A Texas plan to provide intravenous drug users with bleach and instructions for cleaning their needles may never hit the streets. As part of a multimillion-dollar AIDS education and prevention program, the Texas Commission on Alcohol and Drug Abuse has proposed distributing kits to drug abusers that would include condoms, instructions for so-called ``safe sex'' practices, and a one-ounce bottle of bleach for cleaning needles.
The sharing of dirty needles by drug abusers is considered one of the primary sources of the spread of AIDS, and perhaps the single greatest AIDS threat within the heterosexual population.
The commission's plan was not well received by Texas Gov. Bill Clements, however, who questioned the commission's authority to undertake such a program. Part of the state's concern is apparently over liability in the event of injury from state-provided materials. Whether or not the federal funds for the program can be used for such materials is another issue the governor's office wants explored.
Observers speculate that Governor Clements's opposition may also stem from a distaste for a program that could be construed as promoting illegal or immoral conduct. A spokesman for the governor's office said that was not an issue, however.
The bleach idea is not new. Already more than 250 kits like the ones the Texas commission proposes to hand out have been distributed since last fall by the Dallas County Health Department. And Dallas got the idea from San Francisco, Newark, N.J., and other cities around the country.
``It's a program that's showed some real success in controlling the spread of AIDS elsewhere,'' says Bob Dickson, executive director of the Texas commission. The program's emphasis would be on getting [addicts] to come in for treatment. But with some studies showing that as few as 5 percent of heroin and other intravenous drug abusers ever take that step, Mr. Dickson adds, ``we want to try to educate.''
Still, the viability of such programs remains in doubt. While education efforts concerning AIDS and homosexual practices appear to have had marked impact on behavior in the nation's gay community, the same is not true among drug abusers. ``There's really been no change in the high-risk practices in the drug community,'' says Ed Kain, a professor of sociology at Southwestern University in Georgetown, Texas. ``That's where we're seeing the greatest increases right now in the number of cases. Just how successful these programs can be is really still a question.''
The Dallas County program ``has really been a pilot program,'' says Charles Haley, epidemiologist with the Dallas County Health Department. He says his department will ``pass on what we've learned'' when the area's main methadone treatment center takes over the program under a substantial anti-AIDS grant.
Dr. Haley says his department was ``not ever really interested'' in dispensing free needles to drug abusers, a proposal that recently caused an uproar in New York City. ``That would be an easy thing to do. But we feel it's more important to use the opportunity to teach about hygiene.'' The Dallas program has had no problems from abusers misusing the bleach, and, according to a field worker for the county, such problems in the longer-running programs on the two coasts have been minimal.
The Dallas bleach and safe-sex kits are paid for with federal money, according to Haley, but he notes that they have been approved by a local ``literature review committee.'' Such reviews, to ``make sure our materials are effective but inoffensive,'' he adds, are a prerequisite for using federal AIDS education funds.
Whether or not the kits ever see broader distribution in Texas may hinge on their passing the Bill Clements review.