and (Ex)Change

What the election means for heroin users.

by Isaiah Thompson

voting really matters

Michael T. Regan NEEDLE EXCHANGER: Jose Benitez of Prevention Point, which runs Philly's only sanctioned clean-needle program. (CLICK IMAGE FOR LARGER VERSION)

Take an afternoon stroll down Kensington Avenue, and you're likely to hear a certain word coming softly from the mouths of ragged-looking men on the corners. As you walk, you hear it repeatedly, again and again, like a kind of chant: "Works, works."

"Works" means needles.

In the state of Pennsylvania, it is illegal to buy, sell or distribute syringes without a prescription. But people who inject drugs — likely tens of thousands in the metropolitan region, according to one estimate — need to find their needles somewhere. One place to get them is on the Avenue — that is, on the street. But street needles might not be clean.

There is another way: Drug users can go to a van staffed by the nonprofit Prevention Point Philadelphia and exchange a dirty needle for a guaranteed-clean one. The program began in 1991; a year later, then-Mayor Ed Rendell issued an executive order legalizing needle possession in Philadelphia, in contradiction to state law. Strictly speaking, the program is still illegal. For 17 years, though, the city of Philadelphia has not only tolerated the program, but helped fund it.

Why? Because it works.

The difference between a clean needle and a dirty one can easily be a matter of life and death. Historically, drug injectors have suffered extremely high rates of HIV/AIDS and other diseases, like Hepatitis C. But those numbers, here and elsewhere in the country, have been decreasing: In Philadelphia in 2002, the number of new HIV/AIDS cases likely resulting from injection drug use represented more than 30 percent of all HIV/AIDS cases in the city; by 2006, the most recent year for which data is available, that number had dropped to just under 20 percent. Overall, new infections among drug users have declined 80 percent nationwide since the late '80s.

It's hard to say how much of this decrease is attributable to needle exchange, but national studies, including one authored by the Surgeon General eight years ago, have consistently shown the programs to be effective without increasing drug use.

"The only risk categories where HIV was actually lowered [in Philadelphia] was in needle drug users," says Prevention Point executive director Jose Benitez. "We think that is happening ... because of the syringe exchange."

Yet, of the many AIDS programs operating in the city, Prevention Point, the only sanctioned needle-exchange program, is one of the least-funded. The entire operation — which also includes disease testing, counseling, condom distribution and referral services — operates with a full-time staff of only 15 and a shoestring budget of $1.5 million annually (with less than $500,000 for syringe exchange), most of which comes from the city.

The reason one of the city's most successful anti-AIDS programs is also one of its least-funded is a federal ban from 1988, which prohibits the spending of any federal money on needle exchanges. Of the over $35 million spent by the government every year to stop the spread of AIDS in greater Philadelphia, not a penny of it funds clean needles.

That could change. You won't hear Sens. Barack Obama and John McCain talk about needle exchange in their debates, and you have to dig deep to find any mention of the subject on either of their Web sites. Still, there's a difference between the two. Obama has publicly and consistently supported lifting the ban. McCain has declined to take a stand, and his campaign did not return multiple phone calls and e-mails asking for his position on the issue.

Obama wouldn't be the first president to contemplate lifting the ban. Ten years ago, anti-AIDS activists had reason to hope President Bill Clinton would do so. Built into the original measure is a provision allowing the secretary of the U.S. Department of Health and Human Services to lift the ban if the government proves that such programs reduce the spread of HIV/AIDS and don't encourage drug use.

In 1997, Clinton HHS Secretary Donna Shalala issued a preliminary report doing just that. But in April 1998, in the immediate wake of the Monica Lewinsky scandal, Shalala announced that while needle exchanges did reduce the spread of HIV and did not encourage drug use, the administration would not lift the ban.

Since then, needle exchange programs have multiplied anyway. Many run on shoestring budgets.

"They might have one or two people, maybe a couple of volunteers, often no one receiving anything approaching a reasonable salary," says David Purchase of the North American Syringe Exchange Network in Tacoma, Wash. "And often they are under some degree of legal pressure."

Besides allowing programs like Prevention Point to expand, federal funding "would legitimize these smaller programs," says Allan Clear, executive director of the Harm Reduction Coalition, an advocacy group. "Even though it helps individuals, in some cases it's civil disobedience."

This is why, for needle exchange programs (and the public health community), syringe access is very much an election issue.

"We're reaching a small percentage of people who are using," Benitez admits — about 4,000 Philadelphians every year. And even if they could somehow double that number, they wouldn't be able to afford the syringes. In 2006, Prevention Point exchanged 1.2 million needles. Cheap as they are — 10 cents apiece — those costs add up fast.

With three weeks to go until Nov. 4, it's probably a safe bet that neither presidential candidate will mention the ban on funding needle exchange. But with AIDS rates persistently high, it's just as likely that ban opponents won't stop lobbying to have it scrapped. Recently, House Rep. Jose Serrano of New York introduced a bill — the Community AIDS and Hepatitis Prevention Act — which likely won't come to a vote until after the election.

If someone — Serrano, Obama or anyone else — does try to lift the ban, the religious-right and concerned city residents will undoubtedly fight it. But Benitez hopes they'll come to see needle exchange as more a matter of numbers than of morals.

"There's a sense in the populace that these are separate behaviors that don't apply to general society," he says. "But these people are in our families, they're in some cases doing normal things that everyone else does. They have sex, they sometimes use condoms and sometimes don't."

"This is a public health issue," he emphasizes. "To pay a dime for a syringe that could prevent HIV — that's good policy."

Prevention Point, 166 W. Lehigh Ave., 215-634-5272, preventionpointphilly.org.

THIS ARTICLE HAS BEEN CORRECTED: Originally, I wrote that needle drug users are at risk for Hepatitis B. This is true — Hep B can be spread through needle use —but the far greater threat for needle drug users is Hepatitus C, a liver disease which is primarily spread through needle drugs and which can be very difficult to treat. According to the Center for Disease Control and Prevention, approximately 3.2 million people suffer from chronic Hepatitis C Virus (HCV) infections. —IT

(isaiah.thompson@citypaper.net)