Getting The Point In New Haven

THE VAN, PAINTED WITH VIVID stripes and a rising sun, plies the drearier streets of New Haven, Conn., drawing eager throngs like some dark version of the Good Humor truck. Four times a week, the "dope fiends," as they call themselves, line up to enter the vehicle. They identify themselves to city workers by their code names ("Carol Burnett," "Streetcat," "Wizard") and, in exchange for used needles, receive survival kits: bottles of bleach, bottles of water, clean needles, and condoms. They do this because they are terrified of the epidemic that is raging through their city. "Just because I shoot drugs doesn't mean I don't care about AIDS. I care a lot," says a petite white woman, 45, who works as an executive assistant. That's right, says a dope dealer known as "Philip Morris": "Heroin don't make you retarded."

No, it doesn't, but for years the acrimonious debate over how to protect heroin users has impeded efforts by health authorities to control the spread of AIDS. Civic leaders have been caught up in moralistic arguments over whether providing clean needles to addicts would only accelerate inner-city drug abuse. In minority communities, opponents insisted that needle handouts were akin to genocide. Meanwhile, AIDS raced through intravenous-drug-using populations. Today one-third of the nation's AIDS cases originate from IV drug use. More specifically, 71% of all females with AIDS are linked directly or indirectly to IV drug use, as are 70% of all pediatric AIDS cases. Still, health experts wrangled over what to do.

Suddenly that has changed. In a dramatic turnabout, New York City last week announced that it would support a needle-exchange effort, two years after Mayor David Dinkins halted such a program. The mayor of Washington also called last week for needle exchange for addicts, as well as the distribution of free condoms in city schools and jails. Rhode Island, New Hampshire and Connecticut will probably soon take the even more dramatic step of decriminalizing the possession of hypodermics. Movements are under way in New Jersey, California and Massachusetts to remove legal barriers and begin officially sanctioned needle programs. Even in the U.S. Congress, Charles Rangel, who has led opposition to needle exchange on the ground that it threatens blacks, has asked the General Accounting Office to reevaluate the effects of such programs.

The most important catalyst for this change has been the experiment conducted in New Haven. The two-year-old program has demonstrated that needle exchange dramatically slows the rate of infection without encouraging new IV drug use. Some indicators even suggest that the program has been responsible for a decrease in both crime and the amount of drugs used illegally. The city's new police chief, Nicholas Pastore, claims that crime actually dropped 20% over the past two years, perhaps because of the improved relationship between city workers and the community. Meanwhile, referrals to drug-treatment centers increased. These results have enabled policymakers elsewhere to break the logjam. Says New York City's health commissioner Margaret Hamburg: "It all came together in the New Haven experiment."