STUCK ON PREVENTION

A Needle Exchange Program Aims to Give Users a Better Shot at Survival

So the man sits down, opens a rumpled Chinese takeout bag, drops two
weeks' worth of used syringes in a plastic bucket. He counts off:
"There goes 130, 131 . . ."

He's high today, a heroin addict for more than half his
life.

". . . 132, 133 . . ."

He is 69, unemployed, homeless, divorced, his legs and right arm
wrapped in pus-stained bandages.

"134, 135, 136 . . ."

Ron Daniels, looking the man in the eye, hears the last one hit.
"That's 137," Daniels says. "Is that all?"

Donald, the man with 137 syringes, grunts. He's thirsty and fidgety,
and asks for a cup of ice water.

"Have you been tested for HIV?" Daniels asks. "Have you been tested
for hepatitis C?"

Donald nods twice.

"You sure?" Daniels asks again, holding eye contact.

It's a sticky, humid Friday, and there's a line of 21 people outside
the Winnebago, spilling into the parking lot of a Shell station on the
littered corner of Minnesota Avenue and Clay Street NE.

This first-name-only "exchange site" -- short for needle exchange,
funded by the nonprofit group Prevention Works! -- is the day's first
of three, and the slowest. David, 49, eyes bloodshot, turns in 58
syringes. Before him, Denise, 48, stick-thin, turns in 15 . It's
controversial, giving David and Denise clean syringes, but Ron Daniels
has a job to do. By 5:30 p.m., he's collected more than 3,000 dirty
needles from more than 80 addicts.

The mobile unit stops in Wards 6, 7 and 8, mostly east of the
Anacostia River, far from "official" Washington. But those who come
for service are as much a part of life in the city and its suburbs as
they are hidden from it: a Metro employee in his uniform, a carpenter
on his lunch break, a social worker in a charcoal skirt and white top,
a homeless man in his wheelchair. Of course, there are addicts who can
afford to buy their own syringes. But these are the ones who show up,
day in and day out, waiting in a relentless line to make these free
exchanges. It's a weekly routine -- twice a week for some -- and
faces, after a while, become familiar.

"We work year-round," says Daniels, one of two full-time employees of
Prevention Works! "You can't stop being an addict 'cause the weather
is bad."

He is 46, built like a gymnast, as agile and quick as he is focused
and intense. As the only full-time employee in charge of the streets,
he has a lot riding on his 5-foot-6, 150-pound frame. Here are some
numbers: 9,856 District residents inject drugs, approximately 1 out of
20 has HIV, and the incidence of AIDS cases here is the highest among
large U.S. cities, according to local health officials. Trace the root
of those staggering statistics, Daniels says, and it leads to a shared
needle for many.

"If these syringes weren't collected -- by someone, anyone -- where
would they go? In backyards, trash cans? Parks? Somewhere in the
monuments?" asks Daniels, surveying the crowd outside the mobile unit,
talking and teasing and sitting around, some in the parking lot of the
Shell station, others across the street outside the Payless Shoe Source.

He's a calming presence in the storm of their lives, the way he
respectfully speaks, the way he carefully puts his hand over someone
else's. "They've been in the heat all day," he says. "They're not
eatin' right, not sleepin' right, not drinkin' enough fluids."

He pauses.

"Sometimes, you just fall down."

Hooked

Nothing matters when you're high. Not the job, the wife, the kids.
Nothing.

Daniels needed four hits a day. He took two in the morning, two in the
evening. Sometimes he took the last one as he looked for a place to
sleep: parking lots, shooting galleries, basements, hallways.

Daniels got hooked at 15. First it was alcohol. Then came angel dust.
Then marijuana. Then PCP. Then the big one: heroin.

"It started out bein' excitin'," he says. "I thought it was fun. I
thought it was cool. The next thing I know, I was beyond what I asked
for. . . . It was no longer 'I'm gonna stop.' It was 'I had to have.'
"

For 22 years. But he got through high school and almost got through
college, studying social science at the University of the District of
Columbia until Gerildine, his girlfriend back then, got pregnant. He
quit school and joined the Navy, completing two tours at sea before
coming home in 1984.

The addiction worsened when he returned, he says. In 1989, after
sharing a dirty needle, he tested positive for HIV.

He's the youngest of seven. His siblings didn't tolerate his
addiction. Neither did his mother, Willette, who worked at the post
office on North Capitol Street NE, or his father, John Sr., who left
their two-story home on Sixth Street SE when Daniels was 13. Willette
died when Daniels was in the ninth grade; John Sr. died when Daniels
graduated from Ballou Senior High.

"Ron didn't have my father's iron fist coming down on him like we all
did," says Phyllis Daniels-Peters, who is five years older. "Then
having all these sisters, we babied him, gave him everything he wanted."

His only brother, eight years older, has a less understanding point of
view.

"Ron was very weak during that time," says John Jr. "I never felt
sorry for Ron. I felt that if he chose not to listen to what was being
conveyed to him -- that he should quit, that he should stop -- then
ultimately he'll be the one to suffer. He did. He suffered very much.
"

"You have to understand that as an older brother, you have very little
tolerance for weakness. You don't want to hear excuses. You don't want
to look for reasons why your brother is not able to do something as
simple as changing his lifestyle."

His younger brother couldn't keep a job. Not the one at the Boys Club.
Not the one at St. Elizabeths Hospital.

"I would get a job, but I couldn't get to work," Daniels says. "I
would get a job, but I couldn't grow in the job."

He broke promises to his kids. He was in and out of jail 15 times --
for using and, he says, for "rustling," selling drugs to support his
habit. "I was too busy runnin' around to be bothered with anythin'
else."

Then came that cold November day in 1997.

Daniels made it up a hill in Southeast Washington to get two dime bags
of heroin but couldn't make it down. He was sweating profusely.
Something was wrong.

"I was strugglin' in just walking. I had a hard time breathin'," he
says. "Even when I took a hit, I still wasn't feelin' all right."

He fell face-down on the pavement of Valley Avenue. Luckily an
ambulance was driving by, and he was rushed to Greater Southeast
Community Hospital. Doctors told him the problem was a combination of
things: the drug use, not taking his HIV meds, the general stress of
his life. The doctors didn't think he'd make it, Daniels says, and
started asking for his next of kin.

But which next of kin?

His 17-year-old daughter and 16-year-old son who rarely saw him? The
mother of his kids, Gerildine, who was too afraid to let him in her
house? His siblings, so frustrated that they allowed him in their
homes only to take showers?

That did it.

"It wasn't that I felt sorry for myself," Daniels says, recounting
that day. "I was a blamer for too long. Blamed my family. Blamed
Gerildine. I cursed everybody out.

"When you don't face who you are, or what you're dealin' with, or what
you're doing, then, yeah, you're a blamer. Because the bottom line is
it all starts and ends with you."

Daniels went into detox. It wasn't the first time, but it was the
last.

Organization Man

What's your first name?

What's your mother's first name?

What's your date of birth?

These are the questions the participants must answer in the 1992
Winnebago Adventurer. The information is typed into a laptop computer
on the middle table of the vehicle, while Daniels or part-time health
educators Henry Mallory and John Turner pack syringes and needles in a
brown paper bag. Turner, a robust man at 67, usually distributes
fliers outside, urging participants to get tested for hepatitis C.

The motor home is meticulously organized, and Daniels keeps it that
way. Shelves are labeled and relabeled. There are bandages, alcohol
pads, towelettes, lube, needles and vitamins, in addition to bag after
bag of syringes, condoms, dental dams and brochures that hang next to
the front dining table: "HIV Mom-to-Be," "AIDS in the African American
Community," "Hepatitis C," "S Is for Speed, C Is for Cocaine." The
room in the back -- with a table, VCR and color TV -- is for testing
and counseling. There are clothes back there, too, and food (fried or
baked chicken, mixed vegetables, soup and salad) is given out on
Tuesday and Thursday.

"This is more than just an exchange site," Daniels says.

There are no freebies. To get a clean needle, you have to hand over a
dirty one. The "apples" and "blue heads" are the most popular, used by
addicts who've been shooting for some time, while "groins" are for
addicts who've been shooting for years. With no more "good" veins, the
addict shoots wherever there's an artery. The neck. The groin. "That
can get real dangerous," Daniels says of injecting into the groin.
"You miss. Bam! You can bleed to death."

Daniels has been with Prevention Works! since it started five years
ago. There used to be a full-time driver, but finding a dependable
driver is tough. So he drives and supervises the Winnebago himself.

He does the work in the only city in the United States barred by the
federal government from using its local tax dollars to fund a needle
exchange program. In October 1998, Congress passed, and President Bill
Clinton signed into law, a ban on government funding for any group
that operates a needle exchange program for D.C. drug users. Rep. Todd
Tiahrt (R-Kan.), the House of Appropriations Committee member who
authored the ban, went further, threatening to revoke government
funding to any agency that exchanges needles. Such a program, with
four full-time staffers, was run by the Whitman-Walker Clinic, the
largest provider of AIDS services in the Washington area. That
program, exclusively funded by local dollars, turned solely private,
and Prevention Works! was authorized by the D.C. Department of Health
on Dec. 2, 1998. To be sure, the Whitman-Walker Clinic didn't want to
endanger its government grants.

The organization's other full-time employee is Paola Barahona, the
executive director, who works in the main office on 14th Street NW,
busy with phone calls and e-mails and fundraising. The current budget
is $393,000, "the most ever spent in this city for needle exchange,"
Barahona says. Inevitably, in this line of work, questions arise: Is
giving clean needles encouraging drug use? Is it preventing the spread
of sexually transmitted diseases?

"By handing out needles we encourage drug use," Tiahrt said in 1999.
"It does not help the children of Washington, D.C., to take taxpayer
money to fund these programs."

Daniels's reaction to such arguments is usually simple: "They just
need to be educated," he will say. But one Wednesday morning as he
sits in front of the laptop, he loses that cool exterior. "They need
to come out and experience what we really do," Daniels says. "We don't
give people syringes to use drugs. We give them syringes to reduce
HIV, STDs and STIs [sexually transmitted infections].

The needle exchange work has its roots in the efforts of Jon Parker, a
former injection drug user who nearly 18 years ago began distributing
(then exchanging) syringes in the streets of New Haven and Boston. Now
more than 125 needle exchange programs, privately and/or publicly
funded, exist in the United States. Organizations including the
Centers for Disease Control, the National Commission on AIDS and the
American Public Health Association support exchange programs. Since
heroin addicts will shoot anyway, they argue, it's better they do it
with clean syringes.

Last year, Daniels helped give out 360,143 clean syringes to 3,180
participants.

His hours are from 9:30 a.m. to 5:30 p.m., but the work is never
really over, at least not for him. He's quick to give out his cell
phone number, and participants call him at home, looking for referrals
or advice. Like the guy who learned he was HIV-positive and called to
ask, "How do I tell my wife?"

Often, the faces stay with him all day, sometimes through the night,
or while he sits at home, watching reruns of "Law & Order" with
Barbara, his girlfriend of seven years.

"It's easy for people to say, 'Well, you use drugs. You should feel
bad. You should feel guilty. You should live this way,' " says
Daniels, driving to the second site, catching his breath. He was
diagnosed with chronic obstructive pulmonary disease in 1998, a lung
disease that killed his mother and one of his sisters.

The light turns red.

"But no. That's not the way. If she can't quit drugs right now, then,
okay, fine, but use a clean needle. If he can't quit drugs right now,
then, okay, fine, get tested for HIV or hepatitis C.

"Point is, you gotta stop looking down at them."

The light turns green.

"You gotta meet people where they're at."

Summerfield

It's 1:40 p.m. at the second site of the day. Summerfield steps into
the mobile unit, turns in 25 needles.

"How you doin' today?" asks Daniels.

"Everythin' all right," Summerfield, 44, says. "Everythin' all right,
Ron." Summerfield's hands have swelled to the size of oversized
baseballs, the result, Daniels says later, of fluid buildup. "Too much
heroin injections."

The two first met 22 years ago at a shopping center on Naylor Road and
Alabama Avenue SE -- "at 6 in the morning," Daniels recalls. The two
met to shoot dope, unable to do anything until they got their fix.
Sometimes, they shared needles.

"Summerfield has come a long way," Daniels says, a host of questions
left hanging in the dry air. If Daniels can quit, then why not his old
friend? What makes the difference? How does Daniels come here every
day like this, seeing his former running buddies? Does he miss the
high? Is he ever tempted?

"Sure, I feel bad when I see him. Sure, I do. But you gotta look at
where he was and where he is now, and you gotta look at that from his
point of view," Daniels says.

These days, he says, Summerfield uses sterile water, new bottle caps
(for cooking the heroin), clean syringes. To an addict like
Summerfield who's been injecting heroin since 18, those are big steps,
Daniels says.

"He is a model participant. He gets tested for everything now," he
adds. "From a clinical standpoint, where I've seen him before, he's
doing better."

"Look, I've been there before, I know what it's like to be on the
other side, and, no, I don't miss the high, I don't miss that life I
had."

He goes on. "I see the folks out here and it just breaks my heart --
does it break yours? You look at them the way I look at them, with
that 20/20 hindsight, and the temptation goes away."

Full Circle

Daniels parks the Winnebago at Hechinger Mall and listens to 1230 AM.
There's Lee's BBQ, Subway, McDonald's and Pizza Hut nearby. Safeway,
in case he needs ice for the cooler, is only a few feet away.

Henry Mallory, the part-time health educator, comes in and sits on the
front dining table, snacking on potato chips and soda. Mallory is
transgender, and Daniels refers to him as "her."

"Let me tell you something about this man," says Mallory, 48, a former
drug user and street worker who has AIDS. It was a little rough when
they first met more than two years ago. ("Sometimes Mallory was rude
in talking with some of the participants. Yelling at them. Telling
them off," Daniels says later. "I had to take her to the back room and
say, 'I will not allow you to talk to people like that. That's not
what we do here.' ") "This RV is his addiction," Mallory continues.
"Even when he's not supposed to be here, he's here. You just can't
stop him from worrying about this unit and the participants. He's
always telling people, 'I'm gonna do this and this for you.' You can't
stop him."

Daniels sits quietly behind the steering wheel and looks out the
window -- the morning's sunshine has been replaced by a light rain.

Moments later, he takes off, drives toward the last exchange site of
the day. "What more can I ask for?" Daniels says, smiling. "I think I
got another 15 years to live."

He is "in excellent health," he says; his CD4 count -- a measure of
immune system health -- is over 500, a good sign. He is "very close"
to his siblings, Paulette, Ora, Phyllis, Patricia and John Sr. The
family makes it a point to get together for dinner and a movie once a
month. He is "extremely close" to his children, Kevin and Kieyannia,
and his grandchildren, 3-year-old Berry and nearly year-old Takayai.
Recently he completed more than 1,200 hours (when only 20 hours were
needed) to be a certified addiction specialist.

"This is the happiest I've been in twenty-somethin' years. It's sad to
say that because there's no reason for me to be happy from the outside
lookin' in," Daniels says. Four more hours until dinner. Barbara is
waiting at their one-bedroom apartment in Southeast Washington.

"I didn't wake up one day, you know, and say I wanna be a drug addict.
I didn't wake up one day, you know, and say I wanna be HIV-positive.
But in the last 25 years, both of those things have been a part of
me," he says. "Who would have ever thought I'd get here? That I'd come
full circle? That after all those years I'd get to help people out,
people who were just like me?

"It ain't no fun walkin' in this rain, in this rain that's comin' down
now, not havin' no money, no place to go, no food. It ain't fun.

"Look at that man sittin' out there on the steps."

Daniels parks the Winnebago in front of St. Matthew's Baptist Church,
where "All Are Welcome," the sign says at New Jersey Avenue and L
Street SE, a few blocks from the Capitol.

Turner grabs his hepatitis C fliers; Mallory sits at the
laptop.

The man waiting in the rain is Al, another old buddy. He and Daniels
grew up just a few houses apart on Sixth Street SE, and Daniels
idolized him. He played ball well. He got the pretty girls. He drove a
nice white Caddy.

He's 49 now. His left eye is gone, lost in a prison fight. He's a
regular at this exchange site, and says he's proud of the work that
"Boo" -- as Daniels was once known -- is doing.

At the moment, Al is the only one waiting. But the man who used to be
called "Boo" hurries out of the Winnebago and heads toward his old
friend.

"How you doin' today?"