Local authorities in three cities took action affecting needle exchange programs (NEPs) this week, with San Diego finally giving the go-ahead to a privately-funded NEP, Albuquerque forcing one of the nation's largest NEPs to close or relocate, and Chicago giving well-deserved recognition -- and cash -- to one of its area NEPs.
In San Diego, the city council finally declared a health emergency and okayed a one-year trial program. (See http://www.drcnet.org/wol/207.html#sandiegonep for earlier coverage.) Under a bill signed by Gov. Gray Davis (D) in 1999, NEPs are legal in California if local authorities declare a health emergency. Surrounding San Diego County has refused to declare such an emergency, and it has taken the San Diego city council more than a year to approve a program proposed by the nonprofit Alliance Healthcare Foundation. Meanwhile, according to the county Health and Human Services Agency, AIDS and Hepatitis C are on the rise, Hep C having increased by 50% since 1999.
Under the approved plan, Alliance Healthcare will provide the $344,000 needed for the program so city taxpayers incur no costs.
The program had been recommended by a city task force, but was opposed by the local police chief, county sheriff and prosecutor. It passed narrowly on a 5-4 vote and carries some restrictions designed to placate opponents. Under the plan approved by the city council, the mobile van that will dispense syringes must not get within eight blocks of a school, and any council member can block the van from stopping in his district.
"It's time for San Diego to catch up," Councilman Ralph Inzunza told the council before voting in favor of the program. "People are dying, and we're not doing anything about it. I don't think telling a heroin addict to 'just say no' is the answer."
Now the city of San Diego is beginning to do something, even if the restrictions and council member's veto power are disturbing.
If San Diego is moving forward, Albuquerque is moving in the opposite direction. The Albuquerque city council voted unanimously this week to impose location restrictions on NEPs in a move clearly aimed at the Harm Reduction Project on Silver Avenue SE. The bill sets up a permit process under which permits will be granted only in certain parts of the city and with the mayor's approval. Under the bill, the center will be forced to move to a location not within 500 feet of a church or residential area or within 1,000 feet of a school.
The Harm Reduction Center runs one of the nation's largest NEPs -- it exchanged half a million syringes last year -- and also provides a range of goods and services to its clientele, including condoms, HIV testing, hepatitis screening and immunization, treatment referrals, peer education groups, bleach kits and naloxone. The clients can even do their laundry and get a quick shower. Operated by the nonprofit Health Care for the Homeless and funded by the state Department of Health, the program is one of a dozen NEPs in the city.
"Syringe exchange is probably 25 percent of what we do there," Maureen Rule, clinical adviser at the Harm Reduction Center, told the Albuquerque Tribune.
That was too much for neighbors in the trendy Nob Hill area near the University of New Mexico to handle. "How do they get their money for their drugs?" resident Judy Pratt told the newspaper. "They break into our houses and they break into our cars. All... the... time."
Her complaint was typical. Resident after resident complained to the council of thefts, robberies, drug dealing, discarded syringes and similar quality of life issues. The council listened, overriding testimony from public health experts that the measure could have disastrous consequences on the city's ability to contain HIV and Hepatitis C.
Even some program supporters acknowledged that neighborhood concerns needed to be dealt with. Dr. Steve Jenison of the infectious diseases bureau of the New Mexico Department of Health told the council neighborhood "issues need to be worked out."
Dr. Bruce Trigg, who runs a Department of Health clinic nearby, pointed to a solution. "The state Health Department would like to have many sites all over the city so that people don't congregate at one place," Trigg told the Tribune. "None of the other places has ever had a complaint from anyone anywhere."
While Albuquerque experiments with "harm reduction free zones," Chicago officials awarded the Chicago Recovery Alliance (http://www.anypositivechange.org) the city's Excellence in HIV Prevention Award. Mayor Richard Daley is presenting CRA with the award in a ceremony at the Garfield Park Conservatory on November 30, and the award includes a $25,000 grant to be used for CRA's mission as they see fit.
The Chicago Recovery Alliance provides NEPs and other harm reduction services throughout Chicago and into the northern, southern and western suburbs. Last year, according to its annual report, it distributed more than 2.1 million syringes to more than 27,000 program participants.