Baltimore's needle exchange program has been deemed an overall public health success. But most younger drug users aren't participating, and the city's worried.

Reaching out to the fringes

September 14, 2005|By Alec MacGillis | Alec MacGillis,SUN STAFF

THE COUPLE — The young redhead with the stylish black backpack and heart-shaped earrings had come a long way to be standing at Monroe and Ramsay streets in Southwest Baltimore, waiting her turn outside the big white van. For years, she'd put off this moment: signing up herself and her husband for the city's needle exchange program.

The couple -- their street names are Pebbles and Bam-Bam, a nod to the Flintstones television characters -- have been injecting heroin since they were 17, she said. They've been sharing used syringes with others and attempting to clean them with water and bleach between uses, rather than coming to the exchange for new ones, even though they were aware of the serious health risks in sharing.

"I always think, `I'm going to get clean, so I don't need to [join the exchange],' but then we don't get clean, and we don't accept the fact that we're using," said the 21-year-old woman, who is from southwestern Baltimore County. "So just today, I said, `We're going.' I've been thinking about getting clean, but if I'm going to keep living this lifestyle, then I ought to at least do this."

At a time when heroin remains Baltimore's leading drug scourge, city officials wish more addicts like the couple would make use of the exchange program -- a key tool in efforts to curb the spread of HIV. But despite growing up in the shadow of AIDS, or acquired immune deficiency syndrome, most younger drug users are not participating, a problem especially acute among whites in their teens and 20s.

A recent study by researchers at the Johns Hopkins University Bloomberg School of Public Health found that only 10 percent of people who started injecting drugs in the past five years rely on the exchange as their main source for syringes. An additional 18 percent of the 294 users surveyed, most of whom were interviewed in Southwest Baltimore, said they were mainly obtaining their syringes from pharmacies, where a 10-pack costs about $2.50.

But most users said they bought needles on the street -- a risky practice because they can't be sure the needles are new -- or shared them.

While the study found that addicts were more likely to visit the exchange as they grew older, Susan G. Sherman, the lead author, said "it's really important" to attract users soon after they first start on drugs.

"Habits get established very early," she said.

There are no reliable statistics for what proportion of drug injectors of all ages rely on the needle exchange, which the city instituted 11 years ago after overcoming opposition from some state lawmakers and other critics who argued it would encourage drug use. The exchange has registered more than 15,000 people since it began and has about 325 visitors a week, many of whom are believed to distribute or sell the needles they obtain to other users.

Overall, the program, which costs just under $500,000 a year, has been deemed a public health success: Every week, the exchange's two vans distribute about 6,500 syringes and other injecting equipment (swabs, cookers, bottles of water and bleach) in exchange for dirty needles at a dozen sites around the city. The vans also offer HIV tests and drug treatment information. Since the program's inception, the rate of new HIV cases attributed to intravenous drug use has dropped by a fifth, to about 40 percent of cases.

But Monique Glover Rucker, the city Health Department's senior adviser on HIV/AIDS and harm reduction programs, acknowledged the problem identified by the Hopkins study. Only 6 percent of those the program has enrolled since it began were younger than 25, she said, and the number of younger addicts registering with the exchange has remained flat even as the program has expanded its number of sites.

To address that, the city is applying for a $25,000 grant from the Tide Foundation to improve the exchange's reach among younger users, Rucker said. The grant money would be used to pay younger addicts who use the exchange to do outreach work among other younger injectors and to pay for a new weekly exchange time that would be dedicated to users younger than 30.

The hope is that such measures could increase the comfort level that younger addicts, particularly younger white addicts, feel toward the exchange, Rucker said. Previous studies have shown that heroin addicts in their teens and early 20s in Baltimore tend to be white, whereas blacks tend to start using hard drugs later, in their late 20s and 30s. The exchange's staff is all black, which Rucker speculated could deter some white addicts from using it.

"Ideally, the [exchange's clientele] would be completely representative of [the addict population], but it's not. The users are changing, and we need to make sure we're reaching all of the population," Rucker said

Increasing the program's reach among younger users won't be easy, however. Interviews with about 20 addicts who recently visited the city's exchange site at Monroe and Ramsay revealed a variety of reasons that others stay away.

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