by: Theresa Dulce
Needle exchange is legal in the state of Oregon as a method of HIV prevention. There are four bodily fluids that transmit the HIV virus: blood, semen, vaginal fluids, and breast milk. Conventional wisdom tells sexually active people to use a condom, latex glove, or Saran wrap when having sex. Women who are pregnant are encouraged to get tested for HIV by their doctor, for the welfare of the unborn child. That leaves injection drug users (IDU) for consideration. Using AIDS research, it was determined that people can stop the spread of HIV if they don't share needles.
Needle exchange is a controversial issue. The conservatives think IDU's should stop shooting dope and get clean- that will stop HIV and drug use. Front line outreach workers figure that if someone is going to use a needle, they might as well use a clean one so they don't get a disease in addition to their drug addiction. It is estimated that 40% of the 652,000 cases of AIDS in this country are directly or indirectly a result of injection drug use, as well as 70-75% of cases among women and infants. The national Centers for Disease Control states that half of the 40,000 new cases of AIDS each year are linked to injection drug use.
Portland's Outside In started one of the first syringe exchange programs in the nation. Outside In is a non-profit organization and offers street folk assistance and affordable health care. From humble beginnings at the X-Ray on Burnside in 1989, Outside In now exchanges 150,000 syringes annually. To date, five local agencies administer needle exchange, a total of five days a week, and have built the collaborative Harm Reduction Coalition. This coalition is a roundtable collective that shares information and anecdotal research not found on medical charts. It is believed that this movement of harm reduction is partially responsible for the low rate of HIV infections among drug users in the Portland area.
Harm reduction is when someone takes small steps to bettering their own health, beginning with where they are at today. For instance, if somebody starts using a condom every time they have vaginal sex, maybe eventually they'll try the same practice with fellatio. Then perhaps that person will be interested in getting tested for HIV or other STDs. Concerning injection drug use, the harm reduction philosophy agrees that abstinence should be the final goal. The method provides IDU's with a continuum of services that keeps their personal health a priority during different phases of their drug addiction. Allowing IDU's to exchange clean needles is the most effective way to familiarize this population with detox programs, methadone clinics, drug treatments and the various public health services available to them. It has also proven cost effective; being that a clean syringe costs 10 cents in comparison to a minimum of $12,000 per year to treat one person with HIV (assuming no hospitalization costs).
And it's not just HIV anymore. Doctors are seeing Hepatitis B and C being transmitted via syringe. And not only by blood in the needle, but through IDU's sharing cotton, cookers, spoons, alcohol wipesthe works. There is a vaccine for Hep B, but right now Hep C is for life and does a real number on the liver. What about an overdose? A doctor who works in a Portland hospital emergency room says the majority of IDU's he sees are not because they OD'd, rather their abscess needed immediate care. An abscess is an infected, swollen sore that can happen when injecting on a surface area that isn't clean, or because the needle is too dull to puncture the skin. If detected early, an abscess can be removed with a simple procedure. Many IDU's don't go to the doctor for fear of being scrutinized for exactly how they got the abscess; however, an abscess does not go away and amputation may be necessary if the infection is too severe.
If reaching IDU's to get help is one obstacle, contacting their sexual partners is a greater one. The Oregon State Planning Group for HIV Prevention determined that women are one of the leading populations to get infected. One example is the gal who isn't an IDU, and may or may not know her partner is (or was) and has unprotected sex based on "trust." Or the woman who does use, and relies on her partner to inject the drugs. Co-dependency aside, this puts the gal second in line for a hit, using most probably a dirty needle. A group of outreach workers in Chicago taught women how to inject themselves, and to become less dependent on a man for their habit. A collective in New York received money for a radical program called 'Get Straight'. Their concern was that street prostitutes were compromising safer sex with pushy clients in order to get money for drugs. (Resulting, conversely, to the dollar value dropping for sexual services by non-using pros.) The program lent the street girls money to get their drugs before they started working, and at the end of their shift they paid back the outreach workers.
Men who have sex with men (MSM) have always been a focus for AIDS education. An MSM who is also an IDU is double jeopardy. This effects a youth subculture that health care providers know little about. Oregon Law states that no one under the age of 18 can get a clean needle. Agencies can provide bleach kits and information, but it stops there. Washington State allows a person 14 years old to obtain needles. Although some programs are tolerated in California, needle exchange overall is still illegal. Acknowledging nomadic movement up and down the I-5 Corridor, there is reason to believe public health is affected by its surrounding counties and states.
The North American Syringe Exchange Network (NASEN) hosted its 8th National Conference for needle exchange last April in Baltimore. Quite by coincidence, the conference was held days after President Clinton made the decision to keep the ban on federal money being used for needle exchange programs. "The federal government is withholding a proven, effective treatment in the fight against AIDS," Kathy Oliver says in her opening statement to the Oregonian on May 8th. Ms. Oliver is the executive director of Outside In and gave birth to exchange in Portland. "The decision was made in spite of the fact that Health and Human Services Secretary Donna E. Shalala determined that, based on a review of research findings, syringe exchange programs do help prevent transmission of HIV, and do not increase drug use." She adds that the American Medical Association, the American Public Health Association, the National Commission on AIDS, the National Institutes of Health and the National Academy of Sciences support syringe exchange.
Presently, programs are run on grants from the state and private donations. Too many of the people who attended the Baltimore conference were still operating underground and risking arrest if found exchanging needles. Some bigger cities rallied local support and have acquired a level of tolerance, i.e., run your program just don't give us a headache about it. The Mayor of Baltimore, in alliance with the city's Health Commissioner, offered to do needle exchange personally and told the Governor of Maryland to please arrest them. The suits sorted it out and now Baltimore operates under a jurisdiction that excludes syringes in its paraphernalia law. Outreach workers drive an RV to neighborhoods with prevalent drug use and offer people abscess care, HIV testing, and toiletries, in addition to clean needles. An outreach worker in Hawaii said their volunteers were flown to the smaller islands. They recruit people who use, and turn them into harm reduction educators. Peer education is strongly effective and it reaches the people who are still apprehensive with public health sites. San Francisco started the first woman only site last year; they offer child care, a lady doctor that gives female check ups, and a support group. Austin, Texas uses a van a few times a week, but it is still very illegal and the program is underground. How do you reach someone if your program is a secret? "You think that's tough," a volunteer told me, "try fundraising for a needle exchange program without using the word 'needle exchange'."
Teresa Dulce is the executive director of Danzine, a local non-profit for sex industry workers. Danzine hosts a needle exchange site every Friday evening in Southeast Portland, from 7:30-9 pm at 82nd/Powell. All exchanges are anonymous and confidential.