Many people are now aware, from books like And the Band Played On by Randy Shilts, of how the government and medical establishment shamefully fiddled while the early AIDS flames began sweeping through the gay community. But there is almost no public discussion of today's deplorable failures around AIDS prevention, which continue to wreak havoc in the ghettos and barrios.
The latest example is hardly known beyond the immediate circles of AIDS workers. Health agencies and AIDS service organizations distributed hundreds of thousands of leaflets over the years teaching a quick bleach method for sterilizing needles and syringes. It involved shooting a 10% solution of bleach in and out three times and then thoroughly rinsing with water. The method looked good when tested in the laboratory, and it made sense to try to get the information out quickly and widely. But when actual studies in the field were completed in 1993, the results were a very high rate of transmission, 45 revealing that the method was useless on a practical level.
Health authorities an*lyzed what went wrong and developed a new – more thorough and complicated – bleach method that should work well if the user takes the time to conscientiously carry out all steps. Literature published after 1993 describes this new, more effective method. But there has been no wide-scale effort to publicize – to ring an urgently needed alarm – about the error of the old method that was disseminated to perhaps hundreds of thousands of people. As I know from my work in the field, most IDUs don't even bother to look at new literature because they're sure they already "know" the bleach method. At the same time, there's been no serious effort to find ways to teach IDUs, who may be impatient to get high, practical methods to a**ure they complete the cleaning process properly. Studies indicate that 80% of drug users do not clean their equipment for the more than 30 seconds that is required. 46
A main reason the authorities haven't trumpeted the warnings about the problems with bleach – the failure of the old method and the difficulty of getting IDUs to take the time to do the new method correctly – may well be to avoid pressure for programs that provide users with new, sterile needles and syringes. In fact the government initially suppressed the report on a study the government itself had commissioned on "needle exchange programs." (NEPs). The report, which concluded that NEPs are highly effective, was eventually leaked to the press.
The main resistance comes from politicians who don't want to risk being labeled "soft on d**." Drugs are indeed incredibly destructive to oppressed communities, but the phony posturing of politicians is no part of the solution. Instead of decent ways to make a decent living, the politicians dish out poverty and despair; instead of drug treatment centers and programs to build community cohesion, they proceed with wholesale incarceration of the youth; instead of seeing the need for self-determination in the Black and Latino communities, the politicians use the drug crisis as a rationale to catapult us toward a police state. The vehement opposition to NEPs follows this same failed pattern. It does nothing to stop d** but rather sows pain and d**h for people of color.
The study that the government commissioned and then tried to suppress involved a comprehensive review of all known needle exchange programs and experiments in the U.S. and Canada. The authors found no evidence that the NEPs led to any increased drug use. 47 (And of course such programs could even help reduce drug use if they served as a form of outreach for involving users in drug treatment programs – except that the "anti-drug" politicians aren't providing the funding for treatment.) While it doesn't increase drug use, providing sterile equipment is highly effective in reducing HIV transmission. In one telling example the study found the rate of HIV among IDUs to be five times higher in states where needles are proscribed compared to states where they are legal. 48 A recent open letter from 32 AIDS prevention researchers declared that, after extensive research, experts are virtually unanimous that NEPs are highly effective in reducing HIV transmission without leading to increased drug use. Yet, there is still a ban on any federal AIDS funds for such programs, and many states still outlaw possession of needles. 49
Tens of thousands of IDUs, their lovers and their children have been condemned to die because health agencies won't advertise their mistake and because politicians won't risk being labeled "soft on d**."
Shared needles is just one of the areas for risk reduction. For overall prevention work, the far and away most effective method for sharply reducing HIV transmission is peer education. 50 Homeboys and/or homegirls with appropriate training in HIV/AIDS information speak the same language, live in the same situations, and can work with the people in their communities in the detailed, consistent, caring, ongoing way needed to achieve concrete changes away from risky behavior. In fact, such peer programs are the only approach proven to work.
Prisons are not only a locale of some of the highest HIV rates in the U.S., but they are also a place where people who might have been constantly on the move in the street are stationary and collected – a perfect setting for peer education. And the vast majority of prisoners eventually return to their outside communities – where they can spread AIDS awareness, or they can spread AIDS. But prison administrations have generally been hostile to peer-led HIV-AIDS education; only a pitiful handful of such programs exist, and many of those are hamstrung by bureaucratic restrictions.
Allowing misinformation about cleaning needles to persist, blocking needle exchange programs, failing to treat STDs, thwarting prison peer programs are major examples of the current criminal negligence on AIDS – and in particular of how this plague has been allowed to expand in the ghettos and barrios.