The entrance to Prevention Point, the only government-sanctioned syringe-exchange operation in the Philadelphia region, doesn’t look like much from the street: It’s a drab gray door down a set of steps from a drab alleyway, around the corner of a drab building on Lehigh Avenue in Kensington, along which flows a parade of people looking various shades of troubled.
But behind the door is a considerably brighter scene: The sparse hallway inside has been slathered in cheerful colors — blue, orange. A TV sits in the corner, surrounded by couches. Encouraging signs are everywhere, offering services, explaining health issues. A pot of hot coffee sits invitingly in the middle of it all. There is a lot of hand sanitizer.
The tiny facility is, in more ways than one, a rare oasis for the population it serves: In a city brimming with recovery houses and addiction clinics — not to mention illegal drug markets and shooting galleries — it’s a safe, professional environment in which intravenous-drug users can exchange used needles for clean ones and go on their way.
The demand is apparent. Managing the exchange on a recent Friday were Prevention Point employee Gus Grannan and one volunteer. In the three-hour span during which the exchange was open for business, they would see about 120 clients and exchange thousands of clean syringes for used ones.
But the program is beginning to buckle.
Thanks to a dearth of resources, Prevention Point has had to cut back on its services. It’s had to lay off employees and cut its case-management services. Needle exchange was rolled back from six days a week to five.
And, maybe most alarming, Prevention Point and the few other sources of free clean needles in the city are falling short in their ability to meet the demand — and beginning to see the consequences on the street.
Syringe exchange and other forms of “harm reduction” haven’t exactly had the warmest reception in the United States since syringe exchanges began to take off in the ’80s. While syringes themselves are legal, exchanges have faced all sorts of state and local legal challenges, and the federal government last December reinstated a long-standing ban on funding such programs, just two years after the prohibition had been lifted. Maybe it’s not so hard to understand: The idea of handing to drug users the very tools they require to use drugs can be, for some, a tough ideological pill to swallow.
But the medicine works. Several studies indicate that needle exchanges don’t increase or encourage drug abuse; what access to clean needles has been tied to is major reductions in incidences of HIV and other diseases like hepatitis C among intravenous drug users. It’s one the most successful methods of reducing those diseases (among that population) that anyone’s found, and it has had that effect in Philadelphia. Even as HIV rates remain disturbingly high among other (especially African-American male) populations in Philadelphia, the rate of HIV infection among intravenous drug users has dropped from above 40 percent in the early ’90s to somewhere around 10 percent now — thanks, according to the Philadelphia Department of Health, largely to Prevention Point’s syringe-exchange program.
But, says Jose Benitez, the group’s executive director, that success is being challenged as costs ouptpace resources.
While city funding for the program has been steady, Benitez says that health-care costs for his employees (who are exposed to more health risks than most) are becoming a major issue. “We’re a relatively low-paid staff, but what we do pay for is health insurance, and that’s gone up consistently,” Benitez says. Private foundation support, meanwhile, has been drying up.
Understanding the scope of the problem facing Prevention Point — and, by extension, the city’s health officials — requires wrapping your mind around a few ideas that might seem less than intuitive: the fact, for example, that Prevention Point has begun to limit the number of clean syringes a drug user may receive in exchange for used ones to 300.
Yes, 300. Per person. Per visit. It might sound at first, as it did to this reporter, like a lot. But it didn’t take much time watching the exchange in action to see the significance, as Grannan called out the count for each client’s exchange: 200, 300. “How many you need?” Grannan asks one man. “Four hundred? You know we gotta cap this at three, right?”
“The reality is that we’re rarely getting people just here for themselves,” explains Grannan. “People are exchanging for other people” — partners, friends, sometimes households. Some needles, no doubt, are being sold on the street — but from a (somewhat counterintuitive) public-health standpoint, that isn’t necessarily a bad thing: What matters is people not sharing infected needles.
And that’s what’s got Grannan and director Benitez concerned about their own tightening supply of syringes: “Like any economy, people are going to find a way,” says Grannan, “and if we bottleneck with syringes what happens — what’s already happening — is users will go and share.”
The inevitable consequence of a smaller supply of free, clean needles, in other words, is going to be the larger use of dirty ones.
Grannan isn’t the only one who sees signs of a mounting problem. City Paper heard similar reports from members of Project Safe, a small group of volunteers who maintain relationships with female drug users, many of them sex workers who aren’t reached by Prevention Point’s services. Project Safe’s team provides these women with condoms, lubricant, reports of abusive or dangerous johns — and clean syringes.
The tightening supply of syringes, says volunteer Kahn Miller, “is putting a strain on our own incredibly limited supply. And when [Prevention Point] can’t give out, we run out more quickly.”
Lindsay Roth, another volunteer, says her group is “having our own little crisis” dealing with the situation: “There are just not enough clean needles to go around … and I think that, because of that, people are engaging in riskier behaviors.”
There is one other place where a user can almost always buy a syringe — and that’s beneath the El tracks in Kensington, where “works” are sold more or less openly. But, says Roth (and confirms Prevention Point’s Grannan), prices have been going up. And the higher that price goes, they say, the more users will share.
City officials acknowledge Prevention Point’s difficulties — and are sympathetic: “We absolutely believe that IV drug users are a priority [and] our focus is absolutely still with them,” says Jim Garrow, a Health Department spokesman.
“Steady funding these days is akin to a cut in funding,” he acknowledges. “But it isn’t a cut in real funding, which I hope demonstrates our priorities. … In this time of state budget cuts, it’s a pinch for everybody in human services.”
Of course, he’s right — as Benitez knows. “If I were in their place, I’d be thinking the same way,” he says, referring to the allocation of resources toward other at-risk populations. “[But] this is one prevention that really, really works, and it gets funded the least.”
The volunteers for Project Safe put it even more starkly: “We host karaoke fundraisers” to pay for outreach, emphasizes Roth. “How is it in Philadelphia that a public-health measure that is the one known way to prevent hep C and HIV [relies] on a bunch of anarcho-chicks getting their friends to pay for booze?”
