You can learn a lot from an ex-convict with a bucket of dirty needles.
This, after more than 10 years, is what New Haven scientists and public officials are finally coming to realize as the city’s needle exchange program begins its second decade of operation.
Despite considerable financial and legal adversity, the program has exceeded expectations in slowing the spread of HIV and AIDS to a trickle.
In the beginning, there were addicts.
And, for much of his life, Jon Stuen-Parker was one of them. Long before he graduated from Yale’s School of Public Health, Parker used to break into pharmacies to steal drugs.
By 1983, his efforts were no longer focused on getting drugs for himself but on saving the lives of New Haven’s drug users. He marshalled a group of current or former users to help him distribute clean needles to curtail the spread of AIDS.
“The people who did all the early work in the program had AIDS,” Stuen-Parker said. “They were blacks from the Dixwell area who saw what was happening and didn’t want it to happen to their friends. They’re all dead now.”
In the early days of the exchange, it was illegal for private citizens to own needles.
Stuen-Parker, committed to challenging the law, publicly possessed needles in all 11 states where this was illegal. The only states where he was not arrested were Connecticut and Maryland.
He did get publicity in Connecticut for his actions, however, and this opened the door for the eventual legality of needle exchange.
“After we challenged the law, we got all this great press.” Stuen-Parker said. The debate over legalization of needles paved the way for publicly funded needle exchange programs.
Truth in Numbers
When the program was officially born in 1990, only scarce data had been provided by a handful of needle exchange programs around the country.
Relying heavily on questionable European statistics, New Haven planners had little else but logic on their side in convincing the state Legislature to allocate funds for the project.
The numbers, however, were quick in coming.
Before the program had been in place for a year, Yale professors Robert Heimer and Edward Kaplan proved in a study that it reduced the incidence of new HIV infection by 33 percent. Still, critics like former federal drug czar Bob Martinez claimed that the study was flawed and inconclusive.
Many studies later, the results still stand. In 1990, 65 percent of needles turned in to the exchange program were HIV positive; today that number is 45 percent, according to the summer 2001 issue of Yale Medical School Magazine.
The number of new cases has dropped from 121 to 38, and over 1,000 addicts have been put in treatment by the program, the article states.
Skeptics argue that needle exchange programs encourage drug use, draw drug addicts to an area, and increase drug-related crimes.
“It’s not going to decrease drug use,” said Ian Fisher ’03, chairman of the Yale Conservative Party. “If taxpayer money is involuntarily going toward programs that support drug use, then that’s not right.”
Kaplan argues that all of these points are only a front for moral objections.
“There are people who just can’t fathom giving needles to I.V. drug users, so they keep throwing around these arguments,” Kaplan said. “There has been a drop in infection, and no crime increase related to drugs.”
Death of the Cash Cow
Despite the program’s success, the following problem remains: Why isn’t needle exchange reaching all of New Haven’s drug users?
Of the roughly 2,600 I.V. drug users in New Haven, 1,600 routinely use needle exchange. Because the Community Health Van disappears with the sun, the 1,000 that fall through the cracks are the toughest to reach.
“They [I.V. drug users] live lives like other people,” William Quinn, director of the New Haven Department of Public Health, said. “They aren’t home all day.”
Right now, the van operates on a 9-to-5 schedule. Later hours would require an increased staff and more resources, which the program can’t afford.
“We’re working on getting more hours right now,” Quinn said.
“Whether it’s in addition to the 9-to-5 hours or we have people come in later, we want to do it.”
Needle exchange programs receive no federal funding — a fact not expected to change in the future, explained Matthew Lopes MED ’77, director of the city Health Department’s AIDS division. It must rely on the state Legislature and private organizations for resources.
“I’m sure I could double the clients with more resources,” Lopes said. “We even do home delivery, but there’s only so many people you can reach.”
Yet there may be little that can be done in the way of funding. As the country faces an economic slowdown, state funding for programs is unlikely to increase in the near future.
The money most recently given to the program from the state Legislature was rescinded, due to across the board losses after the Sept. 11 attacks.
“In times of plenty, we bought a bunch of syringes that have lasted us until now,” Lopes said. “But the cash cow isn’t putting out a lot of milk.”
Red Tape on Red Boxes
Access to clean needles has been a significant step in fighting AIDS, but it has brought with it a host of new problems.
In 1992, Connecticut repealed laws that made needle purchase and possession a crime.
“Now that syringes are legal,” notes Quinn, “a lot of them are ending up on the street.”
The directors of the New Haven program are now looking to some of its protege programs, of which there are more than 150 nationwide, for ideas.
Baltimore, for example, has instituted a system where red boxes are placed around the city for the disposal of used needles.
In New Haven, such an initiative has run aground.
“We can’t get the post office to give us the mail boxes,” Lopes said. “We have two boxes available now, but where do you put those two?”
Lopes recalls times in the past when stray needles were a danger for neighborhood children across the country. The safe disposal of drug paraphernalia is integral to preventing this from happening again.
“We don’t want those needles lying around, whether these people have HIV or not,” Lopes said. “Even diabetics have syringes. We need to dispose of all of these.”
The Road Ahead
Financial setbacks and bureaucratic obstacles notwithstanding, the work of the program continues. The needles still go out in the same colorfully handpainted, delivery van that once delivered Yale’s bread.
Although the van is now just green, it is still easily identifiable by New Haven drug users. Every day, the van goes to the same predetermined spots throughout the city, and also makes home deliveries upon request.
Additionally, the program also pays for treatment for some of its users.
“We get between 25 and 30 people in treatment each month,” said Lopes. “People do survive and actually clean their lives up.”