Clean Crack Pipes as HIV, Hep C Prevention Tool?

San Francisco city supervisors and health advocates are continuing to greet the idea of distributing crack pipes with a mix that includes open-mindedness and silence.

Some believe such a program could help decrease transmission of HIV, hepatitis C, and other diseases. In January, members of the HIV Prevention Planning Council, an advisory group to the health department that sets priorities for HIV prevention in the city, voted unanimously to support an action plan that includes collecting data and exploring legal issues around crack pipe distribution.

One advocate recently called crack cocaine use "a significant driver" of HIV infection in San Francisco, with risks including crack smokers being likely to engage in unprotected sex.

Public Health Director Barbara Garcia and Mayor Ed Lee have vehemently opposed the idea of distributing crack pipes, but others, including District Attorney George Gasc-n and gay Supervisor Scott Wiener, have expressed openness to the idea.

Some supervisors approached for this story also offered their thoughts on the idea of distributing crack pipes, while one refused to discuss it at all.

Gay Supervisor David Campos said in an interview last week that he didn't know enough about the idea "to take a position."

"I'm supportive of harm reduction efforts, but I don't know enough about this to know if this is the right approach," said Campos. He has questions about liability and other issues. One of the things he'd like to know about is whether the city would be liable "if someone overdoses."

He said he hadn't approached anyone in the health department to discuss the idea of distribution, but he said he'd schedule a meeting with Garcia.

"I certainly want to sit down with [her] and learn more about her thoughts," he said.

Campos said he'd also be "happy to sit down with people proposing this idea to learn more from them," and he also planned to meet with members of the HIV Prevention Planning Council.

Board of Supervisors President David Chiu, who is running against Campos for the 17th Assembly District seat soon to be vacated by gay Assemblyman Tom Ammiano (D-San Francisco), said he's against the idea, but open to changing his mind.

"My initial thought is that distributing crack pipes is not a good idea," Chiu said in an email. "I believe there are other ways of engaging with people who have substance abuse issues, and I don't think the health issues with crack pipes are the same as with needles. All that said, if our public health professionals make a case that this is a good idea, I'll listen to their case."

As the representative of District 6, it may seem that Supervisor Jane Kim would have more to say on the topic than almost any other supervisor. Her district includes the Tenderloin neighborhood, which is home to many crack users.

But Kim hasn't responded directly to interview requests, and her aide Sunny Angulo has worked to discourage the inquiries.

In an email this week, Angulo wrote, "Like I said, the office is not leading this initiative and has not been approached by community groups or advocates. Last week was the first time seeing the proposal in the press. Jane doesn't have comment for the story currently, but we'll be monitoring the issue as it develops."

She said that since the Bay Area Reporter will continue reporting on the issue, she's "assuming there will be plenty of opportunities to engage." She added, however, "We also want to make sure we're giving informed, substantive contributions to the conversation."

Garcia and Lee haven't offered specific explanations for why they object to distributing crack pipes.

Garcia didn't respond to an interview request this week, and in an email, Christine Falvey, Lee's spokeswoman, declined an interview request by saying, "The mayor is relying on his public health director to assess, recommend, and implement the best interventions for HIV prevention. For more information, please contact the Department of Public Health."

The San Francisco AIDS Foundation, which is the city's largest HIV/AIDS-related nonprofit and receives funding from the health department, has been involved for years in syringe access programs. The programs are credited with helping to cut local HIV infection rates.

Neil Giuliano, the AIDS foundation's CEO, said that "a number of years ago," his agency added "crack kits" to its syringe access program. The kits don't include a pipe, but do contain sterile water, caps that can help protect people's lips, and other equipment. He said including the kits "helps us increase the level of client engagement and linkages to service," among other benefits.

Giuliano said the AIDS foundation would review data in order to "better understand" whether adding pipes to the kits would "significantly impact" HIV transmission rates among the people the nonprofit serves.

The AIDS foundation's leadership team has had a conversation about the topic, but, "We don't have a position on it. It has not gone before our board," he said.