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Needle Exchanges Battle AIDS and the Law : Public health: Addicts spread HIV by sharing contaminated syringes.


By the time she was 16, Gretchen Adams was a veteran junkie, shooting up daily with amphetamines, getting so wired she often didn't sleep for days, wandering the streets of Hollywood in a hallucinatory fog.

If her needle got dull, she sharpened it on a matchbook. If the plunger stuck, she lubricated it with earwax. If the needle broke or got lost, she'd share one with someone else--her boyfriend, other addicts, almost anyone--as long as dope flowed in her veins.

In those days--the early 1980s--few addicts knew needle-sharing was a fast track to AIDS, that the virus could be spread on the tip of a contaminated spike. Adams shared thousands of times. And now, at 28, she has the deadly affliction.

"If I had some drugs and you had a syringe, and I didn't know you from Adam, I'm going to give you drugs so I can use your syringe," said Adams, a North Hollywood social worker.

She is among the estimated 14,000 Los Angeles County residents infected with the human immunodeficiency virus as a result of using contaminated needles. Intravenous drug users are the second-largest group of AIDS sufferers in the county, and the main transmission route for the disease to heterosexuals, their sex partners and children.

Needle-related HIV infections have nearly doubled in five years in the county, and public health experts warn that local government is not doing enough to battle the virus among injection drug users.

One of the best ways to attack the problem, health specialists say, is by supplying sterile injection equipment to addicts through "needle exchanges." However, city and county officials have provided little or no support for such programs, amid concerns that they violate state law and encourage drug abuse.

Operating outside the law, two private needle-exchange groups have struggled to fill the vacuum, trading new needles for used ones with AIDS-conscious addicts at rundown motels, behind buildings and on street corners. But both programs run on shoestring budgets and organizers say they reach only a fraction of those they should.

Health experts warn that while the infection rate is a relatively low 7.5% among the estimated 190,000 injection drug users in Los Angeles County, it will rise in the face of government inaction. Specialists point to the New York City area as an example of how bad things can get. There the infection rate is a horrific 50% and an army of more than 100,000 people has contracted HIV through needles.

"On the East Coast, the horse is out of the barn. Here, (the infection rate) is still low enough that we can have an impact," said Dr. Tom Horowitz, a longtime member of the county Commission on HIV and AIDS.

"Unless we have major intervention, (the infection rate) is going to go up. A certain percentage of people will share (needles), and a certain percentage will get infected. . . . It's going to go up until we stop it."


As a portable klieg light shone down harshly on her green-tinted hair, the young addict stood in the Hollywood parking lot, pleading for more needles.

Her face was half-hidden in the hood of a dirty sweat shirt. A small metal ring pierced her left eyebrow. She was about 20.

Before her stood another young woman, a volunteer for Clean Needles Now, a private group that supplies addicts with new syringes in exchange for used ones. The week before, the young junkie had received 17 needles. But this night she wanted more.

"I need 30 needles," she said, seeming unsure whether to beg or demand. "Seventeen last week sucked. And my friends took them."

Each Wednesday night, a group of young volunteers--artists, social workers, graduate students--knowingly breaks state law by distributing sterile needles in the parking lot behind the Los Angeles Gay and Lesbian Community Services Center in Hollywood.

Nervous junkies--many in their teens and 20s--materialize out of the night and turn in dirty needles for new ones on a one-for-one basis. They stuff their old needles into a red plastic bin labeled "Infectious Waste--Biohazard." Then they slip back into the shadows.

Since it was formed in 1991, Clean Needles Now has exchanged more than 350,000 sterile needles with IV drug users in Los Angeles. Rene Edgington, a Clean Needles Now founder, said the group was formed because she and other early members were appalled that no public or private agency was taking such a simple step to fight the virus.

Beyond the simple moral imperative of trying to save lives, she said, needle exchange is highly cost-effective. While it costs $180,000 or more to care for someone dying of AIDS, a new needle costs 7.4 cents.

There is remarkable consensus among health professionals that needle exchange is a cheap, effective way to reduce the spread of AIDS among drug injectors, and a number of medical studies support that conclusion.

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