It's 6 p.m. Tuesday, neddle-exchange time on Duboce Street near the Safeway supermarket, where I'm standing alongside five volunteers from Prevention Point, an organization that - in violation of state and city law, as well as a June 7 attorney general ruling - distributes 1.5 million syringes a year to an estimated 2,500 of San Francisco's injecting drug addicts.
The point of the exchange, so the speak, is to reduce the spread of AIDS and other diseases via needle-sharing, something junkies are notorious for. Theoretically, if you give druggies clean needles in return for their dirty ones, they won't use the dirty ones again - because they can't. Neither will their friends, lovers, or spouses. Kids won't prick their fingers on Dad's used point. Fewer cases of HIV transmission, less hepatitis-B and -C transmission, a whole lot fewer abscesses and heart and blood infections.
By now, everyone knows that bleach can be used to sterilize syringes and needles, but bleach isn't a long-term solution to blood-borne infection. Bleached syringes become weathered and worn, and after repeated use the points on the Micro-Fine IV needles grow dull, making them painful to use. Sometimes the needles turn kinked ot barbed, causing more pain and infection. New needles are a must.
Needle exchange is the boldest example of "harm reduction," a '90s public-policy idea that holds that the enforcement of drug laws should be less harmful and costly to users and bystanders than the dangers inherent in drug use itself. Harm reductionists like Arnold Trebach of the Drug Policy Foundation and the people at Prevention Point posit that drug use is a public health problem, not a criminal problem. They say imprisoning drug addicts for a habit they seem unable to curb makes as much sense as busting children for having chicken pox.
After almost a decade of vilifying heroin users, our culture seems ready to humanize junkies via outreach projects like needle exchanges. Armes with medical evidence that drug users can take better care of their health if given the chance, the harm reductionists are tilting against high political odds to bring drug users inside the medical tent. Help them help themselves, say the harm reductionists, so we can fight AIDS. So we can slow or stop drug users' self-destruction. So we can decrease the costs engendered by drug use to society - theft, illness, the warehousing of drug users in megaprisons. The message is simple: If drug users are sick, a compassionate society should attempt to minimize their suffering.
The Duboce exchange consists of a couple of small steel tables upon which a banquet of condoms, cotton balls, and alcohol wipes is displayed. But these are a sideshow. The main event is the thousands of clean Becton-Dickinson U-100 insulin syringes displayed in their bright orange boxes, waiting for a new home. There's also a "biohazard" bucket beside one of the tables for the safe caching of contaminated needles prior to their incineration.
Prevention Point currently operates nine exchange sites in the city, as regular as a bus schedule. In fact, Prevention Point has printed a schedule in English ans Spanish on a convenient 3x5 card. Each site dispenses needles and accessories one night a week, except for Sixth Street, which runs three nights a week.
The Duboce Street site is popular, garnering 60 to 90 people during each two-hour-long exchange. It's not as popular as the one on 14th Street near Mission, which regularly attracts around 200 exchangers, but businesss is so brisk that the clientele forms a line before the exchange opens.
Located behind the Safeway between Church and Market streets, the Duboce Street site is inconspicuous but not invisible to passers-by. Not inconspicuous enough, if you ask Safeway. Although the exchange is conducted on a public sidewalk, a couple of Ambassador Security guards dressed in cop drag, their radios squealing full blast, approach the exchange as it gets under way. For the fourth consecutive Tuesday, they politely ask just exactly what is going on.
The stream of clients lined up at the exchanges ripples away from the guards. Nobody wants attention. Nobody wants trouble. The clients perform the mental equation in their heads: Is this where the needle exchange finally gets busted, and what happens to people who are caught walking toward it with a bunch of highly illegall, slightly used hypodermics? No way to get out of that one, friends. They can type my DNA. I've seen the O.J. trial.
Might be better to come back after this has blown over.
Yana Wirengard, who is ferrying Prevention Point's supplies between this site and two others tonight, knows the drill. Deftly motioning the guards away from the exchange, she patiently explains that this is public property, that she's tried - without success - to reach the store's manager for a meeting about the exchange.
After a few minutes, she persuades the guards that yes, this has all been talked about before; yes, yes, this a public property, we've been trying to meet with the manager, yes, yes, yes. The guards leave, satisfied until next Tuesday, and the needle exchange begins in earnest. The clients queue up as if a cashier has opened a new register in a busy Safeway. Orderly lines form. Most used points are bundled into groups of five or 10, and there is no limit to the number of needles you can swap. One drug user brought in 500 at the Taylor Street exchange, saying that he was exchanging for his entire household. A clipboard-wielding volunteer ticks off the points as they're deposited in the biohazard bucket and calls the total to another volunteer handling the clean syringes.
"34, huh?" a volunteer says to the client. "OK, you want longs or shorts?" in reference to half-inch or 1-inch needles. The older the client, the more likely he'll want longs - he might have to dig a little deeper to find a vein.