Dr. Yen Chun-tso, a doctor of internal medicine, has made the leap to become a public health official at the county level, where he hopes to deal with the double threat of drug abuse and AIDS. (Jimmy Lin)
Should the Department of Health provide free needles to drug addicts? The question recalls the mid-1990s debate over selling condoms through campus vending machines--society can't help but wonder whether such programs would encourage drug addiction and promiscuity.
In early 2005, Tainan County deputy chief executive Yen Chun-tso responded to Taiwan's problems with out-of-control drug use and drug-related transmission of AIDS by boldly proposing a policy that has some history of use abroad. In so doing, Yen has led Taiwan into a new era in disease and drug-use prevention.
Yen began his career as an internist and has continued to make use of his medical training since taking up government service. When Taiwan was hit by SARS in 2003, he established Taiwan's first fever-screening station at the clinic he was then running. Yen has been just as courageous in the fight against AIDS, and his Tainan County harm-reduction program is certain to be a model for other counties and municipalities.
Fang-hua is a pharmacist who has run her own pharmacy in a seaside village in Tainan County for nearly 20 years. She knows well the importance of trust between patient and practitioner.
"When they first come in," she says, "they look around from the doorway, buy a 'sharpie,' and leave quickly." The "they" she's referring to are intravenous drug users (IDU), and the NT$10 "sharpie" is usually a 40-cc syringe.
Sometimes, Fang-hua has the syringe out even before they ask for it. "They have a very particular body odor," she explains. Her husband, who helps mind the pharmacy, nods his agreement. "After they've bought them a few times, some will chat with us a little," says Fang-hua.
And, after they've built a little trust, "We let them know that they can get free needles," adds her husband.
Free needles are central to the harm-reduction program. Those who come in to buy "sharpies" can instead fill out an anonymous form and get a paper bag filled with equipment that an intravenous user of heroin must have--three syringes, a tourniquet, a diluting cup, condoms and a small health-education booklet.
The DOH's original plan for the harm-reduction program had called for distributing ten single-use safety needles at a time. However, after consulting with individuals with experience using intravenous drugs, the department decided instead to provide three reusable needles at a time.
"If you get ten at once," explains one addict, "you have to carry the unused ones with you and worry about being arrested. And, because you can only use them once, safety needles are inconvenient. When you finish, you have to go buy more or exchange them."
Between November 2005 and April 2006, Fang-hua's very ordinary pharmacy distributed nearly 200 of the paper bags, or almost 600 syringes.
"They say they're giving us syringes, but really they're trying to educate us a little," says "Little K," a young woman of barely 20 with dyed red hair. She has been to Fang-hua's pharmacy for needles many times, and often chats a bit when she comes in. "Some bits of the booklet are really boring," she says, "but it also shows us how to clean the diluting cup and needles. That's stuff we really want to know."