If the spread of AIDS is to be stopped, the president of Niagara County's Board of Health says, the public and politicians need to get over some outmoded ideas.
Dr. Mitchell R. Zavon said Niagara County should establish a needle-exchange program, similar to the one in operation in Buffalo since 1993.
More than a third of the AIDS cases diagnosed in Niagara County since the disease was first identified were caused by infections obtained through sharing of contaminated needles by intravenous drug users, according to the state Health Department's Bureau of AIDS and HIV Epidemiology. HIV is the virus that causes AIDS.
Under a needle-exchange program, drug users go to a particular location, turn in used needles and syringes, and receive new ones.
The state made a special exception to its laws against possessing drug paraphernalia to accommodate these programs, over political opposition that it, in effect, would be subsidizing drug use. Federal funding of needle-exchange programs is prohibited and officially opposed by the Clinton administration.
"Most recent research shows that there appears to be absolutely no increase in the use of drugs where a needle-exchange program is instituted," Zavon said. "Instead of this being treated as a public health problem, morals get involved, in this puritanical nation of ours.
"We'd rather see somebody die, oftentimes, than recognize that we're not going to change their lifestyle. Since doing anything with them would be morally repugnant to some people, we don't do anything, and then they die.
"The fact that AIDS was first discovered in the homosexual community resulted in a moral stigma in the traditional society," Zavon said. "Now that's it's throughout our society, we still retain that attitude that there's something reprehensible about it."
Philip R. Santangelo, executive director of the AIDS Alliance of Niagara County, said of Zavon's recommendation, "I'm ecstatic. There may be a low incidence of IV drug use, but once they start using (those drugs), they're at risk of spreading AIDS."
Zavon said a needle-exchange program can be cheaper than treating people with AIDS in the long run.
"The failure to do such a (needle-exchange) program, at least in selected instances, simply signifies that we as a society are failing to do whatever can be done to contain this epidemic and prevent additional cases," Zavon said.
"Anything that can be done to prevent a case of AIDS is, I think, morally imperative. From the public health standpoint, it's absolutely essential. And from the economic standpoint of cost to the taxpayer, there isn't any question that preventing a case of AIDS is likely to be very cost-effective," Zavon said.
Treating AIDS is not cheap. Kelly Panzica, program director for the county Health Department's HIV/AIDS case management program, said it currently serves about 40 clients. Its total budget for 1997 is $182,543, which works out to $4,563.57 per client.
"From a standpoint of county economics, it would be cheaper to pay for some replacement needles than to pay the county's share of the cost of therapy for someone who contracts AIDS," Zavon said.
"Needle exchange has been proven to save lives," Ms. Panzica said. "There's been a lot of advertising about how AIDS deaths are dropping, but what they don't tell you is, young people are still being infected."
A study in the June 21 issue of the British medical journal The Lancet examined 29 city needle-exchange programs worldwide. It concluded that the prevalence of HIV infection in intravenous drug users decreased 5.8 percent per year where needle exchange was available but increased 5.9 percent per year in 52 cities where an exchange program was not operating.
A 1993 University of California study, however, found only that needle-exchange programs result in less risky behavior by drug addicts, showing "no clear evidence that they reduce HIV infection rates."
Through June 30, state figures blame intravenous drug use for 48 of the 133 AIDS cases then known to have been diagnosed in Niagara County. That's almost as prevalent as cases linked to homosexual or bisexual sexual intercourse, to which 51 cases are attributed.
Both factors are present in six of the cases, the state reported. Heterosexual intercourse is blamed for 17 cases. Four cases derived from tainted blood transfusions; two victims were hemophiliacs; and five cases could not be assigned to a definite risk factor.
The number of new cases seems to be accelerating. As of July 31, 1996, the all-time total of Niagara County AIDS diagnoses was 107. By Dec. 31, 1996, it had grown only to 113. The number jumped to 133 by last June 30, and stood at 140 as of Aug. 31.
There are no figures for persons infected with HIV who have not yet come down with full-blown AIDS. Unlike other sexually transmitted diseases, a positive HIV test is not reported to the state Health Department.
The Board of Health governs the county's sanitary code, but has no authority to start a needle-exchange program.
Legislature Chairman Sean O'Connor, D-Niagara Falls, said, "If it (needle exchange) looks at combating the spread of AIDS, I'd be for it, but you have to look at the bottom line. We'd have to see what the cost is going to be, the benefits and who would administer it."
State funding may be available for such a program. The state pays $133,000 a year for Buffalo's needle exchange, operated by Buffalo Columbus Hospital's Columbus Community Health Center on Niagara Street. A satellite site is located at GROUP Ministries on Jefferson Avenue.
Since 1993, the two clinics have collected about 600,000 used hypodermics and passed out 713,000 new ones.
Santangelo said his group, which has headquarters at 469 22nd St. in Niagara Falls, has been discussing the chances of setting up its own needle-exchange program. He said one of the problems has been finding a hospital or clinic willing to host it.
Santangelo said his group has distributed 111 bleaching kits in the past few months. The bleach is used to try to sterilize used needles. "We get requests for demonstrations on how to use them. I get calls at home. There is a need," Santangelo said.
"I feel badly that the public health community and everybody in general didn't react much more strongly when AIDS first appeared on the horizon," said Zavon, who has been involved in public health matters for 47 years. "If we had, we might have avoided this whole epidemic, which has killed millions of people worldwide.
"With the development of knowledge about HIV, about drugs, about the communicability of AIDS, we simply have to educate the public, and particularly our representatives in government, to recognize that this, unfortunately, has to be one of the cornerstones of a policy aimed at containing and, maybe sometime, just as with polio, eliminating the disease."