Unusual Program Delivers Clean Needles to Drug Users
BOULDER, Colo. (AP) _ Roberto Dansie was scared the first time he approached a tough-looking drug user to offer a clean needle as part of an innovative AIDS prevention program, one of only a handful in the United States.
″I saw these tough guys and thought, ’He’s checking me out from top to bottom,‴ Dansie said, recalling how he convinced the drug user that he wasn’t an undercover cop, but a county health counselor actually delivering a hypodermic needle along with information about how AIDS spreads.
″It takes a matter of time to overcome the distance, apathy, resentment and suspicion,″ he said. ″I must assure confidentiality. I put myself on the line.″
Dansie’s work is part of a three-month, county-funded program to discourage intravenous drug users from sharing needles, a major way in which the AIDS virus is transmitted.
There are at least three other needle distribution programs in the country. New York City and the Tacoma-Pierce County Health Board in Washington state operate publicly funded programs and Seattle has a private program. Opposition has blocked similar programs in Los Angeles, Chicago and Boston. One in Portland, Ore., has been delayed by liability insurance concerns.
The Boulder County program is the only one in which counselors visit users’ homes to exchange needles.
In New York City, users can sign up for the program and exchange needles only at one Health Department office, because community opposition prevented opening other sites. In Tacoma and Seattle, users exchange needles at tables set up on street corners.
Recently, Dr. Louis W. Sullivan, U.S. secretary of health and human services, endorsed local needle-exchange programs as an AIDS prevention tool.
The concept has been criticized in many areas as promoting illegal drug use. But when the program was adopted in this relatively liberal county northwest of Denver during a hearing Feb. 13, only two of the nine people who spoke opposed the plan.
Officials estimate 200 IV drug users live in the county. About 29 cases of AIDS have been documented since the county started collecting information in 1984.
County health counselors visit about two dozen drug users weekly to exchange needles, and offer information about safe sex practices and substance abuse, Dansie said. Either they already were involved in counseling or were contacted through friends who are former users.
Dansie said he makes it clear that there must be no dealing and no drug use while he is visiting. If he sees drugs, Dansie said he must report it to authorities.
″I am very upfront in that because I also have another responsibility,″ he said, referring to fighting drug abuse.
On the first visit counselors give users five needles for one used needle. Later, they replace needles on a one-for-one basis and teach them about sterilizing needles with bleach.
The program, which went into effect immediately after it was approved, costs about $2,500 for supplies and will be evaluated every three months. There were no estimates available for the administrative costs.
The needle-exchange program has generated ″a tremendous amount of support,″ said Federico Cruz-Uribe, Boulder County Health Department director.
″It wasn’t a controversial decision. It wasn’t like giving out birth control pills in the school,″ he said, which he predicted would have triggered a flood of calls.
However, some residents told Boulder District Attorney Alex Hunter in a recent forum that the program sounded like the government is in the drug business.
″At first blush, it does not sound like good idea to anybody,″ he said. ″But people have got to look deeper and need to understand that the motivation here is to prevent AIDS.
″Boulder is the kind of community where we’re willing to experiment and try some things,″ he said.
Colorado also is unusual in that needles legally can be sold over the couter at pharmacies rather than by prescription.
Dansie, who has been a substance abuse counselor for eight years, said it was difficult for him to decide whether it was proper, morally and ethically, to give needles to drug users.
″It was only after I started to work with people who had AIDS, it was only after seeing babies (who can be infected in the womb) and seeing other implications that I understood for myself what is worse - for somebody to be hooked to a needle or somebody to be spreading AIDS,″ he said.
″I am not enabling people to do drugs,″ he said. ″How could I do my job if I did? We must cut AIDS first ... surviving first and increasing the level of life secondly.″