12 percent increase in the proportion of Maryland residents who support needle exchange programs (Figure 4.1). These results also point to a larger increase (19 percent) in the city of Baltimore than in the state as a whole. Moreover, findings from a recent nationwide telephone survey undertaken in February 1994 showed that, among the 1,001 adults sampled, 55 percent favored implementing needle exchange programs to reduce the spread of diseases such as AIDS, 37 percent favored allowing drug users to buy sterile needles without prescriptions from pharmacies, and 40 percent favored removing criminal penalties for the simple possession of needles and syringes (Hart, 1994).

We turn now to discussion of the views of particular groups in communities across the nation.

AFRICAN AMERICAN VIEWS

Much of the voiced African American opposition to needle exchange and bleach distribution programs must be understood in the context of perceptions that historically there has been government negligence in response to the drug abuse epidemic, distrust of public health authorities, and fear—and, for some, the conviction—that the broader society considers large segments of the African American population expendable (Thomas and Quinn, 1991, 1993). Pervasive throughout the African American community are uncertainties about the motivations of what they perceive as the white establishment.

This underlying distrust is grounded in part in a history of medical neglect and significant violations of human subjects. Most specifically, the legacy of the Tuskegee Syphilis Study is a vivid reminder (Thomas and Quinn, 1991). This study, conducted by the U.S. Public Health Service from 1932 to 1972, deliberately and irresponsibly withheld treatment for syphilis from an African American community in Tuskegee, Alabama. The Tuskegee study continues to serve as the basis for much of the widespread distrust of public health and government authorities (Jones, 1981). Recently confirmed reports about other government abuses (e.g., radiation experiments, cocaine distribution) are portrayed as further evidence to support suspicions and fears about the motivation and intent of officials urging the utilization of needle exchange programs.

According to Thomas and others (Thomas and Quinn, 1993; Belgrave and Randolph, 1993), many African Americans, including many who are well educated, believe that HIV is manufactured and that drugs are being deliberately supplied to African American communities. The prevalence of AIDS itself, as well as programs purported to reduce its spread, are viewed as part of a larger genocidal conspiracy against African Americans. In a 1990 survey of the views of African American churchgoers in five cities—Atlanta,



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