Navigation – Plan du site
Mouvements sociaux, d’ici et là, d’hier et d’aujourd’hui

Scientific and Legal Opportunities” for the U.S. Drug and AIDS Movement

« Opportunités scientifiques et légales » pour le mouvement contre le SIDA et la toxicomanie aux Etats-Unis
Gilbert Elbaz


Cet article examine l’activisme contre la toxicomanie et le SIDA qui a pris naissance aux Etats-Unis dans les années 1980, en particulier celui qui se développa dans la ville de New York. Dans le cadre de la théorie des mouvements sociaux, la perspective de « l’opportunité politique » semble appropriée pour analyser un tel mouvement. Cependant, contrairement à ce que suggère cette perspective, la thèse de cet article défend l’idée que « les opportunités scientifiques et légales », plutôt que « politiques » expliquent le succès relatif de ce mouvement entre les années 1980 et 1990.

Haut de page

Texte intégral


1The drug and AIDS movement was born in the mid-1980s. Its members, mostly white-middle class, used new social movement strategies to achieve their ends, including press conferences, meetings with scientific and political officials as well as acts of civil disobedience (Elbaz, 1990). With the help of scientists and a judicious, albeit risky, use of the law, drug and AIDS activists, often users or ex-users themselves, were able to mount a social movement that led to the creation of needle-exchange programs throughout the United States. Even though these needle-exchange programs are still the object of controversy today, as federal funding for them has been voted down in 2011, they are operating thanks to local funding, and continue to save thousands of lives. From a social movement perspective, this article analyzes the emergence and development of the drug and AIDS movement in the United States, with a particular focus on New York City, where activists took advantage both of “scientific and legal opportunities”.

2In order to understand the emergence, success and failures of the drug and AIDS movement, it is important to delve into social movement theory. The prevailing paradigm in social movement theory has been called the “political opportunity structure” (Turrow, 1994; Zald and Garner, 1987), according to which three components determine whether or not a social movement will be successful or failing: Firstly, activists must identify a “strain” in the social system, marked by the inability of the latter to resolve a structural problem; they then develop an “insurgent consciousness”, which gives them the analytical tools and the willingness to bring about structural changes. Secondly, activists must garner what adepts of this model have called “organizational strength”, that is the ability to muster leadership and resources, particularly external resources. And thirdly, activists must benefit from the opening of “political opportunities” thanks to a pluralistic political system, declining repression, and discords within the elites, leading to increased political recognition of the social movement (Turrow, 1994, 1998; Zald and Garner, 1987). With some variants, adepts of the “political opportunity structure” paradigm agree with Doug McAdam’s definition of a social movement as "those organized efforts, on the part of excluded groups, to promote or resist changes in the structure of society that involve recourse to non-institutional forms of political participation"(McAdam, 1982: 25).

3Within the “political opportunity structure” model, it is imperative that the three components be present (McAdam et al., 1996). Grievances and resources alone are not enough for a movement to be successful; “political opportunities” must also be opening in the social structure, which means that the political system, or at least part of it, must become favorable to the activists’ demands. The political opportunity model explains then why social movements arise, when they do it and how they do it. For authors such as Doug McAdam, John D. McCarthy and Mayer N. Zald, (1996), political opportunities refer to the structure; they are then “structural political opportunities”, because, according to them, social movement actors are primarily constrained by structural factors in their decision to take action.

4Critics of this approach have pointed to the inconsistencies in the “structural political opportunity” model. Jeff Goodwin (1999) for example argues that what Tarrow (1994) calls political opportunity structure is simply political opportunity. In fact for Doug McAdam (1994), another proponent of the structural political opportunity model that he calls the “political process model”, which highlights the social movement’s dynamic aspect, agrees with this observation when he writes that political opportunity is often “perceived opportunity” (McAdam, 1994: 39). Political opportunity is then more situational than structural. Likewise, Tarrow’s definition of “political opportunities” seems to agree with this “conjunctural positioning” as he defines them as: "dimensions of the political environment that provide incentives for people to undertake collective action by affecting their expectations for success or failure" (1994: 85). As Goodwin rightly notes there cannot be incentives if there is no preliminary interpretation. Opportunities are then more strategic and conjunctural than structural. In his later publications, Tarrow went as far as dropping the word “structure” from his newly named “political opportunity model” (Tarrow and Meyer, 1998). Notwithstanding these rightful correctives to his conception of “political opportunity” Tarrow’s positioning, some say “bias” (Goodwin et al., 1999) remains resolutely structural.

5In accord with Goodwin’s critique, the present article agrees that political opportunities are more conjunctural than structural. In addition, it posits that political opportunities are not the only type of opportunities that leads to movement emergence and success; opportunities, or lack thereof, in areas other than the political system may also account for social movement’s success or failure. In fact, it has been already argued that the lack of political opportunities (Eisinger, 1973; Gould, 2009) may account for the rise of social movements. In the same vein, the present article argues that scientific and legal opportunities accounted for the relative success of drug and AIDS activists engaged in the fight for the creation of needle-exchange programs. It is only after these two opportunities arose that political opportunities really began to open up, eventually leading to the official recognition of needle-exchange programs. The present article lays out the “strain” faced by the activists, the development of their “insurgent consciousness”, the mobilizing of their resources, not just external, but also internal, the rehabilitation of drug users’ social and affectual perception and finally, the scientific and legal opportunities that opened and led up to political opportunities eventuating in the official recognition of needle-exchange programs in New York City and other cities.

6The information for the present article was drawn from several sources. Data from a survey of five hundred activists provided their socioeconomic profile (Elbaz, 1990). Access to the activists’ archive in New York City (ACT UP Needle-exchange program, 1990), as well as the scientific and journalistic literature on drug and AIDS in general delineated the socio-cultural context within which the drug and AIDS social movement emerged.

1. The Drug and AIDS movement

7Science is inextricably entwined with drug and AIDS activism, from the identification of the “strain”, the development of the “insurgent consciousness”, the mobilization of resources to the “scientific and legal opportunities” from which participants benefitted.

8Marginalized both by lack of political opportunities, resources and social stigma, drug and AIDS activists, user and ex-users themselves, were able to mount a social movement through coalition building with other social movement organizations, facing tremendous medical challenges. With a fairly radical use of democratic institutions, they were also able to construct a dignified identity for themselves and think up efficient strategies to face the twin epidemics of drug addiction and HIV/AIDS.

1.1. The strain

9In the mid-1980s, unsafe injection drug use represented the second main behavior by which HIV transmission could occur. Skyrocketing HIV transmission among injection drug users (IDU) primarily through the exchange of blood happened while sharing hypodermic needles, syringes, cotton (or other material used as a filter), and “cookers,” containers in which the drug was heated and/or dissolved (Friedman et al., 1990). Despite the devastating AIDS epidemic among drug users, very few prevention programs existed, almost no clinical trials, and hardly any treatments specific to conditions contracted by this population.

1.2. Shooting galleries

10The spread of HIV among IDUs was linked to the use of “shooting galleries”, hidden places where drug use and dirty needle exchange occurred without any control. Studies showed that 90-100% of IDUs reported sharing needles and almost three-quarters frequented shooting galleries (Sufian, 1991).

11In smaller cities, shooting galleries were not as common. Instead, a dealer who was selling illicit drugs for injection would often keep a set of “house works”, injection equipment that was lent to a purchaser so that drugs could be used immediately. These “works” were then returned to the dealer for lending to the next customer. Needle sharing also often occurred as part of an initiation into drug use (Friedman, 1990).

1.3. Injection drug use, the statistics

12Although in the late 1980s it was very difficult to determine the extent of illicit drug injection, the U.S. Public Health Service estimated that there were 750,000 “regular” injection drug users (IDUs) and another 750,000 “occasional” IDUs in the United States (Centers for Disease Control and Prevention, 1989). A “regular” drug user was defined as a person who injected at a frequency of at least once per week. “Occasional” IDUs were persons who used drugs intravenously, but had never injected more than once per week. It is worth noting that statistics did not capture middle- and upper-class individuals who could afford clean needles, and thus escaped the attention of federal health or justice agencies. Even the New York City Department of Health estimated that drug users were being undercounted by 130% (Sufian, 1991).

13In 1988, over 20% of the Centers for Disease Control (CDC)-defined AIDS cases nationwide were attributed to dirty needle sharing. Over 50% of female CDC-defined AIDS cases were attributed to unsafe drug use. Black women, in particular, represented almost four times the number of white or Hispanic women with CDC-defined AIDS (Centers for Disease Control and Prevention, 1989). The number of births to women who used narcotics continued to increase sometimes dramatically. In New York City, 80% of pediatric AIDS cases were attributed to a present or former drug-using parent and by 1993, 50% of New York City AIDS cases were among IDUs (New York City Department of Health, 1990).

14In New York State, there were approximately 260,000 IDUs, the largest concentration being in New York City and 60% of them were HIV positive (New York State HIV/AIDS Annual HIV/AIDS Surveillance Statistics, 1990). In 1988, for the first time, the drug-using population in New York City was outnumbering gay men in terms of reported AIDS cases. Compared to the rest of the U.S., New York State's persons with AIDS (PWA) were at least three times as likely to be IDUs (New York City HIV/AIDS Annual HIV/AIDS Surveillance Statistics, 1990).

15Three states--New York, New Jersey, Connecticut--accounted for almost three-quarters of CDC-defined AIDS cases involving heterosexual IDUs. Studies of historically collected blood samples from IDUs indicated the potential for a very rapid spread of the virus within the group (Centers for Disease Control, 1989).

16Because needle possession was a crime in New York City, a subculture with its own economy had evolved. Fear of AIDS had spurred a market for new syringes, often supplied by diabetics, although many addicts still bought used ones (Friedman, 1990).

1.4. State target: street users

17A quick overview of some drug regulations reveals how street users increasingly became the authorities’ favorite targets. Surprisingly, until the turn of the century, drugs were not regulated and not prohibited. Opiates were used as pain-relievers and as treatment for menstrual cramps and diarrhea. This situation quickly changed.

18In 1914, the Harrisson Narcotics Act was adopted, limiting the distribution of all opiates including morphine and heroin to licensed physicians. Implementing a zero-tolerance approach, the government had banned opiates by the mid-twenties. Targeting specifically small users, Congress added marijuana on the list of proscribed substances, and in 1966, Nelson Rockefeller proposed from 15-year-to-life-imprisonment for possession of two ounces or more of any narcotic substance, plus stiff penalties for marijuana (Gahlinger, 2001).

19With “Operation Intercept”, Nixon started the “war on drugs” in the 1970s to step up boarder control with Mexico; subsequently, smugglers began to fly airplanes. However, not everybody agreed with the government’s zero-tolerance posture: during the same period, Jacob Javit and Edward Koch sponsored a marijuana decriminalization bill. Eleven states decriminalized marijuana possession, while one--Alaska--legalized marijuana cultivation for personal use (Barrios, 1998).

20Despite obvious opposition in certain political circles, President Ronald Reagan appointed Vice-president George Bush in 1989 to be the director of the South Florida Task Force, an agency aimed at controlling drug trafficking in and around Miami. He also appointed as “drug czar” William J. Bennett who declared in a speech in Washington:

“The drug crisis is a crisis of authority-in every sense of the term “authority”… What those of us in Washington, in the localities can do is exert the political authority necessary to make a sustained commitment to the drug war. We must build more prisons. There must be more jails. We must have more judges to hear drug cases and more prosecutors to bring them to trial, including military judges and prosecutors to supplement what we already have” (Lazare, 1990).

21The major outcome of the government’s coercive approach was the incarceration of vast numbers of street users, mostly people of color, leaving drug lords untouched. The failed « war on drugs” quickly became the “war against street drug users”, the most visible and vulnerable targets.

22Without any government support to help them, street drug users were often led to commit acts of violence or engage in survival sex to obtain drugs. In the late 1980s, the price of sex dropped as more women and men had become addicted to crack and turned to prostitution often with infected drug users as clients. Don Desjarlais (1992) estimated that the number of regular crack smokers in New York could be anywhere from 50,000 to 400,000. After IDUs, crack users were probably the next generation of HIV infected.

1.5. State production of hate toward street users

23The US government’s hateful perception and repressive handling of street drug users became doubly hateful and repressive towards street drug users with HIV/AIDS. As in the case of the gay community, government neglect toward drug-users had a punitive component to it. Hateful attitudes or “addictophobia” toward drug users had been best exemplified by the debate around “blood” which had been frequently used as the symbol of racial purity, as a divider of “us” against “them.” Street drug users were denounced by the government for disseminating “contaminated” blood. Yet many more drug users lived in upper- or middle-class homes than in the street, and these users were educated about the different effects of drugs, had easy access to clean needles, and knew how to preserve their anonymity. What then made street drug users distasteful to the eyes of the government was not so much their addiction as their visibility. Representing a specific community, street drug addicts were disenfranchised not only by their addiction and their socioeconomic status or lack thereof, but also by the government’s hateful and repressive attitudes and measures towards them.

2. Activists “insurgent consciousness”

24The government’s repressive attitude did not allow any negotiation, any “political opportunity” for the activists who for the most part aligned themselves with the already existing drug reform movement. The following statement encapsulates their positioning, or their “frame”, to use a social movement terminology:

“Terrorism death agent wartime consequences-this was the language of a political culture that had detached itself from reality and was spinning wildly out of control. Jackson and Rangel notwithstanding, minorities are the greatest victims of the drug war. Military courts such as those sought by Bennett would not be set up in the suburbs, where brokers snort and occasional line of coke and teenagers sneak off to smoke joints. Rather, they'd preside over battle zones like Washington Heights and the South Bronx. That's where the drug trade is concentrated, that's where the cops concentrate their forces, and that's where civil liberties are first to come under assault. It's also where the indirect effects of the drug war-crime, corruption, and the displacement of background business and needle-borne disease such as AIDS-are most intense” (Lazare, 1990).

25Drug activists condemned the criminalization of drugs which appeared to target the wrong culprits. Politicians, organized crime and members of almost all known communities were involved in the drug market. Drugs came from all over the world: marijuana and cocaine were imported from Latin America, in particular Colombia, Peru and Bolivia. Heroin was imported from South East Asia, China and the Mid-East. Drugs were also produced in the United States where residents could design their own drug, as in the case of crack, designed in a Los Angeles kitchen. Like crack, drugs were increasingly synthetic, a characteristic that increased their immune-suppressing effect (Barrios, 1998).

26Activists advocated for the decriminalization of drug use, a law that would undercut the drug lords. Instead of expending vast sums for police, prosecutors, prison guards, the city would be able to finance non-coercive drug treatments. An alternative to a “war on drugs” was a policy based on educating the public about the dangers of drugs, much as massive anti-tobacco campaigns had educated millions of US residents (ACT UP fact sheets, 1990).

27According to the activists, a rational policy would recognize that all drugs are not necessarily dangerous and that drug use does not necessarily constitute abuse. On the other hand, it would recognize that just as some people persisted in smoking, some would persist in doing hard drugs. Rather than punishing those who did, legalization would promote moderation while seeking to minimize the risk to users.

28Countering state addictophobia

29One of the goals of the drug and AIDS movement was to counter the state production of hate toward drug users and rehabilitate their social perception, instilling positive feelings about them. Contrary to popular belief, activists, some of whom had been addicts themselves, sustained the idea that users cared about their lives, could understand HIV-risk, and organize accordingly. Using research, they argued that scientific data had already shown that users were willing to change their behaviors. Two studies-the Lower East Side Health Project (LESHP) (Friedman, 1990) and the Risk Factors Study (O’Keefe and al., 1991)--including respectively 1,541 and 1,056 subjects concluded that the typical profile of the IDUs was black, white or Hispanic, 37 years of age with 11 years of formal education. Both studies showed that drug users were aware of their personal risk status and were informed of the modes of transmission for HIV and harm reduction. About 80% of the sampled IDUs had taken steps to lower their own risk of HIV infection. Generally, these risk-reduction behavior changes had been either reduction of needle sharing, or increase in bleaching of shared needles or condom use. Clearly, activists were using these studies to counteract the government’s heinous attitude towards street drug users, strengthen the latter’s self-esteem, and more generally challenge the media’s and public’s prejudicial feelings about them.

3. Scientific issues

30Increasingly using scientific data that supported their position, activists mobilized around the-then defective AIDS definition, exclusionary biomedical research criteria, and insufficient treatments.

3.1. AIDS definition

31With the strong support of dissenting scientists, those who did not agree with the interpretation of the government, drug and AIDS activists mobilized around the official definition of the syndrome. In its AIDS definition, the CDC had not included pulmonary tuberculosis, the opportunistic infection mostly contracted by drug users. Just as in the case of women with AIDS, the CDC had not taken into account the socio-cultural and environmental context within which certain AIDS-related conditions could develop within the IDU population (Sufian, 1991).

32Although life-threatening, lung cancer and cancers of the GI tract, bacterial infections, tuberculosis, HTLVI and II, endocarditis/septis, pulmonary TB and herpes zoster which occurred mostly in male IDUs, were not AIDS defining. Unlike gay men, drug users did not seem to develop Kaposi's Sarcoma and PCP, which indicated the existence of HIV-related disease. In conclusion, markers and therapies for HIV-related disease were inadequate for conditions contracted mostly by IDUs (Sufian, 1991).

3.2. Biomedical research

33Drug users faced other barriers in the research arena, which appeared to be more of a social than a scientific nature. Highly prejudiced against drug users, some researchers coined them “unreliable subject population," and thus denied them access to drug trials and subsequently too much needed health care. Yet even without HIV, drug users were in need of healthcare as their immune system was already quite weakened, exposing them to infections such as hepatitis, endocarditis, syphilis and septicemia, as well as injection-related injuries such as cellulitis and abscesses (Sufian, 1991).

3.3. Treatment issues

34Still supported by scientific data, activists argued that drug users who sought treatment faced another layer of difficulties: the paucity of available treatment centers. Paradoxically, many treatment slots remained empty for weeks because no one knew they were open. Women were particularly affected by the failings of the treatment system as they could not take care of their children while in treatment. Finally, although Blacks were over-represented in drug statistics, Whites held a disproportionate number of spaces in methadone clinics (Blanchy and Hopkins, 1989).

3.4. Scientific cleavages

35Drug and AIDS activists knew that in-depth scientific knowledge was central to their identification of the structural “strain”, the development of their “insurgent consciousness”, and the articulation of their “frame”. It also became evident that scientists did not all agree on the same issues. Although many researchers uncritically sided with the repressive attitude of the government, while others stood still, afraid of potential reprisals for possibly emitting disagreement with the official position, others yet increasingly sided with the activists, lending their expertise and providing “another scientific view” in the area of drug use and HIV/AIDS. The obvious cleavage among this “elite” gave activists an “opportunity” to air their grievances with more scientific legitimacy in the eyes of the public and the media.

4. “Harm reduction” approach or activists “frame”

36Certainly one area that sparked tremendous controversy in the area of drug use and HIV/AIDS was what came to be called the “harm-reduction approach”. This approach represented the “activists’ frame” or their official position with regard to drug and HIV/AIDS issues.

37In accord with the Drug Reform movement, drug and AIDS activists advocated a “safer-drug use” approach because, as scientific data showed, it would take a long time to open enough treatment programs to accommodate the whole IDU population. Critics opposed this approach on the ground that it might encourage continuation of an illegal activity. Those who advocated it, however, saw it as necessary to reduce HIV transmission among users unwilling or unable to stop injection drug use despite the threat of AIDS (Friedman, 1995).

4.1. Needle-exchange programs

38The best implementation of the “harm-reduction approach” was embodied by the needle-exchange programs (NEPs). In these NEPs, IDUs returned their used injection equipment to a specific site where activists would give them a new one. These needle exchanges provided for potential therapeutic contact between health officials and drug users as well as for the safe disposal of potentially contaminated equipment.

39Drug and AIDS activists were fully aware of the scientific literature on the outcomes resulting from needle-exchange programs throughout the world, as the concept of needle-exchange did not originate with the AIDS epidemic. It began in the early 1980s as an intervention strategy in the Netherlands in order to reduce the spread of Hepatitis B among users. With the outbreak of the AIDS epidemic, the Dutch program had increased its distribution of sterile needles and syringes from 25,000 to over 600,000 per year, leading to no increase in the number of IDUs and no decline in the number of drug users entering treatment (Friedman, 1995).

40Similarly, in Canada, Australia and England, where needle-exchange programs were implemented, only 4% of IDUs were seropositive (Tross, 1991; Friedman, 1995). In the early 1990s, needle-exchange programs spread throughout the U.S. despite state laws criminalizing the possession of drug paraphernalia, creating the context for the longest act of civil disobedience organized by drug and AIDS activists.

4.2. Civil disobedience, resource mobilization

41Only 12 states in the USA required prescriptions for the sale of needles and syringes, but these included almost all of the states with large numbers of IDUs. In many other states, drug paraphernalia laws made it difficult for needle users to obtain sterile equipment. The decimation of, and discrimination against, the drug-using community caused drug and AIDS activists to illegally create the needle-exchange program of ACT UP in February, 1990. This program was not the first as Yolanda Serrano, a Hispanic activist, startled the authorities in 1988 when she announced that she would defy a New York State law by distributing clean needles and syringes to drug addicts. Her effort led to the creation of a pilot needle-exchange program by the New York City Department of Health. Likewise, Jon Parker, a member of the activist group “National AIDS Brigade”, had already been doing needle exchange in Boston.

42In 1990, ACT UP/NY was a very potent social movement organization with great ability to raise money, one that could come to the rescue of street drug addicts, the-then most disenfranchised and despised population. ACT UP provided the money to create the needle-exchange programs, as well as the logistical context to make this act of “civil disobedience” a reality supported by financial means as well as scientific and legal expertise. Therefore, contrary to what the structural opportunity model suggests, resources were drawn, not from “outside” the movement, but from “within” the movement.

43Twenty volunteers were regularly involved in the needle-exchange program of ACT UP/NY, with a budget of about $17,000 every six months. About a third of them identified themselves as ex- or recovering drug injectors and brought their experience to the street. Some lived in the neighborhoods or had bought drugs on the street where the sites were located. Some were men and women of color; some spoke Spanish, some were seropositive, and most were gay men or lesbian.

44Illegal in New York, needles had to be ordered from another state. The illegal distribution of clean needles, considered a felony by federal regulation, exposed activists to three years in federal prison. Nonetheless, needle-exchange programs operated in the West Bronx, East Harlem, Lower East Side and Brooklyn. Each borough was a fixed site, but activists had "roving" teams to outreach to the shantytown. While the sites worked together in a coalition known as the ACT UP Needle-Exchange Program (ACT UP/NEP), each outreach team operated its needle-exchange site autonomously from the others because, to be effective, outreach sites had to adapt themselves to the unique street scenes in which they were located.

45In the exchange site, they set up a table, providing individuals with bleach kits, alcohol and extra condoms. Bleach, in particular, had proven a vericide against HIV, and so had been incorporated into AIDS prevention kits which contained Spanish and English instructions and pictures on how to clean needles and use condoms. The ACT UP/NEP catered to those the government rejected most, the poorest.

5. Lessened repression

46The ACT UP/NEP was able to operate within a political climate apparently marked by hypocrisy. Officially unsupported by the city administration, the ACT UP/NEP was never harshly repressed to the point of extinction, probably because city officials were torn apart by the divisions among scientists, a cleavage which would later become more obvious during a high-profile trial.

47Sometimes the police harassed the activists as had been the case in May of 1990, when they confiscated the works that activists were distributing. However, after negotiations with the precinct, it was agreed that they would move, and keep a low profile. The same year, Tompkins Square Park, a central meeting place for drug users, was temporarily closed.

48More vocal than the police's or the city administration’s opposition was the opposition of some Black leaders who called the ACT UP/NEP "genocidal." The Black Leadership on AIDS was:

  • 1 Not all Black officials were against needle exchange. State Senators Patterson from the Bronx and M (...)

“gravely concerned that the distribution of bleach or drug paraphernalia represents a Trojan Horse for the African American community in that it is superficially attractive but contains an element of grave risk. The risk is that such methods fail to address the long term problems of continued drug use and the current inadequacies of drug treatment and rehabilitation programs within the African American community (Black Leadership on AIDS, 1990)1.

5.1. The New York City Administration

49Unavoidably, there were attempts by the city administration to curtail the ACT UP/NEP. Thus, siding with the Black Leadership on AIDS, city officials decided to use their coercive power to deter exchange programs from flourishing. In May 22, 1990, Woodrow Myers, New York City Health Commissioner, decided to cut funding for the Association for Drug Abuse Prevention and Treatment (ADAPT), which pioneered safe drug-use education in the streets of New York. ADAPT would continue to receive funds for safe-sex programs, but city money could no longer be used to teach addicts how to clean their needles.

50In response, ACT UP/NY along with the Minority Task Force on AIDS, zapped the Department of Health. Two top scientists, Don Desjarlais and Mathilde Krim of the American Foundation of AIDS Research came out in favor of the ACT UP/NEP. They laid out the results of several studies in the U.S. and abroad, demonstrating that teaching users how to clean needles reduced high-risk behavior and correlated with reduction in HIV infection rates. Myers discounted the studies, leading Krim to observe: "I had the impression that he hadn’t actually read the studies" (Szalavitz, 1990).

51Another attempt at curtailing needle-exchange programs was made by the Department of Health (DOH) as it refused to take care of the dirty needles returned by ACT UP. The latter then organized another demonstration successfully pressuring DOH to accept and dispose of the 20,000 needles returned monthly by the activists (Jose, 1996).

52However, another conflict erupted when DOH announced that it would no longer distribute condoms to community-based organizations, including ACT UP/NEPs. Activists then organized several sit-ins and demonstrations and met three times with DOH officials before the latter agreed to provide condoms. At long last, DOH officials capitulated to the activists' demands and recognized the Needle-Exchange Program of ACT UP/NY. Clearly, the inconsistencies of the city administration, its inability to propose a plan to face the drug and HIV/AIDS epidemic, and above all its inability to justify a total repression of the activist work in the area of drug and HIV/AIDs eventually led to the official recognition ACT UP/NEP.

5.2. “Scientific and legal” opportunities

53The “cleavages” amongst scientists became most apparent during three trials involving drug and AIDS activists charged with felony for illegally distributing clean needles to IDUs. Four public and deliberate arrests were at the origin of the now quasi-legalized needle-exchange programs. Firstly, members of the National AIDS Brigade, an activist group located in Boston, were arrested in August 1988; one of them, John Parker had already been arrested 12 times. Activists were tried and then acquitted.

54Secondly, four activists from ACT UP/New Jersey and New York were arrested in Jersey City in April 19, 1990 and were then defended by the ACLU/New Jersey for distributing syringes in front of the Spectrum Health Care Methadone Maintenance Program. They had chosen this site to demonstrate their disapproval of methadone as a way to cure drug addiction. The defense was scientifically so convincing that not only were the four activists acquitted, but one of the jurors himself became a member of a needle-exchange program (Jose et al., 1996).

55Thirdly, ACT UP activists were arrested in June 1990 in Delaware on 3 felony charges because they gave needles to undercover officers. Charges were dismissed, however, for fear of embarrassment as Delaware was one of the States which had no AIDS policy and had never allowed condom distribution (Jose et al., 1996).

56Fourthly, activists announced in a March 2, 1991 Newsday article, that they would be distributing clean needles. As a demonstration was organized by other ACT UP members, a counter-demonstration was organized by the Guardian Angels, calling the AIDS activists "murderers." Eight activists both from ACT UP and the National AIDS Brigade were arrested while distributing clean needles on June 25, 1991 between Essex and Delancey streets in New York City. Activists were then brought to justice.

5.3. “Scientific opportunities”

57City officials brought “their” expert to the bar to testify that data on distributing clean needles to users as a way to control the HIV/AIDS epidemic were inconclusive. However, independent testimonies by experts such as Dr. Don Desjarlais, Chemical Dependency Research Director at Beth Israel Hospital and Dr. Ernest Drucker, Director of Community Health at Montefiore Health Center and Professor of Epidemiology at Albert Einstein Medical School, supported the activists who were eventually acquitted. Here is an excerpt of Don Desjarlais’s testimony:

“As a researcher in the AIDS and intravenous drug-use field, I have been monitoring the results of the syringe-exchange programs being conducted in Europe, Australia and in a limited number of cities in the United States. While these studies will be continued for many years, it is possible to draw some conclusions from the current findings: 1- There is yet no data to support the belief that syringe-exchange programs lead to increases in drug injection 2- syringe-exchange programs should be conducted in conjunction with treatment programs to reduce abuse. Syringe exchanges can serve as excellent recruitment sites for drug-treatment programs. 3- Participation in syringe exchanges is associated with large reductions in HIV transmission behavior” (Don Desjarlais, 1991).

58Even Stephen Joseph, former city health commissioner, once despised by the AIDS activist community, testified in favor of the activists:

“Clearly the availability of clean injection equipment is a way of stopping the transmission of the virus from person to person. That availability of clean injection equipment is also a way to bring people, whether they are infected or not, into a stream of health care and public health preventative efforts that are equally important in this epidemic” (Joseph, 1991).

59Joseph explained that while he was the Health Commissioner of New York City, he instituted a small scale pilot needle-exchange program in November 1988, planning to locate the program at four neighborhood sites. Vehement community opposition prevented this plan and ultimately the Department of Health shut down the program.

60Although very constrained, the program demonstrated that a needle-exchange program could be effective. Interviews with the addicts suggested they did not continue sharing their needles and did not increase their drug use. In addition, 78% of the participants ultimately entered drug-treatment programs. However, soon after he took office, Mayor Dinkins ended the politically compromised Needle-Distribution Program in New York City, arguing that any program that would bring more needles into the inner cities is an act of "genocide" against the minority community. This decision was made even though Don Desjarlais announced that the study of 40 needle-exchange programs throughout the world had drawn the same conclusion: needle exchanges did not lead to increased drug use (Jose et al., 1996).

5.4. “Legal opportunities”

61In each of the three trials, the judge's verdict agreed with the activists' use of the "necessity" justification defense to explain their breaking of the law in order to "save lives." The law read as follows:

“... conduct which would otherwise constitute an offense is justifiable and not criminal when:

  • 2 Penal Law Section 35.05(2)

(2) Such conduct is necessary as an emergency measure to avoid an imminent public or private injury which is about to occur by reason of a situation occasioned or developed through no fault of the actor, and which is of such gravity that, according to ordinary standards of intelligence and morality, the desirability and urgency of avoiding such injury clearly outweigh the desirability of avoiding the injury sought to be prevented by the statute defining the offense in issue. The necessity and justifiability of such conduct may not rest upon considerations pertaining only to the morality and advisability of the statute, either in its general application or with respect to its application to a particular class of cases arising thereunder”.2

62Evolved at common law, the necessity defense recognized that extraordinary circumstances could justify violation of the law.

  • 3 Ibid.

“The law ought to promote the achievement of higher values at the expense of lesser values and sometimes the greater good for society will be accomplished by the criminal law.... The matter is often expressed in terms of choice of evils. When the pressure of circumstances presents one with a choice of evils, the law prefers evil by bringing about the lesser evil”.3

63In the case of the New York City trial, the judge ruled:

“Turning to the facts in this case, this court finds it was reasonable for the defendants to believe their action necessary as an emergency measure to avert an imminent public injury. Without a doubt, AIDS has created an imminent crisis in New York City. There is no dispute that use of clean needles by addicts prevents the spread of HIV infection. The defendants presented significant expert medical and public health witnesses who testified that needle-exchange programs have proven successful as a means of providing addicts with clean needles which addicts will use” (Elbaz, 1992).

64By highlighting cleavages among scientists, the drug and AIDS activists’ trials provided the “scientific opportunity” to present “research data” different from the city administration’s. Then, by acquitting the activists and admitting that the HIV/AIDS epidemic in New York City could be qualified as a “crisis”, that use of clean needles controlled the spread of HIV, the judge’s decision confirmed an increasing “cleavage” among the various “elites”, mainly researchers, the city administration, and more generally the federal government. Ultimately, this decision provided activists with a “legal opportunity” to bring about social change elsewhere in the country.

6. The gains

65As a result of the “scientific and legal opportunities” that opened up to the activists, changes were happening at the national level, leading this time to the opening of “political opportunities”. Thus, in its "Report: the Twin Epidemics of Substance Use and HIV, July 12, 1991”, the National Commission on AIDS (1991) recommended the removal of legal barriers to the purchase and possession of injection equipment. The report was backed up by the once-critical Black Leadership on AIDS who then wrote a positive statement on the needle-exchange program (Navarro, 1991). Most importantly, David Dinkins, Mayor of New York City, made a dramatic move in November 1991, declaring that he would allow activists to pursue their illegal needle-exchange program, issuing a legal waiver for them. As he would still deny them financial support, the American Foundation for AIDS Research (AmFAR) came forward, making grant money available to implement the NEPs (Navarro, 1991).

66At the federal level, activists would have to wait two decades for the ban on federal funding for NEPs to be lifted (Clark & Fadus, 2010). Expressing in his own way the existence of the “scientific opportunity” in the federal decision, Bill McColl of the Washington D.C.-based advocacy group AIDS Action saw: “the vote to lift the ban as a vote for science” (Sharon, 2009: 1). Unfortunately, the victory was short-lived as the ban was reinstated in 2011 (Barr, 2011), a decision that activists perceived as only political therefore conjunctural and that they are already working on changing.


67In keeping with the critique of the political opportunity-structure paradigm, also called “political process” model, or “political opportunity model”, analysis of drug and AIDS activism highlights various specificities: Firstly, resources were not garnered from outside but from within the movement, as drug and AIDS activism benefitted from the money-raising capacities of an already existing powerful social movement organization. Secondly, in accord with research done in the area of emotions and social movement (Goodwin, 1999; Gould, 2009) analysis of AIDS and drug activism shows that emotions, hardly present in the political opportunity model, have been central to the activists’ strategies as they endeavored to change the feelings and attitudes of the media, the state and the public towards drug users.

68Finally, analysis of drug and AIDS activism demonstrated that political opportunities, if at all existent, were situational more than structural as they were the result of created conflicts and heartfelt negotiations. Unlike what political opportunity proponents suggest, the drug and AIDS movement did not arise out of pre-existing political opportunities, but on the contrary out of “contracted” political opportunities leading up to acts of civil disobedience organized on the basis of science and law. With the support of renowned researchers who sided with the activists’ “frame of harm reduction” or their interpretation and resolution of the “crisis”, “scientific opportunities” opened up. Through deliberate arrests and then various trials and acquittals, activists converted “acts of civil disobedience” into exceptional but legitimate, and eventually legal, breaking of the law, as thousands of lives depended, and were saved, upon the illegal distribution of clean needles. The legal opportunity then followed the scientific opportunity as activists were acquitted, leading up to further such decisions around the country.

69Political opportunities were then not necessary for the rise of the drug and AIDS movement. “Scientific and legal” opportunities preceded political opportunities that led up to the official recognition of needle-exchange programs throughout the United States. Even though the ban on funding needle-exchange programs has been reinstated by the federal government, this decision is viewed by many as political, therefore situational, and it is a matter of time and politics before it can be revoked again.

Haut de page


Barrios, L. and R. Curtis (1998). “The Impact of the War on Drugs on Puerto Ricans: A Lost Generation”, in Jefferson Fish (Ed.), How to Legalize Drugs, Northvale, NJ, Jason Aronson Inc.

Blanchy, F. and W. Hopkins (1989). Current Drug Use Trends in New York City, New York,New York State Division of Substance Abuse Services, June.

Centers for Disease Control and Prevention. (1989), HIV/AIDS Surveillance Report.

Clark, P.A. and M. Fadus (2010). “Federal funding for needle-exchange programs”, Medical Science Monitor, Jan, 16(1): PH1-13. Institute of Catholic Bioethics, Saint Joseph's University, Philadelphia, PA, USA.

Des Jarlais, D.C., J. Wenston, S.R. Friedman, J.L. Sotheran, R. Maslansky, M. Marmor, S. Yancovitz and S. Beatrice (1992). “Implications of the revised surveillance definition: AIDS among New York City drug users”, American Journal of Public Health November, 82(11): 1531-1533.

Drucker E. and A. Clear (1999). “Harm reduction in the home of the war on drugs: methadone and needle exchange in the USA”, DrugTexts, International Substance Use Library, Online Journal, URL: <>.

Eisinger, P. (1973). “The conditions of protest behavior in American cities”, American Political Science Review, N° 81: 11 – 28.

Elbaz, G. (1990). Measuring AIDS Politicization, 6th International Conference on AIDS, (Poster presentation), San Francisco.

Elbaz, G. (1992). PhD Dissertation, The sociology of AIDS activism, CUNY graduate Center.

Friedman, R. Samuel, R.T. Furst, B. Jose, R. Curtis, A. Neaigus, D.C. Des Jarlais, M. Goldstein and G. Ildefonso (1998). “Drug Scene Roles and HIV Risk”, Addiction, 93(9):1403-1416.

Friedman, S.R., D.C. Des Jarlais, CE Sterk, J.L. Sotheran, S. Tross, J. Woods, M. Sulfian and A.S. Abdaul-Qader (1990). “AIDS and Social Relations among Intravenous Drug Users”, The Milbank Quarterly; 68: Supplement 1: 85-110.

Friedman, S.R., D.C. Des Jarlais, T.P. Ward, R. Curtis, B. Jose, A. Neaigus and M. Goldstein (1995). “Harm Reduction in the United States of America”, in J Gölz (ed.), Der drogenabhängige Patient (The Drug-Addicted Patient), München, Wien, Baltimore: Urban und Schwarzenberg: 124-132.

Gahlinger, M. P, M.D. (2001). Ilegal drugs: A complete guide to their history, Chemistry and abuse, Sagebrush Press.

Goodwin, J. (1997). “The Libidinal Constitution of a High-Risk Social Movement: Affectual Ties and Solidarity in the Huk Rebellion”, 1946 to 1954. American Sociological Review, 62(1): 53-69.

Goodwin, J., M.J. Jasper and K. Jaswinder (1999). “Caught in a Winding, Snarling Vine: The Structural Bias of Political Process Theory”, Sociological Forum, 14(1): 27-54.

Gould, D.B. (2009). Moving Politics, Emotion and Act Up's Fight Against AIDS, University of Chicago Press.

Jose, B., S.R. Friedman, A. Neaigus, R. Curtis, B. Sufian, Stepherson, D.C. Des Jarlais (1996). “Collective Organization of Injecting Drug Users and the Struggle Against AIDS”, in T Rhodes T. and Hartnoll R. (eds.), AIDS, Drugs and Prevention: Perspectives on Individual and Community Action. London: Routledge: 216-233.

Lafave, R. and A.S. Scott (1986). Substantive Criminal Law § 5.4: 629.

Lazare, D. (1990).How the Drug War created Crack”, Village Voice, 35(4).

Mala Szalavitz, M. (1990). “DOH Waffles on Needle Hygiene”, Voice, May 22.

McAdam, D. (1982). Political Process and the Development of Black Insurgency, 1930-1970 University of Chicago Press. (Latest edition in 1999).

McAdam, D., J.D. McCarthy and M.N. Zald (eds.) (1996). Comparative Perspectives on Social Movements: Political Opportunities, Mobilizing Structures, and Cultural Framings, Cambridge, England: Cambridge University Press.

Meyer, S.D. (2004). “Protest and Political Opportunities”, Annual Review of Sociology, 30: 125-145.

National Commission on AIDS (1991). Report on the twin epidemics of substance use and HIV, Washington, DC, July.

Navarro, M. (1991). “Studies (and Politics) Guided Switch on Needles, New York Times”, New York Times.

New York State HIV/AIDS Annual HIV/AIDS Surveillance Statistics, 1990.

NYC Department of Health, New York City HIV/AIDS Annual HIV/AIDS Surveillance Statistics, 1990.

O'Keefe, E., E. Kaplan and K. Khoshnood (1991). “Preliminary Report City of New Haven Needle-exchange program”.

Penal Law Section 35.05(2)

Rathje, W. (1984). “The Garbage Decade”, American Behavioral Scientist, 28(1): 9-29.

Sarah, B. (2011). Needle-Exchange Programs Face New Federal Funding Ban”, Kaiser Health News, URL: <>.

Sharon, S. (2009). “Ban Lifted On Federal Funding For Needle Exchange”, NPR, URL: <>.

Stephen, J. (1991). Criminal Court of the City of New York, July 5.

Sufian, M, S.R. Friedman, R. Curtis, A. Neaigus and B. Stepherson (1991). “Organizing as a New Approach to AIDS Risk Reduction for Intravenous Drug Users”, Journal of Addictive Diseases, 10, 4: 89-98.

Tarrow, S. (1994). Power in Movement: Social Movements, Collective Action and Politics, Cambridge, England, Cambridge University Press.

Tarrow, S. (1998). Power in Movement, New York, Cambridge University Press. 2nd ed.

Tarrow, S. and S.D. Meyer (1998). The Social Movement Society: Contentious Politics for a New Century, Rowman & Littlefield.

The ACT UP Needle-Exchange Program, Fact Sheet. (1990), Unpublished Document.-

Tross, S., A.S. Abdul-Quader, H.M. Silvert, B. Rapkin, D.C. Des Jarlais and S.R. Friedman (1991). “Determinants of Needle Sharing Change in Street Recruited New York City IV Drug Users”, Paper Presented at the Seventh International Conference on AIDS.

Useem, M. (1975). Protest Movements in America. Indianapolis, IN: Bobbs-Merill.

Zald, M. N. and R.A. Garner [1966] (1987). "Social Movement Organizations: Growth, Decay, and Change", In Social Movements in an Organizational Society: Collected Essays, edited by M.N. Zald and J. D. McCarthy. New Brunswick, NJ and Oxford, England: Transaction: 21-41.

Haut de page


1 Not all Black officials were against needle exchange. State Senators Patterson from the Bronx and Montgomery, from Bedford Stuyvesant, for example, were in support of it.

2 Penal Law Section 35.05(2)

3 Ibid.

Haut de page

Pour citer cet article

Référence électronique

Gilbert Elbaz, « Scientific and Legal Opportunities” for the U.S. Drug and AIDS Movement  », Études caribéennes [En ligne], 29 | Décembre 2014, mis en ligne le 15 décembre 2014, consulté le 23 mars 2017. URL : ; DOI : 10.4000/etudescaribeennes.7171

Haut de page


Gilbert Elbaz

Université des Antilles et de la Guyane

Articles du même auteur

Haut de page

Droits d’auteur

Licence Creative Commons
Les contenus d’Études caribéennes sont mis à disposition selon les termes de la Licence Creative Commons Attribution - Pas d'Utilisation Commerciale 4.0 International.

Haut de page
  • Logo Université des Antilles
  • Logo DOAJ (Directory of Open Access Journals)
  • Logo ERIHPLUS (European Reference Index for the Humanities and Social Sciences)