Living Clean

"I've been thinking about this for a couple of days," she says, her dilated pupils floating without focus; a half-bottle of Contac cold medicine slurring her speech; a late-day trip to the methadone clinic stilling the smoke-filled air with pregnant pauses.

"Call me Greta. No one will ever guess it's me. Not my boss. Not my boyfriend. No one." Unveiling her alias momentarily jerks Greta awake. A devious smirk creeps across the 27-year-old's aged face. She rubs her tear-swollen eyes, shakes the cobwebs from her head and hunts for another cigarette.

Thirty seconds later she nods off to sleep, her head jerking in feeble resistance.

A junkie since 1993, Greta has been struggling to escape her $100-a-day habit since Thanksgiving. A month short of May Day, she's shooting heroin "once or twice" a week. When morning coffee isn't enough to get her up for the 9-to-5 grind, she sniffs coke. Her chances of kicking for good are minimal. But she says she wants to. She says she's trying.

Until May of 1995--when the Minnesota AIDS Project (MAP) instituted its then-controversial needle exchange program--Greta had to buy her own needles; in a state where, under current drug paraphernalia laws, no one can sell syringes if they know, or have reason to believe, the product will be used for illicit purposes. A prescription isn't required at the local pharmacy. But chances are high that customers who are poor or black or strung out (or all of the above) will be turned away--especially if they're shopping in the inner city.

To aid those who don't know about, or won't use, its self-funded program, MAP has made increased access to clean syringes a key provision in the 1997 HIV Awareness and Prevention Act. Specifically, as part of the Crime Prevention Omnibus Bill (which has taken its first pass through the State House and Senate), a provision was introduced to lift restrictions on the sale of needles. If the legislation passes intact, pharmacists will be allowed to sell up to 10 syringes to anyone, regardless of how the needles might be used.

"Those motherfuckers (at the Legislature) could actually make a difference on the street this summer," Greta says. "People wouldn't have to die because they don't look like Mr. and Mrs. Edina."

Before hooking up with MAP, she had tried everything: She studied the symptoms of diabetes; removed her nose ring, donned a second-hand business suit and bused to the suburbs in search of trusting pharmacists; she even recruited her boyfriend's clean-cut buddies as buyers. Too often, though, her Jones bum-rushed her patience and she would share a syringe or sharpen one of her own dulled, dirty needles on a matchbook. Last year, Greta's boyfriend was diagnosed as HIV-positive. Today, he's living with AIDS.

"Look at these," Greta says, rolling her sleeves up over two separate, 3-inch strips of purplish scar tissue; red on the edges, black in the center. "I've lost more veins than I can count because I used bad needles."

Currently, MAP's exchange program--run out of a renovated ambulance that roams the metro--serves Greta and more than 200 fellow addicts. When they exchange their dirty needles for an equal number of clean syringes, users can pick up needle-cleaning kits, free condoms and, if they choose, get access to counseling. According to MAP's Executive Director, Lorraine Teel, 65 percent of those who use the service are men. The clientele is predominantly white and somewhere between the ages of 25 and 30. Frank Guzman, who has manned MAP's van since the program's inception, says many of his clients drive in from the suburbs. Others come to exchange needles for entire inner-city neighborhoods.

Whether African American, Native American, and female users are uncomfortable with, or unaware of, MAP's self-funded exchange program is unclear. What has been established by the National Institute of Health, in a study completed in February, is that women are at a higher risk for HIV infection through injection drug use (IDU) than men, while people of color are at a higher risk than whites. In Minnesota, MAP's Public Policy Director, Bob Tracy, reports that twice as many women as men who've tested positive for HIV listed IDU as a contributing factor. When infected people of color were polled, 20 percent were injection drug users, as opposed to 8 percent of HIV-infected whites. And, according to Tracy, 72 percent of Minnesota's newborns infected with HIV were born to mothers who had been injecting illicit drugs.

Despite these daunting numbers, Minnesota is still ahead of the national curve: IDU accounts for 7 percent of MAP's AIDS cases, as opposed to 36 percent nationwide. According to a 2-year-old international study, in five smaller metro areas with rates of infection similar to the Twin Cities, increased access to clean needles has prevented a "cascading effect" of HIV infections among people of color, women and children. All of which should make a clean-needle law politically feasible.

But on Friday, April 25, Rich Stanek (R-Maple Grove) introduced an amendment in the Minnesota House of Representatives to strike the clean-syringe provision from the Crime Prevention Omnibus Bill. Bob Tracy, who routinely works the State Capitol for MAP's constituents, wasn't surprised by the move. While the Omnibus Bill was making its way through the Senate a week earlier, he was already lobbying House representatives on both sides of the aisle with hard data designed specifically to counter Stanek's unsubstantiated objection: that by making it legal for pharmacists to sell needles, the state was sanctioning drug abuse.

Studies and reports by the National Academy of Science, the General Accounting Office, the Office of Technology Assessment, the National Institute of Medicine and the National Institutes of Health all conclude that increased access to syringes will cause no increase in the rate of drug use, or it will cause a decrease (usually because of accompanying educational efforts). A study of increased syringe access in Boston showed no escalation in the crime rate, no initiation of young people into drug use, and no attraction of addicts from other cities. More important, when Connecticut implemented a similar pharmacy-access law in 1992, new HIV infections were reduced by a third.

In light of this information (and because major media outlets from CNN to Time/Warner have recently reported on the correlation between dirty needles and HIV) Tracy was confident the syringe provision would enjoy wide, bipartisan support. Still, when Stanek's amendment came to a vote, it was defeated by the narrowest of margins: 66 for, 67 against. Sue Power, Director of Women with a Point, says she isn't surprised by the Legislature's reticence. She's been working with addicts on South Minneapolis streets since last June, providing more than 20 drug-addicted clients with on-the-street outreach, education, and prevention, including clean needles.

"People are so concerned about contributing to someone's habit, they forget that if you're giving an addict clean syringes you're saving their life," Power says. "I work with people all the time who are HIV positive. And they're gong to shoot up whether they get a clean syringe or not. They're going to use dirty, they're going to share, they're going to shoot with a broken one. That's sad, but it doesn't mean we should turn our backs."

Another House amendment to the Omnibus Bill, requiring that pharmacists take in one dirty needle for every one they sell, was introduced by Peggy Leppik (R-Golden Valley) on Friday. It passed. Tracy, who calls the amendment "not particularly workable," hopes a compromise can be worked out in conference committee. "We agreed to this amendment, because disposal is a consensus-building issue," Tracy says. "The retailers and pharmacists aren't going to like it. They're concerned about logistics. But I think we'll end up with something everyone can live with--which is amazing. Four months ago, it would have been very hard to get bipartisan support for increased access. I think people have realized this is a way to get ahead of one large part of an epidemic."

One pharmacy expecting increased traffic if syringe access becomes law is Butler Drug at 2600 Nicollet Ave. in Minneapolis. The store's owner of 30 years, Herb Whittemore, supports MAP's initiative for the same reason he helped set up a neighborhood methadone program and provides condoms for people on medical assistance. "When people get overtaken by the fire of human desire, all we can do is work to make sure they don't burn themselves or others."

Characterizing his current syringe-sale policy as "fairly conservative" because of drug paraphernalia laws, Whittemore says he's looking forward to seeing whether increased access will make a difference to his customers. But he doubts other pharmacists will act accordingly, even though the Minnesota Pharmacists Association hasn't object to MAP's proposal; because the choice to sell syringes to customers without prescriptions will still, ultimately, be up to each individual pharmacist. Which means people like Greta--slurring their speech and fighting off sleep--can still be turned away.

"There's no protocol. No mandate for the pharmacists," Whittemore says. "So if they don't like how you look or how you talk, you're on your own: back on the streets; back to the dirty needles."

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