Stopping HIV in Baltimore [Editorial]

Nearly three decades into the AIDS epidemic, medical professionals now have a much better understanding of the disease and how to treat it. But prevention is still the first line of defense against this devastating killer, which has already taken the lives of some 35 million people around the world, including 620,000 Americans. That is why we applaud the Maryland House of Delegates' passage last week of an expanded needle-exchange program in Baltimore City, which has been shown to drastically reduce new HIV infections among intravenous drug users. The state Senate had earlier approved a slightly different version of the same legislation, and we urge the two chambers to bring this matter to final approval before the legislature adjourns next month.

With the development of powerful new anti-retroviral drug therapies, AIDS has become a chronic but manageable illness rather than the death sentence it was when the HIV virus was first discovered. But the fight against this devastating killer is far from over. In Baltimore City, which has the fifth highest AIDS rate in the country — twice the national average — health officials are still struggling to reduce the dozens of new infections each year that allow the disease to spread.

One of the city's most effective tools to cut the HIV transmission rate has been the health department's needle-exchange program, which allows IV drug abusers to turn used needles and receive new sterile syringes in return. The program, which operates a fleet of vans to deliver clean syringes to the communities where addicts live, also offers drug treatment and counseling services for people who want to kick the habit and educates them about the risk of infection associated with using dirty needles. The outreach effort has been remarkably successful in persuading IV drug abusers, who often have little contact with the public health care system, to adopt harm-reduction strategies such as avoiding sharing needles and using a clean syringe every time.

As a direct result of program, the number of cases in Baltimore in which injected drug use was identified as the cause of infection dropped from 60 percent of newly diagnosed HIV cases in 1994 to fewer than 30 percent little more than a decade later. Similar programs around the country have shown similar drops in HIV infections transmitted through infected syringes, and by now there is a large body of evidence compiled by public health researchers indicating that such interventions are one of the most effective ways of curtailing the spread of AIDS among the traditionally hard to reach population of IV drug users.

The legislation passed by the Maryland House last week would expand the city's current needle exchange program by replacing the one-to-one limit on how many clean syringes an addict may receive for each dirty needle turned in with a needs-based model that would allow health outreach workers to supply up to 10 clean needles for every dirty syringe presented for disposal. Health officials say the change is needed in order to maximize the probability that addicts will always have a clean needle to use for injecting drugs even if a needle dispensary van isn't available when they need it due to weather or other problems, or if for some reason they are unable to travel to where the van is parked. Since it often only takes one injection with a contaminated needle to infect a user, health officials want to ensure that addicts always have access to a sterile syringe.

The Senate bill passed earlier does not specify the number of needles that can be obtained at one time. Either version of the bill would be an advance, and the particular number of needles in question should not be an insurmountable stumbling block as the two chambers negotiate. We know from our own experience and that of other states with needle exchange programs that easy access to clean syringes can help stop the spread of HIV. This measure would simply make Maryland's program more effective.

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