NEWARK, N.J. — Gregory Howard found his calling in an infectious disease ward in Newark. He'd gone into detox to withdraw from a decade on drugs. Suddenly, he'd begun losing weight and his lymph nodes had swollen. His skin crawled as though infested with bugs.
Lying there, he heard the doctors talking about a new disease. It was killing men who injected drugs and who had sex with other men. Howard had done both. He called his parents and told them he was dying. When he pulled through, doctors blamed the episode simply on withdrawal.
But Howard got interested in that new disease. After 12 years on heroin and cocaine, it became something of a cause. Two years later, in 1984, he went to work for the state of New Jersey as a new breed of public health worker, educating intravenous drug users about AIDS.
These days, Howard moves lightly down the weary streets of Newark, a tall man in cowboy boots skirting the slag heaps of blackened snow. On the street corners of dilapidated neighborhoods, he talks about the deadly virus that lives in the blood in dirty needles.
The job is a kind of sword dance with Howard's fears: He has chosen not to find out whether he is infected. As for his city, studies suggest that at least 60% of its addicts are already infected. Newark may have lost the war before it was officially declared.
How does that make him feel? Howard was asked recently.
"Afraid," he answered sadly, aged 35 with a newly adopted son. He thought for a minute, about his friends and himself. Then he added, "It's like sitting on a time bomb. Waiting for it to explode."
Needle users have become a crucial front in the battle against acquired immune deficiency syndrome. They are seen as the conduit through which the disease is reaching uninfected groups: To them is traced most of the virus's seepage into the heterosexual population and the alarming increase in babies born infected.
In New York City, at least 60% of the estimated 200,000 intravenous drug users are believed already to be infected. In New Jersey, drug users account for more than half of all AIDS cases. Another 6% involve their sexual partners; another 3% are their children.
For unexplained reasons, the problem is especially devastating among blacks: A disproportionate percentage of black users are becoming infected. A recent California study found black drug users nine times more likely than white users to test positive for infection.
Yet efforts to stop the spread of AIDS among intravenous drug users have lagged--for reasons many say are logistical as well as political. They include confusion over how to tap the self-interest of the self-destructive, and society's ambivalence about drug addiction.
For example, there is little data on how best to persuade drug users to change their habits--to stop sharing needles or to clean them with bleach. And there is no conclusive data yet on whether programs to distribute needles or bleach slow the spread of AIDS.
In addition, law enforcement authorities and some public officials say such programs are immoral: To encourage needle hygiene is to condone addiction, they argue. They say the answer to needle transmission of the AIDS virus is to get addicts off drugs.
But public funding for drug treatment has plummeted. The number of treatment admissions in New Jersey dropped from 22,000 to 14,500 over the last eight years. In New York City, 2,800 people are on lists waiting to get into drug treatment programs.
Identified Too Late
So in the East, where the AIDS virus hit first and spread fastest, the problem among intravenous drug users lurched out of control before officials even identified it. As early as 1982, 30% of drug users tested in New York City already had been exposed to the virus.
In the West, it has spread more slowly among needle users--a fact attributed to a different "culture of drug use." But some experts fear the relatively low numbers may be a curse as well as a blessing because it saps the sense of urgency about addressing the problem.
"People don't seem to take this epidemic seriously until it's too late to do anything about it," said James L. Sorenson, chief of substance abuse services at San Francisco General Hospital. "By the time you get a significant number of cases, it will be too late."
One New York expert was more blunt about the situation in the East.
"Things are going to hell," he blurted recently when called by a reporter. "That really is a capital description of the situation."
It was the only point on which he asked not to be quoted by name.
Colleen Marshall started on heroin in the late 1960s. Back then, it was cool to be high, the New Jersey woman recalled recently with bitter incredulity. Who had ever heard of "Just Say No?"
"So I was just out there, you know, messing with a guy who was on coke and dope," said Marshall, a wiry, 38-year-old grandmother with a shock of rust-colored hair. "I didn't have to get out there and hustle or buy or nothing. It was easy, flowin' around me, you know?