This is a public service announcement:

For your health and well-being, the United States of Me kindly requests that you shut the f*ck up about my work with needle exchange.

That proclamation is to serve as a slightly comedic, mostly serious introduction to today’s topic – Needle Exchange: Preventing HIV vs. Enabling Heroin Addicts.

First, allow me to introduce the topic to those of you unfamiliar with it. Needle Exchange Emergency Distribution (NEED) is the large needle exchange program (NEP) in the Bay Area. NEPs are based on the health care model of harm reduction. They are usually established in the face of skyrocketing AIDS rates. In this area, San Francisco and other counties declared a state of emergency due to AIDS a few years ago. AIDS rates of IV drug users (IDUs) can range from 25-60% in different areas.

IDUs contract HIV due to the sharing of needles. It is illegal in most areas to possess needles without a prescription (for example, given to diabetics needing to inject insulin). Opiate withdrawal does not merely suck sweaty ass, it kills, sometimes, especially if the cold turkey method is used outside of the naloxone-dispensing expensive rehab centers. When IDUs need to inject, they really, physically, need to inject. Opiate addiction is one of the most physical of all possible addictions. In the absence of clean needles, they will use old ones, even ones on the street or in abandoned housing. Once HIV penetrated this community, it is easy to see how it would naturally spread like wildfire.

NEPs were developed in response to the alarming levels of HIV transmission due to dirty needles. They claim not to advocate drug use but rather to provide individuals with the healthiest possible choices within a decision that they have already made. Opponents claim that they are enabling drug use, diverting candidates from rehab, and encouraging initiates to use because of the facility of attaining all but the main ingredient through the NEP.

Admittedly, certainly, there is logical reasoning to the argument of those that believe NEPs are the work of misguided enablers. Not only do NEPs provide individuals who might have been hesitant to use because of HIV risk with clean and sterile alternatives, they also provide a venue through which to connect with experienced users who can provide further assistance to them in their path to full-blown addiction.

The founders of NEPs are not idiots. They recognized this possibility. So, we had a hypothesis. The hypothesis was that NEPs enable heroin use. And what better to do with a hypothesis than to test it? Surely, you’re not going to take it out to lunch, as it doesn’t have a stomach, and inviting it to do so might hurt its feelings. No, it seems like testing it is the best idea.

Let the scientific mountain of support begin to accumulate. Some of the most extensive studies to date have been completed by UCSF AIDS Institute, one of the best, if not THE best, AIDS research facilities in the world. They studied 52 cities throughout the world, mostly in Europe. The cities with NEPs experienced an overall 6% decrease in AIDS whereas the cities without NEPs experienced an overall 6% increase in AIDS. No rise in heroin use was reported in any NEP city. In fact, candidates for rehab were often reached through NEPs that would refer them if, and only if, they asked for such assistance.

Once NEPs were legalized in 2000 (at least in this area), the fight for federal funding began. Previously, NEED here in Berkeley was an underground operation, activist hippies passing needles out from a baby carriage, sometimes being arrested once discovered. In 2000, significant research mandated the legalization of the programs. However, in the current federal political environment, funding for the projects is banned. The government put together a research panel to recommend whether federal funding should be used for NEPs. Out of eight participating institutions, eight found NEPs to be effective AIDS prevention policy, six of them going on to recommend funding and two of them abstaining from recommending or not. Despite this, the federal government refused to lift the ban as the results did not come out as they wished. NEPs have been supported by the former head of the Department of Health, the former head of the NIH, and the former Secretary General.

Why, though, do NEPs NOT increase drug use? Opiate use is a complex psychological and physical process that is independent of facility of obtaining supplies. If supplies are there or drugs are there, people will find them. Unfortunately, often what they find are low-quality or dirty supplies and drugs, increasing not just their risk for HIV, but also their risk of overdose and death.

But some people don’t care about the IDUs. They did it to themselves, they claim. If that is your stance, though I disagree with you, I would still urge you to consider the innocent people that are also at risk for HIV transmission due to the behavior of IDUs, particularly the sexual partners and even children of users. How do you look at a baby with HIV from its mother’s drug use and not have NEPs in the back of your mind, wondering if they could have saved these two lives?

Unfortunately, police officers often target IDUs coming to NEPs, waiting across the corner to arrest them with drug paraphernalia charges. This causes fear that I have personally seen in participants, many of whom come for their friends, even their parents. Some of the people who pick up supplies are not IDUs but they know their father is and want to protect him. Meanwhile, NEP volunteers face criticism and misunderstanding from the local communities, people screaming about how we are helping “dope fiends� and bringing them into the neighborhood.

Right now, one of my friends refuses to talk to me because of “what I am doing.� I hope that we will come to a more enlightened conclusion, based on the substantial scientific evidence, for the good of the world community that is facing a raging AIDS epidemic.