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The glittering vision of Atlantic City that gamblers experience at night -- with the streets jammed with limousines and the casinos ablaze with light -- melts away with the rising sun. In the cruel light of day, the casino strip is dotted with homeless people, tapped-out gamblers and garishly dressed prostitutes, staring into the windows of passing cars. Move onto the side streets and you encounter young men holding down proprietary street corners and people who are clearly addicts, skittering nervously along in search of drugs. Drugs and prostitution -- always birds of a feather -- have turned Atlantic City, the gambling capital of the East Coast, into the scene of an AIDS epidemic and the backdrop for a public health emergency. City health officials estimate that 1 in 40 residents is infected with H.I.V. Many of the infected are prostitutes who turn tricks to earn money for drugs. The largest single group appears to be intravenous drug users, who may make up as much as 15 percent of the population. They become infected while sharing dirty needles with other addicts, then pass on the disease to lovers and unborn children. The addicts need treatment and counseling. But treatment programs are in short supply, and the community can't wait to slow the spread of infection. A critical part of the solution is to supply addicts with clean needles. Most states have permitted these programs, prompted by studies showing that needle exchanges cut down the transmission of H.I.V. without spreading drug addiction. But five states, including New Jersey, still have laws on the books that make it a crime to possess needles without a prescription. The City Council of Atlantic City voted to create a needle exchange program despite the law, hoping that officials would look the other way given the emergency circumstances. The county prosecutor, however, has sued to stop the program, setting up a court battle that is being closely watched by public health advocates across the country and abroad. Gov. James McGreevey has danced around the issue while claiming that he supports needle exchanges in principle. But he couches his support in vague terms, saying he could endorse only a program that was somehow "hospital based." The problem, AIDS researchers say, is that needle exchange programs set in hospitals fail. Addicts are afraid to present themselves at medical centers -- where they walk through metal detectors, encounter people who know them and meet the police. The best way to reach this population is through neighborhood storefronts or roving vans that seek out addicts where they live and congregate. I recently spent time with one of those vans, which have become fixtures in the city's roughest neighborhoods. It was parked not far from a homeless shelter and just opposite the Stanley Holmes housing, a public development that the state attorney general recently described as the home base of a drug cartel. The van's driver, a middle-aged man named Tug, has a booming voice and an imposing physique that naturally keeps troublemakers at bay. The van's medical staff consists of two formidable women: Scherri Rucker--Graves, a veteran nurse, and Rosemary McMenamin, a nurse practitioner who once worked in the state prison system. The neighborhood was naturally suspicious when the van began to show up about a year ago. But after the nurses reassured people, the outreach team developed a rapport with the neighborhood -- thanks in part to a large supply of modest gifts, like condoms, lanyards and white T-shirts promoting the testing program. The small park near the housing project was teeming with ill fed and poorly dressed women from the nearby homeless shelter. "We just hang out where they hang out," Ms. Rucker-Graves said, "close to the housing projects, close to the supermarket, close to the rescue mission." People who are most at risk know frighteningly little about the disease, the nurses say. Some young women were under the impression that condoms weren't necessary for oral sex because, they thought, oral sex was not really sex. Others believed that even if they were infected, they might magically be protected from AIDS. Working within the current constraints has been painfully difficult. About 480 people have been tested in the last year; roughly 6 percent were found to be H.I.V.-positive. But the test that is currently allowed on the van requires a two--week waiting period, and about one--fifth of those tested do not come back to hear the results. Approximately 30 percent of the people tested in the van are addicts, but if they turn out to be infected, the team's options are limited to counseling and medical referrals. Every time the van hits the street without clean needles, an opportunity is lost and new lives are placed at risk. |
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