Of the 184 US needle-exchange programs -- a means of helping drug users reduce the risk of contracting and spreading deadly diseases -- only two are in North Carolina, and neither are in Mecklenburg County, the state's largest metropolitan area.
"It's desperately needed," said Eloise Hicks, executive director of the Regional HIV/AIDS Consortium.
It's also entirely illegal. But that didn't stop Thelma Wright from starting a program in High Point. Stung by the havoc wreaked by HIV in her community, Wright began giving out clean syringes to drug users in 1999. She'd search areas around bridges, ravines and empty houses, where addicts, mostly street people or "soon-to-be street people," would shoot heroin. She'd crawl through windows and lift up mattresses to collect dirty needles. At first, users greeted Wright with skepticism. "But once they learn who you are, they're your friend," she said.
Wright is now co-chair of the Campaign to End AIDS, a national coalition of grassroots activists, and she wants to stir interest in needle-exchange programs throughout the state, particularly in Mecklenburg County.
A report to county commissioners in January 2004 found that a needle-exchange program could reduce transmission of disease in Charlotte. It got nowhere, of course, though some commissioners have voiced support. "Certainly, you want to discourage bad behavior, but you also need to be realistic," said County Commissioner Jennifer Roberts, who wasn't on the board then. "We need to look at it from the standpoint of saving lives."
Guilford and Buncombe counties have passed resolutions supporting exchanges. And a regional HIV/AIDS planning group, organized by the state at the behest of the Centers for Disease Control and Prevention, has come to a "general consensus" that a needle-exchange program would be helpful, said Brian Witt, a health educator with the Mecklenburg County Health Department.
But until the General Assembly authorizes such programs, all non-underground implementation is impossible. Democrats in the House of Representatives have sponsored needle-exchange bills during several legislative sessions without luck. A bill sponsored by Rep. Thomas Wright, D-New Hanover, never made it out of committee this year, though Thelma Wright (no relation) says there's an unlikely chance the legislature could take it up when they meet for a short session in May.
Several groups, including the CDC, the National Research Council and the National Institutes of Health have concluded needle-exchange programs work. But opposition remains strong among people who believe the exchanges condone or encourage illegal drug use. "I think some people can't get past that and look at the public health issue," Witt said.
Even among HIV/AIDS prevention advocates, needle exchange isn't categorically supported, Hicks said. And such initiatives give drug treatment professionals even more pause. Flay Lee, clinical program director at Hope Haven, personally believes needle-exchange programs can save lives, but said that's not a uniform belief among everyone at the treatment center.
Alice Harrison, president of Hope Haven, has mixed feelings. Harrison said she believes exchange programs delay people from getting clean. "As long as they can continue getting clean needles and using the drugs, they're not going to get treatment," she said. "I feel like the needle-exchange programs can make it easier to use drugs without the fear of contracting disease, which is something that may get people into treatment."
Still, she said, many users aren't thinking about the consequences of using dirty needles. "It's hard for me to condone a free exchange program. . . At the same time, if people are going to be using IV drugs, then we certainly want to stop the spread (of disease)."
Needle-exchange programs tackle only a small percentage of HIV infections. Of cases reported in 2004, only nine people listed intravenous drug use as the sole reason, while five men attributed their infection to drug use and gay sex, according to county health department data. But Witt suspects many more people who test positive may not tell him or other health workers that they shoot up. Last year, 157 new HIV infections were attributed to "unknown" or "other" causes. That's nearly half the reported cases.
Wright said she's heard Mecklenburg has a tendency to go it alone. But she hopes that through advocacy with the Campaign to End AIDS, she can find a local figure to push the issue. "I've been trying to get people to understand: This thing is across the board, and it's the only thing that North Carolina doesn't have in place to stop the spread of the disease."