They were homeless and drug-addicted, high on alcohol and hungry, waiting in line to swap their dirty needles for clean ones through a city program that aims to reduce the spread of HIV. Yesterday afternoon, staffers told them they were in for a beautiful surprise.
Minutes later, the newly crowned Miss America, Kate Shindle, swept out of a car in a long black wool skirt and bulky turtleneck sweater pinned with a sparkly tiara brooch. She came to one of Baltimore's toughest neighborhoods to praise the needle exchange program that she had condemned just weeks ago.
"It seemed to work against common sense to give drug addicts needles," said Shindle, echoing the concerns of many private citizens and politicians in what has become a long-running national debate. After hearing her comments, Baltimore Mayor Kurt L. Schmoke and others helped change her mind, quoting studies that show Baltimore's effort significantly reduces the spread of HIV and doesn't encourage drug use.
Congress has recently been wrangling over needle exchanges and whether federal dollars should pay for them. At the same time, some members of the Presidential Advisory Council on AIDS have said they may quit, angered that the administration won't buy clean needles when evidence shows that such an effort curtails the spread of the human immunodeficiency virus which causes AIDS.
Meanwhile, the Baltimore exchange, one of the country's largest, is emerging as a national model. Rep. Elijah E. Cummings, a Baltimore Democrat, is touting it to his congressional colleagues and pushing a bill that would direct the creation of federally TC funded needle exchanges. Baltimore officials plan to expand distribution to two west-side pharmacies, and researchers have completed studies showing drops in drug use and crime among hard-core addicts.
Shindle, 20, has stepped in the middle of it all.
"It may seem like it doesn't coincide with Miss America, but if she's going to be relevant, she has to tackle tough issues," said the Northwestern University senior, admitting that her viewpoints have caused some controversy. She launched her reign with a pledge to promote HIV prevention.
"Controversy gets people talking. In this disease, silence is one of our biggest enemies," she said.
Yesterday, at the corner of Mount and Westwood streets in West Baltimore, Shindle explained her change of heart to a crowd of neighbors and addicts and complimented the program for "not passing judgment on the lifestyle or behaviors of anyone," but focusing on saving lives.
"Hey, all right!" shouted people in the audience, applauding her.
Michele Brown, the program's director, said getting Miss America's stamp of approval may open others' minds to the idea of exchanges. "I definitely didn't know what to expect," said Brown. "But she definitely did her homework. She knew what she was talking about."
Others who stood nearby took little comfort.
"They need more programs to help those trying to get off drugs," said Joseph Lyle, 42. Clothed in a dirty jean jacket and old navy sweat pants, he lives in vacant houses and shoots heroin and cocaine. He said he's tried for years to get into treatment, even faking suicide attempts and going to local emergency rooms.
He comes to the needle exchange because the program, besides swapping needles and giving HIV tests, refers addicts to treatment -- about 600 so far. Lyle is hoping to get a slot soon.
Nationally, experts estimate that over the life of the epidemic, contaminated needles have led to the infections or deaths of 200,000 Americans. In Baltimore, where 80 percent of all acquired immune deficiency syndrome cases in the past two years are linked to intravenous drug users, their partners or their children, the needle exchange program is key to saving lives and money.
Participants can swap needles on a one-for-one basis. About 1.2 million needles have been turned in since August 1994, and about 6,100 addicts are tracked by computer.
Johns Hopkins University researchers have found that hard-core addicts using needle exchange cut their risk of HIV by 40 percent. Two new studies, to be presented at coming meetings, add to the evidence.
In one study, scientists looked at addicts using the needle exchange who were referred into treatment, before admission and then three months later. Their days of illegal activity dropped from 13 days a month to two. Their illegal income dropped from $800 to less than $10 a month. Their daily drug use dropped to less than two days a month.
This group of about 100 hard-core addicts also posted a retention rate in treatment of 80 percent to 85 percent, said Dr. Peter Beilenson, city health commissioner. A second Hopkins study found that crime in the vicinity of the needle exchange sites dropped about 20 percent, comparable to an overall drop in the city.
There are 115 needle exchange programs in 29 states, the District of Columbia, Puerto Rico and U.S. territories. They are funded by city, state and private money. Several major organizations, from the Institute of Medicine to the U.S. Conference of Mayors, have endorsed the concept.
But critics like Bob Maginnis of the Family Research Council in Washington argue that the programs promote drug use and crime in depressed neighborhoods. He also said that the exchanges are a gateway to legalizing illicit drugs such as heroin.
"These people are killing themselves slowly," said Maginnis. He said they need help to kick their habits.
Cummings, whose district includes neighborhoods with some of the state's highest rates of AIDS cases and deaths, understands that thinking. But he stressed that Baltimore residents asked for the program, which operates at six sites.
"I was talking to a mortician the other day. He said it gets so bad, he can't order the caskets fast enough," Cummings said. "My aim is to stop the deaths, stop the spread of AIDS."
Back on the Baltimore corner, Miss America thanked her hosts. She eagerly accepted a black sweat shirt emblazoned with the program's name and logo. Then she began calling all the staff to be photographed with her.
"Where's Michele? Michele!" Shindle said. "Come on everybody, get in the picture."
Together, they posed, all shouting at the same time: "Needle!"
Pub Date: 11/06/97