The New York Times

Thursday, November 7, 1996

DISPENSING NEEDLES, NOT JUDGMENT

Drugs' Captives With a Program to Deter AIDS

by Douglas MARTIN

Jerry Lopez hobbed up on crutches on a recent Tuesday, his thin mouth creased by an attempt at a smile, his bloodshot eyes smeared with tears. He is 49, and has been addicted to drugs since he was 13. The thing is, he thought he had finally quit.

He had been clean for more than two months after falling in front of a subway train and smashing his right foot. There were no illicit drugs in the hospital. But this day, his first back on the street, he had fallen into the same old. on his way home from buying a big new television set and VCR with his $130,000 settlement from the Transit Authority, he had bought $40 worth of cocaine.

"I'm not happy with myself," he said unsteadily. "I thought I had more will power."

Mr. Lopez's next stop was this cheerless intersection at Park Avenue and 110th Street in East Harlem, a grim cityscape of bricked-over windows, vacant lots and nothing dreams. He approached a white van and went to the window with the friendly face. Like the waitress who remembers how you like your coffee, she gave him his usual: 20 needles, a kit to cook heroin, a "bleach kit" to clean infected needles, and some antiseptic swab to wipe up with.

"Take care of yourself, O.K.?" said Angel Thompkins, a substance abuse counselor. "You only got two legs, sweetheart."

This is life as viewed from the rectangular window of a van passing out free syringes. You could say Mr. Lopez had just saved himself $30 or so,

and you would be rights. But he also reduced the chances of handing a dirty needle to someone and passing on the AIDS virus, with which he is infected. Less obviously, he had accomplished something else. He had connected.

"I have no problem with letting them know they're connected here," Ms. Thompkins, site supervisor at the needle exchange, said. "Sometimes, that's what they most need."

Ms. Thompkins is motivated by the many people she know who have died of "the virus," as AIDS is known on the streets. Needle exchanges like this one have cut in half new HIV cases among New York City's intravenous drugs users, according to research first made public in 1994 by the Chemical Dependency Institute at Beth Israel Medical Center and just this month reported in The Lancet, the international medical journal published in London. Though prosecuted in the early 1990's as purveyors of drug paraphernalia, the city's six free exchanges have been financed by New York State for more than two years.

And they have become places to go for people with nowhere to go. Junkies do not usually have the luxury of being accepted by people unlike themselves. And they know they cannot trust people like themselves.

"Desperation brings them here," said the Rev. Margaret Reinfeld, an Episcopal priest who runs the van program, New York Harm Reduction Educators. "What keeps them here is the quality of the relationship. We're giving them a place that belongs to them."

So Ms. Thompkins mainly knows clients by nicknames she gives them, this being an anonymous program. There is "Michael Bolton," the spitting image of the singer. There is "my Italian friend," who touched Ms. Thompkins had though the window and asked how she felt.

A group of prostitutes wandered up and shared neighborhood gossip in this case concerning a prostitute knifed to death on a nearby roof. There was a mother who regularly exchanges needles for her teen-age children. A succession of pregnant addicts talked about the weather.

To Ms. Thompkins and her three colleagues in the van, everyone is "honey," "babe," or "old friend."

This is the place where nobody calls the addicts losers. The fact is, many seem amply able to do that for themselves.

"I'm a full-blown junkie," said a 32-year-old woman from South Carolina. "I've got to call myself that. That's the way it is."

The woman had ridden her mountain bike to East Harlem from her home in Astoria, Queens. She kicked down her kickstand and stood expressionlessly in line. After turning in her dirty needles, she carefully put the new ones in a new backpack.

The woman- she did not want her relatives to see her name in the newspaper and so refused to be identified - went to New York for a job as a purchasing executive, then lost it. She keeps thinking of her many interests, including playing the mandolin and sailboat racing. Do junkies play in bluegrass bands?

Then, she said, she realizes that life is getting harder, and that drug abuse is like a train running down the track to a bad destination.

"Any other fulfillment your life might take is consumed by drugs getting money to buy them, getting them, using them, getting well enough to buy them again," she said. "It just makes you crazy."

The van is here noon to 5pm on Wednesday and on other street corners around the city other weekdays. It exists to give clean needles to people who otherwise would buy on the street. A New York State law requiring a prescription to buy hypodermic syringes has long meant a considerable black market, which are not believed to add substantially to the market.

"By and large, drug users don't like to travel," said Brian Murphy, a Harm Reduction program manager. Accordingly, he said, the program routinely exceeds its own limit of 30 needles a visit on the theory that the more clean needles floating around, the better. "We're not philosophically inclined to setting limits," he said. Users themselves scoff at the suggestion that the program is an incentive to shoot up more often. "Us abusers, we need needles, and one way or another, we're always going to get them," said a man in a baseball cap and threadbare coat.

The procession was steady at the rectangular window, and by the end of the day nearly 300 had stopped by one of the van's two windows. Ms. Thompkins again and again asked the question, "Orange or blue?" Orange are the smaller diabetic syringes, best for pure heroin. The blue ones are bigger, and best for mixing cocaine and heroin, a practice called speedballing.

All clients are asked for their cards, which contain a code composed of the initials to their last and first names, the first initials of their mother's last name, their birth years and zip codes. "If the cops try to bust them for possession of drugs paraphernalia, they can show the cards," Mr. Murphy said.

People are also offered free condoms and a variety of medical and legal services. Acupuncture is available. Music from salsa to rap is constant. Occasionally, passers-by, including the addicts, break into dance.

The van itself is like a small doctor's office, with medical supplies sterile and in neat piles. Greeting cards from clients are pasted on the walls. Clients bring cups of coffee and snacks. The staff members occasionally spell one another to chat and read newspapers. Not a few of the men flirt with Ms. Thompkins.

"Is this the day you're going to make me a lucky man?" a man said with a twinkle in his eye.

A woman dropped by carrying a baby in a papoose pouch and leading a toddler by the hand. She used to exchange needles, but now said she was trying to quit drugs. She just said hi. But Maria Fowler, who had a pint bottle of fortified wine in her coat pocket, was in a hurry to pick up her granddaughter from day care up on 155th Street.

"At least you don't have to share the needles," she said. "That's important because I have the virus and wouldn't want to give it to no one. I have clean sex, too."

Khamillo Parker, a keyboard player, comes for needles but also volunteers to pass them out once a week. The soft-spoken man said he quits drugs for months a time, then comes back. He said he thought he would someday quit altogether.

Without the free needles, he is certain people will still use the same amount of drugs. "The main priority is getting high, and a gamble is a gamble," he said. But he suggested the stakes were getting higher.

"I've seen a lot of people drop dead in the past three years," he said. "I mean close friends."

"Just a block way on Lexington Avenue, ..." he continued, beginning to recite one of the many tragedies. Then his voice trailed off, and he said goodbye.

Myron Warrick turned in 68 needles and got 68 back. He use 15 or more most days. He said he supported himself by robbing people, shoplifting and selling drugs once in a while. His language was direct and his message was stark. In a hurried voice, he said that many addicts don't bother with clean needles.

"Some of them don't even dry them off after using them." he said. "They're pretending like they're new. You know if a lot of people have the virus, they want to take somebody else out with them.

"That's life."