From the North County Times
December 1, 1999, and Pam Slater's position
Health officials want needle-exchange plan
San Diego County representatives say program would send wrong message

GIGI HANNA
STAFF WRITER

Decades after AIDS cut its swath across racial, economic, ethnic and sexual lines, the debate over how to better contain it continues to rage.
Even as World AIDS Day is observed today -- with events designed to open channels of communication, strengthen the exchange of information and forge a spirit of social tolerance -- local activists say they hope San Diego County officials will consider supporting clean needle exchange programs for drug users. Sharing hypodermic needles is one of the ways HIV, the virus that causes AIDS, is spread.

 Current state law, with a few exceptions, prohibits the furnishing, possession or use of hypodermic needles or syringes without a doctor's prescription. But in October, Gov. Gray Davis signed a bill that requires cities and counties to use emergency powers to authorize needle exchange programs, and exempts cities and employees from criminal prosecution for distributing syringes. The legislation goes into effect Jan. 1.
Four California cities -- Berkeley, Los Angeles, San Francisco and Santa Cruz -- and Marin County have adopted emergency ordinances allowing needle exchanges to help fight AIDS.
Local activists want San Diego County supervisors to follow suit and institute emergency measures locally.

NEEDLE, B-4
NEEDLE

Continued from B-1

Proponents of needle exchange programs say they don't advocate drug use or legalization, and they compare needle exchange programs to using seat belts or a designated driver. The idea for an exchange program is to lessen the harm that drug users inflict on themselves, their families and the community
"People always fear a mass distribution of needles, and that's not really what would happen," said Linda Lloyd, vice president of programs for the nonprofit Alliance Healthcare Foundation.
The San Diego-based foundation funds programs that address the health-care needs of the under-served and works to educate the general community about critical health-care problems. Founded in 1988, the foundation awards about $5 million per year to programs that provide services to the medically indigent. Three of four dollars the foundation grants are for programs in San Diego County.
Needle exchanges reduce unsafe practices, such as sharing needles, and curtail the transmission of infectious diseases such as HlV/AIDS and Hepatitis B and C, Lloyd said. Alliance officials envision a San Diego County program that would provide clean needles and offer education, health and drug treatment referral.

 But that is unlikely to happen any time soon, said the county's top health officer.
The county Board of Supervisors vetoed a needle exchange program in 1997 on the basis that it might send the wrong message about drug use to children.
"The bottom line is that the Board of Supervisors are the policy-makers and I have seen nothing to indicate that the board has changed its position on needle exchange," said Robert K. Ross, director of the county's Health and Human Services Agency.
"The scientific literature shows that for those persons who comply with a clean needle exchange program, showing up each week, turning in their old needles, that population can reduce its HIV/AIDS transmission by 30 to 35 percent," Ross said. "That is different than saying you can reduce HIV/AIDS in a community.
"In order to have a truly effective program, you would want to enroll the majority of the county's intravenous drug users in a program and I have difficulty grasping that in a relatively conservative environment like San Diego County that the Board of Supervisors would provide enough resources or overcome enough community outcry to provide that."
 "Needles take lives whether they are clean or dirty, and that's the board's position," said John Weil, chief of staff for Supervisor Pam Slater. "Supervisor Slater thinks needle exchange is bad public policy (and she) ... does not believe that government should be in the business of providing needles to addicts.
"However, if addicts want to turn in their needles in exchange for entering a detoxification and rehabilitation program, the supervisor will gladly make that trade," Weil said.
San Diego County health officials estimate that there are 20,000 people who inject drugs -- methamphetamines and heroin.
The rate of new cases of HIV/AIDS has fallen since the 1980s, with 10,015 cases reported in San Diego County since its outbreak, said county health officials. The profile of the patient has changed from then, when most of the cases were among homosexual men.
"What is rising and is of concern are the numbers of heterosexual transmission and injection drug user-related transmission," Ross said.
In the most recent cases of AIDS among heterosexual men in the county, 7.3 percent of them were traced to injected drug use, compared to 3.2 percent at the beginning of the early 1980s. In women the percentage is 3.2 percent, compared to the 1.4 percent attributed to drug use in the early cases.
 Hepatitis B cases have steadily risen since 1996, when there were 883 people reported with chronic infections. In 1998, the last year for which numbers are available, there were 1,115 cases of Hepatitis B. Hepatitis C cases were not tracked before 1998, when there were 1,936 people with symptoms of the infection but no acute cases.
Alliance officials point to the rise in hepatitis cases as proof the county's current drug-prevention programs are not stopping the spread of disease.
Officials estimate that nine of 10 intravenous drug users have Hepatitis C, which puts themselves and their sexual partners at risk for liver disease that can ultimately require liver transplants.
Alliance officials estimate that a comprehensive program that includes a needle exchange could cost $200,000 annually, compared to the $137,000 it costs to treat a person with HIV/AIDS through the course of the disease. A liver transplant costs at least $300,000.
But the numbers aren't enough to sway public opinion, Ross said.
"This is not as easy as many of the advocates have spelled it out to be," Ross said. "Even if we got past the policy issue of clean needle exchange, implementing a widespread program is extremely problematic. Expanding drug treatment and outreach efforts is the course we're on now and will stay on it?,

NEEDLE, B-6
NEEDLE

Continued from B-4

While Ross said a needle exchange program can help reduce the spread of disease within the drug-using population, he cautioned that it's only one tool available.
"Even though Hepatitis B and C continue to pose themselves as important health problems, we need to find other ways to contain those diseases," he said.
Alliance officials say that is not enough.
"People think if you support needle exchange you don't support treatment," Lloyd said. "The sad reality is we don't have enough treatment and we won't ever have it."

 More than 100 U.S. cities in 32 states have needle exchange programs, with Baltimore being the most established. California has 24 needle exchange programs in Los Angeles, Marin, Sonoma Alameda, Santa Clara, San Francisco, Monterey and Santa Cruz counties.
"It's not a cure-all," Ross said about needle exchange programs. "But, all politics aside, from a public-health standpoint, needle exchange is a useful tool."
But further complicating matters locally, Ross said, is an unwillingness to place such programs in neighborhoods.
 "It's not as simple as the board saying 'sure, let's do it,'" Ross said. "Very, very few people think having a clean needle exchange program in their neighborhood is a good idea."
In 1996 the Alliance commissioned a study done by Cal State San Marcos and a private research firm to study the reaction to needles exchange programs among 1,01S registered voters in San Diego County. That study found that, even among those who identified themselves as very conservative, more than half supported needle exchange programs, as long as they were well monitored and low profile.
 Most said they would prefer a county-supported program rather than a privately run one.
Ross said the broader. issue is that while there are programs nationwide, they aren't federally funded.
"Alliance Healthcare Foundation and others may be painting the Board of Supervisors as being unduly conservative on this, but even the Clinton administration has not approved support for these programs.
"Although federal health officials have indicated that a clean needle exchange program can be of help, the federal government has not approved funding for the programs, because many in the administration feel that it sends the wrong message to kids" Ross said.
Pam Slater's position against needle exchange

Pam Slater

SUPERVISOR, THIRD DISTRICT
SAN DIEGO COUNTY BOARD OF SUPERVISORS
MY POSITION REGARDING NEEDLE EXCHANGE

October 27, 1997

Dear Friend:

On Tuesday, October 7, 1 voted with my colleagues to officially oppose the implementation of Needle-Exchange programs in the unincorporated area of the county. As you may know, Needle-Exchanges are areas set aside where addicts can exchange dirty needles for clean ones. The project has been proposed by various groups throughout the state as a means for stopping the spread of AIDS, though the results of various studies have produced conflicting opinions.

In fact, former intravenous drug-user Sheressa Hill, testified before the board that, "The frequency of my use depended on the availability of clean needles. Needles take lives, whether they're clean or dirty."

Studies have proven that drug use is the number one crime problem in San Diego County. I believe that law enforcement authorities and health officials have only begun to measure the devastating impact of drug use on our society. I could not, in good conscience, vote to support a needle exchange between addicts who have no visible means of support and must somehow support a habit that can cost more than $500 a day. Needle exchange cooperates with an addict's desperate need to prey on our communities to find ways to buy drugs at all costs. Addicts are slaves to the drug lifestyle. Handing out needles perpetuates drug induced slavery.

Not only is needle exchange bad public policy, it is back door problem solving. I simply do not believe that government should be in the business of providing needles to addicts.

Rather than attack our nation's problems at their core, today's government turns to midnight basketball to fight gangs, long-term welfare to end poverty and needle exchange to contain AIDS. This is public policy gone haywire.

Drug rehabilitation programs must be available to anyone who needs them and the county must continue to push for our fair share of federal and state funding for prevention and treatment. With limited health and safety dollars available to stop the spread of AIDS and drug use, I prefer intense anti-drug education in grade school, safe sex/abstinence education and much tougher sentencing for pushers. In what has been called a drug war, I've yet to see us go to war. Rather than sentence addicts to a lifetime of drugs, we should sentence pushers to a lifetime in jail.

During our Board meeting, my colleagues and I heard testimony about an eleven-year-old child who drowned while on drugs. To bear this story, then in the same day vote to support needle exchange, would mean that we are turning a blind eye to the truth.

I will not support needle exchange. However, if addicts want to turn in their needles in exchange for entering a detoxification and rehabilitation program I'll gladly make that trade. But they won't get a needle from me.

Sincerely,


PAM SLATER
COUNTY SUPERVISOR
DISTRICT 3
COUNTY ADMINISTRATION CENTER 1600 PACIFIC HIGHWAY • ROOM 355 SAN DIEGO, CA 92101-2470
(619) 531-5533 TOLL FREE 800-852-7334
Back

To

 Pam Slater on Health, Welfare and Domestic Violence
Paid for by Friends of Pam Slater, Larry Scott, Treasurer, I.D. No. 960892
PO Box 1274, La Jolla, CA 92038-1274