On a grey December morning, at the corner of 110th Street and Park Avenue, a small community – HIV counselors, outreach workers, volunteers and intravenous drug users – assembled inside a worn tent pitched on the sidewalk.
Miguel Ramos tenderly placed a handful of clean syringes, antiseptic wipes and condoms into a paper bag for a client. He was one of more than 30 participants who would stop by over the course of the day to drop off dirty needles, pick up clean ones and possibly take advantage of the other services that New York Harm Reduction Educators offers at sites throughout East Harlem and the South Bronx.
“We see them as they come, we don’t discriminate against them,” Ramos said, as he packed up another set of works for a client. “We’re the ones coming into their world.”
Like others working in syringe exchange, Ramos is committed to meeting the needs of his clients, whether or not they decide to seek further treatment for their drug addiction. At the very least, Ramos knows that clients enrolled in NYHRE’s harm reduction program are taking a step to protect themselves from HIV.
In the U.S., nearly 20 percent of all HIV cases can be attributed to the sharing of contaminated needles. Compelling evidence shows that syringe exchange programs, which provide clean needles to drug users, greatly reduce the spread of the disease among users and their partners. But syringe access programs remain controversial and under-funded. Now public health advocates are cautiously optimistic that the Obama administration might lift a long-standing ban on federal funding for syringe access, boosting the reach of programs, particularly in states like New Jersey where syringe access has only recently become legal.
Organizations like NYHRE, operate what is known as a continuum of care, which includes access to sterile syringes. By providing a variety of supportive services to intravenous drug users, they are able to tackle complex problems of drug addiction, from many angles and at many stages in recovery, while immediately distributing clean needles that drastically reduce the spread of HIV.
“Needle exchange has been proven to be the most effective measure in the fight against HIV infection,” said Hilary McQuie, Western Regional Director of the Harm Reduction Coalition, which advocates for federal funding for syringe access programs.
The studies back McQuie up.
Medical, legal and scientific institutions from the American Medical Association to the American Bar Association to the Centers for Disease Control and Prevention agree that syringe access greatly reduces the transmission of Hepatitis C and HIV. But with the stigma attached to drug use, and particularly to intravenous drug use, politicians tend to be wary of supporting needle exchange programs.
While many states moved forward with needle exchange programs in the early 1990s, as the AIDS crisis and evidence in support of syringe exchange mounted, New Jersey did not. But in late 2006, New Jersey became the last state to legalize syringe exchange, after a long struggle by state and national public health advocates to pass syringe access legislation.
“New Jersey was infamous in the public health community because it had no syringe access and high rates of HIV – and our neighbors were doing syringe exchange.” said Roseanne Scotti, Director of the Drug Policy Alliance of New Jersey. New York City and Philadelphia had well-established syringe exchange programs by the late 1990s, and they were funded in part by city health departments, institutionalizing the work they did.
When Scotti and her allies first tried building support for syringe access in New Jersey, they had their work cut out for them.
“It was such a hot button issue that legislators wouldn’t touch it,” Scotti said. “So we focused on education and building our coalition.”
The statistics helped Scotti’s educational cause. New Jersey has the 5th highest rate of HIV infection in the U.S., the 3rd highest rate of HIV infection among children and the highest rate of HIV infection among women. Fourty-seven percent of women infected with HIV in New Jersey were infected through sharing of HIV contaminated needles. Thirty-four percent of women infected with HIV in New Jersey were infected through heterosexual sex, the majority of which involved an injection drug-using partner.
After four years, the effort that had become the Campaign for a Healthier New Jersey succeeded. On December 11, 2006, the New Jersey state legislature passed the Bloodborne Disease Harm Reduction Act. It created four syringe access pilot programs in Atlantic City, Camden, Newark and Patterson. In contrast, in New York City alone, New York Harm Reduction Educators operates six distinct syringe access sites and works alongside at least 10 other syringe exchange organizations that operate multiple sites.
The New Jersey syringe exchange pilot programs have now been active for almost a year. Pilot programs in Atlantic City and Camden have distributed more than 55,000 syringes. Pilot programs in Newark and Patterson each have enrolled more than 300 participants.
Bob Baxter is the Director of Project Access of the New Jersey Community Research Initiative in Newark. As director of addiction services at the largest AIDS prevention organization in New Jersey, it seemed logical for Baxter to add syringe access to his array of services.
“When HIV first hit in 1983, I’d just started working in drug treatment,” Baxter said. “I watched entire families get wiped out. It was unnecessary.”
Baxter had waited for syringe access to become a reality for a long time, and although he was pleased with the results, the syringe exchange program in Newark initially faced some challenges in its reception by the public.
“When we first opened, we had two or three arrests of clients every week,” Baxter said. “The criminal justice system and the courts didn’t yet understand the new laws. But we dealt with this as an educational opportunity.”
A year later, arrests of registered syringe exchange participants are down to only one every few weeks. Still, even as communities become used to their presence, substantial financial challenges remain for Project Access and the other New Jersey syringe access pilot programs.
Across the board, even long-standing syringe exchange programs like those in New York City strain to maintain their funding. A handful of foundations support their controversial work, but many cities and states steer away from offering financial support to nonprofits for needle exchange.
The solution, according to advocates, is federal funding for syringe access. This means that Congress and the Obama administration must repeal a federal funding ban that has been in effect for 20 years. The current national AIDS strategy, a platform developed by a wide range of AIDS policy and advocacy organizations, calls for lifting the ban. Those working on the ground recognize the potential of federal funding too.
Reggie Jackson is an HIV positive activist and syringe exchange outreach leader with Prevention Works in Washington, DC, where a ban on local government funding for syringe access was lifted only last year. With the added boost in funding, Prevention Works was able to open a new harm reduction drop-in center to complement the 10 mobile syringe exchange sites that it already operated throughout DC.
“When I first got tested, there was no counseling,” Jackson said. “Counseling creates compassion and we can provide that. Federal funding would allow us to do even more of what’s needed now.”