By Seth Hemmelgarn

Needle exchange programs for intravenous drugs users as a method to prevent blood-born illnesses such as HIV and Hepatitis C have faced furious opposition over the years, but in some ways, the situation is improving.

California Assembly Bill 110, authored by Assemblymember John Laird (D-Santa

Cruz), was signed into law by Governor Arnold Schwarzenegger in October. It changes state policy to allow local government agencies to use state HIV prevention and education funds to buy syringes for needle exchange programs.

“Clean needle exchange programs are an essential part of locally-focused efforts to reduce the transmission of HIV and other blood-borne diseases,” Laird said in a statement. “This bill clarifies state support for local programs that save lives and protect our communities.”

Needle exchange programs were started in the 1980s in an effort to curb the spread of HIV from sharing needles. In the early days, there was so much opposition to the programs they often operated underground. The federal government prohibits any use of federal funds for such a program.

In 1999, then-Governor Gray Davis allowed needle exchange programs. The funding for such programs came from cities, counties and foundations and the state over the years. The needle exchange programs are cost effective. Many programs distribute hundreds of thousands of clean syringes a year, on budgets of $300,000 or less. That’s far less than the more than $600,000 it costs to care for an HIV-positive person over their expected lifetime, according to a study published in the November 2006 issue of the journal Medical Care.

The California Department of Health Services reports that 1,000 to 1,500 new HIV infections occur annually in California due to the sharing of needles. That’s compared with more than 800HIV infections a year in San Francisco alone due to unsafe sex, according to the county department of health.

Needle exchange programs can cut new infections of HIV and Hepatitis C, both of which can be spread through sharing needles. According to the San Francisco AIDS Foundation, injecting drug use now accounts for less than half a percent of new HIV infections in San Francisco, down from15 percent in the 1990s.

Many estimate that at least eight out of 10intravenous drug users have Hepatitis C, a disease that damages the liver and, according to the Centers for Disease Control and Prevention, kills up to 5 percent of the people who get it.

Walk Right By

Despite neighbors’ fears of increased crime and unwanted visitors, the programs appear to operate quietly and can be easy to miss. On a bustling street in San Francisco, the San Francisco AIDS Foundation runs one of its10 needle exchange sites in a small office that easily escapes notice.

The foundation distributes more than 2 million needles a year. There are about 14 similar programs in Bay Area cities. The IV drug users at the site exchange their used syringes for clean ones, and grab some sterile cooking equipment – water, tins and cotton.

Some chat with the volunteer staff a little before they leave. Despite the facility’s unremarkable façade, “Everyone knows we’re here,” said Katie Bouche’, referring to users. Bouche’ is logistics coordinator for the foundation’s HIV Prevention Project, which runs the sites.

Most users inject drugs such as heroin, methamphetamine or cocaine. Not all of them are living on the streets, like you see in the movies. Rather, they are functioning people who resemble the average office worker. Willie Dudley, exchange coordinator at Casa Segura in Oakland, said he sees plenty of participants pulling up in Volvos.

“You would think they were pulling up to ask for directions,” Dudley said.

The programs follow a harm reduction model. Clients know where to find treatment if they ever feel like they want it, but even if they never want it, they can at least keep from getting infected. And that’s important for non-drug users, too.

“The straightest person doesn’t want a world where their kid’s at a greater risk of getting HIV,” said Joey Tranchina, founding executive director of the AIDS Prevention ACTION Network in Redwood City, which he operates out of his house.

People might be willing to acknowledge drug use in their community, but “most people would like to see something that’ll go away with just a few more police,” said Peter Davidson, board chair for San Francisco’s Homeless Youth Alliance, which offers a needle exchange program, among other services.

Explaining how syringe exchange programs benefit everyone helps ease concerns of community members who often balk at the idea of giving syringes to drug users. Many people don’t realize how effective the programs are, and misconceptions persist. People are afraid the programs encourage drug use or lead to more crime in neighborhoods.

According to program officials, neither fear is based on reality.

Not in My Back Yard

Community fears appear to have halted Kevin Hutchcroft’s attempts to find a permanent structure for Santa Clara County’s mobile exchange program, which would help staff provide more services. Hutchcroft is senior health care program manager for the county’s HIV/AIDS Prevention and Control Program.

The program’s needle exchange staff visits five sites a week in San Jose. Last year, they distributed about 241,000 syringes. There were about 800contacts last year – which doesn’t necessarily translate to 800 people, since some were seen more than once. Hutchroft said he couldn’t find a willing landlord when he looked at properties last year.

“This is a classic case of ‘Not In My Back Yard,’” Hutchcroft said. “Some people accept the preventive science and the logic, but they do not necessarily want (syringe exchange) in any neighborhood near them.”

Homeless Youth Alliance, which distributes more than 10,000 needles a year, recently proposed moving into a church a block away from its cramped headquarters in San Francisco’s Haight-Ashbury neighborhood. But protests at a neighborhood meeting attended by about 200people were strong.

“A lot of people in the neighborhood didn’t know we existed,” Davidson said. He said people seemed to be projecting their frustrations about homeless people in the neighborhood onto the needle exchange program. The group decided to hold off on the move for at least another six months to “clear up misconceptions about what we do,” Davidson said.

The Haight-Ashbury Neighborhood Association, which hosted the meeting, didn’t respond to an e-mail requesting comment.

No Trouble

Program officials said despite whatever fears communities might have, syringe exchange hasn’t brought any trouble with it. Most of the programs have been in existence for more than a decade. Sgt. Steve Mannina, of the San Francisco Police Department, said he couldn’t recall any trouble– such as drug dealing or car break-ins – being associated with any of the programs.

Zach Friend, Santa Cruz Police Department spokesman, said one wouldn’t be able to tell from the department’s records system if arrests had anything to do with the syringe exchange site. Police in Oakland, Redwood City and San Jose did not respond to requests for comment.

Improper Disposals

One problem that did arise this summer was used, uncapped syringes cropping up in San Francisco’s Golden Gate Park. Many blamed the syringe exchange programs for the needles. Program officials said they always encourage users to dispose of their needles safely, and there’s no way to tell where the needles came from.

Needle exchange advocates in San Francisco said they’ve tried for years to install safe deposit boxes in areas where IV drug users are found, but city officials haven’t allowed it.

Only 17 of California’s 58 counties have authorized needle exchange programs, according to Center for Health Improvement, a national nonprofit health policy center.

Another Kind of Infection

Besides offering clean syringes, the programs also offer other service many people might not get otherwise. A major concern of people working in syringe exchange is helping treat abscesses –infections caused by things like using dirty syringes, or missing a vein while injecting. If the infection spreads to other parts of the body, such as the heart, it can be fatal.

Injecting drug users often don’t like to go to the emergency room.

“So many people don’t get the care they need,” said Susan Pratte, director of education and prevention for the Santa Cruz AIDS Project. Pratte said that emergency rooms aren’t known for being attentive to injecting drug users. She said Santa Cruz County has a good public nursing program, but she knows participants who’ve died after getting abscesses.

Tranchina, in Redwood City, said the quality of drugs has gotten worse in recent years, leading to worse abscesses.

“I’ve never seen abscesses like I’ve seen here,” he said. “I’ve seen people coming to needle exchange with what look like shark bites under their arms.”

Most programs offer education on how to inject drugs properly in order to avoid injury, as well as what to do if it looks like someone has overdosed. Condoms – both male and female – and tips on safer sex are also made available at many sites.

Some sites offer HIV and Hepatitis C testing and referrals, as well as referrals for services such as housing and mental health, or help with domestic violence issues.

Program Data

The race, ethnicity and gender of people who visit syringe exchange sites vary, depending on the city and the neighborhood. Programs report the majority of their clients are often white men over 40. But at Casa Segura’s site in Oakland’s Fruitvale District, 65 percent of the participants are Latino.

The San Francisco AIDS Foundation had 21contacts with transgender participants in October. Program officials know there are plenty of injecting users who don’t come to the sites.

Tranchina said, for example, younger people maybe more reluctant to come because they might think they’re drug use won’t be ongoing. If they go to get needles, that confirms they’ll use again.

Some young people are eager to partake in the programs, however. When asked how the Homeless Youth Alliance’s needle exchange program has helped her, one client happily said, “I don’t have Hepatitis C!” The 25-year-old, who did not giver permission for her name to be used, said she has been injecting drugs for seven years.

One man Tranchina’s helped, who would only give his name as Patrick, said he does have Hepatitis C, and has also struggled with homelessness and arrests, but he’s got a place to live and a job now.

“I’m not sitting around saying ‘poor me, poor me,’” Patrick, 50, said. “… I’m trying to keep a positive attitude about everything.”

The programs have struggled for funding over the years. The new law will help release some funds to pay for the needles but it may not be enough to support the level of work that needs to be done to not only prevent the transmission of diseases, but get people additional help they need.

“It’s a challenge for us to keep these issues in the public mind,” said John Conley, deputy public health director for San Mateo County. “The risk is very real.”