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D.C.'s largest needle-exchange program running out of cash

By Debbie Cenziper
Washington Post Staff Writer
Thursday, December 24, 2009; B01

Despite $1 million in city AIDS funding over three years, the District's largest needle-exchange program is nearly out of cash and has at times been unable to supply clean syringes to intravenous drug users.

The shortage comes after years of turmoil at Prevention Works, which offers needle exchanges at its Northeast Washington headquarters and from a mobile unit that sweeps the city's most drug-addled neighborhoods.

"I am distraught," said Philip Terry, executive director of Prevention Works. "I am not happy that we're in this circumstance."

For nearly a decade, Congress had banned the District from using government money to give addicts clean needles, even though intravenous drug use is blamed for helping to spread HIV in the District. The ban was lifted in 2007, freeing the city to fund the needle exchange at Prevention Works. At the time, it was the only program of its kind in the District.

Just after Thanksgiving, however, Prevention Works' employees learned the agency was out of rubber gloves, antibiotic ointment and diabetic needles, the needles of choice among addicts. There was no money for payroll or gas in the mobile unit.

The agency's cash crunch had been simmering for months, with bills to consultants and vendors unpaid and clients turned away without supplies, interviews and records show. Three employees said the agency ran out of biohazard containers over the summer, forcing staff to stash dirty syringes in bags and boxes.

A series of e-mails, obtained by The Washington Post, chronicles the agency's struggles.

In August, the program director of Prevention Works, Mary Beth Levin, e-mailed a colleague: "Tried to use the [Prevention Works] credit card today at Staples but was rejected."

In October, she wrote: "We are short $13,831.95 for payroll."

Early last month, quality assurance coordinator Rachel Gutfreund e-mailed Terry: "It is upsetting to see clients walk out of here with the same dirty [equipment] they came in with. I have received no explanation for why we are continually out of [needles] and other supplies not just for a few days -- but for many weeks multiple times throughout the year. . . . What is going wrong?"

Late last month, Prevention Works' director of administration, Kumara Rama, e-mailed the city: "We have payroll on Friday and once again we do not have the funds needed to make payroll."

Terry said the agency's financial problems are not unlike those affecting other cash-starved nonprofit groups. He said private donations were lower than expected this year, which left Prevention Works several hundred thousand dollars short on a $1 million annual budget.

Prevention Works has six full-time staff members and 13 workers funded by the United Planning Organization, the city's community action agency.

Terry said he drained Prevention Works' contingency fund over the summer to make payroll and replenish supplies. By Thanksgiving, he said, the group was broke. Terry said Prevention Works eventually received a $27,000 payment from the city, which helped the group pay some bills, make payroll and buy needles and supplies. He said the agency is also expecting $300,000 in annual contributions from private foundations; the money is expected to arrive early next year.

"We're going to keep this place going," Terry said.

'Lack of transparency'

Some former employees and longtime supporters are fed up, saying years of missteps and questionable spending have compromised services.

Prevention Works was launched in 1996 under the auspices of the Whitman-Walker Clinic in Northwest, which has provided AIDS services in the city since the early 1980s. When the needle-exchange ban was imposed in 1998, Prevention Works separated from Whitman-Walker and became its own nonprofit group, to continue the needle exchange. The group was supported by private donations.

In 2007, the D.C. Health Department's HIV/AIDS Administration awarded a grant to Prevention Works to counsel people with HIV. After the ban was lifted later that year, the city also awarded a $300,000 needle-exchange contract to Prevention Works, turning the organization into one of the city's more prominent AIDS groups. City money has flowed ever since.

To oversee the agency's expansion, Prevention Works in 2007 brought in a new executive director, Ken Vail, who had run a needle-exchange program in Cleveland.

In one of his first moves at Prevention Works, Vail awarded a consulting contract to a former colleague from the Cleveland needle-exchange program, records show. Sam MacMaster, hired to do evaluation work for Prevention Works, teaches at the University of Tennessee. Vail also hired one of MacMaster's colleagues to serve as Prevention Works' clinical supervisor.

"Why is he hiring people through previous relationships instead of working with people from D.C. who are more aware of the issues here?" former Prevention Works program director Junette McWilliams recently told The Post.

Vail did not return calls seeking comment. MacMaster said he was brought on while Vail was trying to quickly reorganize the agency.

In 2007, Prevention Works received a $100,000 grant from the MAC AIDS Fund, founded by MAC Cosmetics. The money was supposed to pay for a van and home-delivery services for addicts unable or unwilling to seek clean syringes from the mobile unit, former staff members said. But the van was never purchased, and the launch of the delivery program was delayed for months.

In the end, staff members rented cars to make the deliveries. Terry, the executive director, said a sport-utility vehicle was eventually donated to the agency.

McWilliams said she tried to determine how the grant money was spent.

"Ken was very secretive about budgets," she said. "There was a lack of transparency."

Prevention Works also lost out on new AIDS grants because applications were not submitted on time, former employees said. At the same time, the group lost money from the Washington AIDS Partnership, a grant-making group supported by private philanthropies.

"We reduced our funding significantly while Ken was there," said Channing Wickham, Washington AIDS Partnership's executive director. "I don't think he was the best hire."

Vail left the agency in mid-2008.

A controversial move

Terry, former senior director for emergency and international services at the Red Cross of the National Capital Area, stepped in late last year. He said that he found no evidence of malfeasance at the organization and that independent audits have come up clean.

Terry reorganized the staff, requiring higher-level education and professional credentials. In the process, three employees widely known in the community were let go.

Terry also moved himself and two administrators from the headquarters in Northeast into a rented office on 17th and K streets NW, drawing criticism from some staff members who said the extra expense was unnecessary. The staffers said that Prevention Works' leaders should be based with case managers and needle-exchange workers in Northeast, close to the neighborhoods they serve.

"They disassociated themselves from us and from the community," said former Prevention Works case manager Ron Harris, one of the three employees who lost their jobs. "Why move to 17th Street with lobbyists and lawyers when we're doing needle-exchange at the grass-roots level?"

Terry said the building in Northeast was too crowded: "We outgrew the space when we moved in."

The problems are alienating some longtime supporters.

Mary Murray ran an HIV training program for Prevention Works in October. She is still waiting to get paid.

"I've been a supporter of Prevention Works," said Murray, who is owed $1,000. "Needle exchange is such an important piece in HIV prevention. I'm frustrated. To be honest, they've been on my list of organizations that I typically give year-end donations. But they are not on my list this year."

Staff researcher Meg Smith contributed to this report.

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