D.C. GROUP OFFERS NEEDLE EXCHANGE TO METH ADDICTS

Prevention Works Clients Are Mostly Gay White Men

When a methamphetamine user approaches Kristen Degan, she offers a
practiced response.

She regularly welcomes meth addicts to Prevention Works, a privately
funded program in D.C. that operates a needle exchange program and
encourages addiction treatment.

Degan, a program assistant who specializes in meth issues, counts the
number of needles brought to her, disposes of them, then provides an
equal number of clean needles in return. She also gives meth users
several condoms, towelettes and antibiotic ointment.

Then comes the clear but gentle reminder: Drug addiction treatment is
available.

"We try to remind clients of this without sounding too pushy," Degan
said. "If someone's not ready to go into treatment, treatment isn't
going to work for that person."

About five minutes after clients arrive, they leave via the same
alley door behind 1816 14th St. NW. The hidden entrance makes drug
users more likely to visit Prevention Works.

"It's a pretty busy alley, so I think people feel pretty comfortable
walking through it," Degan said, "but it feels really anonymous."

The anonymous alley entrance, fast turnaround and other practices are
designed to make Prevention Works more accessible to users of meth
and other drugs. The clean needles are designed to prevent the
sharing of needles, which has been the source of HIV transmission for
all sorts of IV drug users.

Meth addicts comprise a small, but growing number of the program's
2,300 clients. The users -- predominantly gay white men ages 25 to 34
- -- are known for their reluctance to trust programs like Prevention
Works. That's left Degan and other staff members struggling to
determine how Prevention Works can best help meth users.

"This is our current challenge," she said. "We're not exactly sure
what their needs are."

Meth use linked to HIV

As more users seek help from Prevention Works, police are fighting an
increase in meth use and trafficking.

D.C. Police Sgt. Brett Parson, commander of the Gay & Lesbian Liaison
Unit, said meth is particularly a problem among the city's white gay
population.

"For the most part," he said, "if you're gay and white in the
Washington area, you probably know somebody who's using meth."

Parson said the drug, which gives users an intense high followed by a
depressive crash, is a recurring factor in arrests.

"Chances are, if we're making a drug-related arrest in the gay
community," he said, "meth is involved."

James Millner, the Prevention Works board president, said meth is
particularly problematic for gay men because sharing needles can lead
to the spread of HIV.

He said meth also gives users prolonged boosts in energy and sex
drive. People under its influence are reckless, irrational, and
unlikely to practice safe sex, he said.

Millner said Prevention Works has worked for years to keep meth users safe.

"The ability to be ahead of the curve rather than play catch-up was
important," he said. "This was a good opportunity for us to slowly
and methodically work with the clients and make our services into
something they want and will use."

Although the Prevention Works staff was initially unable to reach
meth users, Millner said, a connection eventually was made.

"They sought us out," he said, "which indicates that there is a
willingness, and an ability to work with crystal meth users to do
things that will protect them from HIV, and Hepatitis B, and other
blood-borne illnesses."

Degan said meth users first exchanged their own needles, but now also
exchange needles used by friends.

"People are really interested in keeping their friends safe," she
said, "and we feel very fortunate that people who are using the
program are trusting us."

Trust fosters conversation

With that trust, Millner said, comes an opportunity for Prevention
Works staff to encourage safer choices.

"Eventually, the staff and the volunteers get to know who these
clients are, and know more about who they are and where they are in
their life," he said. "It can be a very personal -- a very detailed
- -- conversation about what that client needs at that point."

But that bond takes time, Degan said. In the meantime, Prevention
Works can only offer a standard reminder that treatment is available.

The American Medical Association officially "encourages needle
exchange programs," but the practice remains unpopular and
controversial among some lawmakers and other public officials. AMA
research shows that programs like Prevention Works do not encourage
illegal drug use, and can reduce drug use through effective referrals
to drug treatment.

The Bush administration affirmed in 2001 that it would continue a
Clinton administration policy of not allowing federal funds to be
used to pay for needle exchange programs. But unlike the Clinton
administration, Bush did not raise objections to Congress' decision
to bar the District of Columbia from using its own taxpayer-generated
funds to support a needle exchange program offered by the
Whitman-Walker Clinic.

Whitman-Walker was one of the first D.C. groups to carry out needle
exchange programs to curtail the spread of HIV among injection drug users.

Beginning in 1999, Congress began adding annual "riders" to the D.C.
appropriations bill that prohibits the city from using its own funds
to support needle exchange programs. Fearing a possible cut-off in
federal grants for other programs, Whitman-Walker discontinued its
needle exchange program and helped launch Prevention Works, which has
carried out the program since that time using private funds.

In recent years, the Senate has dropped the D.C. funding ban for
needle exchange programs in its version of the D.C. appropriations
bill. But House Republican leaders have insisted on keeping the ban
in place, and a House-Senate conference committee each year has sided
with the House.

D.C. Congressional Delegate Eleanor Holmes Norton said she is hopeful
that the House will eventually drop the ban.

Parson said some District police officers also question the practice.
But he noted the core mission of Prevention Works is to help people,
so police support the program.

"I think any organization that is trying to -- in any way -- work
with people who are addicted," he said, "and help them to more safely
lead their lives is doing a good thing."

Millner said he values the ongoing cooperation that Parson and other
officers lend.

"This is a program that reaches people that we would never reach
otherwise," he said. "There's a personal conversation that can happen
because there's trust that's built up over time."

Millner said the program is important to Washington -- and gay
residents -- and needs to grow.

"If we're talking about reaching 2,300 clients a year, that's maybe a
fifth of what we should be doing," he said. "But we just don't have
the resources to do any more."