Heroin addicts are, by definition, creatures of habit. So it seemed odd that the bedraggled young man who ambled up to the needle exchange in New Brunswick was uncertain about what kind of syringe he would prefer.
He closely examined several different types of needles. Finally, he selected one, abruptly announced that he was an undercover agent from the Middlesex County Prosecutor's Office and arrested an AIDS-prevention advocate named Diana McCague for violating New Jersey's ban on possessing or distributing syringes.
"I should have known right away he was a cop," said Ms. McCague, who had been distributing clean needles to drug addicts since 1994 and has been arrested twice. "Users are very particular about the kind of works they use -- they don't need to compare them. He seemed a little too clean to be real, too."
Ms. McCague's arrest, in the fall of 1998, forced her organization, the Chai Project (chai is Hebrew for life), the last of New Jersey's organized needle exchange programs, to stop distributing syringes. Volunteers now set up their van twice each week outside a soup kitchen in New Brunswick, distributing condoms, H.I.V.-prevention pamphlets and bleach kits to sterilize needles, but no syringes.
The needle-less campaign, and the unusually aggressive tactic of using sting operations to snare advocates for AIDS victims, has made New Jersey the most active front in the nation's fierce political battle about the merit of needle exchanges. The state's unrelenting opposition to the programs also places Gov. Christine Todd Whitman in the uncharacteristic role of hard-liner.
With her centrist views on social issues like abortion, gay rights and gun control, the Governor has cultivated a national reputation as a leader of the Republican Party's moderate wing. But mention needle exchanges, and the fact that New Jersey has the nation's third-highest rate of intravenous H.I.V. infection, and Governor Whitman can grow heated.
Republican governors in New York, Connecticut and Pennsylvania use state money to pay for the programs, arguing that they save lives and spare taxpayers the high cost of treating AIDS victims, which can top $20,000 per patient per year. Mrs. Whitman lauds the county prosecutor who arrested Ms. McCague for "enforcing the law."
The Centers for Disease Control and Prevention, the National Institutes of Health and the Surgeon General have all released studies concluding that needle exchanges significantly decrease the spread of H.I.V. without increasing drug use. Mrs. Whitman dismisses their research as "dubious, at best."
Her appointed Attorney General, Peter G. Verniero, released a study in 1998 that was critical of needle exchanges. The study cited as one of its sources an article by the right-wing Heritage Foundation, which also advocated conversion to Christianity as a cure for drug addiction.
And when Governor Whitman was asked recently to explain the factual basis for her unflinching belief that needle exchanges send the wrong message to children, she grew frustrated, as if the hypocrisy of the programs were so obvious it needed no explanation.
"As a mother, I know that it sets a bad example," she said during an interview last month. " 'Do as I say, not as I do' is a lousy way to lead, whether you're running a family or running a state."
The fight over needle exchanges began more than a decade ago, and today 113 programs exist in 30 states, and exchange 17.5 million syringes annually, according to a survey by the Centers for Disease Control. About half the programs operate legally, and 16 others are illegal, but tolerated by their local governments. The rest operate underground.
With a few notable exceptions, medical experts from the American Medical Association to the National Academy of Sciences to the United States Department of Health and Human Services view the needle exchanges as a matter of public health and say that the goal of decreasing H.I.V. infection rates far outweighs the drawbacks of providing syringes to drug addicts.
Some law enforcement officials, led by Gen. Barry R. McCaffrey, the White House director of drug policy, oppose the programs as a matter of principle: drugs are illegal, they maintain, and government sends the wrong message to children by providing addicts with the means to break the law.
In trying to balance the diametrically opposed priorities of AIDS prevention and substance abuse, some government officials have performed political contortions. New York State finances 14 programs, and in New York City, where Mayor Rudolph W. Giuliani last year argued for the abolition of methadone, 12 needle exchanges are in operation.
But the needle programs in New York took hold only after years of debate and false starts. The first was begun under Mayor Edward I. Koch, but was scrapped by Mayor David N. Dinkins after he took office in 1990. Despite his concern that it would encourage drug use, Mr. Dinkins reversed his position a year later after studies found that the programs slowed the spread of AIDS among drug addicts and their sex partners.
President Clinton acknowledges that needle exchanges reduce H.I.V. infection without fostering drug use. But last year he gave in to pressure from Republicans in Congress and prohibited the use of Federal money to pay for them.
In fighting the needle exchanges, Governor Whitman has encountered an unlikely adversary, David W. Troast, whom she chose in 1996 to head the state's Advisory Commission on AIDS. As a wealthy businessman and an acquaintance in Mrs. Whitman's social circle in well-heeled Somerset County, Mr. Troast was hardly someone who would be expected to side with drug users and radicals.
After taking the job, however, Mr. Troast interviewed dozens of experts in public health, epidemiology and AIDS prevention, and was stunned by the magnitude and severity of New Jersey's AIDS problem.
New Jersey has 26,000 people with AIDS, and the nation's highest rate of H.I.V. infection among women and children. The state also has 9,100 orphans whose mothers have died of AIDS.
Mr. Troast said he was also struck by the overwhelming consensus among health experts that any serious attempt to slow the spread of H.I.V., which now infects 2,100 additional New Jersey residents each year, must include a needle exchange program.
Mrs. Whitman rejected the Commission's proposal, and when Mr. Troast pushed the idea again several months later, she rejected it again. As their wrangling became highly publicized, Mr. Troast began to notice a pattern.
"Whenever my council's actions got the attention of the media, the authorities cracked down on Project Chai, and Diana McCague got locked up," Mr. Troast said. "I feel personally responsible for her plight."
In the fall of 1998, Mrs. Whitman wrote a letter telling the Commission that she would never change her opposition to needle exchanges, and urging them to move on to more productive matters, like developing strategies to cut the infection rates among pregnant women and adolescents. Mr. Troast said the Commission did focus on those problems, but arrived at the same conclusion: that a small needle exchange program could cut the state's number of new H.I.V. infections by as much as 50 percent.
"How do pregnant women get infected with AIDS?" Mr. Troast said. "How do adolescents get it? It keeps coming back to dirty needles. "Two-thirds of the new infections come directly or indirectly from dirty needles, more than any other state in the country."
Governor Whitman appointed two new members to the Commission, both of whom oppose needle exchanges, in the fall of 1998.
Many AIDS prevention advocates, including Mr. Troast, suspect that Mrs. Whitman's intransigence on the issue is a political attempt to appease right-wing conservatives in the Republican party who disagree with her support of abortion rights.
Mrs. Whitman brushes aside those suggestions, and insists that her position is a deeply held conviction, based on common sense and firsthand experience with some of the seriously impaired children born to drug-addicted mothers.
Before her first run for governor in 1993, Mrs. Whitman visited a Newark hospital that treated children born addicted to cocaine, and held some of the children who had been born with profound developmental disabilities because of their mothers' drug use. The experience convinced her that it would be better for society to discourage drug use.
"When you have a newborn infant who is unable to bond, because it's constantly crying, it's in withdrawal, it's addicted to drugs, the psychological and emotional damage can be just devastating," Mrs. Whitman said. "If you get a mother with H.I.V. and convince her to take AZT, you can vastly reduce its chance of passing H.I.V. on to the child. But these low-birth-weight babies, there's almost nothing anyone can do. It's not an either-or situation, and these are terrible choices, but the child born addicted never really has a chance."
Convinced that Mrs. Whitman will not reverse her position, Ms. McCague and other advocates are now concentrating on protests calling for changes in the state's law after the Governor's term expires in 2001.
"It's unfortunate that the Government's own statistics show that four people will be infected by injection-related H.I.V. every day between now and then," Ms. McCague said. "That's 4,400 people between now and the end of her term."
In the meantime, there is one last advocate who is known to operate an underground needle exchange in New Jersey, a Hudson County man who would identify himself only as Frank.
Equipped with syringes donated by advocates in other states, and advice from the Chai Project on how to spot an undercover police officer, he travels quietly each week to street corners and shooting galleries to replace dirty needles with clean ones.
On a Friday night in January, rainy weather and a new shipment of heroin drove most of his usual clients indoors. The one man who showed up to exchange a handful of used syringes, an auto mechanic named Tony, said most users considered the new needles more a matter of convenience than of health. On the black market, new needles cost $5 -- about one-third the price of a bag of heroin -- so many addicts reuse them simply to economize, and are often too distracted or careless to sterilize their syringes with bleach.
With or without the clean needles, Tony said, he would continue shooting heroin twice a day, the same as he has for more than a decade.
"You'd like to have a new needle for every blast, because it gets dull and your arms get sore," he said. "But when you want to get high, that's all you think about. You're going to use whatever's there, clean or not -- whatever."