Transcript for the Piece Audio version of Part Three: NEEDLE EXCHANGE PROGRAMS BRING HOPE AND FACE CONTROVERSY

HOST: NEEDLE EXCHANGE PROGRAMS ARE ONE WAY OF PREVENTING THE SPREAD OF THE HIV VIRUS. BUT THEY CAN BE CONTROVERSIAL. IN PART TWO OF VOICES OF HIV, FRANCESCA RHEANNON REPORTS ON ONE NEEDLE EXCHANGE PROGRAM IN HARTFORD, CONNECTICUT.

On a street corner in Hartford, a group of men are standing around. Battered furniture is strewn in the street near a broken down car. Many of the men carry their possessions in garbage bags and shopping carts. Some are injection drug users. When a van pulls up at the curb, they move toward it. It belongs to Hartford?s Needle Exchange Program.
Inside the van, outreach worker Dean Carlson puts together supplies he hopes will keep his clients free of HIV:

CARLSON: O.K. here we have cleaning kits for needles, to keep people from getting HIV. We have all the makings for the kits. They consist of alcohol pads, cookers for the drugs, and water [rattles the supplies for underlying sound]. These are the alcohol pads that are used by our clients to clean up the areas where they shoot up...

Carlson says he feels no conflict about providing equipment for people to use drugs.

CARLSON: I love my people out here. And what I can do to help their lives, I will do.

The director of Hartford?s needle exchange program, Gregorio Rivera, says almost fifty percent of the HIV and AIDS cases in Connecticut are directly related to injection drug use:

RIVERA: By providing the clients with new syringes and equipment, we are preventing the spread of HIV, Hepatitis B or C, and other diseases.

Sharing needles through injection drug use is the leading cause of HIV infection in Hartford and western Massachusetts. Needle exchange programs like Rivera?s have been found to decrease HIV transmission by up to one third, according to several major government-funded studies. The Hartford program offers an array of services in English and Spanish, including HIV testing, counseling, and referrals to drug treatment. The strategy is called "harm reduction", says Rivera:

RIVERA: We go where people already are using and try to first provide the safety net for them, the harm reduction, and, at the same time, slowly talk to them about getting out of the cycle, to save their life.

In Holyoke, seventy percent of the people living with the virus are Latino and almost half are injection drug users. The only needle exchange program in western Massachusetts is in Northampton. Holyoke's Center for Education, Prevention and Action, or CEPA, operates a van several times a week to take clients to the Northampton needle exchange program. But CEPA director James Arana says many area Latinos don?t feel comfortable going there:

ARANA: Our community residents feel apprehensive because people of color who are going for that service stand out... So they don?t want to draw that kind of attention to themselves.

Without access to needle exchange programs in their own communities, most injection drug users in those cities end up sharing dirty needles. In one Springfield study, almost two thirds of addicts reported shooting up with used needles in the previous month.
The lack of needle exchange in Springfield leads to a significantly higher rate of HIV infection as compared to Hartford and New Haven, both cities with programs. Yet needle exchange remains controversial. Proposals for it have been voted down twice in the Springfield City Council. Opponents like City Councilor Dominic Sarno claim it would encourage drug use and put a strain on city services.

Ax 4 SARNO: At this point in time, I could not support the aspect of a needle exchange program. If you give them the tools of their trade, you're enabling them to use the illegal drug.

But Helen Caulton-Harris, Springfield?s director of Health and Human Services, says needle exchange is good public health:

CAULTON-HARRIS: I think what?s critical to remember here: while everyone has an opinion on needle exchange, and certainly rightfully so, the public health and scientific communities have been very clear that needle exchange is a strong intervention for IV drug use in reducing the harm to communities and families.

City Councilor Sarno say he would accept needle exchange if tied to substance abuse treatment on demand. But although Massachusetts has the highest rate of heroin use in the nation, state funding for drug treatment has been cut by nearly thirty five percent since 2001. Tim Purington, head of HIV prevention programs for Tapestry Health Systems in western Massachusetts, says needle exchange cannot wait:

PURINGTON: Nobody is a bigger supporter of treatment on demand than needle exchange advocates. Unfortunately, that's not a reality. There is no such thing as treatment on demand and there's never going to be.

He says that needle exchange addresses a hard reality:

PURINGTON: Addiction is a chronic relapsable condition. Even if we have the best treatment system in the world, people are going to relapse, and people are going to put themselves at risk, and the goal of a needle exchange program is that hopefully, once somebody gets clean and sober, they won't have HIV.

Back in Hartford, the needle exchange van idles on a street corner. One young man, who didn't want his name used, is standing next to it. He sees the clean needles as a lifeline:

YOUNG MAN: This is a good idea. I always change mine, every morning I come, go and change them, I use them, I come back again, change 'em, you know. It's worth it.

The van is on the street only thirty five hours a week. That means that injection drug users who work during the day or sex workers who are sleeping can't get clean needles. And on weekends, many of the van's clients are left without any access to clean needles at all.

For Voices of HIV, I'm Francesca Rheannon.

HOST: VOICES OF HIV WAS PRODUCED WITH 88.5 WFCR IN AMHERST, MASSACHSUETTS.

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