The Ohio Department of Health has recognized needle exchange programs as successful in preventing AIDS, but Cincinnati officials don't share that mindset.
On May 15, Ken Vail, a Cleveland resident, was awarded the state's Advocacy Award for his work at the Xchange Point, a needle exchange program that provides clean syringes to drug users who inject drugs like heroin.
But some say even this statewide recognition and support of a needle exchange program will not be able to move Cincinnati forward with this kind of prevention strategy.
Steve Townley, the Ohio AIDS Coalition board of trustees president, said a needle exchange will happen in Cincinnati, "only if we can build a stadium for it."
"This kind of prevention strategy is still a second-tier funding priority," Townley said. "Although the state is now recognizing it as a viable prevention strategy, there is still a lot of catch-up to be done."
Last year, the Cincinnati Health Department organized a public forum to discuss strategies to prevent the spread of HIV and AIDS through drug use.
Most of the forum was used to discuss a report from the Cincinnati Regional Advisory Group on HIV Prevention Planning, which prioritized and identified the need for HIV prevention strategies for Cincinnati until the year 2001.
Needle exchange was not placed in the highest level of priorities, Townley said.
And some of the top-level priorities still have not received funding, he said.
Dr. Judith Daniels, medical director of the Cincinnati Health Department, said that discussions about the possibility of a needle exchange program in Cincinnati are ongoing.
In April, the Cincinnati Academy of Medicine met to discuss issues surrounding needle exchange.
But even with all this talking, there has been no action taken toward implementing a harm reduction program such as needle exchange.
"I don't think it's an issue that will go away," Daniels said. "It's an issue that's been brought to the forefront over and over again."
CityBeat reported in February 1998 that the city of Cincinnati was unprepared to deal with the rise in local heroin use because it had failed to track intravenous drug use in the city despite a previous city council decision to do so.
A 1994 report from the Greater Cincinnati AIDS Consortium recommended a street-level outreach program, and an increase in efforts to track intravenous drug use so that the option of a needle exchange program could be evaluated.
As CityBeat learned, however, the city had no better information than it did four years ago.
Townley thinks the one way to speed up implementation of a needle exchange program in Cincinnati is through grass-roots organizations like Vail's in Cleveland.
But Townley said that it would not be an easy task.
The Xchange Point has had an extensive and laborious history.
Vail, its founder and executive director, first worked at Cleveland's Free Clinic, the first needle exchange in Ohio.
But Vail thought there was a need for an additional clinic to extend the outreach programs.
"There are an estimated 8,000 heroin abusers in Cleveland," Vail said. "There was definitely room for two clinics to hand out needles. And the Free Clinic was moving so slow on getting needles to the right places."
In September 1996, Vail began a 3-year-long battle with the city of Cleveland.
He began with a few volunteers handing out bleach kits and provisions around neighborhoods with high drug usage. But the city fought to get rid of the Xchange Point.
The director of public health had passed an emergency order that allowed a needle exchange program to operate only if it was connected to an established institution such as the Free Clinic. This emergency order did not include independent operations such as Vail's needle exchange program.
After jumping over "unnecessary barriers" the emergency order was changed in May 1997 to include Vail's needle exchange program as the second program in the city.
Although it seemed the battle was over, the city arrested Vail last April for operating in the same zone as a day-care center.
Vail remembers that it was a day after President Clinton's administration announced that it would not lift a ban on federal funding for needle exchange programs that had been in place since 1989. The charges later were dropped.
Despite setbacks, Vail views his award from the Ohio Department of Health as an indicator that the state is moving forward in terms of HIV prevention.
"Harm reduction strategies have come very far in Ohio," he said. "They have recognized and acknowledged that (intravenous drug users) are a population that needs to be served."
He realizes that needle exchange programs still are controversial because of the misconception they promote drug use. But he is optimistic that these alternative prevention strategies could spread to cities as conservative as Cincinnati.
"This award has been bittersweet," Vail said. "But without a doubt, it can only help needle exchanges and other HIV prevention programs grow statewide."
Townley is equally hopeful about a potential needle exchange in Cincinnati.
"There is a need in Cincinnati, and I think this could take us one step closer," Townley said. "This award definitely legitimizes needle exchange programs as good harm reduction."