Twenty years ago, I was a drug addict, a drugstore cowboy. My time was spent burglarizing drug stores to get whatever drugs I could find. I was in and out of jails in the New England area. But I was lucky. I was able to stop using drugs, turn my life around, attend college and will soon be graduating from the Yale University School of Public Health.

Many addicts today do not have that choice because there is a deadly epidemic among IV drug users — AIDS. Once an addict gets AIDS there is no reason to stop using drugs because your life is limited. There is also no reason to conform to the mores of society. Indeed, an addict with AIDS will hate society. Many in the "addict world" already start from the underclass and distrust the "straight world." Once the straight world lets them get AIDS, and they see political leaders like Mayor David Dinkins of New York City enacting policies that allow the virus to spread among addicts, they will hate society, commit more crimes and not conform.

I have been living with and working with drug addicts for many years. One reality that the straight world does not understand is that addicts do care about their health. They are not out to destroy themselves. They will make choices that protect their health if given the opportunity. One such choice is not sharing needles. The Na-tional AIDS Brigade has surveyed addicts in New Haven and Boston. When we ask them if they would share their needles if clean needles were available nearly 100 percent say they would not.
When I faced prosecution in Boston for possession of syringes many experts from the United States and Europe testified on my behalf. But the most powerful testimony was the testimony of a reformed addict. Three years ago I met him in a bar and told him about AIDS being spread by syringes and works. He didn't believe me. I showed him a magnified picture of the AIDS virus in a syringe. He made a choice. He took responsibility and stopped sharing needles. This was the first of many choices he made to protect his health. When he testified at trial he said that this choice was the first choice toward becoming drug free. When he realized he was able to choose to prevent AIDS, he realized he could make other choices as well. This man said needle exchange saved his life.

Needle Exchange Is Urgently Needed In the United States

Today, the fastest growing source of new AIDS cases is among IV drug users. IV drug users represent the number one conduit through which AIDS is being spread to the heterosexual population and to new born children. From the public health point of view, every measure that can prevent the spread of AIDS by IV drug users must be seriously considered. This is an emergency situation that must be acted on now.

While drug abuse is a serious concern it is dwarfed by the AIDS epidemic. AIDS has already killed more Americans than either the Vietnam War or the Korean War. Failure to properly make AIDS a higher priority than drug abuse will result in the spread of this deadly epidemic into new segments of society.

The containment of HIV infection among IV drug users should be an objective with the highest priority. Needle exchange programs play an important role in keeping participants seronegative, and, if already infected, in preventing them from infecting others. The availability of sterile needles also helps IV drug users avoid risky situations in which sharing may occur and helps them maintain safe injection practices. By setting up "user friendly" AIDS prevention services that are confidential, nonjudgmental and not aimed at immediate abstinence, we will see participants who are beyond the reach of other agencies. Doing this helps minimize the harm to the community, to our society and to the individual drug user.

Needle exchange programs should be a single part of a wide ranging AIDS prevention system. It should not be viewed as an alternative program but one that compliments other AIDS prevention programs. Needle exchange programs reach individuals who are not in touch with other services and does this at a reasonable cost. The strategy of these programs is based on a knowledge and means approach to behavioral change. Participants are given both AIDS prevention knowledge and the means to stay AIDS free (sterile needles, bleach, condoms, literature, etc.). Needle exchange programs empower IV drug users with the means t,o make a valuable difference in their own lives. This often helps erase IV drug user cynicism and can be the first step towards successful drug treatment.

Opposition to needle exchange primarily focuses on the unproven fear that needle availability will increase drug abuse. Common sense and research tell us that is not so. For example, people do not begin smoking tobacco because they walk by a pipe store. Our research, and research from throughout the world, shows the following:

- needle exchange increases the number of people seeking drug treatment;
- needle exchange provides an opportunity for counseling, advice and referral;
- needle exchange reaches IV drug users who are outside of the usual assistance systems;
- needle exchange stimulates the return of contaminated injection equipment and thereby reduces the availability of such equipment on the streets;
- needle exchange will reduce needle sharing and thus slow the spread of HIV infection.

Addicts Must Unite and Form A Drug Users Union

The immediate social response to epidemics is to attack the victims. AIDS was originally referred to as the "Gay Plague." Although this resulted in victimization, the affluent, articulate and politically connected gay community fought back. The same must happen among drug users. Unlike the gay community the addict community is unorganized, poor and lacks political clout. However, IV drug users are beginning to show signs of organization. When we asked addicts, "Would you join an IV drug using union?" one hundred percent of the respondents answered, "Yes." This indicates that IV drug users want to gain control over their lives, acknowledge the need for organized representation, and believe they will benefit from representation.

Forming an IV drug user union will require overcoming several obstacles. First, IV drug users are more likely to be concerned with drug use than with volunteering towards any organizing effort. IV drug users are not a cohesive group, lacking identity as a group they have little capacity to campaign for funding or recognition. They are generally disliked by the public and often use secrecy to avoid arrest. The second largest battle for an IV drug user union will be against established AIDS organizations. Many of these organizations are eager to claim "turf ownership" for political gain, for empire building, to protect or increase funding or because of personal ambitions.

An IV drug user union will not only be important to addicts, it will be important to society at large. Our current drug policy is developed without consultation with drug users. Our policy makers prefer to describe drug users as "evil traitors" who are the cause of crime and murder in our cities. If policy makers made an effort to understand the drug using population they would be more realistic in their appraisal of addicts. Reality would help make drug policy more effective. It is absurd for policy makers to expect to develop sensible drug policies without talking to the people the policy most directly effects. A drug user union can help bridge this reality gap and add some common sense and practical experience to our ineffective drug policy.

History and Philosophy of the National AIDS Brigade

The National AIDS Brigade was formed in 1985 when we began educating drug users about the dangers of AIDS. We undertook this task when public health officials believed that IV drug users "didn't care." The Brigade is working to create a system of AIDS Prevention Walks to fund a system of AIDS Prevention Storefronts. The Bri-gade operates on a shoe string budget and would not exist except for the support of dozens of volunteers who care greatly about the health of people who our government prefers to either ignore or warehouse in prison cells. Many of these volunteers are themselves current or former drug addicts.

In January, 1986, the Brigade rented a New Haven storefront and nine months later began the nation's first needle exchange program. Eleven states — California, Illinois and nine states on the northeast seaboard — require prescriptions for hypodermic needles. Currently our needle exchange work reaches into nine of these eleven states and also the District of Columbia. Data collected from needle exchange participants shows that most IV drug users will stop sharing needles, increase their AIDS prevention knowledge and practice safe sex. In short, this data shows that IV drug users are human beings that simply need to be given the choice to help themselves.

Our AIDS Prevention storefronts will not only offer AIDS testing and counseling, but will be a place for community outreach programs, work referral, housing referral, education and recreation. The main focus of our work will be to educate IV drug users about the dangers of sharing syringes, water, cottons and cookers. In addition to needle exchange, outreach workers will supply IV drug users with AIDS prevention kits containing bleach, water, cotton, cookers and literature. To enhance the effectiveness of this work, outreach workers will distribute AIDS prevention kits and do needle exchange on a steady basis.

Besides the individual and the family, our AIDS Prevention Storefronts will involve the neighborhood, the church and voluntary organizations. We hope to develop networking of self-help, mutual aid groups. The storefronts will be based on the notion that absence of disease does not equal good health. These storefronts will be facilities where mind, body, and spirit are not to be considered separately but as complimentary parts making up the whole. Volunteers will attempt to be fully understanding of human needs and be humanistic in attitude, ethics and behavior. This will put individuals utilizing the storefronts more at home and make their experience more meaningful.

The AIDS prevention walks serve two purposes. First, they are an important source of funds for the storefronts and our other activities. Second, by holding them in neighborhoods where drug abuse and AIDS are high, the walks show addicts that the community cares about them. Particularly when we have police officials involved in the walks we begin to bridge the gaps between the addict world and the straight world.

The National AIDS Brigade has seventy members divided between groups located in Boston, New Haven, New York and Chicago. ACT UP has joined the Brigade in our needle exchange efforts and in the fight to strike down existing needle laws. The Brigade and ACT UP have needle possession cases pending in Rhode Island, New York, New Jersey and Delaware. We have been able to challenge needle exchange prohibitions with the help of the Drug Policy Foundation and the American Civil Liberties Union. These challenges have produced positive results. Instead of making arrests, police in Baltimore, Washington, D.C. and New Haven have allowed needle exchange work. Recently, Boston police have also allowed our needle exchange work, in large part as a result of my acquittal in Commonwealth v. Parker.

The idea to challenge needle laws came after a Boston court found needle possession justified to limit the spread of AIDS. The decision of this Massachusetts trial court did not bind any other courts in Massachusetts, let alone in other states. The Brigade and ACT UP hope to set a needle. precedent by winning one of our needle exchange cases in a higher court and by challenging similar laws in other states. Rhode Island considers needle possession to be a felony. Rhode Island felonies bypass the municipal court and go directly to the Superior Court, thus quickening the chances for a precedent setting needle case victory in that state.

The Brigade is currently active in ten states and Washington, D.C. Here is what we are doing: Massachusetts — On August 13, 1988 I was arrested in Roxbury's Mission Hill area and charged with unlawful possession of hypodermic needles. I was represented by Arnold Abellow, who was assisted by a pro bono attorney brought into the case by the Drug Policy Foundation, Sharon Beckman. The Drug Policy Foundation and the ACLU came to my assistance providing legal assistance and filing a friend-of-the-court brief. The court was urged to find my conduct justified under two separate legal theories.

First, the defense pointed out that while it is clear that the legislature intended to prevent illegal drug use, nothing in the statute suggests that the legislature intended to impose criminal punishment on those who possesses or distribute sterile needles for the purpose of preventing the spread of disease. Second, we argued that although I admitted violating the needle law, my conduct was nevertheless legally justified under the doctrine of necessity. This doctrine, also known as the choice of evils defense, holds that there should be no violation of the law if the reason to break the law was more important than the reason the law was made. Commonwealth v. Iglesia, 403 Mass. 132 (1988). To establish the defense of necessity under Massachusetts law I had to prove that I was faced with a clear and imminent danger, reasonably expected this action to be effective in abating the danger, there was no legal alternative and the legislature had not firecluded the defense by a clear and deliberate choice regarding the values at issue.
Judge Sally A. Kelly held I was not guilty of violating the law because my actions were taken solely for the purpose of limiting the spread of AIDS. The court adopted our first argument by focusing on my lack of criminal intent. Judge Kelly saw my intent was to save lives, not encourage drug use.

Acquittal on these charges helped change the Boston Police Departmenes position on needle exchange. Instead of making arrests, police allow the Brigade to openly exchange needles. Each Wednesday our needle exchange van travels to Mission Hill. The needle exchange van frequently visits Boston's Combat Zone, Dorchester, South Boston, East Boston and South End. Needle Exchange also occurs in the following Massachusett's cities: Lowell, Lawrence, Haverhill, Glouchester, Holyoke, Springfield and Worcester. We are striving to deliver sterile needles to these cities on a steady basis.

Although Boston Police allow our needle exchange work, this hasn't completely stopped arrests for needle possession. Recently, two needle exchange recipients were charged with needle possession and these men plan to fight these charges in a jury trial. Hopefully, acquittals will help to further change the Boston Police Departmenes position on needle exchange.

The factor that most limits our work is not the lack of sterile needles, but the lack of AIDS prevention supplies, e.g. bleach bottles, water bottles, alcohol wipes and condoms. The Brigade desperately needs these supplies but city officials have continually refused to help. In the Spring of 1988, the Brigade spent two hours with Mayor Flynn's aid, Bob Finnerman. We discussed the urgent need for IV drug user AIDS prevention. We told him about the Brigade's needle exchange program. The City of Boston took no action to respond to this emergency. Two years later, Mayor Flynn still has refused to supply basic AIDS prevention supplies.

Our storefront in Boston will concentrate on AIDS prevention among the homeless. The rate of AIDS among homeless Vietnam Veterans is soaring. Several Bri6de members are Vietnam Veterans who are both HIV positive and homeless. The men fought for their country, began shooting heroin during their military service and now are being neglected by our government. It is a disgrace. Helping these former soldiers fight AIDS among homeless Vietnam Veterans will be the Boston storefront's highest priority.

Rhode Island — Every day Massachusetts heroin buyers stream into Providence for $10 bags of heroin. These same heroin bags sell for $25 to $30 in Boston. This drastic price increase allows hundreds of small time heroin buyers/ sellers to maintain their addictions. Cheap heroin does not mean cheap sterile needles. Providence is the only known city where hypodermic syringes are routinely sold for $10 — the same price as the heroin. This higher than usual price for needles increases needle sharing and creates an urgency for community based needle exchange programs.

In Summer, 1987, the Brigade began South Providence needle exchange work. Providence's huge heroin trade (New England's largest) has led to rampant IV drug use. Although IV drug users were very receptive to our presence, lack of supplies has made for inconsistent needle exchange work.

In April, 1990 the Brigade challenged Rhode Island's needle law. Police approached three Brigade members carrying out needle exchange in East Providence's Broad Street. The police officers were told about our needle exchange program and the Brigade was directed to seek authorization at Police Headquarters. Minutes after entering Police Headquarters, we were arrested and held on $1,500 bail. In Rhode Island it is a felony to possess hypodermic needles without a prescription. Felony cases are sent directly to Superior Court, allowing us the opportunity for a precedent setting needle exchange victory.

Connecticut — During the Spring of 1985, a handful of Yale medical students, public health students and undergraduates began educating New Haven IV drug users about the dangers of AIDS. In February of 1986 our group rented a York Street storefront. In November, Brigade members began needle exchange at five locations: Dixwell Ave., Grand Ave., Kilby Street, Congress Ave., and New Halville. The next year, we concentrated our needle exchange efforts on Dixwell Ave. Friday afternoon needle exchange also occurs inside a nearby shooting gallery. Four IV drug users (3 on Dixwell Ave., one in the shooting gallery) are Brigade volunteers. When supplies are avail-able, these men often volunteer full-time. A good example of this volunteerism is seen in the shooting gallery. Before the New Haven Health Department stopped giving AIDS prevention supplies, the shooting gallery owner made sure that every IV drug user using his establishment was offered AIDS prevention kits and needle exchange. These AIDS prevention kits contain bleach, water, cottons, cooker, condoms and literature.

In May 1990 the Connecticut legislature passed a bill that allows a New Haven needle exchange program. This made Connecticut the second state to authorize a needle exchange program. The first was Hawaii. In New Haven, Health Department counselors will take new needles to the neighborhoods where addicts live or where they shoot up and will offer AIDS prevention kits from a marked Health Department van. Considering the results of the Brigade's needle exchange program, this pro-active neighborhood approach to needle exchange — in contrast to requiring a downtown site — greatly increases the chance of success. New Haven has made its needle exchange program, user friendly. This is critical to the success of such efforts.

The National AIDS Brigade played a major role in the Connecticut legislative victory. In March, 1990, four members of our group testified before the General Assembly's Public Health Committee. After dramatic testimony about needle exchange, the Public Health Committee voted against seeking repeal the state law controlling the sale and possession of needles. The committee chairman exclaimed: "Don't bring back the needle bill next year!"

We realized that New Haven has the nation's highest percentage of IV drug user-related AIDS — 72 percent. Therefore, the Brigade fought hard to win public support for needle exchange. Our main weapon was the media. Not only was our needle exchange work featured on local television and in local newspapers, but also seven times on national TV. This media coverage helped gain public support for needle exchange in New Haven. One month before passage of the needle bill, the Brigade set up a table on Dixwell Ave. and openly exchanged the clean needles for dirty ones. Patrolmen quickly intervened, but were told by their superiors not to make arrests. The local media reported that the police tolerated needle exchange and the public responded with approval.

Recently, a New Haven needle exchange recipient was charged with needle possession. The Brigade arranged for legal help to defend the charges. We saw the prosecution as selective enforcement of the law and believe that in cities where needle exchange is allowed by police others should not be arrested for needle possession. As expected, this needle case was quickly dismissed.

New York — New York City has an estimated 200,000 IV drug users, half of which are suspected of being HIV positive. Delay in effective community based needle exchange programs is greatly responsible for this tragedy. Further delay guarantees an ever increasing amount of heterosexual AIDS, pediatric AIDS and high death rates in minority communities.

Although IV drug user AIDS will devastate the black and Hispanic communities, the major opposition to needle exchange comes from politicians of color. Mayor David Dinkins and Congressman Charles Rangel, by opposing needle exchange, are signing death warrants for tens of thousands of people from their community. As the crisis worsens, eventually every weapon, including needle exchange, will be used against IV drug user AIDS and eventually the public will see the beneficial results of needle exchange. The public will ask: "Who is responsible for allowing so many deaths?" The answer will be politicians like Mayor Dinkins and Rep. Rangel who preferred moralistic posturing to saving lives with pragmatic and proven public health strategies.

In April, 1988, the Brigade began needle exchange in the Lower East Side of Manhattan and the Williamsburg section of Brooklyn. In Spring 1990 ACT UP/ New York joined our efforts and greatly helped to expand this needle exchange work. Presently, our two groups do needle exchange work in three New York City boroughs—Manhattan, Bronx and Brooklyn. This work is done four days a week with most needle exchange occurring in the South Bronx.

In March, 1990, ACT UP and the Brigade openly did needle exchange work in the Lower East Side of Manhattan to protest Mayor Dinkins closing of the official needle exchange program. Almost immediately, ten individuals were arrested and charged with criminal possession of hypodermic needles. We hope our arrests will help to strike down existing needle laws or help make needle exchange again become official in New York City — the city where needle exchange is needed most.

New Jersey — In Summer of 1990, the Brigade began needle exchange work in Jersey City. Although IV drug users were very receptive to our presence, lack of supplies made for inconsistent needle exchange work.

In April 1990, the Brigade and ACT UP challenged the New Jersey needle laws. Four people were charged with both illegal possession of hypodermic needles and possession of drug paraphernalia (bleach kits).

Delaware — In the Fall of 1989, the National AIDS Brigade began work in Wilmington, Delaware with the help of local IV drug users. Although IV drug users were very receptive to our presence, lack of supplies has made for inconsistent needle exchange work.

In June of 1990, the Brigade and ACT UP challenged the Delaware needle law. Four people were arrested, our transportation van was illegally searched and a copy of my thesis on needle exchange was stolen by the police. Twelve hours after arrest, we were taken to night court and told to sign a statement demanding that we "Cease operations . . . in Delaware." The stolen thesis stated our goal for a national AIDS prevention system. We believe this openly stated goal was the reason for our late night court appearance and our being forced to sign the above statement.

The Delaware prosecutors have dismissed the charges against us presumably because they do not want to defend the statute and because they hope we will not come back. However, we will not go away, we will not "cease operations in Delaware."

Pennsylvania — In Fall of 1989, the Brigade began North Philadelphia needle exchange work with the help of local IV drug users. Although IV drug users were very receptive to our presence, lack of supplies has made for inconsistent needle exchange work.

Maryland — In Fall 1989, the National AIDS Brigade met with Baltimore health officials and were invited to begin needle exchange work. That afternoon a local outreach worker brought the Brigade to East Baltimore. Media coverage of our needle exchange work was very positive and encouraged city leaders to announce plans for an official needle exchange program. Baltimore is led by a dynamic mayor, Kurt Schmoke, whose intelligent leadership on the drug issue led to his receipt of the Drug Policy Foundations Richard J. Dennis Drugpeace Award in 1989. Along with the Health Commissioner of Baltimore, Maxie Collier, MD, they have developed plans for an official needle exchange program. We applaud the efforts of these enlightened and courageous political leaders.

Washington, D.C. — In Winter of 1990, the National AIDS Bligade began needle exchange work in Washington, D.C. IV drug users congregated around our table causing police to think individuals were selling drugs. Eight police cars converged on the street corner and we were forced to stand against a wall and be searched. The police search only produced condoms as we had already distributed all of our needles.

One month later the Brigade returned to do needle exchange work accompanied by a Washington Post reporter. The following week the National AIDS Brigade openly challenged Washington, D.C. needle law in the presence of television and newspaper reporters. Police choose not to make arrests. Lt. James Dotson stated: "We didn't feel it was worth the manpower to sit and wait on them?' Although Washington, D.C. IV drug users were very receptive, lack of supplies and travel distance has made for inconsistent needle exchange work.

Illinois — In Spring of 1990, two Chicago area residents invited the National AIDS Brigade to visit and begin needle exchange work. Bleach kits were brought from Boston, needles were purchased in Wisconsin, needle exchange work occurred on Chicago's West Side. Police quickly intervened and we were lucky to avoid arrest. The two Chicago area residents have adequate prevention supplies, but lack of outreach personnel has hindered continued needle exchange.

California — In Winter of 1989, a San Mateo resident joined the National AIDS Brigade to consolidate his needle distribution with our national effort. For a number of years this man has been exchanging needles with San Mateo IV drug users. Our AIDS prevention kits and needle exchange information have been incorporated into his needle exchange efforts.

So Much Needs To Be Done

In a few short years anti-AIDS activists have done a great deal to raise consciousness about preventing AIDS among IV drug users. We have done all of this on virtually no budget. We are grateful to the Drug Policy Foundation for awarding us and West coast needle exchangers, the Richard J. Dennis Drugpeace Award. The $100,000 prize that goes with the award will save a lot of lives. While $100,000 is a good deal of money it will go very quickly and more financial support will be needed. I hope you will help us.

Needle exchange is only the beginning. Addicts need to be empowered to make choices and be responsible for themselves. They need to feel like society wants them so they can become part of our community, rather than being apart from it. Successful needle exchange is a first step toward a more humane, and more successful, drug policy. Please help us — so we can help each other.

Jon Parker is the founder of the National AIDS Brigade,
P.O. Box 201, 492 East Broadway, Boston, Mass. 02127. (617) 269-8236