S.F. SCRAMBLES TO FIX NEEDLE-SWAP PROGRAM AFTER PUBLIC OUTCRY

City officials and nonprofit agency leaders, responding to an outcry
over used syringes littering parks, say they are looking at ways to
reform San Francisco's needle-exchange program - including locked,
24-hour syringe drop boxes and technologically advanced syringes.

The city's needle-exchange program gives out 2.4 million needles a
year and receives 65 to 70 percent of them back after they're used.
Other cities - including Portland, Seattle and jurisdictions
throughout New Mexico - have return rates of well over 90 percent.

In San Francisco, The Chronicle reported recently, many unreturned
needles wind up in parks, playgrounds and other outdoor expanses.

"We can recover a lot more needles," said Mark Cloutier, executive
director of the San Francisco AIDS Foundation, which runs most of the
city's needle-exchange sites. "We understand it's a public health
problem, and we're excited about the attention that's happening."

Cloutier said a locked, 24-hour biohazard drop box will be installed
on Sixth Street within the next six weeks. It will be available for
anonymous needle drop-off any time, sort of like drop boxes for
library books or rented movies. The AIDS Foundation likely will test
it for six months but expects to open others around the city.

"We're not going to put it in the middle of Union Square," he said.
"It's where people can experience some anonymity."

As it is now, injection drug users usually return their used syringes
during the hours needle exchanges or health clinics are open. The
AIDS Foundation operates seven exchange sites around the city, each
of which is open two to four hours a week.

Public health officials also will meet soon with manufacturers of
retractable syringes - in which the needle fully retracts into the
syringe's barrel after one injection. These are considered much safer
than the syringes commonly used and would prevent children or others
who pick up dropped syringes from infecting themselves.

The retractable syringes cost seven times more than the common ones -
an average of 35 cents compared with 5 cents - but might prove to be
worth the extra money, according to Dr. Mitch Katz, the city's public
health chief.

Supervisor Ross Mirkarimi still has some retractable syringes in his
office desk - left over from the board's discussion two years ago of
switching to the new syringes. At the time, they were deemed too pricey.

Mirkarimi said Thursday that he thinks the Public Health Department
has been slow to deal with the needle problem but that a switch to
retractable needles would be better late than never.

"This would be an apt opportunity for the city to pursue this option," he said.

Other options are on the table, too.

Tracey Packer, interim director of the health department's HIV
Prevention Program, said officials are looking at providing homeless
outreach workers with biohazard boxes to carry with them, giving
users of the needle-exchange programs small biohazard packs that can
carry 10 used needles at a time and better educating users about needle safety.

Packer said the city needs more drop-off sites, and fire stations and
soup kitchens could be good options.

The San Francisco needle-exchange program was begun in 1992 under
Mayor Frank Jordan. The Public Health Department contracts with the
AIDS Foundation, the Homeless Youth Alliance and Tenderloin Health to
run the exchanges at a total of $850,000 a year.

But, as reported recently by The Chronicle, not everyone is returning
the needles, and parents are sharing horror stories about their
children finding needles in parks and playgrounds.

Supervisor Bevan Dufty said Thursday he successfully advocated for
the closure of a play area at the Eureka Valley Recreation Center
because children were finding needles in the sand.

"I have a child, and I want my child to be able to play in the sand,
but I no longer felt comfortable having a playground feature be
dangerous like that," he said. "I'm open to ideas."

Mayor Gavin Newsom last week asked Katz to come up with ways to make
needle disposal easier and safer. The issue is politically tricky
because disease prevention and social services are important to San
Franciscans, but so are public safety and clean parks and playgrounds.

"This is a difficult situation, but we can't end our needle-exchange
program," said Newsom's press secretary, Nathan Ballard. "It saves lives."

The health department is looking at needle-exchange programs in
Portland, King County, Wash., which includes Seattle, and the entire
state of New Mexico. Drop boxes seem to have proven especially effective.

New Mexico began its program in 1998 and has 24 drop boxes around the
state, mostly outside health department offices and nonprofits. It's
about to get six more.

Bernie Lieving, who works in the state's public health department's
infectious disease bureau, said the drop boxes have been popular not
only with intravenous drug users but also with diabetics and others
who use needles for medical reasons.

"They're available 24 hours, they're locked, they're bolted to the
concrete," he said. "The only problem we've had is people backing
into them with cars."

The drop boxes have helped the department achieve a 97 percent return
rate - and have never been vandalized.

"Why would somebody want to break into a medical waste box and get
out used syringes?" he asked. "That doesn't make sense."

One thing just about everybody associated with the needle-exchange
program in San Francisco agrees on: It is saving lives and will
continue as a city program.

Cloutier said six years ago, 16 percent of new cases of HIV in the
city were attributable to injection drug use. Now, the figure is down
to 0.5 percent.

"We have proven in San Francisco that this largely solves the
problem," he said. "Needle exchange has been enormously successful."