By 1991, injection drug users accounted for over 25 percent of AIDS cases nationwide. The figure was far lower in King County: three percent, with another nine percent among gay or bisexual men who were also injection drug users. But with an estimated 12,000 to 14,000 intravenous drug users in King County, over 80 percent of whom shared needles, the risk of AIDS spreading in this community was great. Sharing needles put not only users at risk, but it also risked infecting their sexual partners, as well as the fetuses of pregnant partners. The Public Health Department’s first strategy was educating users about the risks and distributing bleach to sterilize needles.
Successful needle exchange programs abroad and at homeNeedle exchanges originated in Europe, Canada, and Australia around 1984 as a means to minimize the risk of HIV and Hepatitis B transmission among people unable or unwilling to cease injection drug use. New sterile syringes were exchanged for old contaminated ones. Needle sharing and reuse were more likely in states like Washington, where state law prevented the purchase of syringes without a prescription. In the United States, the first publicly funded needle exchange was established in Tacoma in 1988.
Public, professional, and political controversyPatricia McInturff discusses how she encountered opposition from a colleague and the public, as well as support for needle exchanges from King County Executive Tim Hill and County Councilmember Greg Nickels. (Oral history interview, September 2015.)
Harm reductionThe idea of distributing free syringes was seen by some as encouraging drug use. But the harm reduction approach to public health argued that even when a person’s behavior (in this case, drug use) doesn’t change, the harmful impact of that behavior could, and should, be minimized. Reducing the harm of contracting HIV and spreading it to others took priority over demanding abstinence.
Even if you can’t cureGary Goldbaum on how AIDS helped the medical community begin to accept the concept of harm reduction. (Oral history interview, August 2015.)
Seattle’s first needle exchangeSeattle’s own needle exchange began in March 1989, operated by the local branch of the AIDS Coalition to Unleash Power (ACT UP).
Stressing the benefits of public oversight, the Public Health Department successfully took over the program from ACT UP two months later and launched the new program with existing city and county funding. It was to be a two‐year pilot program subject to review and evaluation. The program also included referrals to drug treatment and social and health services and distribution of condoms and bleach.
1989252 new cases
What is ACT UP?A grassroots activist group, ACT UP formed in Manhattan in 1987 to draw attention to the AIDS epidemic and to help improve the lives of people with AIDS. From its beginnings, ACT UP used politically savvy demonstrations and civil disobedience to critique the roles of homophobia, racism, sexism, and capitalism in what they saw as an indifferent and flawed national response to the AIDS epidemic.
Robert Wood talks about the needle exchange. (Oral history interview, August 2015.)