Professor prevents AIDS through needle exchange

Credit: Courtesy of []( Credit: Courtesy of [](

The U.S. Centers for Disease Control and Prevention report that injection drug use has directly and indirectly accounted for one third of AIDS cases since the spread of HIV/AIDS was first declared to be a public health emergency.

There are an estimated 11,981 injection drug users in the Pittsburgh area, according to a report published in the Journal of Urban Health in 2004. All across the world, needle exchange programs have been established to help prevent the rapid spread of diseases like AIDS and hepatitis C. Almost 14 years ago, Caroline Acker, an associate professor in the history department at Carnegie Mellon, started such a program in Pittsburgh. It started out as a single table with a pickle jar for used needles on a street corner, and today has turned into Prevention Point Pittsburgh (PPP). The organization has expanded its services from just needle exchange to free, confidential HIV and hepatitis C testing and counseling, crisis intervention and counseling, and overdose prevention and response education
Acker, co-founder of the PPP, said in an interview that she was first exposed to the needle exchange program while living near San Francisco, where “it instantly made sense to [her] because it was so clear that giving injection drug users sterile syringes would prevent transmission of blood-borne diseases.” She stated that her inspiration to take part in the needle exchange program came from “[her] brother’s passing due to AIDS, a family history of addiction, and [her] background in drug education.” However, upon arriving in Pittsburgh, she faced some major obstacles in the project: getting the word out to drug users and getting legalization and funding for it.

“Ironically, getting the trust of drug users was not the biggest problem .... In fact, the first [injection drug user] to participate in this program turned out to be an important partner in [PPP’s] work,” Acker said. However, she had a much harder time trying to gain legitimacy and support. The program was finally legalized in March 2002, and in April of that year, PPP established a county needle exchange site in Oakland. Since then, over 5000 injection drug users have enrolled in the program for critical prevention services.

Acker believes this program is extremely important because there have been studies all around the world proving the success of needle exchange in keeping the level of HIV-positive individuals down.
Acker recounted that a study conducted in the 1980s in such cities as New York showed that two thirds of the 2 million injection drug users were HIV positive. However, when New York State began to fund the needle exchange program, the epidemic curve of the disease showed a reverse.

She also cited another study conducted in 1995 in which cities were studied while HIV prevention work and especially needle exchange programs were present. If the city had an initial HIV infection rate of less than 5 percent, then with both programs occurring, the city showed little or no increase in infection rates even after eight years. Acker considers Pittsburgh to be one of those cities sustaining HIV positive rates under 5 percent.

Carnegie Mellon students have become involved in this program as well. Acker described a first impression to the needle exchange program as “students [asking] why [you would] give needles to people to inject illegal drugs.” However, after she explained the public health rationale, which she stated as “knowing of a dangerous disease ... and identifying the mode of transmission and interrupting that mode of transmission [unclean needles], you can control the disease,” several students from both Carnegie Mellon and the University of Pittsburgh Medical School offered to volunteer in the program.One such volunteer is senior history and policy major Ellen Parkhurst. Parkhurst has been volunteering in the program since August 2007. She has progressed from just volunteering in the needle exchange program to doing a research project on how the supplies given to the drug users are utilized and the extent of the users’ knowledge about health safety.

Parkhurst said, “[I] was able to find out what they are doing with [the supplies] when they leave the site, and that was fascinating to me because it’s always been that we give [drug users] needles, but now I know what they do with [the needles].” Parkhurst also spoke of Acker as “someone who inspires you to do something when you need to get it done and a kind of person who you really want to impress.”
Acker stated that right now “[they] are still a struggling program since there is no federal funding for purchasing the needles.” She also said, “We don’t have enough resources to meet the needs of Allegheny County. So our energies are focused on expanding the program in the city.”

Still, she does wish that groups of people in cities that don’t have the needle exchange program will try to take the opportunity to start one for their cities.
Acker’s dedication to public health as a layperson has earned her the 2008 Benjamin Rush Individual Public Health Award from the Allegheny County Medical Society.