At the stroke of noon on a frigid late-winter Boston day, a dozen or so shivering men and women carrying a banner announcing themselves as the AIDS Brigade began to set up shop across the street from City Hospital. They intended to hand out clean needles to intravenous drug users, they said, and immediately a handful of hopeful syringe recipients lined up. "Let us save lives," the activists demanded, but immediately they were confronted by a band of noisy antagonists. What followed wasn’t exactly a discussion of the public health benefits—which are well documented—of exchanging dirty needles for clean ones to reduce the spread of HIV. "Killers!" the opponents shouted. "How many AIDS deaths will your intolerance cause?" the AIDS Brigade members countered, as a single TV camera whirred and a couple of reporters scribbled notes. Some African-American community leaders from the predominantly black neighborhood of Roxbury, who have long opposed the AIDS Brigade’s tactics, were also taking notes.
Just then Jon Parker, founder of the AIDS Brigade, made his entrance. Parker was carrying cardboard boxes filled with hundreds of used, and maybe HIV-contaminated, needles that he had collected from the streets of Boston. His intention was to hand these syringes over to the city in order to embarrass public officials out of their inaction. At that moment two telegenic policemen, who had been quietly standing by, made their move. The boxes of needles were seized and stowed in the trunk of the police car, and Parker was led away, unresisting. He has been arrested dozens of times since 1986, when as a public health student at Yale he began his crusade to get clean needles into the hands of addicts.
Meanwhile, more than a hundred needle-exchange advocates were convening for the North American Syringe Exchange Convention across town at the Government Center Holiday Inn. The talks were studded with street-smart colloquialisms and drug lingo, Clusters of syringes were pinned on lapels as ersatz boutonnieres; tie-dye and jeans were the sartorial order of the day. The session’s organizer, Dave Purchase, who effectively launched the needle exchange movement five years ago when he set up a TV tray on the streets of Tacoma, Washington, looked like a shambling bear. Cigarette smoke hung thick in the anteroom adjacent to the meeting hall, mute testimony to the fact that addictions can be hard to beat.
Yet for all its countercultural style, the Boston gathering signaled something very mainstream: Needle exchange has come of age politically. The research to back this approach to AIDS prevention has been accumulating for some time. In the late 1980s, studies from several locales—notably Amsterdam, Sydney, Edinburgh and southern Sweden—showed markedly lower increases in HIV infection rates among addicts who exchanged dirty syringes for clean ones. In 1991, confirming research was reported in Tacoma, the first American city to adopt such a program, and in New Haven, where Yale University scientists have been conducting perhaps the most analytically sophisticated efficacy study. The research has rebutted narcotics officials’ fears that such a venture would encourage people to try heroin.
Now other American communities are getting the message. Since 1990 the estimated number of I.V. needles swapped in the United States has more than tripled, to nearly 4 million annually. An impressive array of locales that operate, or at least tolerate, exchange programs sent representatives to Boston, among them New York City, the epicenter of the drugs/AIDS pandemic; New Haven; Philadelphia; Chicago; Seattle; San Francisco; Hawaii (where a statewide program is running); and smaller cities and rural outposts like Boulder, Colorado, and Wyndham, Connecticut.
There were dispirited accounts from Providence and Rochester, where activists have unsuccessfully tried to launch programs; but the feeling was that in these cities, success was just a matter of time. And although there were tales of failures from places like Indianapolis, where the one-man underground operation run by a renegade Public Health Department employee is out of funds, these were the conspicuous exceptions.