December 2002

Needle Exchange and the Church

By Jack H. Taylor, Jr.

Our Church’s General Conventions have adopted 42 resolutions pertaining to AIDS—starting with 11 in 1988, and ending in 2000 with just two. At first blush, it appears that our Church is paying attention to HIV and AIDS and the still increasing toll it is taking on society. But measured by one of the most effective, albeit controversial, approaches to fighting the AIDS pandemic—needle exchange programs (NEPs)—our Church has dropped the ball.

After sexual transmission, the most important way HIV is transmitted is by contaminated blood. It is also the most controllable transmission mode. Because testing at blood banks and by pharmaceutical houses has all but eliminated transmissions by those routes, needle sharing by intravenous drug users (IDUs) has become the second most common route by which AIDS is spread generally, and in certain communities, it is becoming the first.

More than a million people—one million!—inject drugs in the U.S. frequently, at a cost to society in health care, lost productivity, accidents, and crime of more than $50 billion a year. People who inject drugs imperil our own health. If they contact HIV or hepatitis, their needle-sharing partners, sexual partners, and offspring may become infected. It is now estimated that half of all new HIV infections in the U.S. are occurring among injection drug users (IDUs). As tired as we may be, HIV/AIDS still demands that we return to our roots and our history, as NEAC itself has said, adding that we must find the courage to risk being on the edge of a limb.

NEPs fall into the category of harm reduction policy—a concept in which public policy aims to lessen the health and social consequences of drug use. The Centers for Disease Control and Prevention estimate that 90 percent of new AIDS cases in women and 93 percent of new cases in children are linked to injecting drugs. Overall, three-quarters of new AIDS cases are attributable to intravenous drug use.

Of the 42 resolutions passed by our Church, only four—not even 10%—seem to mention NEPs, and then just barely. In 1988, the 68th General Convention called for AIDS education programs in every congregation by the end of 1989 and that models of AIDS education programs be made available by NEAC in conjunction with National Church staff. It requested that such models promote the inclusion of “candid and complete instruction regarding disease prevention measures, such as use of condoms in sexual intercourse and ending sharing of contaminated needles by intravenous drug users.”

That didn’t endorse NEPs at all, all it did was call for an end to sharing contaminated needles. Some of our more conservative brethren could interpret that as throwing all the IDUs in jail.

Another resolution called for the AIDS education models provided by NEAC and Executive Council to “promote safe sexual practices such as the use of condoms during sexual intercourse or ending the sharing of needles by intravenous drug users.” So do we rush out and start an NEP? Or arrest the IDUs?

In 1994 GC resolved to “work to affirm the necessity of needle access” among approaches to the pandemic. That’s a significant improvement over just decrying the sharing of contaminated needles but it still leaves much to the imagination in the way of an actual.

Only in one single resolution did our Church boldly go where no one in the Church had gone. GC expressed support for a federal Executive Order mandating AIDS in the workplace education and for the funding of needle access programs.

The Episcopal Church had called for needle exchange programs at the 71st General Convention, but in 1988 Congress had already banned the use of federal funds for NEPs. However, the secretary of HHS has authority to life the ban if evidence can be shown that such programs do reduce the spread of AIDS. That evidence has been on the secretary’s desk for several years. Eight major government sponsored studies have concluded that NEPs slow the spread of HIV among persons who inject drugs—and they do not increase drug use.

Three former surgeon generals have spoken out in favor of NEPs:

  • David Satcher said NEPs significantly reduce the spread of HIV and that “you do not deserve a death sentence because you’re addicted.”
  • Joycelyn Elders said our best scientific evidence shows that NEPs do not increase drug use, but do reduce the spread of HIV. “Our bright young people are slipping away.”
  • C. Everett Koop said, “When we are dealing with something as devastating as the AIDS epidemic, it doesn’t matter what we do to reach people that have to be reached, we have to do it.”

Yet, in making presentations to churches in my own diocese about our NEP, I never fail to find one or two vestry members who are convinced that exchanging clean needles for dirty ones merely increases drug abuse.

What Can the Church Do?

The Church’s Standing Committee on HIV/ AIDS, reporting to General Convention in 2000, made it clear the Church can do a lot. It can:

  • Stress the Gospel call to heal as a way around the barriers of stigma and politics.
  • Confront our discomfort at talking about sex and sin and drug abuse.
  • Reach out, open up, run some risks.
  • If clergy don’t support NEPs, find active lay people who will.
  • Create an atmosphere where real issues can be talked about, e.g., sex, so that values like commitment and honesty can be addressed.
  • Stop avoiding the subject.
  • Leave dogma and tracts at home and just be compassionate. You have to show compassion. You have to show love.

Some members of the church are showing that compassion, against great odds. The Rev. Luis Barrios of St. Ann’s Episcopal Church in Mott Haven, NY, was suspended, then dismissed by his bishop in 1993 partly because he tirelessly spent months fighting his community’s social ills by a wide range of approaches, including housing an NEP in the church. The church of St. John the Evangelist in Boston includes among its social action ministries an NEP. In conservative Dallas, the diocese has twice contributed financial support to the Dallas Area Needle Syringe Exchange (DANSE).

Where Is the Encouragement GC Resolved to Provide?

I see the General Council resolutions as an unanswered call for the Church to promote, support, even fund the operation of NEPs in every diocese and every community where a need is demonstrated.

NEAC’s mission statement calls for it to work collaboratively for effective HIV/AIDS ministry on and by all levels of the Episcopal Church. But it hasn’t done what it could for NEPs. NEAC’s vision challenges it to “educate Episcopalians about HIV/AIDS issues and empowering them to act on that information.”

How important would that be with regards to NEPs? It could be a watershed unlike any we’ve seen for NEPs in this pandemic.

Just imagine any national church, but especially our Church—THE National Church, if there is one—getting behind NEPs to the point not only of encouraging them but of actually promoting them as outreach ministries.

Let me use our own DANSE as an example of the difficulties of sustaining an NEP, particularly in a politically conservative area, and the successes that doing so can bring. DANSE began in 1991 when the ultraconservative Dallas County Commissioners Court gutted the county health department’s AIDS Prevention Program by forbidding the distribution of condoms, bleach kits for IDUs, and other materials it found objectionable on religious and moral grounds. Into that void came a number of initiatives, including eventual salvaging of an AIDS Prevention Program by the University of Texas Southwestern Medical Center and associated medical entities.

One of those initiatives was DANSE, founded by Marty Krepcho, a former Roman Catholic priest who had been working in the gutted AIDS Prevention Program. It began on a shoestring with the tacit approval of Dallas police, whose commanders were apprised of our intentions.

We began with just a few dozen needles exchanged twice a week in a corner vacant lot near downtown Dallas. Since then we have exchanged as many of 8,000 on one night in an area of southeast Dallas and often work there in conjunction with a medical center van that provides free AIDS testing. We have even had one walking exchange in Dallas’s old Œwar zone,” so called because of the machine gun fire to be heard there every night in the 1980s.

Today, DANSE is one of more than 220 NEPs in operation nationally. Along with programs in Philadelphia, Milwaukee, and Rockford, IL, DANSE is part of an in-depth study of NEP participants conducted by the harm reduction program at Beth Israel Medical Center in New York. Results will be released in about two years.

But I believe this new survey will only reinforce what we already know: NEPs are an efficient way to combat the spread of HIV, and the lack of NEPs may have permitted 10,000 preventable HIV infections in the U.S., as a UC-San Francisco study found back in 1997. How many more infections have we let slip by?

What former NEAC director Sue W. Scott, executive director of the AIDS Service Center in Pasadena, California, said some years ago still applies: “NEAC, the Episcopal Church, and the entire religious community can lead the way into all corners of our world which HIV has invaded. We can support needle exchange; we know it reduces transmission and new infections without encouraging people to become addicts.”

What are we waiting for?

Jack Taylor is managing director of DANSE. He and his wife, Myrna, Parish Nurse and Chair, Dallas Diocensan Parish Nurse Commission, gave a workshop at the conference on “Efficacy and Efficiency of Needle Exchange and the Role of the Church.