As a social researcher I have sought to describe the impact of the spread of HIV/AIDS on our society without inserting my own values. But as a religious person I feel I must speak out on the moral issues surrounding the spread of HIV/AIDS among persons who inject drugs.

The Wages of Sin Are Death, But ...

If a woman has a life-threatening hemorrhage after giving birth, we want the doctor to provide medical treatment at once. We do not want the doctor to first inquire about the circumstances under which the woman became pregnant.

When an ambulance goes to the scene of an accident, we want all the people who need help to be treated, even the person who caused the accident.

When medical science has provided a way to treat an illness, we want that knowledge used on every person that it will help. We do not want medical care to be given only to those whose behavior is beyond reproach — so few of us would be eligible.

Of course, medical interventions go way beyond pills, bandages and surgery. In the name of public health we remove asbestos, cover over lead-based paint, and purify water. All the medical experts who have looked into it carefully tell us that, in their considered scientific opinion, making sterile needles available to persons who inject drugs will slow the spread of HIV/AIDS. Making sterile needles available to persons who inject drugs is a medical intervention of proven efficacy.

The Bible says that the wages of sin are death. But the Bible also says that vengeance belongs to God.

God has led our medical scientists to the knowledge of how to slow the spread of the deadly HIV/ AIDS virus — by stopping the sharing of dirty needles. We have an obligation to use this gift of knowledge.

Letting People Learn from Experience ... Within Limits

An important part of learning is suffering the consequences of unwise decisions. But there are limits:

We have lifeguards at the shore, to save the lives of those who take risks and go beyond their abilities.

We send rescuers for skiers and climbers who have foolishly gone to dangerous areas and injured themselves.

Generally we try very hard to prevent serious injury and death, even to people who are quite incautious. But so far with regard to HIV/ AIDS, we have behaved differently.

We have laws that prevent persons who inject drugs from protecting themselves by using sterile needles. In other words, we have laws that are causing the injection-related part of the HIV/AIDS epidemic.

We need to improve and expand our education about the many harms associated with injecting illicit drugs. But when people choose to be reckless, we need to use our scientific knowledge to reduce the harm of what they are doing.

A number of young adults experiment with injecting drugs for a while and then stop forever. Consider the difference access to sterile needles makes.

The uninfected person who stops using drugs has his whole life before him. The HIV-infected person who stops using drugs almost surely faces serious, painful illnesses and premature death. People who inject drugs may experience:

•    negative health consequences from putting illicit drugs into their bodies;
•    loss of their jobs, if they cannot perform their duties;
•    loss of friends, if the friends no longer want to be around them and their habit;
•    loss of family, when family members cannot tolerate the behavior of the user.

These are serious consequences from which a person can learn and recover.

So far there is no recovery from HIV/AIDS, and it is from this deadly threat that we must protect persons who inject drugs.

Just Punishment

What is the appropriate punishment for injection drug use?

a) No punishment at all. Whatever a person does with his/her own body is his/her own business.

b) A fine and/or mandatory drug treatment.

c) A prison sentence of from a few months up to five years.

d) A prison sentence of six to 20 years.

e) Life in prison.

f) Execution (a swift death, such as death by lethal injection).

g) Execution (a slow, painful death).

In the United States, if we look at the statutes, the answer is (b) or (c) for the first offense and often for subsequent offenses as well. But the reality for increasing numbers of injection drug users has been (g), a slow, painful death by HIV/AIDS.

In the Bible, there is no explicit teaching prohibiting injection drug use. We passed laws prohibiting persons from having access to sterile needles to protect people from the harm of injecting drugs. No study has ever shown that these laws are effective in preventing injection drug use. But these laws have been effective in preventing people who inject drugs from having access to sterile needles.

It is a tragic irony that the laws prohibiting access to sterile needles, laws meant to protect people, are now the cause of people dying from AIDS.

Am I My Brother's Keeper?

There is a dangerous curve in the road. One speeding driver dies. Then another. Then another. Then another. They should not be speeding. They are responsible. But we know the curve is dangerous. Don't we have an obligation to post a warning sign? Put in a stop light? Change the traffic pattern? Perhaps even straighten the road?

And the driver is not always alone. Sometimes a wife or husband is along. Sometimes a newborn child.

And so it is with injecting drugs in the age of AIDS. People who inject drugs know they are taking a risk. But we know too.

I believe we have an obligation to make sterile needles available to the injection drug user for his or her own sake. Injection drug users are God's children too.

And like the reckless driver in the example above, persons who inject drugs have wives, husbands, and babies. And when we abandon the person who injects drugs to HIV/AIDS, we are abandoning their non-drug-injecting partners and babies as well.

God has given us the knowledge of how to slow the spread of HIV/AIDS to all these people, let us use it. •

By the end of 1995, over 180,000 United States residents had injection-related AIDS or had died from it. Over 86,000 of that number were African-Americans.

Dawn Day, PhD, is the director of the Dogwood Center, PO. Box 187, Princeton, NJ 08542. Day is an activist scholar who writes on issues of social justice, drugs and AIDS. She is the author of "Health Emergency: The Spread of Injection-Related AIDS Among African-Americans and Latinos."
 

Special thanks to Eric Sterling for his comments on an earlier draft of this essay.