july 2001 OITM - 11 Needle Exchange in Vermont t BY MARK MELCHIOR A couple of years ago, Vermont lawmakers passed legislation opening the door to needle exchange in our state. The decision couldn’t have come too soon. The demographics of HIV and AIDS have shown consistent- ly that injection drug users (IDUS) are at high risk for contracting and spreading HIV through shared needles, syringes and other injection supplies. Despite this knowl- edge and the success of nee- dle exchange elsewhere, Vermont has been slow to enact such prevention meas- ures. Nevertheless, after over- coming other regulatory hur- dles, two needle exchange sites have opened recently, one inBurlington and a sec- ond in Brattleboro. OITM wanted to find out how things are going with these fledgling programs. .We decided to check in with Tom Dalton, coordinator of the Green Mountain Needle Coop for the Howard Center for Human Services in Burlington, and Lynn Martin, 'a prevention pe 3 ia—l-ist--~-vi;-lie V--oversees A the attlebUro“site ‘for the‘“AIDS‘ Project of Southern Vermont [APSV]. We caught up with Tom and Lynn on a cloudless summer afternoon in Barre, at the recently renovated Alrich Public Library. Getting Connected OITM‘ Let’s start with your program, Tom, since it has been in place a little longer. If I needed to get clean nee- dles, how would I do that in Burlington? Tom Dalton: You’d proba- bly begin by calling us.» We have an outgoing message for our site with the time and place of thenext exchange. We do print this information in our newsletter and other hand-out materials, butHwe’ve tried to be low-key about pub- licity. If you haven’t seen any of our literature, you should call and listen to our message. We are what is called a mobile, multi-site needle exchange andthat means that the time and place varies week to week. OITM‘ So let’s say I’ve called the number, gotten the information, and now am walking in the door at the exchange site, what can I expect? TD: Well, it’s very infor- mal, very low key. There are no lines to wait in. There are usually only one or two peo- ple exchanging at any one time. Usually, two staff peo- ple are on hand to welcome you. We ask you, first, if you _ have any needles, or other supplies to dispose of. If you A‘ do, you dispose of them first, in the sharpscontainer. next to_ the door. . .. -» . If you are new to the “site; we explain to you that your identity is. kept confidential 'Ja”nd...anonymous. Then we ask you about what you need. Some people come just to pick up literature, or get infor- mation from us. If you come to exchange needles, we take time to answer any questions you might have about them or other supplies, and explain how to become a member of the needle exchange. OITM.‘ Whats involved in becoming a member? TD: If you choose to become a member of the nee- dle exchange, and pretty much everyone does, you get an l.D. card with a unique identifier. That card protects you against violating the para- phernalia law. D After people get ‘their cards, they usually want to look around, at the supplies we have, and ask questions. OITM‘ It sounds as if you correctly. They may know not 5. N (3 hr 0 3 or supplies? _ TD: Yes, we do. And you know, many people don’t really know how to use them to share a syringe, but they don’t know that sharing a cooker, for example, puts them at risk, too. Heroin use in Vermont has grown so rap- idly over the last couple of years that a lot of new users ‘ are not necessarily learning from experienced users. As a consequence, there is a lot.of misinformation and ignorance out there. Some users don’t know that when they stop using, they will experience withdrawal. OITM.‘ Lynn, let’s talk about what happens at the Brattleboro site. LM: Well, it actually is very similar to what ~Tom described except that - the Brattleboro ‘site is open two ‘evenings a week at a fixed-I site. It is very informal,‘ anonymous and ep_n__fidential.., .[ thing you may h‘ave.-—brrou.ght~:~.. to exchange in our -sharps container at the front door. We ask you how we can help, and then enroll you as a mem- her, if you agree, and issue your card. tAs Tom said, almost everyone wants to. become a member, and it’s’ , truly in your best interest to have the card. I When we were just getting started, I filled a bag full of the things that we were plan- ning to have on hand at the site, and took it to the police. I met with the assistant police chief, and dumped the bag’s contents out onto his desk and said, Now if youpicked me up and found this stuff on me, would you arrest me for pos- sessing any of these things? He assured me that as long as I had the card from the needle exchange with me, that the police wouldn’t. I should also mention that - the Brattleboro exchange has peer educators on hand. They ' tend to be able to put people at ease very quickly. These are folks who have been there and know what folks who come through the door are experiencing. OITM.‘ Since it’s called a needle exchange, do you actu- ally exchange needles one- for-one? LM: We do exchange one- for-one but there is nothing in the guidelines to forbid other ways. If you are new, and Photo: Brad Lussier‘ don’t I have nythmg to exchange, we‘ will give out up to ten-.ne'e_dles .to_s'tart,.._ We . Y..9.u». ~."~..<.9..r..r.n.-.ira...td_i$e9,ss.atl.an;¥a...;ahe‘P P°'°P‘° Wheremy 3” it’s never: 'b‘een"‘a'bo_utA‘a strict one-to-one exchai1fige‘.i"_'_' WI" ' wouldn.’t want the 2 responsli- bility of turning _fs'omeo_ne away for not having needles. And, of course, you don’t‘ have to exchange needles to come to the exchange. You can come and ‘get condoms, or find out about Hepatitis, or get referrals for treatment. You may want justito talk with a peer educator about whatever is going on,in your life. I Harm reduction: What does it mean, How does it work? 0ITM.- Let ’s talk a little bit about the theory behind nee- dle exchange? The folks who ‘brought us the ‘drug wars’ would say that if we give nee- dles to users then we are encouraging people to be addicts. Obviously, you don’t believe that. Tell us why. LM: My priority is to pre- vent HIV. That’s my job, to keep people free of this virus. We who work on prevention [at the AIDS Project of Southern Vermont] practice what is called harm reduction. It involves asking the folks we serve — and we serve a number of different kinds of people at risk for transmis- msuu wrr NEEDLE ,dl_es.__ that we can start a conversa- . hat is firststep you can take, toward health? What are the too1s_you need to make that» step’? A:n‘d,'~i:how can we support you in ‘that? "i'"If'ithey tell us that what they need is clean needles, we help them to get clean nee- From there, we hope tion so that they feel comfort- able coming to us when they V have .identified other ways that they can be healthy. Basically, my job is getting. people to take care of them- selves so that they can live healthier lives. _ TD: I agree with every- thing Lynn said. Harm reduc- tion focuses on those at risk making the best choices that they can about their health, and reducing drug-related harm. This approach differs from the use of law enforce- ment and some abstinence- based treatment which can focus simply on stopping drug use at all costs. When your sole goal is to end someone else’s drug use, you may end up putting that person, and the general public, at greater risk, because the user may not be able realistically to stop using drugs at the moment, and relapse or overdose. OITM" So you both look at needle exchange from an HIV prevention perspective. TD: Right. Just because someone is using injection drugs, it doesn’t mean that he or she is not concerned about their health. They know that there are steps they can take _ toward being more healthy.