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"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.
Another volunteer dispenses accessories to the clients: Alcohol prep pads to swab the injection site; cotton balls or pellets to stanch any temporary blood flow; rubber bands for wrapping used points in a bunch; a fistful of condoms; and a bottle of bleach, should the client be a do-it-yourself cleaner. The goods are all slipped into a brown paper bag, the kind every jumior-high student has carried his lunch in. Thank you for shopping Prevention Point.
Some clients hurry away, but some stay to chat, or peruse a zine distributed by a Duboce volunteer: Fuck Yer Laws, Fuck Yer Lies. Ostensibly "by addicts, for addicts," FYLFYL's ACT UP-ish politics clash with the quiet junkies making their way through this checkout stand. One volunteer says the zine is still put together by volunteers with increasing help from the users, with volunteers trying to involve them more. One client, fresh points in hand, asks if FYLFYL needs a desktop publishing designer and is diappointed to learn that the production is mostly cut-and-paste - but what cutting and pasting: "Handy Hints by the Australian IV League," a Gray'a Anatomy-style diagram revealing injectable blood vessels like the subclavians, internal and external jugulars, median cubital, cephalic, dorsal venous arch...
There are also bumper stickers for distribution at the exchange: "Fuck Safe [heart symbol] Shoot Clean!
Just Don't Call Me a Junkie
The non-pejorative name in public health circles for junkies is "IDUs" ("injecting drug users"), which replaces the emergency room doc's label of "IVDAs" ("intravenous drug abusers"). IDUs include steroid, cocaine, and amphetamine injectors, and the new label is designed not to judge or stigmatize them.
"They get that elsewhere; why do it here?" asks a Duboce Street volunteer.
IDUs come in all shapes, colors - mostly white in San Francisco, by the way - and from all rungs on the socio-economic ladder. At the Prevention Point sites, I rarely encounter the Planet Eisenhower stereotype of the emaciated, twitching junkie; perhaps 10 percent of the clients I see have a waxiness of complexion, with many having sunglassed their pupils out of scrutiny's range.
I do, however, talk briefly with a 40-going-on-60 future Jane Doe at the Webster exchange. Doe started injecting speed 15 years ago, moving on the heroin. By now, scoliosis has canted her back, her complexion is shot, and her handshake is about as firm as a dying man's last breath. And speaking of breath, she is recovering from a recent pneumothorax - a hole in her lung. (You're not likely to have this malady - unless your lungs are brittle from years of crack-smoking, or you've been shot or stabbed.) Now that Doe is breathing well again, the big news is that she's gained a pound in the last week, fighting off AIDS-related wasting. That leaves her free to worry that the Safeway on Webster might close its bottle-and-can redemption facility.
The IDUs interact alertly and cheerfully with the predominately female staff at Duboce. Whether this camaraderie stems from the volunteers' low-key friendliness or the IDUs' relief at having secured clean, safe points is a tossup. Such is the case with one sweaty man who talks distractedly with the volunteers, struggling with a shoulder bag in one hand, needles in another, while a spoon and a pint of Haagen-Dazs butter pecan teeter in the balance.
I am startled by the number of department store "gimme" bags that pull double duty as syringe cases: Drakkar Noir, Banana Republic, Abercrombie & Fitch Co., Polo. I imagine predatory perfume spritzers at Macy's cornering a matronly Atherton woman: "With every $25 purchase of Lancome Apres-Bath Heroin, you get a free toilet kit for your needles."
Although possessing a needle with this intent to inject illegal drugs is still a misdemeanor under California law, San Francisco officials began winking at an illegal needle program begun by Prevention Point in November 1988. The group, initially a mixed bag of "AIDS researchers, social scientists, HIV counselors, educators, AIDS activists, medical personnel, AIDS-affected individuals, teachers, lawyers, and people in drug and alcohol recovery," is now composed of about 80 volunteers and four paid staff. But in 1988, it was not much more than people standing around, wondering how to deliver needles to IDUs.
Yana Wiren-gard says the earliest organized needle exchangers skulked around the Tenderloin pushing a baby carriage full of syringes. Seeking out IDUs, they'd announce their presence with this greeting: "Can I feed your baby?"
The exchangers worked in constant fear of a bust, but the politics of AIDS in San Francisco made their cause politically popular, with Supervisor Angela Alioto leading the charge. After a few initial hassles by startled police, Prevention Point set up its first regular exchange site on Eddy Street just west of Taylor on Nov. 2, 1988.
As the group gained notoriety, it sought city support and funding, hoping that San Francisco would emulate the Connecticut model, which incorporated the findings of a Yale University study on the spread of HIV in New Haven's IDUs. The Constitution State changed its laws to allow the purchase of syringes over the counter, a rarity in the Northeast. In California, AIDS activists and health officials persuaded the California legislature to legalize exchanges in three successive years - 1992, 1993, and 1994 - but each time Gov. Pete Wilson, currying the crucial punish-the-junkies vote, vetoed the bills.