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Losing more than a needle exchange program in D.C.

By Michael Rhein, Washington
Saturday, March 5, 2011; 10:31 PM

Like too many of those it could not reach, PreventionWorks is dead. Its staff and volunteers have distributed their last sterile syringe, administered their final HIV test, passed out a few remaining condoms and referred their last client to medical or social services. Recent government support was critical to giving PreventionWorks a measure of staying power, but a drop in overall funding, increasing debt and inconsistent leadership were among the factors that led to the organization's decline. As the president of the board that was forced to shut it down, I feel sick to my stomach thinking of the lives we could have saved if we had hung on for another year, another month or even just a week, here in a city where an estimated one in 20 people lives with HIV/AIDS.

The greatest loss with the closure of PreventionWorks is the trusting relationships we had established with several thousand active drug users. Without minimizing or ignoring the real harms and dangers associated with hard drug use, our staff and volunteers empowered program participants to take responsibility for improving their health in any small way they could and then gave them tools to do so.

PreventionWorks met people wherever they happened to be on the continuum of drug use and recovery, treating them with dignity in every encounter. Then, from that place of trust and respect, participants learned how to protect themselves and others, got tested for HIV and hepatitis C, maybe started attending support groups and connected with medical care. No small number entered drug treatment, and some managed to get clean, like one client I spoke with last week. After 18 years of juggling heroin with employment, she was ready for a methadone program. On the organization's final day, our outreach staff was there for her, just as they had been every week beforehand, and they escorted her and her fiancé to drug treatment. When we talked last week, she told me about the times PreventionWorks had saved her life. She wondered who would be there for her addicted brother.

While those directly involved with PreventionWorks understood that it was much more than an HIV-prevention organization, the scale of the HIV/AIDS crisis in the District demands that, if nothing else, the lost syringe exchange services be replaced and greatly expanded by those organizations left standing to fill the void. Syringe exchange programs have been dismissed by those who think they encourage drug use, but hundreds of public health studies and experience nationwide have confirmed the effectiveness of such programs in reducing the spread of HIV without increasing drug use and while providing a vital doorway to drug treatment.

It's important to keep in mind that syringe exchange prevents the spread of disease not just among users, but between users and their sexual partners and unborn children. It also cleans the alleys, parks and garbage cans of used syringes to prevent needle sticks. With over 26 percent of women and 18 percent of all people living with HIV/AIDS in the District reporting contracting the disease from injection drug use, it's a public health imperative to ensure that injection drug users have the tools and information they need to inject more safely. Comparisons to syringe distribution volume in other urban areas suggest we are far from meeting the demand for sterile syringes in the District.

In the wake of PreventionWorks, this city - its government, service providers, civic organizations and community leaders - needs to take a fresh look at what it will really take to stop the spread of HIV/AIDS. It's simply not an option to say that PreventionWorks failed and move on from there. The perspective must be that PreventionWorks persevered through difficult years to save countless lives and to lay the groundwork for bigger and better efforts to follow. This success was made possible by courageous contributors, dedicated staff and an army of volunteers.

While there's a vital capacity that has been lost in the closure of the agency, its philosophy and services can be incorporated and expanded within the organizations that will continue on.

The writer is board president of PreventionWorks. He works as senior vice president with CommonHealth Action and its Institute for Public Health Innovation.

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