A NEEDLE IN A HAYSTACK

Syringe Exchange Activists Not Resting

Right after a landmark decision by the San Mateo County Board of
Supervisors to legalize syringe exchange two weeks ago, Joey Tranchina, the
man who defied the law for 10 years, is already making plans to take the
decision a step further.

Tranchina has been on the forefront of AIDS and Hepatitis C prevention for
many years and often talks at international health conferences about the
two diseases. Right now, he is working on a model prevention program that
all local health departments can follow. But next for this county, he
envisions a dropin center somewhere in the county where drug-users can take
showers, access health information, talk to counselors and maybe grab a
couple of condoms.

"People talk too much about hardware. But syringe exchange is a key to a
community - a community that's not very easy to reach," Tranchina said.

Giving away clean syringes, Tranchina said, is essential in preventing the
transfer of bloodborne diseases like HIV and Hepatitis C. But he said it
also appeals to the drug users' hedonistic side - because shooting up with
a clean needle is far more pleasurable than using a dirty one.

"Shooting up with a dirty needle is like using a nail," one man at a recent
exchange said. Giving users something they want, Tranchina said, opens the
door for information that may help drug-users get the help they need to
live clean - if they choose.

"I'm consistently impressed of how anxious people are of wanting to protect
themselves and their family," he said.

Tranchina doesn't think syringe exchange will take place at the drop-in
center, but for now users can pick up clean needles at 11 a.m. every
Tuesday morning behind the Safeway Supermarket on the corner of Middlefield
Road and Jefferson Avenue.

On a morning before he heads down to the exchange, Tranchina opens the door
to his Redwood City home, offers coffee and apologizes for his bare feet
while Warren Zevon's "Werewolf in London" plays in the background.

The song is from a disc put out by P.R.I.C.S. or Performers Releasing
Information about Clean Syringes - it was released in Australia.

"The Australians are far ahead of us when it comes to health care. So are
the Dutch," he said. "But this is a small step towards simple initiatives
to make our community safer and healthier. It's a triumph over history. San
Mateo County is now far ahead of very progressive countries."

The triumph Tranchina speaks of - an emergency ordinance both legalizing
exchange and public funding for it - is still limited,

After a quick shower, Tranchina says he envisions a health care system in
which no one is excluded - not even the stereotypical homeless man shooting
up under a freeway overpass or in the bushes of East Palo Alto. just 5
percent of his clients fit that stereotype, and Tranchina says many of the
others drive new pick-up trucks and even Mercedes-Benz's.

As Tranchina pulls his red sport utility vehicle packed with empty syringe
boxes into parking lot behind the Safeway, he is greeted by a handful of
men and women gathered around a late 70s electric-blue Cadillac with a red
hazardous material bucket on top. The bucket both holds used needles and
serves as a landmark for people looking for the exchange location.

One blond woman, who looks to be in her 20s, runs to the trunk and quickly
makes the exchange before she drives off.

Pam Kremer, a part-time outreach worker and former drug user, said the
woman was getting needles for her boyfriend.

"That girl once said she lives a double life. A lot of times people need me
to counsel. They say, 'I don't have any money,' or 'I'm tired of
prostituting or stealing,' and I'll make arrangements with a clinic or a
21-day detox," she said.

"A lot of people just need to talk. I'll spend a half an hour with one
client who just needs to talk. Sometimes they're ready [to kick drugs] but
until that time comes when they're ready they'll have clean works [syringes
and condoms]."

Tranchina squeezes just over $500 a month out of private grant money to pay
Kremer for the parttime work she does four days a week. But Kremer said she
does it for more than the money. She used to use the program and when she
kicked the habit two years ago, she decided to start giving back.

"I've been there. I used drugs and I wasted a lot of time," she said.

Johnny Hughes, a 40-year old machinist living in Redwood City, hasn't used
drugs in seven months but comes down to get needles for his friends.

Although the emergency ordinance made it legal for Hughes to get the
needles, he will break the law if he gives them away.

He takes that risk because he said many of his friends are scared of police
and wary of the exchange because they don't know the law.

"People have marginalized [syringe exchange] into an AIDS activity or a
Hepatitis C activity, but that's not what it is. Syringe exchange is just
part of the mainstream public health - no community should allow an
epicenter of an epidemic to get out of hand like this. And [syringe
exchange] is only controversial among very stupid people."

For the five-member Board of Supervisors, the decision to legalize syringe
exchange was easy. After 457 cases of Hepatitis C were reported last year,
Dr. Scott Morrow, Director of the Public Health Division of the County
Health Services Agency said a recently formed Hepatitis C Task Force
reported that needle exchange was an important Hepatitis C prevention strategy.

An October decision by the state legislature, which waived criminal
penalties if a local emergency was declared, paved the way for the board's
recent decision.

"For me, it was an obvious and clear need because there was a serious risk
for health," Supervisor Jerry Hill said. "It saves lives and it prevents
the spread of those two tragic diseases, AIDS and Hepatitis C."

Hill said he is also in favor of a drop-in clinic somewhere in the county -
perhaps co-locating it with a permanent homeless shelter.

"When we're looking for a site for a homeless shelter - not just an
emergency winter shelter but one with a year-round use - we can offer some
counseling and job support to provide a continuum of care," Hill said.

The emergency ordinance to make syringe exchange legal, John Conley, deputy
director of public health said, essentially opens the door for additional
funding for more needle exchanges in the county.

"This gives Tranchina some legal protection and hopefully it'll be a good
fundraising tool," he said.

As executive director of the AIDS/Hepatitis Prevention Action Network and
director of the Peninsula syringe exchange program, Tranchina said he'll be
looking for more funding when a six month grant from the Peninsula
Community Foundation runs out in June.

"They have needle exchange in Silicon Valley," Tranchina said. "So if we
can't convince people that this is a good idea - then we should stay home."