Over the past five years, the HIV infection rate among current and former injection drug users in Los Angeles County has escalated slowly but steadily. In 1989, it was 3.8%; now it is 7.5%.
Despite the county's vast size and population, its infection rate remains far below that of New York City. Experts attribute New York's rate--the nation's highest--to the large number of shooting galleries there, and the throngs of people who share needles in them.
Local health experts say now is the time to aggressively battle the virus in Los Angeles County's intravenous-using population, before the infection rate rises further. In San Francisco, the rate more than doubled in a year, to 13% in 1987 from 6% in 1986.
But Los Angeles city and county officials have long balked at supporting needle exchange programs.
In 1988, a motion to explore the idea of a countywide needle exchange died for lack of a second before the Board of Supervisors. The supervisors waited four years before finally approving, in 1991, the distribution of bleach kits to disinfect dirty syringes. While the supervisors agreed in August to examine the feasibility of a countywide needle exchange program, they have yet to vote on a program.
Since Riordan declared AIDS a local health emergency in September, police have arrested few exchange volunteers. But the city has show little other support for needle exchange.
City officials last year gave $130,000 to three private groups to carry out needle exchanges and other AIDS-prevention activities among intravenous drug users. However, city officials specified that no public funds could be used to actually buy needles, although they could be spent on salaries, rent and similar expenses.
Moreover, one group has not yet started its exchange program, while another is spending the city money on anti-AIDS activities other than needle exchange.
By contrast, local government in San Francisco--with less than one-tenth as many intravenous drug users as Los Angeles County--has aggressively tackled the problem.
San Francisco's health department gives about $235,000 a year to Prevention Point, a private needle exchange that since 1988 has exchanged more than 3.7 million needles with local addicts. The funds are used to, among other things, buy needles. The program operates with the active backing of Mayor Frank Jordan, the city's former police chief.
AIDS activists and public health experts say Los Angeles politicians have dragged their feet partly because they fear being accused of using tax dollars to promote drug taking.
"More than anything else, it's because AIDS is looked at as a political issue, rather than a public health issue," said Dr. Aliza Lifshitz, president of the California Hispanic-American Medical Assn. and a veteran member of the county Commission on HIV and AIDS.
Others charge that since most drug users are poor--and politically powerless--whites, blacks and Latinos, their needs can be safely ignored by local elected leaders.
"The bottom line is, it has always been about color," said Carrie Broadus, who runs the Minority AIDS Program's needle exchange. "It's always been about economic and social class. It's always been about haves and have-nots."
The latest exchange proposal to come before the Board of Supervisors illustrates the conflicting political, medical and legal concerns that traditionally have blocked needle exchanges here.
The supervisors in August directed several county department heads to investigate the possibility of setting up a county-funded needle exchange. But department chiefs issued conflicting reports, and the proposal has bogged down.
County Health Services chief Robert C. Gates noted that extensive studies have shown exchange programs to be effective. He recommended that the county set up a needle exchange, as long as it was linked to HIV testing and counseling, access to drug treatment and AIDS prevention literature and materials such as bleach and condoms.
But County Counsel De Witt W. Clinton said in an October report that the county "cannot take any measures" without breaking state law, and argued that the county might be held liable if an addict was injured with a county-supplied needle. Anyone distributing needles, he noted, could be arrested and prosecuted.
Meanwhile, those who run private needle exchange operations say they reach only a fraction of the addicts needing help.
Broadus, who oversees syringe exchanges at four sites in Central and South-Central Los Angeles, said needles should be available at a dozen locations or more--including the Westside and San Fernando Valley.
"With the large size of Los Angeles County, it's a shame we have not taken a leadership role," she said.
"I believe that in the long run, people are going to view Los Angeles County, if we don't move on this, as the county that buried its head in the sand and continued to let people get infected. And that's a political and moral shame."