At 9:30 this morning, a cream-colored Winnebago will pull onto North Caroline Street, open its door and wait for drug addicts.
After years of debate, Baltimore's needle-exchange program is about to begin.
Acquired immune deficiency syndrome is spreading grimly through the city's population of intravenous drug users.
The new program, in which addicts receive free, clean needles for each dirty one they turn in, is meant to help slow the rate of infection from shared, dirty syringes.
"There's no [AIDS] vaccine on the horizon, no real treatment," says Dr. Peter Beilenson, Baltimore's health commissioner. "So if this program works, it would be unconscionable not to try it."
A federal study last fall endorsed needle exchange and urged expanded federal support.
About one quarter of Baltimore's 48,000 intravenous drug users are infected with HIV, and about 75 percent of new AIDS cases in the city last year were caused by intravenous drug use, city health officials say.
Addicts can become infected by sharing needles with drug users who are infected with HIV, the virus that causes AIDS. Infected people can then pass the virus to their sex partners, and pregnant HIV positive women can give birth to infected children.
About 2,600 Baltimoreans have died of AIDS, Dr. Beilenson said, and about 20,000 city residents are HIV positive.
Baltimore health officials hope the new program breaks the cycle.
The needle-exchange van will be on the streets Monday through Friday, from 9:30 a.m. to 11:30 a.m. in the 600 block of N. Caroline St., in East Baltimore, and from 1:30 to 3:30 each afternoon in the 1100 block of N. Mount St., in West Baltimore's Sandtown-Winchester neighborhood.
The participants will be people "who want to stay alive," said Jacqueline M. Hamm, assistant to Dr. Beilenson. "Just because you have a drug habit, just because you have an addiction, just because you have an illness doesn't mean you want to die of AIDS."
Health officials say they have no way of estimating how many people will join the program.
In Sandtown-Winchester, community leaders asked that the needle-exchange van come to their neighborhood.
"We know we can't stop people from using," said Jerry Cross, community health advocate, in the Sandtown-Winchester Community Building and Partnership program. "So if we can't stop it, let's assist those people who are using and at least stop the spread of this disease."
Curtis Price, the coordinator of Street Voice, an outreach organization for people who live on the street, said the needle-exchange program is "an important first step." But he said he wishes that, in addition to staffing the van, health workers would go into drug houses and give needles to addicts. His group, he said, may take that job on itself.
The Health Department's plan, which will cost $165,000 a year, sounds simple: The drug users who join the program will register but need not give a name or address. They will be assigned a number.
For each needle they turn in, they will be given a clean needle marked with a bar code so that researchers can check on its return.
nTC Users may simply exchange needles or they may talk with a staff member about drug treatment and be tested for HIV, tuberculosis or syphilis. They also may choose to join a Johns Hopkins study that will monitor their drug use, sexual habits and changes in behavior.
Hopkins staff members will collect all the needles and check to see if users who began the program free of HIV remain uninfected. They will check to see if a returned needle shows the DNA of more than one user -- meaning the needle was shared.
The needles don't even have to belong to the person who brings them in. Health officials are encouraging drug users to collect syringes from gutters and empty lots. Other cities, Dr. Beilenson said, have found the streets cleaner near needle-exchange programs. Both city and state police officials have agreed not to monitor the locations, so that drug users feel free to approach the van, Dr. Beilenson said.
The three-year pilot program was approved by the legislature last winter, and Gov. William Donald Schaefer signed the bill into law despite misgivings about the project. In hearings in Annapolis, some lawmakers questioned whether offering needles wasn't encouraging drug abuse.
Yesterday, Dr. Beilenson said that the program might be viewed as giving "some mixed messages." But nearly 40 other cities have begun needle-exchange programs, he said, and studies have shown that the projects slow the rates of infection.