When Orestes thinks about how many times he`s shared needles to shoot heroin and cocaine over the last 18 years, he gets scared.
In the year or so before entering a drug treatment program, Orestes flushed out his ”works”–his needle and syringe–with bleach to kill any AIDS virus. But before that, he engaged in a practice, ”hundreds, thousands of times,” that experts say is one of the most efficient ways to catch the disease.
Orestes won`t be tested, though, to see if he has been infected with AIDS. ”My name might get on a list,” he explained. ” `Big Brother` might put me away.”
Cindy, who still bears scars from needle marks on her freckled arms, says she stopped ”sharing works” when she got hepatitis a few years ago. ”I didn`t even know what AIDS was until Rock Hudson died,” she said. ”When I found out, I was glad the hepatitis made me more careful.”
Cindy and Orestes are two of an estimated 60,000 to 100,000 intravenous drug users in Illinois–80 percent of them in Chicago. They are pivotal to the future of the AIDS epidemic here.
With the rate of new AIDS infection apparently declining sharply because of safe sexual practices among homosexual and bisexual men–until now the principal victims of the disease–experts are urging that action be taken to stem the spread of AIDS among IV drug users, the second largest group of those diagnosed with AIDS.
Epidemiologists say that such action is crucial because IV drug users constitute the most likley conduit for a possible spread of the epidemic into the general population. That has not happened yet, but they fear it could.
But Chicago, like most other big cities with drug problems, is doing little to educate addicts about the dangers of AIDS and things they can do to lessen their chances of being infected.
The only program set up to reach street addicts is run by the University of Illinois-Chicago`s School of Public Health and funded with federal money through the city Health Depart-ment. There are three outreachworkers who try to reduce risky behavior by giving bleach and condoms to drug addicts and dealers.
The Illinois Department of Alcohol and Substance Abuse has no money targeted to combat AIDS in its proposed 1988 budget. ”That is the role of the public health department,” said William Atkins, department director.
The number of AIDS cases among addicts here, while still relatively small, is growing. Some experts fear that, without quick measures, the situation could approach that of New York City, where more than half of the IV drug users are believed to be infected. IV drug users account for 36 percent of all AIDS cases there.
”We are still in a position where we could make a difference by concentrating on IV drug users,” said Jeanette Restagno, an administrator with the city health department. ”But there aren`t enough programs and we don`t know how many people are infected.”
”It looks very bad overall,” said Dan Bigg, program specialist at the Illinois Alcoholism and Drug Dependence Association, a nonprofit group of professionals and agencies involved in drug abuse treatment.
”The state agency does not have its act together,” Bigg said. ”They don`t even mention AIDS in their budget and they have left unanswered letters from us asking for help in getting funds for training.”
”Of course we are not doing enough,” said Jack Doherty, counseling coordinator for the Howard Brown Memorial Clinic, a health and counseling center for anyone with sexually transmitted diseases, including AIDS. ”But the whole history of this epidemic has been a struggle to get funding for gay people or IV users when they are considered marginal people. We don`t have a poster child for the IV drug user.”
IV drug users are harder to reach than gay and bisexual men, experts say, because they are generally not as connected to a network of information on the dangers, often have poor reading skills, and–living on the outskirts of the law–are distrustful of government programs and officials.
IV drug users also cost the most tax dollars to treat as AIDS patients because many have no jobs or health insurance.
Addicts who decide to get off drugs still face a three- to eight-month wait for treatment, according to those in private and public treatment centers.
Anita Zych, clinical nurse at Gateway Foundation, where Orestes and Cindy are among 234 patients at 3 sites, said the name at the top of her waiting list called for an appointment Nov. 12.
There are 68 addicts on Zych`s waiting list for the site in Humboldt Park, and the centers in Lake Villa and Springfield have equally long lists, she said.
The major stumbling block, she complained, is community opposition to drug rehabilitation programs. ”Nobody wants to live next door to us,” she said.
Orestes and Cindy each waited four months for treatment and claim they
”just did more drugs” during that time. ”I went wild,” realled Cindy.
”I ran around from noon to midnight. I did heroin, cocaine, alcohol, Tylenol. When they called with a bed, I thought, `Oh my God. Reality.` ”
Both she and Orestes asked that their last names not be used.
Throughout Illinois, 108 of the 958 known AIDS cases to date–or 10.6 percent–involve IV drug users, about half of whom also have engaged in homosexual activity. But the rate of infection among addicts appears to be growing. Among 110 cases diagnosed this year, 17.1 percent have involved IV drug use, compared with 5.5 percent of 18 cases in 1982.
Nationwide, 37,386 AIDS cases had been diagnosed as of June 22, and 21,621 persons have died of the disease. Of the total cases, 66 percent were homosexual or bisexual men, 17 percent were heterosexual IV drug users and 8 percent were gay men who also were IV drug users.
AIDS–acquired immune deficiency syndrome–destroys the body`s immune system, leaving it defenseless against a number of infections, cancers and other illnesses. There is no known cure.
There is no way of knowing how many of the city`s addicts have been infected with the AIDS virus but have not yet developed the disease. But a survey of IV drug users entering treatment to get off drugs in 1985 that showed that 18 percent had been infected.
And slightly more than 15 percent of the 178 IV drug users who were voluntarily tested for AIDS infection by the Chicago Health Department over the last year and a half were found to be infected.
These figures could be understating the problem, since IV drug users are much less likely to volunteer to be tested than people in other risk groups. During the same time, of 1,178 homosexual or bisexual men who were tested in Chicago, 20 percent were positive.
”About 80 to 90 percent of the addicts aren`t in treatment. They are on the street,” noted Norman Altman, an epidemiologist who works with the outreach program of the University of Illinois-Chicago School of Public Health. That program is funded with $100,000 of federal Centers for Disease Control money, funneled through the city health department.
Wayne Wiebel, an epidemiologist and the director of the program, said he needs 10 times as much money to do the job properly.
”We have about a three-to-five-year window of opportunity to reach that group,” Altman said. ”But if we don`t increase our efforts dramatically, I fear that Chicago could go the way of New York.”
AIDS is spread among IV drug users through contaminated blood that remains on shared needles. The riskiest kind of sharing occurs in urban
”shooting galleries,” where a single syringe may be passed around and used by hundreds of people.
”Some people argue that addicts have little concern about their health and we should write them off and go on to the next wave of the epidemic,”
Wiebel said.
”But dying from AIDS is not like shooting up and you`re gone. Addicts don`t want pain,” Wiebel said. ”When we tell them AIDS kills slowly and very painfully, they are more than willing to limit their risks by cutting down the number of people they share needles with or cleaning them in between use.”
Wiebel said he even gets cooperation from dealers who pass out bleach and condoms when they sell drugs, out of concern that if many of their customers die, business will be affected.
Some health officials have suggested that making needles legally available would cut down on the AIDS risk. That approach is being tried in Amsterdam and is routine in Hong Kong.
Others stress the need for more methadone clinics. In Hong Kong, where methadone clinics are open around the clock and needles are sold over the counter in drug stores, not one drug user is known to have been infected with the AIDS virus.
