Dirty Politics Stops Funds for Clean Needles

When Donna Shalala announced the administration’s decision to recognize the effectiveness of needle exchange (in reducing HIV transmission without increasing drug use) but to maintain the ban on federal funding, she opened up an impassioned debate. Within a week, Republicans in Congress had proposed, and later passed, a bill to prevent any future administration from lifting the ban, under any circumstance.

While the debate over needle exchange has drawn attention to the link between drug policy and AIDS, the discussion of funding has been superfluous. Meanwhile, AIDS in communities of color has reached a new high. The Center for Disease Control’s (CDC) recently issued 1997 report, for instance, documents a dramatic increase in AIDS cases among African Americans and Latinos, with fully 43 percent of new AIDS concentrated among African Americans. Another recent study points to Latinos as the most rapidly growing group testing positive for HIV.

Among African American and Latino women the situation is worse. African American women are fifteen times more likely than white women to contract AIDS, and African American and Latino women together account for seventy-five percent of all AIDS cases among women.

The spread of AIDS in communities of color, and the ban on needle exchange are related, but not as simply as politicians have presented it. Needle exchange is not the magic bullet that the liberals imply. The increase of AIDS in communities of color is not due to the higher incidence of drug use in such communities, as the conservatives like to imply. Drugs do not cause AIDS. HIV causes AIDS; HIV infected syringes cause the virus to be transmitted. Blacks and Latinos are more likely to get AIDS from drugs, or from partners or parents who use drugs, because Black and Latino drug users are more likely to use infected syringes. Blacks and Latinos do not use infected syringes because they like to share, or because they are too poor to buy clean ones. They use infected syringes because most states, including the District of Columbia, have laws that make it a crime to possess or distribute drug paraphernalia not for a “legitimate medical purpose.” These laws, Ricky Bluthenthal at Urban Health Study notes, “make syringes difficult to obtain . . . dangerous to carry [and] creates scarcity at the moment of drug injection.” (Bluthenthal 1997: 18). Paraphernalia laws discourage the possession of clean syringes and encourage the rapid disposal, often on the street, of infected ones.

This problem is compounded in inner city neighborhoods by both differential enforcement and by the more general problem of police harassment. Neighborhood sweeps and fear of arrest have promoted the spread of underground “shooting galleries,” close to drug copping locations where injection equipment including syringes (usually used) are readily available. Studies have found shooting gallery use to be associated with high risk of HIV infection.

The shooting galleries, the sharing of syringes, the difficulty in acquiring clean syringes, and the fear of being caught carrying them, have increased the risk of HIV infection for black and Latino drug users. Among injection drug users, for instance, African Americans are four times as likely to contract AIDS as whites, and Latinos are one and a half times more likely. For adults between the ages of 40 and 45, Dawn Day notes, “the incidence of injection-related AIDS among African Americans is currently eighteen times that of whites, and among Latinos is eight times that of whites” (Day 1997: 7).

HIV infected drug users act as a focal point, for the spread of AIDS throughout entire neighborhoods. The high rate of HIV among black and Latino males in inner city neighborhoods has exposed women (and their offspring), who live in those neighborhoods, to a much higher risk of infection from unprotected sex. In the South Bronx, for instance, neighborhood HIV rates among adults run over 20 percent. A recent Bronx-Lebanon hospital study found that 23 percent of patients admitted for non-AIDS related illnesses were HIV positive. As an editorial in New York Newsday put it, “With that much virus around, just about anyone who is sexually active is at risk” (New York Newsday 1995: A37). Blacks and Latinos have higher rates of AIDS because they live in neighborhoods where the drug war, paraphernalia laws and police harassment have made both injection drug use and unprotected sex extremely risky.

General McCaffrey, in defending his support for the ban on federal funding, argued that the government was not opposed to needle exchange, but feared that federal funding would send the wrong message. This question of funding is beside the point. Needle exchanges are inexpensive to operate and have been operating on shoestring budgets, often illegally, for over ten years. Indeed within days of the administration’s announcement, George Soros committed another million dollars to fund such exchanges.

The much more important point is that in most states, needle exchange is still illegal. Although many needle-exchanges have gotten around the paraphernalia laws by petitioning for waivers, the process is lengthy and arduous. It took D.C. over ten years to get authorization for a single community-based needle exchange. By this time D.C. had the highest rate of AIDS in the nation, and the majority of the new cases were among injection drug users and their partners. In Cleveland the head of a local needle exchange was arrested and held on $10,000 bail. In New Jersey there have been continual arrests of needle exchangers, and this year Jersey City rose to become the city with the highest rate of AIDS in the country. At the same time, the repeal of paraphernalia laws in Connecticut substantially reduced the rate of HIV infection among injection drug users (Bluthenthal 1997: 18). Connecticut now has less than half the rate of AIDS of New Jersey or New York, even though New Haven is a major distribution center for illegal drugs.

Needle exchange is important, but even under the best of circumstances, limited. Even if we multiplied by ten the quantity of needle exchanges in existence, they could only provide syringes for a small minority of injection drug users. This would not be nearly enough to stem the growing rates of AIDS among injection drug users and their partners. To make matters worse, recent studies have found that police harassment impedes the functioning of existing exchanges.

It is critical, then, that the Federal government send a strong message that not only should needle exchange be legalized, but that the paraphernalia laws should be lifted. In the meantime, here in the District, we have among the most restrictive paraphernalia legislation in the nation. Combined with the highest arrest rates, the highest percentage of arrests for drug use, and the recent closing of treatment centers, the District, which recently dropped to second place among the worst AIDS rates in the nation, will be back on top.

We still have the opportunity to reverse this trend and to follow Connecticut in more advanced HIV/AIDS prevention efforts. Let us repeal the paraphernalia laws, fund needle exchange, drug treatment and rehabilitation on demand and stop filling our prisons with drug users, and our hospitals with those dying of AIDS.

Cathy Schneider is an Assistant Professor of International Service at American University. This article is drawn from “Racism, Drug Policy and AIDS,” forthcoming Political Science Quarterly, Fall 1998, and is based on research supported by the Aaron Diamond Foundation.

References

National Commission on AIDS. “The Challenge of HIV/AIDS in Communities of Color,” (Washington D.C., December 1992: 4).

Dawn Day, “Health Emergency 1997,” (Princeton: Dogwood Center, 1997), 22.
Ricky Bluthenthal, Alex Kral, Jennifer Lorvick and John K. Watters, “Impact of Law Enforcement on Syringe Exchange Programs,” Medical Anthropology 18 (1997).

Editorial, “The Changing Face of AIDS,” New York Newsday 9 April 1995.