In an effort to curb HIV infections in San Francisco, members of local HIV prevention groups are cooking up a new plan to distribute pipes to crack users who they say are at high risk for the disease. Although similar to needle exchange programs for heroin users, the recommendation from the HIV Prevention Planning Council has made city officials twitchy at the thought of handing out illegal drug paraphernalia.

Unlike sharing needles, sharing pipes is much less likely to transmit HIV, but as HPPC member and Glide Foundation's HIV services programs manager Paul Harkin explained at a meeting earlier this month, "We do it with syringes, and we should be doing it with pipes." According to Alli Kraus, a syringe access coordinator at Glide Health Services, crack use is a big driver of HIV infections because smoking crack leads to a lot of unprotected sex, particularly the kind that involves sex for money. People who smoke crack are twice as likely contract HIV as non-crack smokers, Kraus explained, although that seems to be more of a function of the crack smoker's lifestyle than the crack use itself.

So how would handing out more pipes curb either crack cocaine use or HIV infection rates? Through outreach, obviously. By giving out the free pipes, public health organizations have an opportunity to interact with one of the most at-risk groups for infection. “It may seem counter intuitive, but it’s a great program,” HPPC member and Deputy State Director of the Drug Police Alliance Laura Thomas said of a similar program in Toronto. “Once you can bring people into your program, make them feel respected, taken care of, then they’re more likely to come back and get on HIV meds and want to be engaged and taking care of their health.”

Of course, Toronto Mayor Rob Ford himself admitted to smoking crack last year, so the opposition is naturally skeptical of the plan. The chair of the San Francisco Republican Party called the proposal, "the utmost of San Francisco absurdity" and "another pathetic idea to entertain viewers of 'The Daily Show.'"

Assuming Jon Stewart and company take the bait, expect The Daily Show's response in 1-2 weeks. In the meantime, the HPPC is putting together a study to consider all the issues with starting such a program in San Francisco, including the fact that possession of crack pipes would be a violation of state law. Barbara Garcia, director of San Francisco's Department of Public Health, on the other hand unequivocally ruled out the idea, saying: "That recommendation has not come to me. And I’m telling you that if it did, I would say ‘absolutely no, we are not going to distribute crack pipes.’ We have a lot of things to consider for those who are using crack for improving their health. And the distribution of crack pipes is not something I’m going to consider.”

Update, January 28: Drug advocates will hand out free crack pipes, whether the city likes it or not.