CAPITAL COVERAGE NEWS SERVICE
media in the public interest
AIDS Experts Okay Needle Swap
by John Zeh
CINCINNATI (July 21) - An alliance of the area's top AIDS care providers on July 14 officially endorsed opening a needle exchange program here to help reduce infection from HIV, hepatitis C, and other blood-borne illnesses.
After several months of study, the Greater Cincinnati AIDS Consortium voted without opposition to approve "availability" of "clean needle access," referral of clients to treatment or rehabilitation services, and development of "public policy" supporting syringe exchanges.
GCAC's blue-ribbon subcommittee on injection drug use (IDU) drafted the position with carefully chosen words, knowing that the issue has sparked vocal opposition from some members of City Council and other area conservatives.
The vote won kudos from individuals struggling with spreading AIDS prevention strategies. "This is a very courageous and proper decision by those who are most informed and closest to the issue, said Councilman Tyrone Yates, who has campaigned for adoption of a needle-exchange program here since 1993.
Religious and anti-drug groups have voiced concern that his plan would send an improper message about drug use. City Councilman Charlie Winburn has promised to work against public and private funding. And elected officials heading northern Kentucky GCAC member agencies, most all of whom are anti-choice on abortion issues, may not be supportive either.
To make matters worse, the area's 1998-2001 AIDS prevention plan relegates needle-exchange to an unfunded priority lower than other proposed tactics.
But Yates and other officials argue that City Council's approval is not necessary for the Board of Health to override Ohio's ban on distributing drug paraphernalia and find funding to implement GCAC's recommendation.
Statistics will document dramatic rises in drug-related viral infections, boost citizen support for clean needle protocols accordingly, and then drive city health officials to declare a medical state-of-emergency, Yates insists.
"This will play out as the numbers increase and the public becomes increasingly aware of the validity and appropriateness of medically-monitored syringe exchange programs as part of a comprehensive AIDS prevention strategy," he told the Chronicle.
Needle-sharing is "directly linked to transmission of HIV disease," the IDU panel reported, citing statistics from the National Commission on AIDS. Nationwide, 32 percent of all adults with AIDS and 71 percent of all females with AIDS are directly or indirectly related to IDU, it said. "Among children with HIV, the majority are infected before birth by an intravenous drug using mother infected through sexual activity with an (IV) drug user."
GCAC voted to okay availability of needle exchange programs which include:
*adherence to public health and infection control guidelines
*education about HIV disease transmission
*confidential HIV testing with pre- and post-test counseling
*access for referral of (IDUs) to treatment and rehabilitation services
*development of public policy to support needle exchange programs with access to health screening and drug treatment services
*utilization of qualified health care providers as resources for quality, cost-effective program outcomes, and
*continued research of the effectiveness of (such) programs which include access to primary heath care screening and drug treatment.
Members of GCAC's subcommittee included veteran City AIDS coordinator Bernard Young, Michael Connley of AIDS Volunteers of Northern Kentucky, Reggie Bronson of Talbert House social services agency, and Ohio AIDS Coalition (OAC) president Steve Townley.
Other GCAC members include Children's Hospital, U.S. Department of Veterans' Affairs, Family service, Hamilton County Department of Human Services, the county Mental Health Board, Jewish AIDS Services, bi-state Planned Parenthood, a private home health care alliance, Social Health Education, University of Cincinnati Medical Center, and three minority AIDS groups.
Ten member groups voted to approve the needle policy; four abstained because approval could not be easily obtained over the summer, participants said.
GCAC vice president Jerry Bedford Jr. praised the panel's report and passage by the 22-member consortium. "If we don't implement this type of hazard reduction now, all of society will pay down the road," he warned, noting escalating costs of treatment and other needle-related fallout.
Even though few people inject drugs, "Everybody needs to be concerned about needle-exchange issues, said Bedford, a member of Naaman's Retreat, a support group for HIV-infected African-Americans. "Society is going to pay in one way or another."
One rising cost is increased liver disease from hepatiis B virus (HBV), which can be sexually-transmitted but is preventable by vaccine, and now, HCV, for which there is no vaccine nor cure.
Prompted by Dr. Evelyn Hess, a GCAC founder and professor of medicine at the University of Cincinnati, the consortium added HCV to the policy. It and other viruses such as staphyococcus "manage to sneak onto needles," she cautioned. "Dirty things put one at risk to a lot of dangers."
City officials logged 1000 HCV cases in Hamilton County over the past 19 months and warned that 85 percent of IV drug users will develop HCV, acording to Victoria Brooks, head of both GCAC and AIDS Volunteers of Cincinnati.
HCV is deemed an silent epidemic hidden among four million Americans with the potential of rivaling HIV in magnitude. The City Health Department's regional Sexually Transmitted Disease Clinic will begin costly testing and counseling for HCV thanks to funding freed up by Director Dr. Malclom Adcock once a screening protocol is finalized.
Funding and minimizing the number of people at risk to HIV also has become more complicated after recent action in Washington. Speaking for OAC, Townley blasted Congress for limiting funding for 1999 HIV prevention to present levels.
"In a time when the federal government has been complacent towards HIV prevention strategies, GCAC has taken a significant step in bringing the need for prevention to the forefront in the battle against HIV/AIDS," he said.
On June 23, the U.S. House Labor, Education, and Human Services Appropriations subcommittee okayed a $181 million increase in "Ryan White" AIDS dollars without increasing prevention spending. (See July 10 and May 1 Chronicles.)
The Congressional panel also proposed a permanent ban on using federal funds for needle exchange programs, an "absurd" move, charged Townley. "To not allocate dollars to these proven prevention methods is an unconscionable head-in-the-sand act, with grave results."
With no federal nor state money in sight, Yates is taking a "build the policy and dollars will come" approach once nascent local support is shored up. "Cincinnati is not too conservative for a syringe exchange program," he insists, "no more, in the final analysis, than it was willing to support smallpox treatment, syphilis prevention, water fluoridation, or intravenous polio vaccination."
"In time, these results too will be acepted by our public as vital and necessary. It won't be a political issue," he said in a confident tone. "With the Board of Health's support, I would not expect any opposition."
