It has been more then twenty-five years since the discovery of AIDS among intravenous drug users, or IVDU’s. The first needle exchange program was funded in the late 80’s, and by 2002 there were one hundred and eighty four needle exchange programs in more than thirty-six states, exchanging over twenty-four million syringes, according to the Centers for Disease Control and Prevention. But does the act of handing in a dirty needle for a clean one prevent the spread of HIV and other deadly diseases? Drug users are still in possession of needles—a means to continue their addicting habits. Those at the Office of National Drug Control Policy believe that the needle exchange doesn’t address the problem of addiction itself.

This session, lawmakers in Texas may authorize a needle exchange program. Legislation sponsored by Sen. Bob Deuell (R-Greenville) and Sen. Leticia Van de Putte (D-San Antonio) would allow local health organizations to authorize one-for-one needle and syringe exchanges.

Under current Texas law, anyone caught with drug paraphernalia can be arrested and charged with a misdemeanor. But Senate Bill 188 may authorize these operations. If drug laws remain so severe, it’s likely that the addicts won’t surface.

Many doctors and medical researchers are stunned at the lack of support for needle exchange programs in light of the evidence that they are not only cost effective, but can also reduce the spread of disease among drug users and those they come in contact with. According to the National Institutes of Health Panel on HIV Prevention, studies show that such programs reduce risk behavior as much as eighty percent, and an estimated thirty percent or greater reduction of HIV in users. With the average cost of a syringe at 97 cents, the potential savings of one HIV infection prevented by needle exchange programs is about four to twelve thousand dollars. This is considerably less than the cost of treating someone with HIV, estimated at one hundred and ninety thousand dollars.

Dr. Jim Zachary of the David Powell Clinic in Austin that treats HIV/AIDS says that he has no idea why there is no needle exchange in Texas. “One has to remember that this is not a needle distribution issue, they are merely exchanging them,” he says, adding that roughly twenty-five percent of his patients have some connection with an IVDU.

For Zachary, drug use is “not a moral issue, but rather a medical one.” Many adult drug users were socially and economically deprived as children, or rendered addicts in a depressive environment. They may also have a genetic makeup that predisposes them to drug addiction. But medical practitioners are learning more about the stages of behavioral change in addicts, and that the power of suggestion, although it may not work all the time, is still very important.

Needle exchange programs are least about exchanging needles. “It’s outreach,” Zachary says. “So if you can use [these programs] as an excuse for contact with an addict then you can ask them what they need,” and try to interest them in other services. According to the CDC, services may include HIV education and counseling, condom distribution, and referrals to substance abuse treatment programs.

“Needle exchange is one of the main tenants of harm reduction,” Zachary says. Like wearing your seat belt, harm reduction can be anything that limits the number of deaths from a certain action or habit. Reducing the number of dirty needles available is not going to eliminate disease or addiction but has the potential to prevent one person from contracting a disease. Providing a clean needle to one user will trickle down to everyone else that person comes in contact with, thus protecting an unknown number of lives.

“It really hits home for me,” says Janet Realini, president of Healthy Futures, a non-profit company to reduce teen and unplanned pregnancy. “I’ve had to tell too many young women that they tested positive for HIV because it was their partner who had a drug problem.” Realini compares the issue to mosquitoes and malaria; like mosquitoes, needles transfer the diseases. So if you control the mosquitoes, then you can reduce transmission.

“If someone is addicted and using drugs, not having a clean needle is not going to stop them from shooting up, and having a clean needle is not going to make someone decide to use drugs either,” Realini says.