America Living With AIDS

Prevention and Education

encouraging injection drug users to
adopt safer injection practices, either
by using bleach or by participating in
needle exchange and distribution programs. These programs have frequently been delayed or blocked by
political and community opposition
and by laws that make possession of
drug injection equipment a criminal
offense. In some localities, criminal
justice officials have looked the other
way as local public health officials and
activists have mounted needle
exchange and distribution programs.
On occasion, local prevention activists
charged with crimes for distributing
clean needles have defended their
actions in court, claiming that any violations of law in distributing clean needles were justified by the need to save
lives. This was borne out in the recent
decision of a Manhattan judge who
overturned criminal charges against
AIDS activists engaged in distributing
sterile needles by stating, "The nature
of the crisis facing the city, coupled
with the medical evidence offered, warranted the defendants' action." Courts
in Massachussetts and California have
also failed to convict people conducting
needle exchange programs.
Fears that needle and syringe
exchange and distribution programs
might encourage drug use and create a
new class of drug injectors have not
materialized. Where such programs
have been operating, they have provided a means of encouraging injection drug users to join treatment
programs. Needle and syringe distribution programs deserve further

experimentation, and laws and regulations that block implementation and
study of such programs should be
repealed.
RED )UCING P E RIN ATAL
IRAN SMIS SION
HIV prevention strategies and messages
for women who wish to consider
becoming pregnant may have to be
quite different than those for women
who are willing to delay having children.
Issues of disease prevention are often
conflated with questions of pregnancy
and reproductive choice. A number of
steps aimed at preventing pregnancies,
such as vasectomies, intrauterine
devices, and oral contraceptives, may
have little or no impact on interrupting
the spread of HIV disease.
In recent years there has been much
debate about whether HIV antibody
testing of pregnant women or newborns ought to be mandatory, routine,
or merely available. The backdrop
against which these debates are taking
place is a set of clinical studies that
reveal that transmission of the virus
from HIV-positive mothers to newborn children is less than previously
thought, approximately 30 percent or
less. HIV antibody testing of newborns only definitively establishes
whether the mothers are HIV positive.
Newborns who test HIV positive may
or may not be infected. Some will test
positive only because of the presence of
maternal antibodies that will eventually disappear. Debates have centered on
whether testing or screening ought to
involve all pregnant women or merely
those at "high risk" of HIV and the
extent to which counseling ought to be

Sew York City,
has an estimated
200,000
intravenous drug
users, approximately half of whom are
HIV positive.
Yet New York has
only 38,000 publicly funded drug
treatment slots.