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Needle exchange & User rooms
Written by Ernest Drucker   

By Ernest Drucker
In a dark season, one million points of light

This October, despite a national drug control policy prohibiting needle exchange programs - a policy that even extends to forbidding government sponsored research on the role of clean needles in preventing AIDS - the one millionth set of clean works was distributed in the USA. As of November 1990, needle exchange programs are operating in over a dozen US cities and more are being added each month - often in the face of harassment, arrests, and threats of violence.

Some of these programs are operating under the auspices of local health authorities using public funds, as in Tacoma in the State of Washington and in New Haven, Connecticut. Others use private and charity funds, but operate with the tacit consent of the local authorities, e.g. San Francisco’s Prevention Point (see IJDP Volume 1, number ¢), and programs in Honolulu, Hawaii; Boulder, Colorado; and Portland, Oregon. Still others operate without official sanction and outside the law. In New York and half a dozen other cities on the East Coast, the National AIDS Brigade and Act Up are out there distributing needles at the rate of 200-300,000 per year - and getting arrested at the rate of about twice a month.

Local prosecutors differ in their zeal for this part of the war on drugs - some ignore the programs, others arrest and let the charges drop. And some, as is the case in New York City and Worcester Massachusetts, are ready to go to trial. The New York "10" includes Jon Parker - acquitted in Boston, but since arrested in ten cities across the US, and Rod Sorge and Richard Elovich, who head the NYC Act Up Needle Exchange.

Given this wide range of activities and their very different circumstances, it never occurred to anyone that we in the US really had a national program of needle exchanges. But two meetings, one week and 3000 miles apart, brought that point home in a most forceful way. For, when we added up all the numbers, we discovered that clean needles and syringes are now being distributed at the rate of over 1,000,000 per year in the USA.

The first meeting was on October 20, organised by Dave Purchase in Tacoma, at the Point Defiance Health Project. The name is geographic in origin, but anticipates the personal courage and sense of direct action politics that, in May 1989, led Dave and others to set up the Tacoma exchange by "simply" putting a table out in the street with needles, syringes and AIDS education material. And daring anyone to stop him. Dave’s meeting focused on the pragmatic aspects of operating exchange programs and began the process of formally knitting the groups now doing the job into a support network.

The second meeting took place in Washington DC on October 25, under the sponsorship of AmFar - the American Foundation for AIDS Research. AmFar is the largest and most visible AIDS specific charitable organisation in the US - Elizabeth Taylor is the National Chairperson and the outspoken Dr Mathilde Krim its founder. In 1989-90 AmFar gave $300,000 to help several exchange programs operate and conduct evaluation studies.

In addition, this second meeting was organised by the Washington based AIDS Action Foundation - a national lobbying organisation which has been most effective in influencing AIDS related legislation in the US. The involvement of these "mainstream" AIDS organisations in supporting our burgeoning needle exchange activities takes them a step closer to formal institution and legitimization .

The Washington DC meeting stressed the issues of changing US policy and extending exchange programs to other localities. Special emphasis was placed on the potentially divisive conflicts between these public health programs and racial politics in America. The perception is that needle exchange programs might signify "abandoning" minorities to drug use and give "the wrong message" - especially if the bearers of this message are white professionals and the drug using communities are largely Blacks and Hispanics.

This issue has paralysed official action in New York City, where the Black mayor and health commissioner closed the city’s modest pilot program last year (see IJDP volume 1, number 5) and more recently has led to the arrest and prosecution of ten activists from Act Up and Jon Parker’s National AIDS Brigade.

The Washington DC conference spent hours struggling with the questions of perception and reality in the racially polarised climate of the drug wars. While the meeting, and the programs it represented, did include many minorities who actively and vocally support this approach - the issue is still deeply divisive in America. And there is no simple, quick solution - no general tradition of trust or good faith on which to build. But there are local examples of well rooted, community based drug and AIDS projects, which are now extending their activities to include needle exchange - and these seem more easily accepted.

Dr Harold Cottman, a Black physician and Baptist minister working in Oakland, California, spoke eloquently of the need to develop a "theology" to support needle exchange in the Black churches - the key institutions of the Black community in the USA. He pointed out that the arguments that really reach the Black community relate to programs that protect women and children.

"We need to get out the facts of the way these exchanges, and other AIDS efforts, protect lives and increase the likelihood of people getting into treatment to deal with drugs and other problems", he said.

What also emerged from the Washington DC meeting, was a set of ideas about the political process that can lead to wider public acceptance of needle exchange programs, and two instances of their successful establishment under local health authorities sponsorship and funding.

In Honolulu, Hawaii, Aaron Peak and the LIFE Foundation carefully constructed a base of political support over the course of two years. LIFE built a strong coalition that included the State Director of Health, the State chapter of the American Academy of Pediatrics, the Haemophilia Association, the State AIDS office, the Hawaii Medical Association, the Hawaii Public Health Association, the Hawaii Council of Churches, and over thirty other civic, professional, and community associations. They were so effective that before they started a public opinion poll showed 62% supported the exchange idea. They even got the LIONS club to help. And while the State Attorney General threatened prosecution, the State Police Chief signalled his support. The Governor signed the bill authorising the program on June 5th and the first needles were distributed one month later on July 5th. The Hawaii program is already seeing over 200 clients in Honolulu’s Chinatown, with plans to expand to five more sites in the coming months.

Elaine O’Keefe and Anthony Stewart, directors of AIDS outreach work from the New Haven, Connecticut, Department of Health, described how they had built a base of community and legislative support for a demonstration project with four paid staff and a new van operating five days a week. They passed around a sample ID card for the program. The client may use a pseudonym, but the card identifies him or her as a participant of the "Needle Exchange Program of the New Haven Health Department" and gives protection from prosecution for possession of works. New Haven built its exchange program on four years of AIDS outreach efforts, a project already well rooted in the community with a high prevalence of "where a lot of people have already been touched by AIDS" Elaine points out. Despite these impressive gains, there are still formidable obstacles to extending such programs and integrating them with other AIDS prevention activities. The New Haven program, for example, is prohibited from coordinating its needle exchange activities with the teams of Community Health Outreach Workers (CHOWS), who are supposedly involved in closely related activities - eg, distributing bleach kits (minus needles) and instruction on safer injecting; condoms and instructions on safer sex; and referrals to health care and day treatment. But the New Haven CHOWS are funded, in part, by NIDA. Since NIDA prohibits the use of its funding for any program involved in needle distribution, State Health officials (too timid to resist NIDA pressure or, possibly, themselves hostile to the exchange program and hiding behind "outside" pressure) have prohibited programs from coordinating their activities, e.g. working the same territory at the same time - the logical thing to do.

Similar pressures have been felt in San Francisco and in Tacoma - where NIDA has been after the Pierce County Health Department closely to justify the working hours of all outreach personnel it funds - to assure that none of their time is devoted to the needle exchange program. This particular piece of government insanity led the DC meeting to form a Working Group which will examine the ways in which NIDA funded programs are, in fact, feeling pressure to distance themselves from needle exchange programs operated by the same local health authorities. Assuming that this pressure is real, the Group plans first to seek public clarification of NlDA’s policy and then orchestrate pressure in Congress to change it.

But a corner has definitely been turned in the US and there is no chance of going backward. While Jesse Helms, the senior demagogue of American politics and architect of the Federal prohibition on needle exchanges, has been re-elected by his fellow North Carolinians, court challenges to his censorship of art and free speech (the Mapplethorpe exhibition and performances by ‘2 Live Crew’) have yielded acquittals. We expect the same if any of the US needle exchange trials ever reach a jury.

needle and syringe exchanges operating in the U.S. (november 1990)¹

Tacoma (WASH)
August 1988
sponsored and partially funded by City Board of Health 3000 1500 (50%) 300.000
New Haven (CONN) 1987
AIDS Brigade Oct 1990 dept of Health
sponsored and funded by City Dept of Health, AIDS Division 3500-4000 500 (15%) 100.000
Honolulu (HA)
July 1990
Operated by LIFE Foundation Private funding State sanctioned 10-12.000 150 (1.2%)ª 7500
Boulder (COL)
May 1990
City Health Dpt sanctioned and some DoH staff 800 113 (15%)ª 2000
San Fransisco (CAL)
Nov 1988
Sponsored and operated by Prevention point Tolerated by health & police no public funds 12-16.000 2000 (18%) 300.000
Portland (OR)
Nov 1989
Community operated partially funded by County DoH & Armfar 7-10.000 500 (5-8%) 60.000
Seattle (WASH)
March 1989 Act Up, May 1989 DoH
Sponsored and funded by DoH 10-15.000 2000 (15%) 200.000
New York City (NY) AIDS Brigade 6/88 Act Up 10/89 Not sanctioned Prosecuted 200.000 1500 (<1%) 120.000

TOTAL 250.000 8263 (<4%) 1,089,500

¹This is not a complete list. There are underground exchanges operating regularly or occasionally in at least ten other cities including providemce, RI, Hartford, Conn, Boston & Worchester, Mass, Jersey city and newark, New jersey, wilmington, delaware and Washington D.C.
ªProgram capacity set to expand significantly after start up.


Our valuable member Ernest Drucker has been with us since Sunday, 19 December 2010.

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