A new study by the National Research Council argues that, contrary to conventional wisdom, the AIDS epidemic can be contained or eliminated in this country by concentrating on prevention efforts centered on targeted neighborhoods around the country where risky behaviors are most likely to spread the virus. If that is true, the General Assembly should pay special attention to a bill that would authorize a pilot needle exchange program for intravenous drug users in Baltimore City.
The statistics are alarming: In the United States, one-third of all AIDS cases stem from the injection of illegal drugs; in Baltimore City, that figure rises to 42 percent. Current best estimates suggest that one-fourth of the city's 40,000 injection drug users are HIV positive, with four to five new infections occurring each day.
These cases have an impact beyond drug users themselves. Of the 200 children now in treatment for HIV infection in Baltimore City pediatric AIDS clinics, 185 can trace their infection to injection drug use, often contracting the virus from their mothers. The epidemic takes a fiscal toll as well. One case of AIDS costs about $85,000, and few injection drug users have private insurance.
Too often, the debate about AIDS prevention among injection drug users bogs down amid fears that needle exchanges imply approval or acceptance of drug use. But as needle exchange programs proliferate, the results show otherwise.
A Yale University study of New Haven's needle exchange program found that the effort reduced new HIV infections by one-third. There was no evidence that the program encouraged drug use. On the contrary, the city noticed an increase in drug treatment referrals, with one in seven users entering treatment after participating in the program. The public likes the results as well: Because the program is a one-for-one exchange, fewer used needles litter the city's parks and playgrounds. Similar positive results have been reported elsewhere in the country.
The city's program would be carefully designed and closely monitored. It would include a research component to evaluate its effectiveness, as well as a provision limiting its duration to 30 months without further legislative action.
The rewards of this program would far exceed the cost -- estimated at about $50,000 yearly from the city and private sources. Given the success of other needle exchange programs, this is one approach the city simply can't afford not to try.