Pioneering Needle Exchange Keeps Saving Lives

George Bucheli prepared a bundle of supplies for the woman who approached the van: needles, cotton filters, antiseptic. He reached into the supply cabinet to add an injection cooker, but she didn’t want one. ​“Leave that for the people who actually need it,” she said.

Bucheli and Ambritt Myers have helped drug users trade in thousands of used syringes for clean ones during 23 years spent running the city’s Syringe Exchange Program’s outreach van. Every Tuesday from 2 to 3:30 p.m., they park the silver vehicle behind McDonalds on Grand Avenue and Ferry Street in Fair Haven and wait for clients to come to them.

The mobile program also sets up in Westville, Dixwell, and the Hill neighborhoods, in total making four stops on each of three days a week. The underlying theory: Helping users shoot up safely will help stem the spread of HIV/AIDS.

Nowadays, at least in New Haven, the needle exchange is an accepted public-health approach. When New Haven pioneered the concept a quarter-century ago, it was anything but.

State and city leaders took a long time to accept the idea, legalizing the syringe exchange nearly 25 years ago after advocates and street outreach workers lobbied fiercely between 1986 and 1990. Then, based on New Haven’s success, New York City and other communities across the country followed suit.

Nearly 25 years later, the effort soldiers on in New Haven in the face of continual challenges, as veterans reflected this week as they continued the street-level work of saving lives.

Besides a brief gap during President Barack Obama’s time in office, Congress has continued to ban federal funding for syringe exchanges, leaving individual programs to keep themselves afloat by other means.

New Haven’s health department struggles to keep its program going with limited resources. The city’s needle exchange will see a 5 percent reduction in state funding, as part of Gov. Dannel Malloy’s emergency budget cuts this month.

“We’re still looking at how to cut without changing anything,” said program supervisor Brooke Logan. Last year, 340 people exchanged 98,000 syringes over 1,500 visits, she said.

Though AIDS is no longer an automatic death sentence, the syringe exchange program is still crucial to keeping infection rates low in New Haven, especially among groups disproportionately affected by the virus, Bucheli said.

Jumpstarting The Exchange

The AIDS epidemic hit New Haven hard in the 1980s.

“People were dying around us,” Bucheli said. ​“Me and my partner kicked into survival mode.” They sought out underground groups in the gay community that were carrying out their own informal syringe exchanges and sharing information they couldn’t get anywhere else. ​“No one was taking care of us so we had to take care of our own.”

An advisory group called the Mayor’s Task Force oversaw a street outreach program in the late ​‘80s, in order to determine the trends in the virus’s spread. The data showed that they had to legislate around injection drug users.

“We wanted to decriminalize the purchase of syringes. We wanted syringe exchanges, more than one,” recalled Elaine O’Keefe, one of the founders, now executive director of the Center for Interdiscplinary Research on AIDS at Yale.

After multiple attempts, the city’s first syringe exchange program was born in November 1990 with the help of $25,000 from the state. The state money came with many restrictions.

“We wound up with a program authorized only for the city of New Haven,” O’Keefe said. To get funding for the pilot program beyond the first year, organizers had to provide the state with data on the exchange, to show that it was working and that it was not increasing drug use. Clients were allowed just five needles per visit.

They had to be creative to get the data they wanted.

Today’s syringe exchange program does not look vastly different from its earlier iterations a quarter of century ago, said Robert Heimer of the Yale School of Public Health. Staffers test for and prevent the spread of blood-borne diseases like HIV and hepatitis C, and provide treatment and medical care for those who want it.

“The program was designed to reach people at risk because they inject drugs … and are at risk for a range of negative consequences,” he said. ​“It was designed to meet people where they’re at.”

Heimer worked with Yale School of Medicine Professor Edward Kaplan to create a method of tracking the rate of HIV infection. Testing people would be a difficult process — the stigma of the disease would prevent people from agreeing to the test, and New Haven was too small to serve as a sample population.

Instead Heimer and Kaplan decided to test the syringes themselves, ​“the vectors of the disease.” Using data from the first eight months of the program, they found that ​“the likelihood of encountering an infected syringe dramatically reduced by a third.”

Over a three-and-a-half-year period, they found a 75 percent reduction in the likelihood of getting infected, Heimer said, ​“preventing more than $3 million spent on HIV costs.” Their data helped get the program re-funded – and changed policy on needle exchange programs nationwide.

“Be Accountable for Your Drugs”

The syringe exchange program is cost-effective, said Bucheli. He is HIV positive and takes medication regularly to keep his viral load low.

“It’s cheaper to hand out a needle … I pay $1,300 a month for 30 pills. Hep C is even more,” he said. ​“Someone’s going to have to pay to get those people treated.”

Each client gets his or her own ​“unique identifier” written on a card. The ID is the first and third letters of the first name, first and third letters of the last name, birth date, and a number to refer to gender (male, female and transgender).

Clients show the program member ID cards to police officers, if they get caught carrying syringes, which is not a crime in Connecticut. Bucheli said he has received complaints of police tearing up the card and trying to charge people anyway. But the officers who know about the syringe exchange program cooperate, bringing them used syringes for disposal.

Connecticut is also the first state to allow pharmacies to sell syringes over the counter. Across Ferry Street from the van’s stop is a Rite Aid pharmacy. Bucheli said many clients go there and are refused syringes, leading them to share unclean ones, especially at times when the van is not operating.

An Independent reporter went to the Rite Aid at 325 Ferry St. that Tuesday afternoon and asked to buy syringes. The pharmacist sold the reporter a single pack of 10 sterile, single-use insulin syringes, the most one person can buy without a prescription. The pack cost about $4.50.

When asked about the store’s policy, the woman at the counter said ​“it depends” on the pharmacy in question and the specific pharmacist working at the time. Sometimes, individuals are turned away because of ​“how they look.”

The van rarely turns people away. Clients are supposed to bring back used needles to get clean ones, in a one-to-one exchange, but sometimes they don’t, either due to forgetfulness, apathy, or fear of arrest.

Myers said she sometimes refuses to give syringes to people who routinely show up empty handed. ​“Be accountable for your drugs,” she said. ​“If we don’t turn the needles in, we don’t get funding.”

Street Cred

Both Bucheli (pictured) and Myers are in recovery from substance abuse.

“The only reason why I stopped [using drugs] was because I killed someone,” Myers said. A victim of domestic violence, she killed her daughter’s father and ended up in prison. ​“I was abused but all that comes from drugging,” she said.

Myers said she knows firsthand what its like to ​“manipulate” and lie to get more cocaine, and she can tell when her clients are doing the same. At the same time, she said she is never ​“judgmental” of the people she works with.

“Those are their choices. Our job is to make sure they do it safely,” she said. ​“A lot of people are judgmental in this business and it kills me. You don’t wake up being an addict.”

Plus, she said, clients trust her more when they know her history.

“It gives you…what’s it called?” Myers said, searching for the right phrase.

“Street cred,” Bucheli responded.

“That’s right. Street credit.”

But the syringe exchange is ​“not just about the needles,” Bucheli said.

They give out food, clothing, and condoms. They refer people to treatment programs, if they want, as soon as they want. Sometimes people come — hungry, homeless, abused — just wanting to talk. ​“We do our best to meet their needs,” he said.

On Wednesdays, they make home deliveries. The Wednesday before Thanksgiving, they prepared to bring 20 bags of groceries and several turkeys to clients’ homes, along with syringes to exchange.

Rates of HIV have gone down overall. But the infection rate has ​“skyrocketed” among young men of color who have sex with men, Myers said.

Today’s young men engage in risky behavior, such as unprotected sex, because ​“a lot of them didn’t see like I saw, someone dying every other day. Sometimes I think I have PTSD,” Bucheli said. When antiretroviral treatment became available in 1995, ​“people started living. HIV didn’t define you.”

After Bucheli’s partner died last September of hepatitis C complications, Myers supported him. ​“If it wasn’t for her, I would have killed myself,” Bucheli said. She went over to his house as he grieved, ​“slapped [him] around,” and reminded him of the responsibilities he had to fulfill. ​“A year later, I’m still here.”

Myers and Bucheli worry that budget cuts will cost the program a position. They are two of four outreach workers.

With more funding, Bucheli said he would expand the van’s hours of operation to 24 hours per day. When the van is off the street, people go back to shooting up unsafely, especially at night.

Working with drug users is difficult at times, but has helped him see his own humanity, he said.

“If I want to get high, I don’t deserve hep C or HIV,” he said. ​“There are all different reasons why people get high. It doesn’t mean you deserve to get sick.”