Originally published in the Ann Arbor Agenda in April 1992.

Please note that all statistics are from that time.

In the late 1970s, while the epidemic known as “disco fever” swept through the U.S., an epidemic known as “junkie pneumonia” raged among injection drug users in New York City. Unlike disco fever, junkie pneumonia was not the subject of intense media scrutiny or public outcry. No movies were made. Few people were aware that large numbers of injection drug users were inexplicably dying of pneumonia. Those few who did notice these deaths did not feel compelled to investigate the public health puzzle they posed. Junkies die all the time. Nor did anyone bring this less danceable epidemic to the attention of the fevered populace. Bringing the epidemic to the attention of the public would not have made much difference. Undoubtedly, some people would have voiced the opinion that people who shoot drugs deserve to die while most would have shrugged and kept dancing. Investigating the epidemic as the potential public health menace it was, however, could have had a profound impact on hundreds of thousands of lives. Had anyone bothered to investigate the deaths of these drug users, they would have found that they had an immune system disorder that we now call AIDS.

Here’s how I imagine things would have been different if such an investigation had occurred back in the 1970s: (1) researchers would have discovered the HIV virus and its routes of transmission many years before they did, and (2) this earlier discovery would have saved many lives now lost; (3) no one would have wasted energy on inane and homophobic concepts such as GRID (Gay-Related Immuno-Deficiency - the first name given to the syndrome now called AIDS); (4) otherwise rational researchers would not have investigated “the gay lifestyle” as a potential causal factor; (5) the media would not have been able to label AIDS as “the gay disease;” and (6) increased anti-gay violence would not have resulted.

Here’s how I imagine all of this would have helped people who shoot drugs: not at all.

More than a decade into the AIDS crisis, the U.S. population first devastated by that crisis remains critically under-served by AIDS prevention programs. The reasons for this are precisely the reasons that junkie pneumonia was ignored in the first place: racism, disregard for the lives of people who shoot drugs, and an ill-disguised war on the poor masquerading as a war on drugs.

Injection drug users are the second largest group of people with AIDS. The majority of women with AIDS and nearly half of all people of color with AIDS are injection drug users or their sexual partners. The majority of children with AIDS (over 90% of whom are children of color) are born to injection drug users or their partners. While rates of HIV transmission are declining among gay men, those rates are rising among people who shoot drugs. It is estimated that 50% of the 10-12 new AIDS cases expected weekly in Michigan will be related to injection drug use. This is a public health emergency which, like most such emergencies, primarily affects women and people of color.

Among people who shoot drugs, HIV is transmitted primarily through the sharing of injection equipment. Research has shown that needle exchange programs (which provide sterile needles in exchange for used needles) are the most effective way to reduce needle sharing. The common belief that such programs “condone” drug use and lead to its increase is not supported by any evidence. In fact, some needle exchange programs have reported a decrease in frequency of injection among their clients. Additionally, as noted by the National Commission on AIDS, “outreach programs which operate needle exchanges and distribute bleach not only help to control the spread of HIV, but also refer many individuals to treatment programs.”

Nationally, Bush’s “war on drugs” mentality has kept the federal government from adopting the recommendations of its own National Commission on AIDS, which supports the removal of legal barriers to the purchase of sterile injection equipment. Locally, this mentality, combined with typical institutional disregard for the lives of people who shoot drugs, has led the Washtenaw County Health Department to drag its feet on bleach distribution and refuse to even consider needle exchange. Additionally, the state drug paraphernalia ordinance can be construed to prohibit distribution of sterile injection equipment to people who shoot drugs.

As is the case in many cities across the U.S., AIDS activists in Ann Arbor have stepped in to provide this critical public health service. Since December, AIDS Coalition To Unleash Power (ACT UP) has run a limited street-based AIDS prevention program which includes needle exchange. This spring, ACT UP plans to expand its Ann Arbor program and to establish a similar program in Ypsilanti.

But, needles are not enough. Injection drug users need AIDS prevention education materials (including both safer sex and safer drug use information) which address the reality of their lives. Medical workers and others who provide AIDS-related services must increase their attention to the particular needs of injection drug users with AIDS. Researchers must include injection drug users in their studies of experimental AIDS treatments. Since addiction to injection drugs is not a healthy way to live, drug rehabilitation and other health care must be made available on demand. Community-based, non-judgmental drug use prevention programs must be instituted everywhere. Most importantly, we must all work to address the poverty, racism, and sexism that lead people to use drugs in self-destructive ways.

This is an emergency. Our lives are your lives. Their lives are our lives. ACT UP.