In this session, we will hear Leon Golson and Nicole Adelman talk about the needle exchange and syringe exchange programs sponsored by HARC, our HIV/AIDS resource center here in Michigan. Syringe and needle exchange is almost always part of a larger harm reduction program. The core idea of the harm reduction approach is that people may not be able to completely stop doing self-destructive things like taking drugs. But they can be helped to, to do less harm to themselves. An example is injecting oneself with a clean needle and syringe rather than ones that carry HIV. Needle exchange has been particularly controversial in the United States. Federal funds could not be used to support needle exchange programs between 1988 and 2009. The programs are less controversial in many other countries. Both Nicole and Leon describe their needle and syringe exchange program as part of larger efforts to offer drug user, users counselling, HIV testing, treatment, and information. When I was preparing these excerpts of my conversations with Leon and Nicole, a new issue of Science Magazine came in the mail. It was a special issue about the successes that Australia has had in combating the HIV epidemic. One of the main articles was about how their harm reduction approach has worked as it applies to intravenous drug users. This session concludes with a video about harm reduction in Australia. We haven't talked about the HARC van and the needle exchange programs. Why don't you fill us in on that? >> Yes. Yes we do have a mobile unit that we take around and offer all of our service on. And we just got a new one so we're really excited about it. And it has our signage on it and everything and we have specific stops in the Ypsilanti Ann Arbor area. And in Ann Arbor specifically, we conduct the syringe access program at the one stop there. But a person can also get tested for HIV. If a person is ready to get into treatment for their substance abuse, we'll help facilitate that process. We also work in conjunction with the county health department, Washtenaw County Public Health Department, at sites in our, in Ypsilanti to offer immunizations STD screening, and enrollment into Medicare. So or Medicaid. I always get those mixed up. >> Medicaid. >> Medicaid. >> Yeah. >> So our unit is very well known very well received in the community and it's been a great tool to actually take our services to community members versus waiting them to come to us. So that's the best part. >> And have you encountered some hostility, especially with the regard to the syringes? >> No, nothing current. >> Good. >> There's been a little history with the old van that we had. One small city, close to Ypsi, was reluctant to have van services continued. So we had to discontinue the services in that particular city. But since then, no negativity. Actually we're working people, wer, we're working closely with the Washtenaw County Sheriff's Department. And we're going to get ourselves positioned to offer them some overdose prevention training. >> Mm-hm. >> So that's in the works. That's going to be coming up very soon in this summer. So so far so good with our mobile unit. >> Good. >> Yeah. >> Good. Tell us about your work in the needle exchange area. >> You know, that was interesting for me because I I almost didn't apply for the job at HARC because you had to do work with substance abuse and I didn't know what that meant. And I thought it meant just telling people not to drink and not to smoke and I wasn't interested in that. And I ended up applying anyway, obviously and getting the job, and realizing that oh no, substance abuse is a whole different thing. I mean it's a, it is all those things but it's, it, it could fit my approach which is more of a harm reduction approach and not just, just like sex. Don't drink, don't smoke, it's not about that. It's about, if you're going to do that, how can you do it and be safe? And so injection drug use is really stigmatized in our society and the needle exchange allowed us to reach a group of folks who had nobody to go to. Couldn't tell, couldn't tell people that they were injecting drugs. And it allowed us to help them, you know, be safer if they were injecting. Have in, have access to treatment if they needed it, testing, and, and lots of other resources. >> Let's be more specific. You had a van. >> [LAUGH] Oh yeah. >> And you took and, and you drove the van to different locations. And in the van you had clean syringes and needles. Is that right? >> Yeah. >> And how would it work? >> So, I mean, it was actually quite political. We had to get approval in every community we did it. Not only in you know, we had to get approved for the city of Ann Arbor and Ypsi and Ypsi Township and not everyone approved it. But also this specific place you were going to park the van, and we had to be at the same place at the same time, so people knew where we were going to be. So we would park the van, we'd spread the word that we were going to be there. And then so if somebody came, and at the time, I think it's a little bit different now, but at the time, they brought us 20 used syringes. They would drop them in the drop box and we would give them 20 clean ones. Brand new clean ones, we wouldn't, you know, clean their old ones. We would give them fresh ones and, and anything else they needed to go along with that. So alcohol swabs to make sure that they were had cleaning their injection site. Or hydrogen peroxide or just different things that they needed to inject safely. And education, so we would talk about, you know, if you're with a bunch of people, you inject first. So if you're going to to share needles, if you have no other choice, the best way to protect yourself in that situation is you inject first and then give the needle to somebody else. Now of course, if you tell everybody that and everybody does that, then maybe there's less sharing of needles. But it's just different ways to get people to understand the risks. And it wasn't just HIV, but hepatitis C, abscesses, you know, using needles over and over again and getting an infection, things like that. >> What percentage of the people were interested in your message, do you think, and what percentage just wanted the needles? >> I think they were all interested. >> Really? >> To be honest, totally honest, I think they just wanted the needles, and they can't talk to anybody else about this. They don't tell, they don't go to their doctor or talk to their doctor. And not everybody was, you know, people have this picture of injection drug users. I mean, we have people that were going to work and injecting drugs. They're not, it's not just, you know, homeless people on the street. It's not. People have a stigma around all that. But people injecting drugs are across the spectrum, but can't tell anybody that they're doing it. So any information that we can give people, I think people are starved for health information. This is, I mean this is why I would do what I did, because they want this information and are afraid to ask for it, or nobody will talk about it with them. >> You used the expression harm reduction and we've heard it before. Tell us a little bit more about that and define it as best you can for us. >> So harm reduction is really about reducing harm. I mean, it's pretty simple to say anything we can do to reduce your risk of harm related to your drug use. Or, in, usually it's related to drug use, but you could say harm reduction around sex. Usually it's called risk reduction around sex, but. So what I said for example, in, if you're in a room and you're all going to share an, the same needle, you injecting first. That reduces your, the harm potentially related to the drug drug use. So, it's very different from don't use drugs it's bad for you. It's a much more realistic approach of saying okay you're using drugs, and maybe someday you wont want to or maybe you'll use less at some point. Or different drugs that are less harmful or less risky. But let's figure what, how to protect you right now. >> Did your change, did your view of addiction change as you, tell us about that. >> Well,. I guess I should correct that. I don't know if my view of addiction changed but I thought the only response to addiction was, just recover period. Recovery, abstinence only, period. I didn't understand that there was a harm reduction philosophy that said, if you're addicted that there are ways to reduce risk. And I think I didn't, I guess I didn't understand it at the time as a as a medical, neuropsychological issue, you know. It's, there's science behind addiction as a, as a disease, right? As a as a chemical reaction in your body. So, I think people just think it's, you know, you just use drugs and you can't stop. But that doesn't happen to everybody, right? So, I think there's a lot we don't know and we don't talk around addiction. >> I think that the emerging view of addiction is that it's a brain disease. But we have a long way to go in terms of accepting that in our culture. >> Mm-hm. >> But we also don't accept mental health. >> That's right. >> That's an issue in our culture, so. >> That's right. Did you encounter as, as a needle exchange person, an educator did you encounter much hostility from people who felt that you were encouraging drug use? >> Absolutely. >> How did that happen? I mean I think, again, I think the majority of, of folks in our community who are vocal about it, so this is the problem, are are really abstinence only, abstinence based. And I think there's value in that position, just like in sexual, in sex education. There's value to abstinence, just then at appropriate times. Also we can get into this with the age issue. You know, it's, it's age appropriate to talk about abstinence when you're talking to younger kids. You know, but at a certain point, when people are using drugs or when people are having sex, it, it doesn't hold the same value to just say don't do it or this is the only right way. So I think a lot of people aren't exposed to this idea of harm reduction and, and that it's not encouraging people to do it. People are doing it anyway. It's, it's meeting people where they're at, and then being there for them when they're ready to change. If they're ready to change. >> One last question about the needle exchange. Did you get, ever get into a situation which frightened you? Where, where you thought you, you were at risk? >> Never. I mean I, you know, I think we were really careful. We talked about that a lot and we prepared for it. We made sure that we had training and, you know, knew, everybody knew where we were. And, I think there was a lot of safety precautions that we took. I also, I did feel like the community knew that we were there to help them. So I don't feel ever like they, that we were at dan, in danger for the people we were helping. I don't think, I think we were truly seen as coming into the community to help.
