Paul Rosas and Ronny Alvarado were out trawling for hypes in a wild pocket of downtown Los Angeles, carrying the message about AIDS and dirty needles to an urban prairie where an addict can get high for as little as 25 cents.
A man squatted on the curb, pumping heroin into a dappled arm. Nearby, another guided a skillet over an open fire, sauteing fish. People stood, slumped, against a chain-link fence, smoking cocaine. A woman flashed a leering grin at Alvarado.
Alvarado approached her. Had she heard about AIDS? Did she know the risks of dirty needles and unprotected sex? Could she use a few condoms? Nope, the woman retorted perfunctorily: She was a woman; she didn't need one.
It's not easy spreading the word about AIDS to intravenous drug users, now a prime target of the epidemic in Los Angeles County. The obstacles range from the life styles of many addicts to the complex culture of drug use in the nation's second-largest city.
Geography is destiny in Los Angeles County: The sprawl of the region has shaped the drug market, and thus the AIDS epidemic. The county's vastness has slowed the spread of AIDS among drug users, but it is making it difficult to reach those at greatest risk.
In East Coast cities like New York, intravenous drug use is centralized. Hundreds of addicts share needles daily in shooting galleries. As a result, more than half of New York City's estimated 200,000 addicts are believed to be infected with the AIDS virus.
But that same density makes addicts easy to find. Public health workers routinely canvass the shooting galleries of cities such as New York and Newark. They have alerted addicts to the risk of AIDS and thus helped cut down on the sharing of contaminated needles.
In Los Angeles County, by contrast, there are few places, except Skid Row, where addicts congregate in large numbers. Drug use is spread out and tends to occur among small groups. Those who share needles tend to do so with a few friends, again and again.
For that reason, and the fact that the virus came late to the West Coast, the HIV infection rate among addicts here appears to have remained relatively low. Just 3% to 5% of the county's estimated 80,000 to 120,000 intravenous drug users are infected, researchers believe.
Difficult to Reach
But that same diffuseness makes it difficult to reach users. They are scattered all over the county, only occasionally in pockets. Public-health workers find themselves forced to go door to door, scouring neighborhoods for an entree, hoping to happen upon a user.
