Preventing HIV Transmission The Role of Sterile Needles and Bleach (1995) / Chapter Skim
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4 COMMUNITY VIEWS
4 COMMUNITY VIEWS
Pages 103-142
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From page 103... ...
It also presents results from cross-sectional surveys of selected African American populations to demonstrate how deficits in AIDS knowledge and attitudinal barriers have shaped the perceptions of African Americans toward needle exchange programs as an HIV prevention strategy advocated by public health authorities. In addition, some of the discussion is based on information from another paper prepared for the panel by David Metzger and Dominick DePhilippis, Treatment Community Views on Needle Exchange and Bleach Distribution Programs (1994)
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From page 104... ...
We then discuss public opinion polls, which are informative to broadly gauge community attitudes toward needle exchange and bleach distribution programs over time. The chapter goes on to discuss the perspectives of a number of community groups and their responses to needle exchange and bleach distribution programs: minority communities, which are disproportionately affected by drug abuse, law enforcement officials, who are sworn to enforce laws, · pharmacists, who hold supplies of sterile needles, and · drug abuse treatment providers, who work with limited funding to impact the difficult processes of addiction.
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From page 105... ...
Although it is beyond the scope and expertise of the panel to fully examine the complex range of ethical issues that might be judged relevant to analyze the establishment of public health policies, we nonetheless present two fundamentally divergent views that may contribute to an understanding of the polarization encountered when the establishment of needle exchange and bleach distribution programs is considered. Within the context of an ethical debate, whether needle exchange and bleach distribution programs contribute to increased drug use in society constitutes one of many harms and/or benefits that must be weighed relative to others (Pellegrino, 1990; O'Brien, 1989~.
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From page 106... ...
Nonetheless, both the public health and community well-being are at stake until we find common ground on which to clarify objectives and establish appropriate ways to reduce the spread of HIV, which may include the establishment of needle exchange and bleach distribution programs. As noted by O'Brien (1989)
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From page 107... ...
We turn now to discussion of the views of particular groups in communities across the nation. AFRICAN AMERICAN VIEWS Much of the voiced African American opposition to needle exchange and bleach distribution programs must be understood in the context of perceptions that historically there has been government negligence in response to the drug abuse epidemic, distrust of public health authorities, and fearand, for some, the conviction that the broader society considers large segments of the African American population expendable (Thomas and Quinn, 1991, 1993~.
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From page 116... ...
Although these results cannot be generalized to all African Americans, they are a disturbing revelation to many who are attempting to conduct HIV and AIDS health promotion and disease prevention activities within these communities. Proponents of genocidal theories also argue that it is not by chance that alcohol and drug abuse plague African American communities.
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From page 117... ...
Much of the initial opposition of the African American clergy to the idea of needle exchange and bleach distribution programs focused on the immorality of the underlying risk behaviors. Certain high-profile and prominent clergy in the African American community have joined forces with politicians, business executives, and health care providers who have determined that these interventions represent a grave risk to the community.
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From page 118... ...
He has indicated that his switch to an opposing stance was in response to his recognition that issues of empowerment and local control were more important than "pushing forth some social policy that came out of some liberal think tank somewhere in America" (Ellis-Hagler, 1993~. The image of African American injection drug users reaching out for drug treatment only to receive clean needles from public health authorities provides additional support for the genocide theory (Thomas and Quinn, 1993~.
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From page 119... ...
119 When the African American religious and political leaders who have expressed opposition to needle exchange and bleach distribution programs have been convinced that these programs can be valuable in reducing HIV infection and the spread of AIDS and that the commitment to support drug treatment programs will be continued, they have been more willing to give their support. Essentially, their objections are less grounded in moral arguments than in political and practical ones.
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From page 120... ...
Our lives are at stake. Latino community members have also urged that, if AIDS prevention programs are to be effective, issues of family and children's safety are critical and require that the programs address sexual and perinatal transmission issues as well as transmission through injection drug users (Rodriguez,
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From page 121... ...
, needle exchange participants have reported being harassed or arrested by police officers (Lurie et al., 1993:151; Stryker, 1989~. Enforcement of prescription laws may result in police harassment of drug users in some cities, which in turn contributes to needle sharing among injection drug users (see Chapter 5 for further discussion of legal issues)
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From page 122... ...
The risk of HIV infection is one of many consequences of injection drug use, and needle exchange programs should be viewed as one strategy that may help reduce that risk. However, these programs should not deflect attention from addressing the underlying causes of addiction.
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From page 123... ...
Reflecting on the dilemmas presented by legislation in the area of needle exchange and bleach distribution programs, another workshop participant commented: If officials pass legislation to legalize needle exchange programs, police personnel will need to be educated before it will be effective. HEALTH PROFESSIONAL VIEWS Two groups of health professionals have direct impact on the behavior of injection drug users and, consequently, on the potential effects of needle exchange and bleach distribution programs: pharmacists and providers of drug abuse treatment services.
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From page 124... ...
. The representative of pharmacy retailers indicated that, although the retailers support the establishment of needle exchange and bleach distribution programs, their association does not feel that pharmacies are the most appropriate sites.
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From page 125... ...
The representative from the American Pharmaceutical Association, whose membership numbers 40,000 professionals, stated that the association has an official policy statement that supports needle exchange programs as part of a comprehensive approach to HIV infection. This approach also includes outreach, counseling, treatment, and community involvement in decisions about how the program should be implemented.
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From page 126... ...
However, in communities in which there is a substantial drug abuse and AIDS problem, pharmacists may be more amenable to selling them. Treatment Service Providers For most practitioners in the field of substance abuse treatment, needle exchange and bleach distribution programs present a dilemma.
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From page 127... ...
Needle exchange programs pose an apparent contradiction to this principal goal of treatment (Work et al., 19901. Critics of needle exchange programs indicate that, by implicitly condoning drug use, these programs are sending conflicting messages not only to current injection drug users, but also to those who are at risk of becoming injection drug users (Singer et al., 1991~.
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From page 130... ...
focus on similar targeted individuals. However, the population being served is the only factor in common between needle exchange and bleach distribution programs and treatment programs.
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From page 131... ...
It would appear that needle exchange programs are serving as a bridge to treatment for a subpopulation of injection drug users for whom traditional treatment recruiting efforts have been unsuccessful. Treatment programs for injection drug use are for the most part methadone maintenance programs.
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From page 132... ...
Federal Regulations Few treatment programs in the United States have instituted training on how to effectively decontaminate needles or provide information on how to legally obtain sterile needles. Federal regulations governing some forms of drug abuse treatment also are obstacles to drug treatment providers and their patients to make use of needle exchange and bleach distribution pro grams.
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From page 133... ...
All share the concern that handing out sterile injection equipment or bleach bottles to injection drug users does not address the underlying problems associated with drug abuse and in fact may create more negative outcomes. In sum, the main argument against needle exchange and bleach distribution programs is based on perceptions that they do more harm than good.
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From page 134... ...
· Programs send a mixed message and may worsen society's drug problem. Ethnic/racial African American · Drug abuse epidemic has been consistently neglected and drug treatment programs are either not established or not funded adequately.
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From page 135... ...
Many of their concerns stem from the view that needle exchange and bleach distribution programs are limited to one type of activity: the exchange or distribution of drug paraphernalia to injection drug users. It is therefore possible that programs taking a comprehensive approach could respond to some of this community opposition.
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From page 136... ...
The change reflects the growing discussion of needle exchange and bleach distribution programs as part of a campaign aimed at stemming the epidemic of parenteral transmission of HIV infection rather than as an incongruous initiative amidst a broader campaign aimed at drug abuse. As community concerns are recognized and addressed, the concept of needle exchange and bleach distribution programs is refined.
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From page 137... ...
Brettle, R 1990 HIV and harm reduction for injection drug users.
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From page 138... ...
Biernacki 1988 The ethnography of needle sharing among intravenous drug users and implications for public policies and intervention strategies.
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From page 139... ...
Lipton, et al. 1989 Determinants of needle sharing among intravenous drug users.
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From page 140... ...
DePhilippis 1994 Treatment Community Views on Needle Exchange and Bleach Distribution Programs. Paper commissioned by the Panel on Needle Exchange and Bleach Distribution Programs, National Research Council and Institute of Medicine.
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From page 141... ...
1994 Presentation at informal workshop convened by the Panel on Needle Exchange and Bleach Distribution Programs, Irvine, California, January 5. The Roper Center for Public Opinion Research 1987 Connecticut Telephone Survey (unpublished material)
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From page 142... ...
Clark, and J Lorvick 1994 Syringe and needle exchange as HIV/AIDS prevention for injection drug users.
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