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Giving Addicts Clean Needles Is Not the Ideal Way to Curb HIV, Dan
Bigg Says; Just the Best One Available

The silver van is back. Right where it always is on Wednesday nights,
idling in a Cicero parking lot under the synthetic moonlight of a
street lamp. At other times it can be found parked next to the vacant
lots of the South Side or on a narrow Uptown street called Blood Alley
or at a dozen other bleak corners scattered across the city and suburbs.

There's no telling who will climb aboard. Maybe it will be an aging
Vietnam War vet who first started riding the heroin horse in the
jungles of Southeast Asia. Or a suburban kid who took her first hit a
few months ago in the family rec room when mom and dad were away at
the time-share. Or a 75-year-old hipster who says he has been shooting
smack into his veins since 1946 and fully expects to die with a spike
in his arm and a smile on his face.

It doesn't matter. Everyone is welcome. Lives are at
stake.

Dirty needles, shared syringes and ignorance have spread HIV infection
like a prairie fire among intravenous drug users, their intimate
partners and their babies. The crew on the van is doing its best to
staunch the flames.

The bread truck-sized vehicle belongs to the Chicago Recovery Alliance
(CRA), one of the largest needle-exchange programs in the country.
Critics say such programs perpetuate and even encourage drug use. No
one on board the van wants to help people stay addicted, though they
recognize the paradox of freely handing out the paraphernalia that
addicts need to inject drugs. Their justification is that addicts will
always find the means to shoot up, but CRA's supplies are sterile and
protect the addicts, their loved ones and the rest of us from the
consequences of their dangerous desires.

Everything is inside except the dope. There are thousands of sterile
syringes: 200 to a box, 10 to a sealed, clear plastic bag. Printed on
the side of each syringe is both an admonition and a prayer: USE ONCE
AND DESTROY.

Next to the syringes are alcohol wipes, purified water, tiny cotton
balls and small aluminum containers that look just like the twist-off
cap on a 40-ounce bottle of beer. The caps are called cookers because
they are used to dissolve heroin over a flame in water or saline
before injection. Addicts who don't use clean cookers are four times
more likely to contract hepatitis C.

On this windy Wednesday night in Cicero, CRA Director Dan Bigg slides
open the door for a nervous 31-year-old woman carrying a black purse
and a brown paper sandwich bag. She looks lost. She sounds scared.

"Come on in," Bigg says, smiling warmly. "Don't mind them," he adds,
gently nudging aside the dogs, Tucker and Sam, who go everywhere with
him.

The woman steps up into the van but hesitates in the open door.
There's still time to turn and run. The smiling man with the dogs,
maybe he's a cop. And that's all she needs, to get busted on a mission
of mercy for her mother.

The woman looks around one last time and decides to risk it. The cops
couldn't be running this show, she concludes. They don't have the
imagination.

Warren Zevon is on the radio.

I took a little risk

Send lawyers, guns and money

Dad, get me out of this.

In the middle of the van, two guys are speaking Russian as they wait
to have their blood drawn for an HIV test by a red-haired volunteer
doctor, bopping her head to the music. "Hi. How are your veins?" she
asks.

Near the front, a young woman is loading up on free condoms and Krispy
Kreme doughnuts. She had turned her back on drugs for a long time, she
says, "thanks to Dan and them." But she got caught up again. Now she's
walking the streets to support her habit. She needs all the protection
she can stuff into her tight hip pockets.

In the back of the van, a man in his 50s also is getting an HIV test
and munching on one of the tacos Bigg picked up on his way to the lot.
The man is tired of worrying every time he gets the sniffles that it's
really the virus kicking in. He wants to know his status one way or
the other. Word on the street was he could find out on the silver van.
For free. No preaching, no judging, no hassles.

The newcomer holds the paper bag away from her body. She speaks so
softly, Bigg has to lean forward to hear her say, "I have 15 of them
in here."

"We don't need to talk about it," he replies. "We'll give you whatever
you need."

Unlike most needle-exchange programs, CRA does not require a strict
one-for-one exchange. Bring in 10 dirty needles, leave with 100 clean
ones. CRA's philosophy is, take whatever you need to inject safely.
What you don't need, pass on. Bigg says the average heroin addict
injects about three times a day, or roughly 1,000 times a year. Each
clean injection requires a new needle.

"OK. Now what do I do?" the woman asks, trying to give Bigg the
bag.

"Drop it in there," he says, indicating a red plastic trash barrel
that can hold up to 3,500 contaminated syringes. There have been days
when four barrels were filled up within two hours. The dirty needles
are later incinerated.

"I'm here for my mother," the woman says. "I have her driver's
license. She gave it to me in case you needed to see it."

"We don't," Bigg says, directing her over to John Gutenson, a
part-time CRA employee.

"How about a hundred?" Gutenson asks.

"I would hope it's not that many," the woman says. "I wish it was
none."

"I know," he says gently. "But remember. One shot, one
needle."

The woman's mother is 58 years old. She asked her daughter to come to
the van because she's sick. She says the heroin helps ease the pain.
"I don't know if I believe her," the woman says. Bigg says her mother
is lucky she has a daughter who's willing to help.

"I don't know," the woman says. "I feel like I'm enabling
her."

"You are enabling her," Bigg says. "You're enabling her not to share
needles or use dirty ones. You're enabling her not to get HIV."

"Maybe you're right," she says. "I just don't know."

Bigg watches her leave, fading into the night. She's probably telling
the truth about her mother, he muses. But maybe not. She might be
using herself. They might be using together. It doesn't matter. What
matters is she brought in a bag of dirty needles and left with clean
ones. Whoever uses those needles is less likely to be a victim or a
carrier of a deadly disease for a while longer. Bigg doesn't have much
time to dwell on it, though. Someone else is at the door.

"Come on in," he says. "We have doughnuts in the back."

Around the world, what Bigg's organization does is called "harm
reduction," or "harm minimization," a movement that started in Europe
and gained momentum in the early years of the AIDS epidemic in the
1980s. Bigg prefers the homegrown phrase, "any positive change."
Whatever you call it, the goal is to save lives by making risky
behavior less dangerous. And you can't get much riskier than injecting
heroin with used needles, the equivalent of Russian roulette with a
syringe.

According to the U. S. Centers for Disease Control and Prevention,
sharing or using dirty needles directly or indirectly causes half of
new HIV infections nationwide. In Illinois, virtually all babies born
with HIV are infected because one or both of their parents did not
have access to sterile syringes, the AIDS Foundation of Chicago says,
adding that 70 percent of AIDS cases among women in the state are
connected to dirty needles.

Despite these statistics, possession of any syringe, clean or dirty,
without a prescription is illegal in Illinois, though that may be
changing. Last month, the legislature sent Gov. Rod Blagojevich a bill
to lift the ban. Aides say he is likely sign it, but he had not done
so by the time the Magazine went to press. "These people strung out on
drugs have a sickness," says Sen. Donne Trotter (D-Chicago), who
fought for the measure for 12 years. "Access to clean needles is an
important tool to stop the transmission of this insidious disease."

Bigg says enactment of the bill would not end the need for his group's
services, though it would allow CRA to spend more money on outreach
and other programs and less money on syringes--$240,000 last year.

Of course, the ideal way to reduce the harm and risk of drug use is to
get people to quit. But not everyone can. One way or another, we've
been trying that for generations, and let's face it, says Bigg, it
hasn't worked. The prisons are full of addicts. So are the cemeteries.

The harm-reduction movement tries to make the best of a terrible
situation. The most common-sense way to reduce the risk and the harm
of injecting drugs, Bigg says, is to supply users with knowledge and
sterile equipment that won't spread disease. It's a strategy that
requires a steely-eyed acceptance of the way things are and a saintly
amount of patience. "Most opiate-addicted people don't want to be," he
says. "They wish it was different. But it isn't. The best we can do is
help them take care of themselves and minimize the harm to themselves
and others until they are ready to stop on their own."

The van is loaded with pamphlets on HIV, hepatitis and overdose
prevention. Taped to the walls are telephone numbers for treatment
centers, where the waiting lists are long. There's also the business
card of a volunteer doctor, who is a psychiatrist and expert on
addiction. Leaning against the van's counter and exam table on any
given day or night are even more experts: staffers and volunteers who
have lived and survived the drug life.

On the van this night in Cicero is a 22-year-old woman who swears she
has been clean for a year. As she talks about how good the heroin made
her feel before it turned on her, she starts giggling, as if
remembering an old boyfriend. At first, it's like floating in a warm
bubble over all your troubles, she says. No, she corrects herself,
it's like the most beautiful flower in the world. But eventually you
put that flower up to your nose to savor the scent, and it devours
your soul. "This place saved my life," she adds, looking around the
van.

A woman old enough to be her mother nods in agreement. She's clean
now, too, but says that if there weren't any consequences from using,
if there weren't any threat to the life she's rebuilt for herself,
she'd be right back on the streets, copping and getting high.

When she was using, losing her house didn't stop her; getting busted
for prostitution didn't stop her; having her son taken away by the
state didn't stop her. The only thing that stopped her was time. After
20 years, she finally decided she had had enough and got into a rehab
program. Watching so many of her get-high buddies get buried had
something to do with it too. "In my day," she says, "we had two
needles for 12 people." Ten of those people are dead, she says, eight
of them from AIDS.

On the South Side, the van is visited by a 22-year-old homeless,
out-of-work cook who rides the "L" all day in order to sleep. "I was
never addicted to any drug except cigarettes," he says. "Then I found
heroin through a friend. Most people, first time they try it, they get
sick. My system embraced it. I felt completely relaxed and calm. I
basically found my drug." The friend who gave him his first hit
recently died of an overdose.

One thing you hear on the van is that getting into a treatment program
is difficult, and completing it is no guarantee of staying clean. Some
people wait and wait for a bed to open up. Others have been in and out
and back again. Nothing sticks. They're clean for a few months, even a
year; then something happens. A spouse dies. Or it's something good, a
promotion or a new daughter, pretty as a full moon. They're mourning
or celebrating and somebody has some stuff. One hit isn't going to
hurt. Bang. They're back in the life. Clean and sober, then dirty and
down. On and on.

At 37, Sharon has hopped on and fallen off the recovery roller coaster
more than once. She started injecting cocaine when she was 18 but
stopped in her early 20s to raise her children. She now has five,
ranging in age from 10 to 19. Then 3 1/2 years ago, her husband left
her and she began a $100-a-day heroin habit, interrupted by the
occasional short stay in a treatment program. "I just kept walking
away," she says. "I couldn't take the sick"--the symptoms of withdrawal.

A couple of months ago, she was so brazen about her drug use that she
injected in the middle of the afternoon in her car, which she had
pulled up in the back yard of an abandoned building. "For 12 years, I
was clean," she says. "I cooked. I cleaned. Then I went from Super Mom
to psychotic drug-addict mom. I threw my kids into shock. I have a lot
of fixing to do."

Once she gets out of the DuPage County Jail, that is.

She was arrested in April for failing to appear in court on a
bad-check charge. "When I get out, I'm going to [Narcotics Anonymous].
I'm tired of this. But even though I'm clean, that needle-exchange
program needs to stay open. It's saved a lot of people from getting
AIDS."

Bigg is an internationally recognized pioneer in the field, an
evangelist for the safer use of illicit drugs. It's a life-saving
sermon to many, a dangerous message in the view of others. "He sets
the pace for needle exchange in America," says Steffanie Strathdee, of
Johns Hopkins School of Public Health, who has studied CRA and
needle-exchange programs in five different countries. "He uses needle
exchange to attract people on the fringes of society who are falling
through the cracks."

"He's a guy who can talk with equal ease to a legislator and a 20-year
heroin addict and make them both feel comfortable," says Karen Reitan,
of the AIDS Foundation of Chicago. "He's a true believer and true
believers are always inspiring."

What Bigg really is, says Judy Kreamer, of Educating Voices, an
anti-drug-abuse group in Naperville, is flat wrong. What he advocates
with words and deeds sends absolutely the wrong message to young
people, she says. It condones drug use. It enables risky behavior.

Essentially, she says, Bigg's message boils down to this: Here's a
nice new needle, go out and buy some illegal drugs and inject them
into your body. If you don't die of an overdose or a drug dealer's
bullet, come on back and I'll give you some more needles and you can
try again. "I've debated Dan Bigg," she says. "I think he's misguided."

There are a few facts about Bigg that are not in dispute. A graduate
of New Trier West High School in 1977, he is a 44-year-old father of
two. He spent Chicago's aldermanic runoff election as a poll watcher
in the First Ward. He often needs a shave and, like the people he
deals with every day, he dresses in jeans and sweatshirts, only he
doesn't ever have to sleep in those clothes, curled up in a doorway.
He recently returned from a week in Paris with his second wife, Karen
Stanczykiewicz, CRA's youth outreach coordinator.

Like many other members of his generation, Bigg has experimented with
drugs. But it never got out of hand, he says. He never used needles.
He did take some wild trips, though, in his younger days. LSD was his
travel agent. He smoked some pot too.

He grew up in Winnetka, one of four boys. His youngest brother is a
Chicago police detective. His father was a doctor, his mother a nurse.
She keeps the books for CRA. "I hate administration," he says, "and I
love spending time with my mother."

He studied psychology at Indiana University. "But I didn't know
exactly what I wanted to do," he says. "I always dreamed of doing
something meaningful and important. I had no idea what it would be.
When HIV came along, I got very interested. More than career
development, I was interested in a cause."

In 1991, he was working as an addiction counselor when he was called
to a meeting of people in the field of recovery and HIV prevention.
There were 12 in attendance, sitting around a couple of tables pushed
together at a Belmont Avenue restaurant in the gathering dusk of a
late autumn afternoon.

The meeting was called to figure out how to respond to the epidemic
spread of HIV infection among drug injectors and their loved ones.
Everyone agreed there had been too much talk and too many eulogies.
People were dying unnecessarily. It was time to take the fight against
AIDS into the streets, into the urban wilderness of abandoned
buildings, vacant lots and tough taverns.

They went back and forth. What was recovery? Was it the traditional
definition of complete abstinence? Or was it something else, something
in the middle, something closer to gray than black or white?

John Szyler, an ex-addict called "Division Street," spoke up. Recovery
was a process, a journey. Recovery was individual. Recovery, he said,
was any positive change.

"The idea of any positive change was perfect," Bigg recalls. "It
allowed us to instantly accept everyone in the room and everyone we
would serve. That still stands very clearly as our reason for being."

Of the 12 people who founded CRA with Bigg in 1991, only three are
still alive. The others are dead--killed by AIDS or drugs or exhausted
hearts.

All told, Bigg has buried 29 friends and colleagues. That is what
keeps him going after all of these years. He hates funerals. "I'm very
poor at burying my head in the sand," he says. "Some people use the
phrase troublemaker to describe me. Others say revolutionary. But the
bottom line is, I have a hard time keeping my mouth shut."

Not too many revolutionaries have the city paying for their
revolution. Last year, using state health dollars, the city provided
more than half of CRA's budget of $807,750. The rest comes from
foundations and private donations. Bigg springs for the pizza.
"They're an extremely effective agency," says Christopher Brown, the
assistant commissioner at the Chicago Department of Health responsible
for HIV and AIDS prevention programs. "We're proud to work with them.
It's a hard program to argue with."

Officials in Washington, however, continue to just say no. The federal
government, under Democratic and Republican administrations alike, has
refused to fund needle exchange, largely on the ground that it sends
the wrong message by appearing to support illegal drug use.

"It doesn't send the wrong message," counters Robert Heimer of Yale
University, who has evaluated CRA and other needle-exchange programs
around the country. "It sends the message that we care about all people."

He says the research is clear: Needle exchange reduces the spread of
HIV among intravenous drug users. When he first started evaluating
such programs in 1990, he had no idea whether they were a good idea or
bad. "I was persuaded by the data," he says. "There don't seem to be
very many downsides. It doesn't promote drug use. It doesn't encourage
people to make the transition from non-injecting to injecting. It just
keeps people from getting infected with HIV and hepatitis."

As long as it's illegal in Illinois to possess syringes without a
prescription, CRA can operate only if it qualifies for a research
exemption. Since its earliest days, the needle-exchange program has
worked closely with researchers studying AIDS prevention and the drug
culture. CRA employees keep careful records of the number of people
exchanging dirty needles for clean ones--their race, age, sex, how
many other people they are exchanging for and how many syringes they
take. "Bigg is as organized as a doctor's office," says Strathdee of
Johns Hopkins.

Each CRA participant is issued a laminated yellow card with an
individually coded identification number. They carry the cards to ward
off the police. The cards essentially state that the bearer is a
participant in a research project and the syringe in his pocket is
legal. But if the participant also has dope in the syringe, he better
be carrying his lawyer's card too, Bigg says. The yellow card won't
save him.

Last year, in exchange for 2.4 million dirty syringes, CRA distributed
2.72 million clean ones to more than 6,000 people, mostly heroin
addicts. In its 12-year existence, CRA has distributed 15.5 million
sterile syringes.

The numbers sound staggering, but they're dwarfed by the magnitude of
the problem. Bigg estimates there are at least 60,000 illicit drug
injectors in Chicago. If all of them regularly got clean needles, the
number distributed would be at least 60 million a year.

Distributing the needles and other services is a CRA staff of 15 full
and part-time employees. The organization also has a troop of
volunteers and an eight-member board of directors. Most of the staff
and the board are survivors of addiction.

One of them is a 24-year-old outreach worker named Steve. He mostly
works with white youths like himself--runaways, metal freaks, Goth
rockers--who hang out in Lake View. His target group is
18-to-24-year-olds. Last year, 40 percent of drug injectors seen by
CRA were under the age of 25.

But Steve will exchange needles with anyone in need. On this chilly
night, he's wearing a black trench coat and a black knit cap with a
skull-and-crossbones design on the side. He has his black CRA backpack
slung over his shoulder. It contains syringes and his poems about
life, music and heroin. "What else is there?" he asks.

Haunted hybrid needle kills the pain today

Still dead inside

I killed my pain

Morgue delight

He is limping as he makes his rounds because his feet are bare inside
his black boots. All of his socks are dirty and he doesn't have any
money for the laundry. "I have better things to spend my money on," he
says with a wink.

Near Clark Street and Belmont, a young man waves Steve over to the
mouth of an alley. He needs needles. "I missed the van today," he explains.

Then he rolls up his sleeve. "I got this rash I want you to check
out," he says. His arm is raw and scaly. "It might just be a reaction
to the bleach," Steve says. People often use bleach to clean their
needles when they have only one or two.

Steve gives the man a bag of syringes. "Try to use those once and
throw [them] out," he says. "Just stock up. I'm out here every night."

Steve was 13 the first time he experimented with drugs. A 21-year-old
woman turned him on to heroin. He's been shooting up off and on ever
since. He was adopted as an infant and had a stormy relationship with
his parents. He always felt like an outcast. The druggies showed him
some love. "I like helping people," he says. "I'm not going to do
anyone any good sounding like their parents. I'm just trying to get
people what they need to stay safe."

Cheryl Hull works the van. Bigg hired her 10 years ago, hoping to
expand CRA's reach and credibility on the South and West Sides. An
addict for 25 years, she was more than qualified for the job. "She can
identify with all the insults that happen to people because of their
drug use," Bigg says. "Cheryl has the biggest heart in the world."

Hull parks the van at its spot at 47th Street and Vincennes Avenue,
across the street from the famous Palm Tavern, now boarded up and
silent. Nearby, Magic Johnson's face on a billboard preaching HIV
prevention peers out over a vacant lot.

A 60-year-old man boards the van. He needs needles, but he doesn't
have any to exchange. His wife found the stash he had hidden and threw
everything out.

"What are you going to do when I give you some more?" Hull
asks.

"I'm going to find me a better hiding place," he replies.

Hull, who is 50 years old, grew up in the Henry Horner Homes public
housing development, where she injected heroin for first time. It
wasn't long, she says, before every waking minute was spent worrying
about how she was going to get the next hit of dope. She lied and
stole. She went to jail. She disappointed her family. She betrayed
herself. "I used to feel so hopeless," she says. "The person that God
intended me to be was gone."

Finally, she looked around and saw what her habit had done to her and
her family, especially to her only child, Tamara. She discovered that
Tamara, who was then 21, was smoking crack. Hull lectured her and
tried to get her to quit. But they both knew her words were useless.
Hull shut up and mother and daughter got high together. It was the
experience of doing drugs with her baby girl that pushed Hull into a
treatment program almost 12 years ago. Her mother, who got to see her
daughter off drugs before she died, "was so proud of me," Hull says.
"My daughter was too."

Even as Hull got clean, her daughter sank deeper into the drug life.
Tamara had two daughters of her own and sometimes, for them, she'd
stop--but only for awhile. During those times, she worked alongside
her mother on the van. "This van is a vision of hope," Hull says. "And
hope is the best harm reduction there is."

But Tamara's hope and time ran out four years ago. She was found
wrapped in a rug, shoved under a porch. She had been stabbed to death.
Hull suspects the killer was someone with whom her daughter was
smoking crack.

"People who don't use," she says, "don't realize how hard it is to
stop. Some people have to get beat all the way down like I was. Some
people have to die."

Michael Wilson is Hull's ex-husband. His job is to train people who
come to the van in how to inject a drug called Naloxone into someone
having an over-dose--known on the street as "going out." Naloxone is
the same drug paramedics and emergency-room doctors use to bring an
overdose patient back from near death.

CRA is one of the first needle-exchange programs in the country to
train its participants in the use of Naloxone and, with a
prescription, distribute it to them. Wilson has a T-shirt from a
harm-reduction conference: "Dead Addicts Can't Recover."

Bigg says the Naloxone training has paid off in saved lives. Over the
last few years, 1,800 people were trained in the program and there
were 142 overdose reversals.

That number grew to 143 on a recent Wednesday night in Cicero, when a
19-year-old immigrant from Poland boarded the van to exchange 20 dirty
needles. His 22-year-old girlfriend from a ritzy Chicago suburb waited
in the car. The young man, tall and thin, had been on the van before.
He knew the routine and within minutes was driving away with two bags
of clean needles.

Twenty minutes later he was back. He jumped out of the car and said
his girlfriend had overdosed in the front seat. Bigg ran to
investigate. The young woman was blue-lipped and unresponsive to pain.
Bigg filled a syringe with Naloxone while other CRA members tried to
revive her. They were having a hard time pulling up the sleeve of her
shirt, so Bigg pushed the needle through the shirt and into her right
shoulder.

Then he began blowing into her mouth. She had a strong pulse, but
there was no movement in her chest. After two minutes, the boyfriend
took over the mouth-to-mouth and within 30 more seconds the woman
revived. She had no idea what had just happened. Her boyfriend was
crying. Bigg showed her the hole in her shirt.

It was the first time Bigg had reversed an overdose. "I've trained a
million people how to do it," he says. "I just did what I've taught
everyone to do. It was really an ecstatic experience."

The couple spent the next hour listening to Bigg explain how to use
Naloxone. The man was anxious to leave. "I was guessing he wanted to
go back to where he purchased the heroin and get some more," Bigg
says. The two got back in their car.

Suddenly, the woman said, "Hold on," got out of the car and gave Bigg
a huge hug. Then the couple drove away.

Bigg stepped back into the silver van, leaving the door open.