Harry walks the streets of Washington Heights with a swagger. This is his home. He does not tell his full name, “it’s just Harry.” His broad frame and confident stance add a dominating aspect to his personality. He has a striking face: Intense blue eyes, chiseled chin, a sharp nose, blond hair that reaches his collar, an expression that swings between courtesy and arrogance. But when he starts speaking too quickly, he sounds like a man high on crack cocaine.
Harry is a homeless man and an intravenous drug user. Many like him live on the streets near the George Washington Bridge approach on West 178th Street. He readily admits that he is an addict. He knows it’s dangerous, and knows the threats he faces from drug abuse and the harmful practices related to it. “I used to share needles,” Harry says, but now he doesn’t. Along with a lot of other homeless or quasi-homeless intravenous drug users, he participates in a needle exchange program at the Washington Heights CORNER Project. “I really admire what they do,” he says.
Jamie Favaro, founder and executive director of the CORNER Project, says, “We are the only organization apart from New York Harm Reduction Educators who engage in needle exchange in northern Manhattan.” Among other services, the non-profit organization provides new needles in exchange for used ones, a harm reduction technique for drug users.
Needle exchange mitigates the spread of diseases like AIDS and hepatitis C among intravenous drug users, who tend to share their needles, putting them at a high risk of contracting disease. The Centers for Disease Control and Prevention estimates that intravenous drug users account for a fifth of the more than one million people living with HIV in the United States and for most of the hepatitis C infections. And AIDS is the top cause of death among intravenous drug users, according to the Global Health Council.
Such programs also promote safe disposal of used needles. When discarded incautiously, used syringes can be a public health hazard, posing danger to unsuspecting people who might encounter them in such hot spots as vacant lots or even playgrounds.
Needle exchange has been under debate nationally since its inception in the late 1980s.
Under state law, launching a needle exchange program requires community board approval. “Washington Heights has had a significant drug problem for a very long time,” Favaro says,adding that this was a reason the community board voted unanimously in 2007 to allow the organization to operate legally.
“New York City is a metropolis that is driven by facts and not fear,” Favaro says. She has not faced opposition uptown, but believes that in some parts of Manhattan – the more affluent neighborhoods — needle exchange still encounters criticism.
Many against needle exchange argue that it promotes drug abuse, but some organizations even question the efficacy of such programs. “We do not support the programs the way they are generally run,” says Calvina Fay, executive director at the Florida-based Save Our Society From Drugs. “Typical needle exchange programs provide unlimited supply of needles,” she says. “There is no accountability.” Fay believes the programs don’t try to get users off drugs, so “the drug addiction continues.” Fay says such programs are ineffective in containing diseases, citing a study conducted in Vancouver in 1997, among others, and believes that the decline in AIDS among drug users has come from other factors.
Needle exchange also sends a flawed message to young people who might be considering drug use, Fay charges. “The message should be that drug use is not acceptable,” she says, adding that easy access to free needles actually becomes an “obstacle for people dependent on drugs” who may otherwise try to quit.
And Dianne Glymph, editor at the Journal of Global Drug Policy and Practice, says other studies demonstrate the ineffectiveness of needle exchange or overstate its benefits, including a paper titled The Effectiveness of Needle Exchange Programmes for HIV Prevention – A Critical Review.
But that is an increasingly minority view.
“A variety of elected officials have opposed needle exchange over the years,” says Chris Collins, director and vice president of public policy at amfAR, an international non-profit organization supporting AIDS research and advocating for HIV/AIDS prevention policies. He notes, however, that scores of scientific studies support needle exchanges.
The organization is very active on Capitol Hill, advocating for allowing federal money to fund needle exchange. Collins says amfAR will “continue to provide background on the issue and act as a source of what scientists say for the lawmakers and media.” As for the argument that such programs promote drug abuse among participants, Collins says simply, “It does not.”
According to the 2009 issue brief of Trust for America’s Health, the World Health Organization, the American Medical Association and the federal Centers for Disease Control and Prevention have endorsed needle exchange programs, along with many other organizations. It also lists a number of studies that have shown needle exchanges to be effective in mitigating the spread of HIV/AIDS and hepatitis C without increasing drug use. For example, a joint analysis of 200 studies, by WHO, UN-AIDS and the U.N. Office on Drugs and Crime in 2004, cited a 2002 report that found that HIV rates declined by 18.6 percent annually in 36 cities with needle exchange programs, while the rates increased by 8.1 percent annually in 67 cities around the world without such programs.
AmfAR’s issue brief on harm reduction cites a New York City case study: “New York City has the nation’s largest population of injection drug users — an estimated 150,000 to 175,000 people, twice as many as the next largest urban population of IDUs. In 1992, SEPs received legal authorization and public funding from New York State to help control the HIV epidemic among IDUs and their partners and families. As a result, the incidence of new HIV infections fell from 4 percent per year in 1990-1992 to 1 percent per year in 1999-2002, and the percentage of drug injectors in the city who were infected with HIV fell from 50 percent to 15 percent.”
The CORNER Project office on 176th Street and Wadsworth Avenue has a neighborly appeal. Photography is not allowed inside the office because the organization protects the privacy of the participants and doesn’t even ask their names, only their initials.
On a sunny weekday morning several homeless people are sitting enjoying coffee, three people talking cheerfully as a fourth person walks in and becomes the focus of discussion. “So why did they take you in this time?” “When did you get out?” Worn clothes are a telltale sign that all four men may be homeless. As the newcomer answers questions about his latest time in jail, the discussion moves back to the original topic: their frequency of drug use, without any inhibitions about who might be listening.
Just to the south of the George Washington Bridge, a small patch of grass and bush is a hot spot for drug users, says Michael, sometimes known as Highway Mike. Mike admits he also has a drug problem, but he says he isn’t into injecting drug. Tom, a tall lean man with long wavy hair and a weary face stands with Harry on the green patch, looking restless and lost. Tom and Mike say they felt unsafe while sharing needles, “but it was tough to get a new needle every time.” New York State Law allows purchase of up to 10 needles without a prescription under the Expanded Syringe Exchange Program, but buying needles at pharmacies was too open, Tom says. “It could easily lead to being hassled by the cops.”
In 1988, Congress banned federal funding for programs that distributed sterile syringes for illicit drug use. But needle exchange was never illegal under New York State law, Favaro says. She receives all her baseline financing from New York State and New York City public health departments. Former Gov. David Paterson signed a bill in August that integrated public health law with penal law, so that a needle exchange participant cannot be charged by the police if he or she is found in possession of a needle with traces of illegal drugs. Before the governor’s action, it was legal to carry a syringe without a prescription, but program participants were vulnerable to police harassment.
Needle exchange goes beyond harm reduction for the participants. Favaro says that for every new needle received, a participant is required to bring at least one used needle for safe disposal. “In other programs the ratio of returned needles to new needle is generally 100 percent,” she says, adding, “Very rarely does it fall below 80 percent.” This aims to reduce the number of used, infected needles disposed of unsafely.
Favaro refuses to provide exact statistics for CORNER Project, saying “it can be an inflammatory comment.” But she says that a minimum of 550 to 600 transactions from her organization every month mean that at least 550 to 600 used syringes are disposed of safely. “Sometimes people bring back containers of used syringes,” which may be syringes the participant has used or has found in public places.
But safe disposal has hardly become universal. A walk over the rocks in Highbridge Park, less than three blocks away from Favaro’s office, reveals needles scattered around and easily accessible to any curious children, who can be seen playing just a few yards away.
Both Tom and Harry insist that they don’t dispose of used needles unsafely. Highway Mike also guarantees that most of his drug-using friends now save the needles to exchange for new ones. But the green patch where they’re standing, smaller than half a basketball court, is full of tell-tale signs of drug use — a forgotten jacket, empty bottles of cheap whiskey, beer cans and human feces. On a weekend when none of the homeless were around, at least seven used syringes could be easily found.
Favaro says a team from her organization often goes to parks where intravenous drug users hang out to pick up used needles for safe disposal. “Prior to this agency,” she proudly says, “there was no proper disposal.” Yet she adds, “We don’t have enough staff for a large geographical area.”
Not having enough resources is one of the main challenges for needle exchange programs, she says. Government funders cut the CORNER Project’s budget by 8 percent last year. “We had to cut down a case manager” who was responsible for referrals and treatments for the participants, she says.
The CORNER Project also provides other services to the homeless like counseling, HIV tests, peer discussions and overdose prevention. “We engage the marginalized,” Favaro says.
Mike, Tom and Harry share their admiration for Favaro and her team. Mike says he is always touched by the compassion of the people at the organization’s office. “They are always so warm.”
“They are really doing great work,” Tom agrees.
Harry, clearly touched by all the help he has received from Favaro’s team adds, “May God bless her, always.”