In the United States. AIDS first struck primarily homosexual men. but today the virus appears to be spreading most rapidly among intravenous drug users. In New York City, 34 percent of all people with AIDS have been heterosexual i.v. drug users, who presumably caught the disease by sharing needles and syringes with someone infected by the virus. Nationally, about one-fifth of the more than 36.000 AIDS cases have involved i.v drugs. An accurate estimate is probably double that, since many addicts’ deaths from tuberculosis, pneumonia and other illnesses are now being recognized as AIDS-related.
The figures on the extent of the AIDS crisis reflect patterns of transmission prevalent years ago. when the people who now have the disease were exposed to the virus. Then, sexual activity among gays, particularly anal intercourse. was the primary mode of transmission. Approximately 26.000 gay men have AIDS or have died of it. But as the gay community has become increasingly aggressive in promoting "safe sex," it has to some extent contained the spread of the disease. No comparable preventive action has been taken among i.v. drug users. An estimated 50 to 60 percent of New York City’s 200,000 to 250,000 needle-drug addicts have already been infected, and AIDS was their leading cause of death by 1985. Today, as an official at the Federal Centers for Disease Control told me, "Dirty needles are the way the virus is spreading."
Infected addicts, in turn, transmit the virus to their sexual partners, a process already responsible for the overwhelming majority of non-Haitian heterosexually transmitted AIDS cases. To an unknown extent, addicted prostitutes are spreading the virus to their clients as well. According to Dr. Harold Jaffe, chair of the AIDS epidemiology division at the Centers for Disease Control, "Infected drug users are the main portal of transmission to other parts of the heterosexual community, and their newborns." Dr. André Nahmias of Emory University said that nearly all of the AIDS-infected infants born in the United States, estimated at between 2,000 and 4,000 a year, are the offspring of i.v. drug users.
One AIDS expert told me that if the disease becomes another "black plague," shared injection equipment will "unquestionably" be the cause. Yet, as The New York Times has reported. "No effective attack has been mounted on the spread of AIDS by shared needles." Worse, in eleven states, including New York, the government plays an active role in perpetuating the disease by maintaining laws against the sale of sterile hypodermic needles and syringes without a doctor’s prescription. In Boston the street price of supposedly clean "works" (needle and syringe) has reportedly doubled since the AIDS epidemic began —"capitalism at its best," in the words of one angry participant at an anti-AIDS meeting there. A woman attending the same meeting asked, logically: "Why don’t they just hand out syringes? That’s the simple solution."
Indeed, the most straightforward government response would be, at minimum, to legalize the sale and possession of works in all states and, ideally, to distribute sterile works as widely as possible, with no involvement of law-enforcement officers, no questions asked and no strings attached. Much more tentatively, the National Academy of Sciences recommended "increased availability on an experimental basis of sterile needles and syringes to reduce sharing of injection equipment, a known mode of transmission."