Background

Hawaii has had a strict drug paraphernalia law since 1987. In August 1989, a local private non-profit AIDS organization, the Life Foundation, planned to initiate a needle exchange program in downtown Honolulu, but was blocked by local law enforcement officials who threatened to arrest and prosecute staff or clients involved in needle exchange.

Objective
To overcome public, law enforcement and legislative opposition to sterile needle and syringe exchange, representatives from community-based public and private agencies formed "The Hawaii Sterile Needle Exchange Coalition" to establish such a program for Hawaii.

Method

A meeting was called for all concerned individuals which included professionals from public health, medical, substance abuse and HIV agencies. Dr. John Lewin, Director of Health for the State of Hawaii gave an update on legislation, law enforcement and public perception of this issue. It was agreed by everyone that a needle ex-change program should be encouraged and developed in Hawaii as soon as possible. Coalition strategy for taking the issue to the media, legislators, law enforcement officials and the public was extensively discussed.

The Coalition determined that the two possible tactics to legalize implementation of a needle exchange program in Hawaii would be to change the drug paraphernalia law (probably not possible, due to the powerful lobbying of the law enforcement sector) or to give the Director broader powers to enable him to take appropriate action in a public health emergency.

Two co-chairpersons were appointed, one a Director of the Medical Unit of the Department of Corrections and the other, President of the Board of Directors of the Life Foundation. This was done with consideration of credibility with the law enforcement community as well as the public. It was also decided at this point that there would be no State or Federal funding for this program and that all funding for the needle exchange program would come from private donations. This would minimize reluctance based on use of public funds for a controversial program.

The Coalition decided to implement three committees to more effectively deal with the many issues of this program.

Legislative Subcommittee

- Draft/refine the needle exchange pilot program bill which gives authority to Director of Health to approve the program. (Does not directly amend drug paraphernalia law).
- Identify key legislators to educate/inform on needle exchange.
- Development of needle exchange information packet for legislators.
- Coordinate information pre-session briefings for legislators and law enforcement officials to assure input.
- Prepare testimony for legislative hearings.

Public Relations Subcommittee

- Develop information on needle exchange back-ground/needs for media.
- Develop media contacts and time line (1-2 months).
- Coordinate needle exchange media resources (Coalition letterhead, pamphlets, buttons, poster distribu-tion).
- Increase needle exchange coalition's visibility to boost number of organizations/individuals supporting needle exchange.
- Coordinate weekly letters to newspaper editors. - Develop special television news series on needle exchange.

Program Development and Evaluation
- Develop needle exchange program specifics for legislative discussion.
- Develop evaluation criteria (goals-objectives) for bill inclusion.
- Stress need for needle exchange to be part of a continuum of services to IVDUs including counseling, testing, outreach and treatment.

The legislative subcommittee revised the bill draft that had been held in the House Judiciary Committee the session before. Key elements of the revised bill drafted by the Committee were:

- The State Director of Health would have the authority to initiate a needle exchange program.
- HIV counseling and testing would be provided at the needle exchange site.
- Confidentiality of the participants will be insured.
- Persons distributing needles for this purpose would be immune from prosecution.
- There would be some type of program evaluation approximately one year after the program had been initiated.
- A deadline ofJuly 1, 1990, would be set to imple-ment the program.
- The Director of Health would have the power to stop the program if deemed necessary due to promotion of drug use or other terms that violated the bill.

In December the law enforcement coalition at-tended an needle exchange briefing held at the State Capitol. A few weeks later there was a briefing for all legislative persons who were interested in learning more about needle exchange.

By this time the group had grown to approximately 30 organizations which some of the Coalition composition include:

- Hawaii Department of Health
- Hawaii Chapter - American Academy of Pediatrics
- Life Foundation
- Hawaii Nurses' Association
- Hemophilia Foundation
- Hawaii Medical Association
- Hawaii Council of Churches
- Governor's Committee on AIDS
- Kapiolani Medical Center for Women and Children
- Drug Addiction Services of Hawaii
- Healthy Mothers, Healthy Babies

The evaluation and program development subcom-mittee came up with a three part approach for evaluating the needle exchange program.

- Demographic - This would be taken largely from the daily log.
- Quick Survey - This would be done by the Life Foundation and would take 10 minutes.
- Extensive Interview (AIA and AFA) - This would be done by the CHOW Project which is a NIDA funded program.

Implementation

After the bill passed both the House and Senate it went to the Governor's office which he signed on June 25, 1990. Although before he signed the bill an Oversight Committee was implemented which was mandated, and consisted of 19 individuals of which 17 are not involved with the Coalition. There are three from the law enforcement community, two from the legislature and the rest are from various professional fields. This Oversight Committee will have input on the evaluation process during the duration of the program. A "Memorandum of Agreement" was drawn up between the Department of Health and the Life Foundation. Some of the items in the agreement were that the Life Foundation would submit a monthly report to the Department of Health for review. On July 5, there was a press conference in the morning at the needle exchange site and that afternoon the needle exchange started.

Conclusion

The Coalition was instrumental in getting the needle exchange bill through the 1990 State Legislature, in the form of a two year pilot program (H.B. 2044, S.D.2). Visible opposition was limited to Honolulu law enforcement representatives (City Prosecutor and Police Department), along with a few individuals opposing needle exchange because it appears to condone substance abuse. Support from local church organizations such as the Hawaii Council of Churches, helped to minimize potential opposition to the needle exchange program.

Aaron Peak is a Community Health Outreach Worker with the Life Foundation, P.O. Box 88980, Honolulu, Hawaii 96830-8980. (808) 971-AIDS.