IN HARM'S WAY

At A Local Nonprofit, Getting Clients To Dispose Of Used Needles Is
Just The First Step

It's not just about exchanging clean syringes for used needles, but
the service providers at Harm Reduction Services may start with such a
swap. Or they'll start with just about any need a client has.

"We're trying to meet people where they are on whatever issue they're
dealing with," said Raven Hoopes, a case manager with the small Oak
Park-based agency. "If someone comes in and says, 'I need a sandwich,'
we start with finding them a sandwich."

The goal in the harm-reduction model of treating health issues-usually
issues involving drug use or other high-risk behaviors for exposure to
hepatitis C, HIV or sexually transmitted infections-is to help clients
reduce the possibility of negative consequences. For example, dirty
syringes can lead to infections or disease transmission, and if
discarded improperly, become a public health risk. At Harm Reduction
Services, clients can exchange their used needles for clean ones,
reducing the risk of harm to both themselves and the public.

One of the most obvious harm reductions, as we mark the 20th World
AIDS Day this week, is the reduction in transmission of HIV, the virus
that causes AIDS.

If that first step of responsibly disposing of used needles provides a
useful improvement in the client's life, he or she may decide to make
other changes. Or not.

"We're interested in the client's idea of what's important to them,"
said Peter Simpson, the executive director. Simpson, Hoopes, outreach
specialist and HIV counselor Dan Wilson, and client Lisa Cook spoke to
SN&R last week in the agency's small but comfortable main waiting
area. The walls were inscribed with messages from clients about the
services received. Rather than feeling like graffiti, the effect was
more along the lines of love notes.

Harm Reduction Services makes its home in a building in Sacramento's
Oak Park, but you're just as likely to run into the care and education
providers anywhere in town. The organization offers outreach wherever
the need exists: downtown, Midtown, homeless encampments, party spots.
With a van and an RV, they can take their HIV- and hep C-testing,
syringe-exchanging, safer sex-educating show on the road. And they
do.

Two things separate the services offered from those available at other
agencies. The first is the open-door policy. Many agencies require a
commitment to abstinence for services. Not Harm Reduction Services.

"We're not anti-sobriety," Simpson said. "We're just not pushing
clients to do anything they don't want to do."

"We accept any amount of change in behavior as a big success," Hoopes
added. "Every little step they make is a celebration for us."

The second difference is in what Simpson refers to as
"do-overs."

"In a lot of programs, if you screw up, you'll be lucky to get one
do-over," he said. "We don't pitch people for screwing up. Every time
you show up here, it's a fresh start."

That open-door policy was just what Lisa Cook needed. Cook came to
Harm Reduction Services to exchange syringes and receive testing. "I
came in spun to the hubs," said the slight, raspy-voiced brunette.
"There was nothing in my life that made me want to be clean."

But she started to make changes for better health, beginning with
using clean needles. She's now been clean for several months and is no
longer homeless, and she says that the no-strings-attached attitude at
Harm Reduction Services helped her make those changes on her own timetable.

"Coming to Harm Reduction Services is like talking to your neighbor,"
Cook said. "I wasn't made to feel like I was less than. I was somebody
that they gave a damn about and they were gonna do whatever it took to
get me through today."

Simpson points out that much of the focus on providing care for
substance abusers is on abstinence and recovery, with attention going
mostly to those who are-or are trying to become-clean and sober. "But
only 10 percent of all drug users are clean and sober at any given
time, while 90 percent are using," Simpson said. "We serve that 90
percent. We want them to stay safe, be better parents, stay out of
jail and have a place to live. Even if they're not clean, they should
be as safe as we can help them be."

And according to Wilson, the key isn't just the needle exchange, "it's
everything that goes with it." He elaborated by noting that, often,
the syringe exchange "is the first interface with services."

"That's when we can start them thinking about bringing the needles
back for exchange and taking part in keeping other people safe,"
Wilson said. "That's when we can let them know that we're there to
help with other things, too."

Or, as Hoopes put it, "That clean syringe holds unlimited
possibilities for change."