HIV Alliance’s controversial needle exchange program provides clean needles to drug users in the hopes of preventing disease and inspiring change among users.
It’s the end of the road; a sign even says so. A tattered flag blows in the breeze and a train rattles along its tracks. Cars pass by without a clue of what is happening on this desolate corner of Eugene, Oregon. It is a depressing scene, and it is here that HIV Alliance’s needle exchange program sets up camp.
The atmosphere parallels the circumstances in which the needle exchange’s clients are in. They are in the grip of drug addiction. For some, there is nowhere to go; they have hit a dead end. People ride up on bikes, drive up in cars, or walk from wherever it is they call home. They bring with them bags, boxes, even jugs of dirty needles, and the HIV Alliance exchanges them for clean ones. From its large, beat-up, white van, the Alliance hopes to make even the slightest difference in someone’s life. As the night goes on, the biohazard bin fills to capacity and another needle exchange comes to a close.
At a base level, needle exchange programs (NEPs) offer a place for the safe disposal and trade of needles, with users getting one clean needle for every dirty needle brought in. Clients of the NEP are often dependent on heroin, cocaine, methamphetamine, or methadone. For some, it’s whatever drug they can get their hands on. However, around 3 percent of clients rely on insulin and hormonal steroids for medical use and they require clean needles too.
But HIV Alliance’s needle exchange offers more than just needles. Founded in partnership with Sacred Heart Medical Center in Eugene in 1999, the HIV Alliance NEP aims to to prevent harm from drug use, “which is occurring whether we have this program or not,” says Jeff Nichols, HIV Alliance NEP coordinator.
“We’re giving [NEP users] the tools to make safer decisions,” Nichols says.
One client of the NEP who suffered from a stroke two years ago met Nichols in the HIV Alliance parking lot. This client was a heroin addict.
“He said he has really been thinking about making a change lately, but honestly was very scared,” Nichols says.
Both the client and his partner were at low points in their addictions, and while talking to Nichols he began to tear up.
“I have never seen such emotion come from him,” Nichols says.
Both the client and his partner had healthcare, but were limited in treatment and detoxification. Nichols and HIV Alliance were able to develop a plan that would work for both of them. They’re now planning to undergo detoxification at different locations.
Nichols became a drug counselor after dealing with his father’s addiction to intravenous drugs. He then became involved with HIV Alliance, working with drug users in the midst of their addiction rather than at the end. Having experienced addiction firsthand, Nichols has a rapport with clients built on trust and understanding.
“Part of their lifestyle is using; it’s not who they are,” Nichols says.
During the nineties, the Government Accountability Office, the Centers for Disease Control and Prevention, and the National Academy of Sciences found that NEPs work in reducing the spread of HIV among drug users, their partners and children, and discourage an increase in drug use. In 1988, Tacoma, Washington’s NEP was the first of its kind, operating with some community support. The program consisted of a table set up downtown.
Today, HIV Alliance’s NEP has grown, working in conjunction with Sacred Heart, the Eugene Police Department, and donors such as Wal-Mart.
“We are very much a full partner,” Lane County nursing supervisor Betsy Meredith says.
“People who are injecting drugs do care about their health and the health of others.”
But it is challenging to educate and explain this to the public.
“Hepatitis C is a serious problem in our community,” says Meredith.
Although Eugene hasn’t seen an increase in HIV in five years, hepatitis C is harder to prevent and control.
Unlike HIV, hepatitis can live outside of the body for eight days. The sharing of needles, tourniquets, and cookers can all lead to the spread of hepatitis. When clients come to the needle exchange without any needles, they are given safer injection kits with the hope that they will decrease their odds of contracting blood-borne diseases.
“It’s always difficult to measure prevented infections,” Meredith says. “It’s easier to count infections that have already occurred.”
Regardless of numbers, the NEP is working to prevent the spread of disease.
In order to help drug users become safer, it is necessary to have an element of trust established.
“You’re dealing with a very desperate population,” says Diane Lang, Executive Director of the HIV Alliance.“They’re disenfranchised from the system.”
Clients are wary of giving the NEP even the most obscure pieces of information, such as the first two letters of their first name and the first two letters of their city of birth. The information is used only for clerical needs, but some clients fear it will be used to aid in their arrest. As a courtesy, the Eugene Police Department stays three blocks away from needle exchange locations.
“I don’t know if we necessarily work with them,” says Sergeant Kevin McCormick of the Eugene Police Department’s Vice-Narcotics Unit.
McCormick doesn’t have a strong opinion of the needle exchange, but he has seen the drastic effects of illegal drug use.
“If having a supply of needles readily available encourages more people to continue their illegal drug habit, then more drug addicts will be out there destroying their lives and the lives of those close to them,” McCormick says.
In the first ten months of 2010, more than 500 discarded needles were found in Washington-Jefferson Park.
“If those came from the needle exchange program, that would be a bad thing,” says McCormick. “If the needle exchange program keeps people from discarding their syringes in children’s playgrounds, that would be a good thing.”
The NEP works to connect people with the resources they need. At each exchange, there is HIV and hepatitis testing, and on Thursdays there is a doctor on site to help with wound care. Also, pamphlets are at each exchange providing information on healthcare, rights as a drug user, and drug counseling.
“If they have something to make their life better, they’ll take it,” Nichols says.
The NEP doesn’t try to push people into rehabilitation; but each time a client comes to the exchange, they are asked if they would like information about detoxification or treatment.
“I’ll drive them there myself,” Nichols says.
“I gotta quit this shit,” says one client of the NEP to the onsite doctor. He explains to her that after three or four days off drugs, the stomachaches and withdrawal are too much for him, and he is back to the exchange for more needles.
“It’s important to get them when they’re ready,” says Lang.
Lang recalls a woman who lived in a homeless camp by the river. “She was not in good shape, and she didn’t trust us,” Lang says.
The woman was a victim of domestic abuse. She lost her job as an office manager and then custody of her two children. In desperation, she began trading sex for drugs. After a long period of not trusting the program she began exchanging her needles. However, she was reluctant to get tested for HIV.
“She was sure she had it,” Lang says. But she tested negative. She became a peer mentor, reestablished contact with her children, and started on the path towards the life she once knew.
Every week Nichols gets clients who are set on making changes.
“We just talk with people who don’t have that social time,” Nichols says. “It’s about taking yourself out of the equation. It’s the client’s decision and the client’s drive.”
But for every client that is ready to change, there is a handful of others who are not.
“I have to have something, so whatever you have is fine,” says a man desperate for an exchange.
Another man recently witnessed a heroin overdose. “What did you do?” asks a volunteer.
“I brought him back,” the man replies.
A conversation that might leave another person dumbstruck is seemingly normal at the needle exchange.
Nichols knows all the clients’ stories and they are genuinely excited to see him after he’s been gone. The clients talk about their children and grandchildren. Some go through a bin of donated clothes from Wal-Mart. They banter about the week’s events and laugh as jokes are told. From the outside it looks more like a get-together than a needle exchange.
“One day we had a hundred pairs of Miley Cyrus pants. They were going like hot cakes,” Nichols says.
But the conversation always goes back to drug use, and a look to the right at the full bin of white and orange needles is a harsh reminder of the dire situation the clients are in.
“Philosophically, one might say it encourages and promotes drug use,” McCormick says.
They are giving drug users the tools to sustain their habits, but they are also giving them the tools to change. Whether they are making a real difference is hard to determine based on numbers and facts alone.
Regardless, something is happening at the end of the road with the faded and flapping flag and the slow moving trains. It may be the exchanging of needles for drug use, or it may be exchanging the chance for hope and change.