AIDS, needles and public health


Two centuries ago this month, Baltimore City appointed its first health officers, two "quarantining physicians" who were charged with dealing with the threat of yellow fever. Even though scientists of the day didn't yet understand that the fever was spread by a mosquito, the challenge facing those two doctors was much simpler than those facing public health officials in the city today.

Nothing could better illustrate those changes than the controversy swirling around one of the health department's top priorities, a plan to institute a needle-exchange program among the city's intravenous drug abusers. The arguments against such a program are familiar -- a reluctance for government to participate in an effort that seems to condone an illegal activity. But in the context of AIDS, a more relentless and deadly epidemic than yellow fever, those objections pale.

AIDS is now the No. 1 cause of death for all Baltimoreans between the ages of 25 and 44. But the virus is spreading fastest among intravenous drug users, as a result of the widespread practice of sharing hypodermic needles. Throughout 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. These cases include the users themselves, as well as their spouses, other sexual partners and children. Virtually all of the city's 100 or so young children with AIDS are the offspring of IV drug users. Already, about one-fourth of the city's 40,000 intravenous drug users carry HIV, and it spreads, on average, to four or five more users each day.

In this context, the city's desire to proceed with a carefully designed needle exchange plan takes on greater urgency. Look at it this way: Each month's delay will eventually result in at least another 120 deaths -- not counting partners or children.

Needle exchange programs have worked well in 26 other American cities and many foreign ones. They can actually decrease drug use -- and resulting crime -- by helping users get into treatment. The program proposed by Dr. Peter Beilenson, the city's health commissioner, would include treatment referrals and other health services, such as testing for tuberculosis and sexually transmitted diseases.

Gov. William Donald Schaefer has long been leery of Mayor Kurt L. Schmoke's support of a needle-exchange effort, but at the health department's anniversary celebration yesterday he announced he will introduce and support emergency legislation in the General Assembly in January. That single act could save hundreds, even thousands of lives -- demonstrating that today's health challenges are as much political as medical.

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