12 » QlTl‘1 july 2001 We try to support users through their relapses and elp them get back on track again as part of an overall harm reduction strategy for. them that grows out of our concern about the transmission of HIV. ‘ 0ITM.' Has it been dtfli- cult to get people to come to your sites? LM: Users are an invisible community, they cut across all demographics and they sel- dom identify themselves as a group. How: do you get the word out about needle exchange to a group that doesn’t ever meet together, or consider themselves a com- munity? We work closely with our peer educators but they only know who they know. We don’t know how many we have yet to reach. I think we’ve had some dif- ficulty getting people to our site because Brattleboro is a small town and people don’t feel as safe or as anonymous as they might in a larger city. It takes a lot more trust and a lot of time to build that trust. OITM' Have you had bet-' . ter success in Burlington get- ting people to your site? TD: Yes, and Burlington is , obviously bigger [than Brattleboro] and maybe less threatening an environment. Plus our site has a lot of con- tact with people through the treatment side of things. That conduit has really helped us to reach people. We often get several calls a day, usually from people looking for treat- ment. Since we have a resi- dential_ component at the Howard Center, I can meet people while they are staying there, and tell them about the needle exchange, and talk about relapse prevention and overdose prevention, too. I try to take that opportunity to tell users that relapse, for many people, is a part of their process of recovery, just like someone who goes on a diet, or quits smoking. Alot of people have to quit several times before it sticks. 01 T M.‘ Maybe Oprah should host a show LM: [laughing] Tom’s right. The medical research is showing is that the process is not one where someone gets addicted and then stops. It is more likely that this person will get addicted, stop, relapse, and stop again. That seems to be the pattern. Our model of ham reduction says, we will work with you wher- ever you may be in the recov- ery process. Money and Politics (The short political history of needle exchange, and the prospects for continued fund- ing) OITM' Letis back up a lit- tle. Could the two of you tell us how needle exchange actu- ally got 0])" the ground in Vermont? TD: Well, Vermont was lucky in that it had a pre- existing law that allowed pharmacies to sell syringes: without a prescription. LM: One important begin- ning came out of a certain AIDS Awareness Day at the Vermont State House. That is the day each year when the People with AIDS Coalition, Vermont CARES, the AIDS Project of Southern Vermont and other HIV/AIDS service organizations present their needs and concerns to the leg- c islature. Part of the conversa- tion that particular day involved Howard Dean. At some point, one of the many folks who had been advocat- ing for needle exchange asked Dean point-blank f he would support needle exchange in Vermont,“ and he said that he would. .From there, a group of people worked with the legislature to expand the then current law to allow AIDS service providers and hospi- tals to distribute injection supplies, and that’s where we started. _ ‘ 0ITM' In terms of support, the Vermont Department of Health supervises your exchange programs but does not fund them. Who does? TD: Most of our support in Burlington comes through private donations and from money that the Howard Center for Human Services, the sponsoring agency, ‘scrapes together from funds not already tied to other pro- grams. 1 LM: The AIDS Project in Brattleboro received a gener- ous grant from a private foun- dation to start. I’m not sure that we will be able to reap- ply, and so future funding is not guaranteed. At this point, Vwliilacle 802~8.59-1230 A MetlhadoneAAdvocates I n1 lpeiél :01 ’ ;§.we do not have the numbers on the . books yet_ ,;th~,atr"will_ qualify us for further funding. We compete with places in 9;‘ Miamiand San Francisco for funds so you can see what we are up against. TD: Neither of our needle exchanges get any federal, state or local money. In most places, that is not the norm; - these sites are supported by state and local government. If these sites are to continue and to be successful, we are going to need to have state and local support, too. What is success? OITM.' How do you meas- ure success in these kinds of programs? And does. your view of success match the views of your potential fund- ing sources? TD: I consider every used syringe or other used injection supplies that we take in, and safely dispose of, is a success. Every time we hand someone clean injection supplies, mak- ing it possible for them to avoid HIV and Hepatitis C transmission — that’s success. And just making contact with people so that we can help them when they need it. If not now, then sometime down the road. Maybe it is with the criminal justice system because they’ve gotten arrest- ed, or maybe they need help getting into treatment. You may not know it but getting into treatment is not easy these days. For a lot of folks, it feels like ‘I want help and no one will give it to me.’ We try to help people past such barriers, and at that, I think we have been very successful. -LM: I agree with Tom. And when I see a user advo- cating for him or herself, that for me is success. nds aim.supponernp in Burlington A ’Dalton' at The Hos/liard_ Center for Human Sen/ices ffic/0.The‘ Project of Southern, Vermont tLynn"4Martin at802-254-8263 A lg/erfmontHVarm Reduction Coalition and the New England Alliance of l‘ Contact Alice Diorio at 800-711-8680 or 802-387-8561 But the groups who fund needle exchange want num- bers, too. They want to know how many people we’ve seen, how many needles we’ve given out, how many refer- rals, etc. Our views of suc- cess don’t always match up neatly. OITM' How would you characterize community response thus far? LM: My experience as someone advocating for nee- dle exchange in and around Brattleboro has been over- whelmingly positive. It seems to me that people are quite supportive when" they know what they are support- ing. But they usually have to be educated before they can be supportive. There are all sorts of break- through moments, but I remember one particularly well. As we were getting ready to open thetexchange, I had spoken to our chief of police several times as we were getting the site ready, and he seemed supportive but I didn’t really know how much. At one community meeting, he was asked whether he supported this work. And I held my breath, and then he said, “You know, this house [the site where the needle exchange is located] once belonged to my mother. And when I was a little boy, she used to feed hungry folks who came up from the rail- road tracks at our back porch. Our neighbors did not like it, but that didn’t keep her from doing the right thing. And frankly, I feel like what the AIDS Project and the Needle Exchange are doing is just like what she was about.” Mark Melchior is a free- lance writer who lives in Guilford. You can contact him at marmel@sover. net.