Shot Up

FUNDING CUTS THREATEN GROWING NEEDLE-EXCHANGE PROGRAM

On a recent evening in a University District alley, two men in
sunglasses sat behind a card table loaded with red bins of alcohol
swabs, hypodermic syringes, and other supplies for shooting up drugs.
Every few minutes, someone would wander up the alley to turn in used
needles, take a few items from the bins, and move on.

The table is King County's last privately operated needle-exchange
site. But its clientele is growing faster than at any other site in the county.

The syringe exchange in the alley used to be operated five days a
week by another group, Street Outreach Services (SOS), until SOS lost
county funding last year for failing to submit an audit on time.
After SOS went away, the People's Harm Reduction Alliance (PHRA) took
over the exchange and expanded it to seven days a week. "We felt
[drug users] needed more access in the north end," PHRA director
Shilo Murphy says. The group now operates the table 365 days a year
with the help of about 25 volunteers. By the end of the year, PHRA
predicts it will have increased syringe exchanges by one-third to one
million syringes--a 10 percent increase overall from last year for
the entire county.

"My hope is that when drug users make the choice to be sober, that
they can do it without having HIV or hepatitis C, which would affect
them for the rest their of lives," Murphy says.

Spurred by the AIDS epidemic, the national movement for syringe
exchanges started in Tacoma in 1988. The next year, the model was
emulated by activists in Seattle, who operated an exchange from a
table in front of Tower Records on University Way.

According to King County, where 2.1 million syringes were exchanged
in 2007, the cities that implemented needle exchanges early in the
HIV boom lowered infection rates among intravenous drug users. For
example, in cities such as New York and Miami, which were late to
adopt the once-controversial practice, the HIV rate among injection
drug users hovers between 40 and 60 percent. In Seattle, it's 2 to 4 percent.

Nevertheless, only a fraction of the injection drug users here use
clean needles consistently. Michael Hanrahan, who runs the county's
needle-exchange program, says 20 million syringes would have to be
exchanged annually to ensure a clean needle for every injection. "If
our objective is to facilitate a clean, single use of equipment, the
market penetration is about 10 percent of what the need likely is," he says.

The community-based University District group seems more nimble at
reaching the target population than the five county-managed exchange
sites, which operate under more restrictive rules. For instance, the
county requires users to trade one dirty needle for each clean
one--rules Hanrahan says are designed as an incentive to get old,
dirty syringes out of circulation. The independent needle exchange,
in contrast, allows users to bank and trade syringes, enabling more
users to take as many syringes as they need.

However, the group struggles to stay afloat. It depends on donations
from users who come to the table, and its supplies are provided by
the county, which is facing a $68 million deficit. Countywide,
syringe-exchange programs cost King County just under $1 million a
year. In October, County Executive Ron Sims will send a funding
proposal to the council that will reduce public-health appropriations
by 33 percent a year for three years--eventually cutting the county's
contribution to public health to zero [In the Hall, Erica C. Barnett,
June 11]. King County Council Member Larry Phillips, who chairs the
council's budget committee, says it's too soon to guess whether the
needle-exchange program will be impacted, but he hopes to maintain
it. "It has proven to be a tremendous public-health aid in King
County," Phillips says.

As the syringe-exchange services strive to stay afloat, SOS has
morphed into a new organization, Harm Reduction Advocates, which is
building support to fund needle exchanges and allow anti-overdose
programs. Executive director Tara Moss says the group was "getting to
the point, with restricted funds, [that] it makes sense to advocate
for the programs rather than provide services."