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Story Publication logo November 26, 2007

Needle Exchanges Pay Off

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With HIV rates second only to those of sub-Saharan Africa, Caribbean islands that conjure visions of...

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SYDNEY, Australia — In a cozy, cluttered office up a flight of stairs from the epicenter of the Australian HIV epidemic and half a world away from the United States, Dr. Alex Wodak can recite the history of the American response to the AIDS epidemic by heart.

The director of a Sydney hospital addiction program and first president of the International Harm Reduction Association, he can recap the voting records of obscure United States congressional representatives and the influence of a series of U.S. presidential advisers. If he is unsure of an exact date or quote, he pulls out a pocket electronic device, where he has it all stored. "Everything," he confirmed, quietly. "I'm obsessed."

His obsession with lowering risks of AIDS transmission led Wodak in the epidemic's early years to push government officials in Australia to launch one of the most effective needle exchange programs worldwide.

It is a policy that Wodak wishes the United States would emulate.

While it is not the only country without such a policy, Wodak said, "It's the most important country."

With the largest number of people living with HIV/AIDS in the industrialized world, he adds, how the United States responds to the epidemic, has an international impact.

"The United States' addiction to the failed and futile policy of zero tolerance has really been very, very costly: in deaths, in hospital beds, in dollars, in misery," he said.

He recognizes that confronting the epidemic where it thrives can be politically challenging.

It was late 1986 when Wodak realized Australian government officials weren't responding to letters he had sent urging them to supply syringes to addicts. The point, to prevent injecting drug users from sharing dirty needles and furthering the spread of the burgeoning AIDS epidemic, seemed as lost on officials in his country as it has since seemed to be on officials in America, he said.

"I said, 'I'm going to do it myself,'" Wodak recalled recently.

He gave $20 to an employee, who went to a nearby diabetes clinic and brought back 1,000 syringes. Then he put a sign out front that said, "Free needles here, ring doorbell."

"No one rang the doorbell the first day," he said. "The next day, they started pressing the door buzzer and they haven't stopped since."

In the process, Wodak said, drug users entered the clinic, got access to health care and learned about treatment options for their addictions.

Within two years, every state and territory had needle exchange programs, Wodak said.

The resulting program now is credited with helping to contain the epidemic in Australia, where .1 percent of people live with HIV/AIDS, while .6 percent of the U.S. population is infected.

The difference between Australia's approach and that of the United States goes beyond supplying syringes to drug users, according to Wodak.

In the years that followed the start of the epidemic, Australia also legalized prostitution and removed laws allowing discrimination against gays.

In addition, Australian officials used bathhouses where gay men gathered as points for condom distribution.

By contrast, the United States closed bathhouses, notched up its "war on drugs" and launched increasing numbers of "abstinence only" sex education programs.

"It is a difference between risk reduction and risk elimination," he said.

Eliminating behaviors — sex, drug use — that can lead to HIV transmission is impossible, he contends. Reducing the risks of those behaviors has been proven to work, he adds.

"Risk elimination is unsustainable. By setting utopian goals and failing to achieve them, we're always much worse off than if we set modest goals and nail them."



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