Goal: Trade syringes with addicts, reduce HIV

Fighting the spread of HIV and other illnesses is Mikal Byrd's job. A battered Nissan Maxima is his office. His supplies include syringes, tourniquets, bleach and condoms.

On a recent Wednesday morning, Byrd and co-worker Jennifer Gonzalez set up shop on West King Street, across from McDonald's. They hoped to speak with intravenous drug users and sex workers, give away injection paraphernalia and safe-sex kits, and encourage addicts to enter treatment.

They go where they see need.

Byrd and Gonzalez are outreach workers for Lancaster Harm Reduction Project Inc., a privately funded syringe-exchange program that hit the streets in November.

Project president and funder Robert E. Field said he wanted Lancaster to join Philadelphia, Pittsburgh and other cities in 34 states where more than 200 exchanges are reducing the scourge of blood-borne disease and guiding users into treatment.

"Syringe exchange is where you meet the people that then can be referred," said Field, noting that success is measured by the number of former users returning to families and work.

The mobile operation employs three, and in December, the first full month of operations, it worked with 47 people, distributed 125 harm-reduction kits, and referred 19 for treatment.

"Trust is a huge issue with referrals," Melinda Zipp, outreach director, said. "We don't push. We wait for them to be ready."

But when someone is ready, Zipp said, a project worker immediately calls rehab programs to find an opening, drives the client to the center, and stays with him or her through the intake process.

Because the state's drug paraphernalia law criminalizes the possession of syringes used for illegal drugs, needle-exchange programs are legally ambiguous operations. However, in September 2009, the state Pharmacy Board lifted a decades-old ban on syringe sales without a prescription.

As a result, syringe exchanges are on firmer ground because they are distributing legally obtained syringes as a tool for preventing the spread of dangerous viruses. Eight federally funded research reports have concluded that these programs reduce HIV transmission without increasing drug use, The Atlantic reported last year.

Exchanges also distribute sharps containers for safe disposal of used needles.

Lancaster Mayor Rick Gray said he spoke with the syringe exchange people, understands their mission, and doesn't see a problem.

"It's a practical way to deal with a difficult problem," Gray said. He said the police must still enforce the law, but like a motorist going 26 mph in a 25-mph zone, "I don't think it would be a very high priority."

District Attorney Craig Stedman said he was not informed of the new syringe-exchange operation and that he'd welcome an opportunity to discuss the legal ramifications with city officials and harm-reduction representatives.

"Under the law, it is illegal," he said. "It's paraphernalia for drug use."

But Stedman also said, "I'm not opposed to new approaches. Pure enforcement of the drug laws is not going to solve the societal issues" associated with addiction.

Lancaster's Bethel AME Church for a number of years operated a harm-reduction program that included exchanging needles. That effort continues today, but on a smaller scale, a church secretary said.

Alice Yoder, director of community health at Lancaster General Health, said the new syringe exchange does help meet a need in the community. She said Lancaster General Hospital and other agencies would welcome the project's referrals for HIV testing, treatment and other services.

Lancaster County has a significant problem. Heroin and narcotic addicts in the county number an estimated 9,000 to 11,000, said Rick Kastner, director of the county's Drug and Alcohol Commission.

Before the Urban League of Lancaster County closed its doors last year, Zipp was director of its Project Hope program, which distributed harm-reduction supplies to intravenous drug users, minus the syringes. But users received a token that allowed them to obtain free syringes at a participating pharmacy.

Zipp said her new position allows her to continue meeting people "where they are, with no preconceived expectations."

She said drug users may not be ready to enter treatment but may have unmet nutrition, clothing or housing needs that her outreach workers can try to address.

"If you start meeting their needs," Zipp said, "it makes them more confident and more willing to go into rehab because they're feeling a little bit better about themselves and not so hopeless."n