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Addicts, AIDS Activism and U.S. Policy Failure

It is insanely pathetic that Iran is doing needle exchange and China is allowing it-- but the U.S. is still going around fighting efforts to provide clean needles to addicts
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The "25th Anniversary of AIDS" has been an occasion for media self-congratulations and continued neglect of a critical policy disaster that has began at the start of the epidemic and continues today.

I'm talking about the horrendous failure of the U.S. to prevent the heterosexual epidemic that still afflicts poor communities, prisons and minorities in this country-- a heterosexual epidemic driven by intravenous drug use. An epidemic that-- as the UK demonstrated-- did not have to happen.

And one that America is actively fighting to enable, as it continues to refuse federal funding for needle exchange programs and to fight international efforts to support it. Early in the American epidemic, at least 2/3 of all heterosexual transmission (and the same proportion of pediatric cases) resulted from sex with IV drug users.

And those original infections in addicts would have been easier to prevent than the later sexual transmission of the virus. Addicts prefer clean needles because a sharp, fresh syringe makes veins--- and therefore a good high-- more accessible. Condoms, sadly, have the opposite relationship to sexual pleasure for many people.

Unfortunately, we didn't take the opportunity to fight the epidemic appropriately back then-- and the high prevalence we see in the African American community now is the result.

Media coverage of AIDS has always neglected IV drug users and those who sought to help them-- a fact that nearly killed me because I became an IV drug user in 1986 and only learned to protect myself by the sheer coincidence of having a friend of a friend visit from San Francisco and teach me to use clean needles. Even in this 25th Anniversary blitz, IV drug users are given little more than a quick mention and very little recognition is given to the activists who worked so hard to get the clean needle message out when it was most urgent.

So, I'm going to do it here. First, I have to thank Nico Adriaans and the Junkiebonds of Holland in the early 80's-- IV drug users who started the first syringe exchange program in the world. This program was aimed at stopping the spread of Hepatitis B-- but quickly adapted to attempt to curb HIV infections.

Then, I have to give credit to the harm reductionists of Liverpool, England-- Pat O'Hare, Dr. John Marks, Alan Parry, Peter McDermott, Alan Matthews, Lynn Matthews and many others who founded and/or staffed and/or argued publicly for the first syringe exchange in that country. John Mordaunt of London, a drug user who unfortunately died of AIDS just before the triple cocktail was discovered, also played an important role in UK user activism.

Honor goes as well to the British Advisory Council on the Misuse of Drugs-- which told Margaret Thatcher's government in 1988 that ""HIV is a greater threat to public and individual health than drug misuse" and supported the concept of "harm reduction," which means aiming to reduce drug-related harm, not drug use for it's own sake.

Thatcher's government must get credit here as well for keeping cheap politics aside and following the ACMD's guidance The UK never had a heterosexual HIV epidemic-- and it is the work of these folks and their allies that prevented it.

Now, to the American activists, who despite an insanely hostile climate, fought hard for syringe exchange here. Despite the federal ban on funding pushed by Jesse Helms, they managed to get syringes and education to many who needed it.

Jon Parker gets pride of place here-- a former IV drug user himself, he was called the "Johnny Appleseed" of needles and he went up and down the East Coast, getting himself arrested in many states in order to overturn laws banning syringe possession on grounds of "medical necessity." We're still waiting for your "Jail to Yale," memoir, Jon!

New York's Mayor Ed Koch should get some credit as well for funding the first municipal needle exchange here-- in 1988.

In New York, Parker was also aided by ACT UP-- he and Velma Campbell, Cynthia Cochran, Richard Elovich, Phillip Flores, Debra Levine, Kathryn Otter, Monica Pearl and Dan Keith Williams were all arrested in the "Needle 8" trial that ultimately legalized syringe programs here in 1991. Pioneering syringe exchange researcher Don Des Jarlais should also be noted, as should Sam Friedman and ACT UP's Rod Sorge and Alan Clear. Edith Springer AKA the Goddess of Harm Reduction also deserves mention, as does Howard Josepher, whose ARRIVE program was one of the first to empower users-- whether former or present-- to work in the HIV field and help each other.

I'm afraid I can't give quite as good a history of syringe exchange activism on the West Coast-- but Dave Purchase, Joey Tranchina, Moher Downing and San Francisco's Prevention Point, Oregon's Outside In and many, many others deserve mention.

So, I apologize for no doubt leaving out many people who should be mentioned-- but at least I've made some effort to correct the record here.

And I want to say that it is insanely pathetic that Iran is doing needle exchange and China is allowing it-- but the U.S. is still going around fighting efforts to provide clean needles to addicts, despite consensus statements from every major scientific body that has ever examined the question that these programs save lives. Shame on us-- and here's a shout out to all of those who did their best to make a difference, especially those whose own addictions and the stigma related to them made activism even more challenging.