The Lesser of Two Evils

By Christine Gorman

"As a public health official, I don't have the luxury to be a moralist." So said an unapologetic New York State health commissioner David Axelrod last week after approving a New York City plan to fight AIDS by providing drug addicts with sterile needles. The controversial program, which could begin as early as this spring, has sparked vehement protests from law-enforcement agents, clergymen and politicians. Says the Rev. Calvin Butts of the Abyssinian Baptist Church in Harlem: "To distribute needles is to cooperate with evil. It is a step to legitimatizing heroin use."

Few disagree that drug abuse is a deadly evil. But the growing AIDS juggernaut, New York health officials argue, is deadlier. As many as 60% of the city's 200,000 addicts now carry the AIDS virus; only 35,000 are in drug- treatment programs. One result: growing numbers of women of childbearing age in the city are infected -- most of them through intravenous drug use or sexual contact with users. Says City Health Commissioner Stephen Joseph: "The IV drug user is the gateway to the heterosexual population." That threat to public health persuaded Axelrod to permit an exception to a state law forbidding distribution or possession of needles without a prescription. His decision legally paved the way for a pilot program for 400 addicts. The group will receive counseling in the ways that sex and contaminated needles transmit the virus. Half of them will also receive clean needles and syringes, stamped N.Y. HEALTH DEPT., that must be exchanged after use for new ones.

Critics of the needle giveaway point out that it places city government legally at odds with itself. Says Sterling Johnson, New York City's special prosecutor for narcotics: "To give an addict a needle to shoot drugs is facilitating a crime." New York Archbishop John Cardinal O'Connor, a member of the presidential AIDS commission, blasts the proposal as an "act born in desperation that drags down the standards of all society." Moreover, he strongly questions "whether it will accomplish its purpose," inasmuch as the free needles will probably be shared.

The clash over the needle program boils down to the question of efficacy -- and differing assumptions about hard-core drug abusers. "The junkie is not educable," declares Father Terence Attridge, director of the substance-abuse program for the Roman Catholic Archdiocese of New York. "You have to get addicts off needle use. It's the only way." Others dismiss such assertions. "Addicts do want treatment," contends Dr. Robert Newman, a founder of drug-treatment clinics and president of Manhattan's Beth Israel Medical Center. "It's wrong to think that as a group they don't care about their health." In fact, demand for IV drug-abuse treatment in New York increased after the news about AIDS hit the streets. "It is a classic case of a lesser evil," says the Rev. Roger Shinn, professor emeritus of social ethics at Manhattan's Union Theological Seminary. "The end, limiting the spread of AIDS, might justify the means, supplying needles to addicts."

So far, needle-exchange programs in the Netherlands, Scotland and Australia tend to encourage that view. Since 1984 an estimated 70% of the 15,000 drug addicts in the Netherlands have registered in treatment programs, which allow health authorities to maintain regular contact with them for AIDS testing and counseling. The underlying strategy of New York health officials is similar. Says Commissioner Axelrod: "Our needle-exchange program has nothing to do with needles and syringes. The needle gets the addict in so we can educate and counsel." Still, some wonder if the project will even begin to curb the AIDS epidemic among IV drug users. "In view of the AIDS risk," says Dr. Jan Walburg, director of Amsterdam's Jellinek Clinic for substance abuse, "New York is starting much, much too late."

With reporting by Martha Smilgis/New York