GAY PEOPLE'S CHRONICLE OCTOBER 29, 1993

REMEMBER the

DEAD

FIGHT for the LIVING

JOIN US on

AIDS AWARENESS DAY DECEMBER 1, 1993 AIDS MEMORIAL MARCH AND RALLY SPONSORED BY

• Assemble at Public Square-10:30 am

• March to Federal

Building Plaza

11:00 am

Rally at the Federal

Building Plaza

ACT UP

CLEVELAND

Join us and support the Barbara McClintock Project to Cure AIDS, Act Up's detailed plan

for an all out research effort to find a cure. The days' events will include: guest speakers • street theatre ⚫a political funeral

volunteers welcome

TIME TO ACT UP!

for more information call 216.321.3440

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Gebbie on needle exchanges

and 'internment' proposals

This is the second excerpt from an interview held on October 4 with Christine Gebbie, U.S. AIDS policy coordinator, conducted by ACT UP Cleveland members Marcos Rivero and Joe Carroccio; and Elren Belton, who is active in the Leadership Coalition on AIDS.

ACT UP Cleveland: We have been trying to implement a needle exchange program here. In light of the fact that you stated publicly that you support needle exchange programs, what advice do you have for grassroots organizations that are trying to pressure local government to get a program going?

Kristine Gebbie: I think syringe exchange programs are seen best when they're part of a whole. It's not just throwing syringes around, but it's built into a system that includes trying to increase drug treatment for people who would come to a syringe program, and including other AIDS preven-

into cooperation from the police agency, because if they're going to harass you at every corner it's not going to work.

and you had court permission to put someone under a restricted order, and every time it had to be time-limited, and renewable only with the court. When I went to Washington state, what I found was an outdated law that dates to the '40s for tuberculosis that does talk about internment . . . yes, I was administering a law that used internment, because that is what I inherited. We never used it. We certainly never used it for HIV.

I believe all states have that law in regards to tuberculosis, and other casually transmissible diseases, and there are some cases of drug resistant tuberculosis, where the only way to contain it is through isolation.

Right. Reporting is a more complex issue. One of the prime ways the health department finds out about the disease is from the lab report... and a committee in the

tion programs. It really does have to be tied "We ration care right now. What Oregon said was, let's be open about it."

Could we get a letter of endorsement or would you be willing to meet with our mayor or health director about these issues?

Yes. There is now good documentation that it [needle exchange programs] does not increase drug use, that they do decrease Hepatitis B. I'm taking that report, and I'm sharing it with Donna Shalala [Secretary of Health and Human Services], and Lee Brown, the new drug czar, and I'm working with [Attorney General] Janet Reno, and we're going to rethink how we can use that research nationally.

Are there plans for a national syringe program?

There is a possibility of some funding nationally through HHS. I think the door is opening nationally in a way that it was never opened before. One of the best things you can do is do your home work... and work with your Citizens Action Committee so P that you can describe how you would relate an exchange program with referrals for treatment, with advocacy for new treatment slots, how you would bring the educators in. A more comprehensive program as opposed to just exchanging needles. Very comprehensive.

[Cleveland] Mayor White is very progressive, and we have key people listening to us, so I think we can actually get it going.

A key group to work with is your drug treatment advocates and the African American community. There is a huge mythology in many parts of the African American community that this whole thing is a genocidal plot, and the only reason we want to give out clean needles is so black people will use drugs and kill themselves... To the extent that you can talk within that community, and help find ways of decreasing that mythology, you're going to find some powerful friends as well.

ACT UP: Right, let's move on. There has been some discussion and discontent that you are not who we would have chosen for the position of AIDS policy coordinator because of some of your policies as health director for the state of Washington. To be specific, lab-based names reporting for people with absolute CD4 counts of under 200, and the proposal for internment for persons with AIDS thought to be acting irresponsibly, and the your support of health care rationing in the state of Oregon. How do you feel about these issues now that you're closer to the plague, and how will those thoughts or feelings reflect on your current position as AIDS policy coordinator?

I have never been in favor of anything that resembles the word internment. I worked very hard in Oregon to re-write the state law so that there was no way that a public health agency could restrict someone unless you have exhausted every voluntary method,

state of Washington, not me, suggested labbased reporting would be one double check that we identify people who fit the new case definitions so they got into the system. The board of health didn't buy it, by the way, they dropped it out. I do think sometime, .. within the next 25 years, there will be HIV reporting that looks a lot more like the reporting for TB and measles and so on.

But I think there are two absolute conditions before we go forward with that. One is, the only reason we report is so people get services. So until we have the services in every local health department, reporting is irrelevant. The second piece is to deal with societal discrimination and confidentiality. Until our laws are really up to date on confidentiality, and when we deal with the attitudinal things—

Then you can't have names reporting. Right. So this has never been an issue with me. There were some ACT UP members in Seattle that thought that by asking for the discussion [of names reporting] I was trying to force the issue. I met with them and tried to explain the context in which I was doing this. It wasn't working, the communication didn't jell, but I'm not rabid about reporting.

One of the things about reporting is the fact that if people think your CD4 results are going to go to the health department, you're going to drive people underground and they won't get tested.

That's been the issue all along with testing. I didn't answer your question about the Oregon system. I was a part of trying to develop that plan for a more logical rationing. We ration care right now. We ration by what color your skin is, and by how far you live from the city and who you work for, and by whether you're poor enough or rich enough, just a crazy system. What Oregon said was, let's be open about it. Let's be honest about trying to get everybody in the door, but if we get everybody in the door, then our check book is limited. So now, what are we going to buy for everybody, and develop a logical system by saying, let's buy the most important services for everybody, and let's not abuse high technology where it has no outcome.

Let me tell you, I'm delighted. I talked with one of the leading AIDS care providers in the state of Oregon, and they took data on their patients over the last several years, and went back, and they had all the information about what kind of care those people had needed, and they looked back to see if we had the Oregon plan in place how would these people have fared, and 85 percent would have gotten better care under the Oregon plan, and nobody would have got-

ten worse care.