News & Blogs History of Health: Needle Exchange in San Francisco (1 Viewer)

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Taken From: http://sfaf.org/client-services/syringe-access/history-of-needle-exchange.html

Throughout the history of HIV/AIDS, there are many moments that stand out as bold acts of courage that forever changed the course of the epidemic. Syringe access in San Francisco is certainly at the top of the list.

The city’s first needle exchange program began in the city in 1988 when a group of people recognized they needed to do something to stop the spread of HIV among people who inject drugs. Acting against the law, they created Prevention Point—an all-volunteer, street-based operation.

The program provided sterile syringes as well as other safer injection supplies such as bleach, cotton and alcohol wipes. It also offered condoms and referrals to drug treatment programs and social services.
needle-exchange-historical-crouching-309x487-jpg.47445_History of Health: Needle Exchange in San Francisco_Staying Healthy_Squat the Planet_11:31 AM


At the time, Californians were not legally permitted to possess syringes without a prescription. So in the beginning syringe access operated as an act of civil disobedience. The founding members of Prevention Point were willing to take that risk to save lives, and in doing so they created a legacy of better health on the streets of San Francisco.

“What was started by Prevention Point continues to serve as a model for the San Francisco AIDS Foundation syringe access services program today,” says Pauli Gray, lead HCV linkage coordinator for the foundation. “By actively engaging users in the intervention process, we hope to compel them to examine the health risks of injecting drugs—and the underlying reasons for why they do it in the first place.”

For nearly four years, Prevention Point operated totally underground. Volunteers actually used a baby carriage to transport sterile syringes to neighborhoods that needed them most. They partnered with researchers and collected data to document health benefits of syringe access and its power to stop the spread of HIV.

In March of 1992, under the leadership of then-Mayor Frank Jordan, the City of San Francisco declared a public health emergency and committed $138,000 to Prevention Point. It was a bold statement from the city’s top elected official and became the first step toward the creation of a comprehensive harm-reduction programs that include syringe access and other prevention tools.

“The actions that San Francisco took back in 1992 to move toward the legalization of needle exchange cannot be understated,” said Gray. “That was 20 years ago, and still in some California counties today people who operate syringe access programs face arrest for trying to distribute sterile syringes. San Francisco truly was a leader in this effort.”

In the years that followed Mayor Jordan’s emergency declaration, syringe access became an integral part of HIV prevention in San Francisco, and adapted to better meet the needs of participants and most effectively reduce new HIV infections.

When the program began, people were provided with 10 syringes with a one-for-one exchange above the 10 returned. In 1990, participants were allowed to access 20 syringes at one time instead of 10. In August of 1990, all limits on the number of syringes that could be accessed were lifted (with limitations only based on program resources). Now, the program (which became part of San Francisco AIDS Foundation in the early 1990s) operates on needs-based access. Participants are encouraged to safely return used needles with each visit and tell staff how many syringes they need. They are not limited to one-for-one exchange.

“If you don’t want people sharing equipment, you have to give people adequate supplies so that they never have to share,” said Terry Morris, director of the 6th Street Harm Reduction Center at San Francisco AIDS Foundation. “When people save their syringes for reuse, because of scarcity, they’re more likely to loan them to someone else. If they immediately throw used syringes into a sharps container for disposal, because they’re not worried about scarcity, they’re going to be safer.”

Research shows that not setting pre-determined limits on the number of syringes people can access makes it less likely that people re-use non-sterile or dull syringes on themselves and also reduces syringe sharing. Participants also leave each visit with enough safe disposal containers to return all used syringes safely.

“You also have to think of people’s real needs in terms of the injecting that they do,” Morris said. “For some people, depending on the drug you’re injecting, you might need multiple syringes in one day. If you give people pre-determined limits on the number of syringes that they can get at once, people may reuse syringes and use other people’s syringes, which makes it more likely they’ll get abscesses, damage their veins and circulatory system, and be at risk for bacterial infections.”

An evaluation of Prevention Point was conducted in 1992 as reach and distribution efforts were growing. The study found that the percentage of people who reported sharing needles fell from 66% in 1987 to 36% in 1992. In addition, participants who used Prevention Point services were significantly less likely to share needles than people who reported not accessing these services.

HIV rates during that time dropped too: The number of new HIV cases among people who inject drugs reached a peak in 1992 with 212 new infections, and dropped by half to about 100 new infections in 1998.

Syringe access services at San Francisco AIDS Foundation and has since grown into one of the nation’s largest syringe access programs, and now offers an expanding menu of services to participants.

syringe-access-sharps-box-250-463-jpg.47446_History of Health: Needle Exchange in San Francisco_Staying Healthy_Squat the Planet_11:31 AM
Each year, the San Francisco AIDS Foundation team distributes sterile syringes at nearly a dozen different sites across San Francisco to stop the spread of both HIV and hepatitis C. The program also offers hepatitis C and HIV testing and linkage to care, overdose prevention and education, homeless outreach, opioid replacement therapy, easily accessible medical care, support groups, and more. Safe disposal and cleanup are integral to the work too, and in 2017 staff and volunteers committed 20 hours per week to cleanup and disposed of 11 tons of medical waste.

“We’ve brought services and partners to a place that’s familiar and welcoming and part of the fabric of people’s lives already,” said Morris, the director of the 6th Street Harm Reduction Center. “Syringe access is incredibly important—it’s a lifesaving intervention—but what we’re really doing is building relationships. And setting the stage for participants to connect with information and education, low-threshold services, and to peers and other people that care about their health.”




Black & white photos copyright Gary Wagner (garywagner.com)

Have you had a positive experience with our syringe access program? Considered volunteering as an exchanger? Or did you just appreciate this perspective on our work? Comment below to let us know!
 
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SlankyLanky

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the city that ill always call home just recently opened its first needle exchange along with now having narcan available. this shits important and really a life saver for anybody struggling with addiction.
 

Tude

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the city that ill always call home just recently opened its first needle exchange along with now having narcan available. this shits important and really a life saver for anybody struggling with addiction.
yeah we've had the needle exchange, city is looking into safe places to actually shoot up - but I doubt that will happen here. However narcam is available - I am certified through college to administer (nasal) and carry at least 3 narcam kits with me at all times. Talking with the Faculty Union and there is interest in having all our Faculty prepped and propped with narcam. Had a kid OD a month ago in the bathroom on the first floor - before his first class.
 

SlankyLanky

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yeah we've had the needle exchange, city is looking into safe places to actually shoot up - but I doubt that will happen here. However narcam is available - I am certified through college to administer (nasal) and carry at least 3 narcam kits with me at all times. Talking with the Faculty Union and there is interest in having all our Faculty prepped and propped with narcam. Had a kid OD a month ago in the bathroom on the first floor - before his first class.
thats great yer certified to administer it, also super positive the staff is interested in being prepared. thats fucking awful about the kid ODing.
 

BusGypsy

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I want to understand. Like I said in another thread...
I feel somewhat mixed about these, tbh.
On the one hand, definite YAY for hard reduction.
But tweakers and heroin addicts are getting really bad here. They leave needles everywhere. They smash and grab homes and cars to feed their addiction.
I think those drugs are just so gross, it's really hard for me to imagine how anyone could think trying them is a good idea. But I also have loved ones who've recovered. I just can't imagine why anyone would even try getting into that stuff. And why should I support it if it leads to more needles?
I kind of feel like proponents of needle exchanges should be cleaning up needles left around.
I wonder how much enabling a dirty habit is a good idea when it seems like it just encourages it. A Needle Exchange pops up, all the needle users flock to it, and suddenly there's more needles around.
 

ScumRag

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I want to understand. Like I said in another thread...
I feel somewhat mixed about these, tbh.
On the one hand, definite YAY for hard reduction.
But tweakers and heroin addicts are getting really bad here. They leave needles everywhere. They smash and grab homes and cars to feed their addiction.
I think those drugs are just so gross, it's really hard for me to imagine how anyone could think trying them is a good idea. But I also have loved ones who've recovered. I just can't imagine why anyone would even try getting into that stuff. And why should I support it if it leads to more needles?
I kind of feel like proponents of needle exchanges should be cleaning up needles left around.
I wonder how much enabling a dirty habit is a good idea when it seems like it just encourages it. A Needle Exchange pops up, all the needle users flock to it, and suddenly there's more needles around.
In theory it works, so just hush up. Hahaha!
 

BusGypsy

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In theory it works, so just hush up. Hahaha!
I don't follow. If I'm finding needles everywhere, and risk getting stabbed because someone has a disgusting self destructive habit, it's not really working.
 

SlankyLanky

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I want to understand. Like I said in another thread...
I feel somewhat mixed about these, tbh.
On the one hand, definite YAY for hard reduction.
But tweakers and heroin addicts are getting really bad here. They leave needles everywhere. They smash and grab homes and cars to feed their addiction.
I think those drugs are just so gross, it's really hard for me to imagine how anyone could think trying them is a good idea. But I also have loved ones who've recovered. I just can't imagine why anyone would even try getting into that stuff. And why should I support it if it leads to more needles?
I kind of feel like proponents of needle exchanges should be cleaning up needles left around.
I wonder how much enabling a dirty habit is a good idea when it seems like it just encourages it. A Needle Exchange pops up, all the needle users flock to it, and suddenly there's more needles around.
Ok uh...you thinking those drugs are gross isn't going to stop people from using. Needle exchanges and places making narcan available saves lives. Straight up. You should support it because users sharing needles means people who have diseases like hiv and hep c could be sharing a dirty needle if there isn't a place to get a clean one. Do I think a needle exchange is going to end this issue outright? Of course not, but any step in the right direction is progress so yea I say yay for harm reduction.

And sure I agree, nobody likes seeing dirty needles laying around, maybe you could do something about it by volunteering and cleaning up yer own community so there's less needles around. Talk is cheap ya know? If yer tired of seeing dirty needles laying around do something about it.
 
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BusGypsy

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Ok uh...you thinking those drugs are gross isn't going to stop people from using. Needle exchanges and places making narcan available saves lives. Straight up. You should support it because users sharing needles means people who have diseases like hiv and hep c could be sharing a dirty needle if there isn't a place to get a clean one. Do I think a needle exchange is going to end this issue outright? Of course not, but any step in the right direction is progress so yea I say yay for harm reduction.

And sure I agree, nobody likes seeing dirty needles laying around, maybe you could do something about it by volunteering and cleaning up yer own community so there's less needles around. Talk is cheap ya know? If yer tired of seeing dirty needles laying around do something about it.
The drug IS gross. Nobody should be doing those drugs.
I dislike saying "always" or "never", and I don't like telling people what to do.
But for me at least, that's a no go, a no man's world. That turns people into zombies.
Not anything I want to enable in any way. I don't see any excuse for people not wanting to get clean.
And ha, no, I'm not going to SEEK out needle so I too can get pricked with their wonderful diseases.
 

SlankyLanky

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The drug IS gross. Nobody should be doing those drugs.
I dislike saying "always" or "never", and I don't like telling people what to do.
But for me at least, that's a no go, a no man's world. That turns people into zombies.
Not anything I want to enable in any way. I don't see any excuse for people not wanting to get clean.
And ha, no, I'm not going to SEEK out needle so I too can get pricked with their wonderful diseases.
Couldn't agree more that nobody should be doing those drugs, but people do and anything that reduces the risks to people's lives is a good thing. Addiction isn't a easy thing to overcome and needle exchange programs more often then not also offer help to people who are struggling.

Fair enough that you don't want to be part of making yer community a safer place for everyone. I understand not wanting to clean up after other people, but the simple fact is people are going to use needles with or without them being clean.

Congrats on yer loved ones recovering though that's super positive!
 

BusGypsy

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Fair enough that you don't want to be part of making yer community a safer place for everyone. I understand not wanting to clean up after other people,
Nice passive aggressiveness with the wording there. I totally don't want to make the world a better place. Right.
I do pick up trash in my community. Often. I do want my community to be safer. Not wanting to risk myself to HIV (like so many intravenous recreational users seem ok with) is different.
 

SlankyLanky

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Nice passive aggressiveness with the wording there. I totally don't want to make the world a better place. Right.
I do pick up trash in my community. Often. I do want my community to be safer. Not wanting to risk myself to HIV (like so many intravenous recreational users seem ok with) is different.
I wasn't being passive aggressive at all. I genuinely understand not wanting to pick up dirty needles. But I appreciate knowing the kind of people who don't see places like this being important.
 

BusGypsy

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I wasn't being passive aggressive at all. I genuinely understand not wanting to pick up dirty needles. But I appreciate knowing the kind of people who don't see places like this being important.
Dayum. You are friendly. The wording just seemed very sarcastic.
That's why I brought it up; I DO think it's important. Damn I'm for harm reduction. My confusion is if the user is using these horrible drugs, how much harm are we really reducing? And are these needle exchange places attracting users, and does that in turn lead to more needle litter?
Part of me wants to say Needle Exchange in every community, for everyone.
But part of me is Damn, this drug is BAD, and seems to ALWAYS lead to bad things like theft, property damage, etc. People breaking into cars and stuff to afford a fix.
I've seen heroin users. I've seen tweakers. They're all over town. Screaming outside of Jack in the box, a needle in hand, or breaking windows and stealing people's guitars or bags to buy drugs, or leaving needles in bathroom sinks.
 

SlankyLanky

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Dayum. You are friendly. The wording just seemed very sarcastic.
That's why I brought it up; I DO think it's important. Damn I'm for harm reduction. My confusion is if the user is using these horrible drugs, how much harm are we really reducing? And are these needle exchange places attracting users, and does that in turn lead to more needle litter?
Part of me wants to say Needle Exchange in every community, for everyone.
But part of me is Damn, this drug is BAD, and seems to ALWAYS lead to bad things like theft, property damage, etc. People breaking into cars and stuff to afford a fix.
I've seen heroin users. I've seen tweakers. They're all over town. Screaming outside of Jack in the box, a needle in hand, or breaking windows and stealing people's guitars or bags to buy drugs, or leaving needles in bathroom sinks.
None of the bad stuff addicts do has anything to do with the fact that having access to clean needles is a good thing. People are going to shoot dope. Having access to clean needles and possibly counseling is a good thing. It's kinda hard to argue against that especially if your had loved ones who overcame their addiction like you said you have.
 

BusGypsy

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None of the bad stuff addicts do has anything to do with the fact that having access to clean needles is a good thing. People are going to shoot dope. Having access to clean needles and possibly counseling is a good thing. It's kinda hard to argue against that especially if your had loved ones who overcame their addiction like you said you have.
It's great they recovered. Like I said, I'm conflicted about the whole thing. Giving away needles just doesn't seem like how to get rid of the problem.
 

BusGypsy

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Blllaaargh insert throwing hands up in frustration.
 

SlankyLanky

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It's great they recovered. Like I said, I'm conflicted about the whole thing. Giving away needles just doesn't seem like how to get rid of the problem.
Giving away clean needles is quite possibly the best way to prevent people being in a situation where they might have to share a needle with somebody they may or may not know putting themselves or the other person at risk for hiv or hep c or a nice fun staph infection. It doesn't stop people from using needles, but it does reduce the risk of these diseases being spread. And that's positive as fuck.
 

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