September 26, 2004 - The Washington Post (DC) Stuck On Prevention A Needle Exchange Program Aims to Give Users a Better Shot at Survival By: Jose Antonio Vargas, Staff Writer

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So the man sits down, opens a rumpled Chinese takeout bag, drops two weeks' worth of used syringes in a plastic bucket. He counts off: "There goes 130, 131 . . ."

He's high today, a heroin addict for more than half his life.

". . . 132, 133 . . ."

He is 69, unemployed, homeless, divorced, his legs and right arm wrapped in pus-stained bandages.

"134, 135, 136 . . ."

Ron Daniels, looking the man in the eye, hears the last one hit. "That's 137," Daniels says. "Is that all?"

Donald, the man with 137 syringes, grunts. He's thirsty and fidgety, and asks for a cup of ice water.

"Have you been tested for HIV?" Daniels asks. "Have you been tested for hepatitis C?"

Donald nods twice.

"You sure?" Daniels asks again, holding eye contact.

It's a sticky, humid Friday, and there's a line of 21 people outside the Winnebago, spilling into the parking lot of a Shell station on the littered corner of Minnesota Avenue and Clay Street NE.

This first-name-only "exchange site" -- short for needle exchange, funded by the nonprofit group Prevention Works! -- is the day's first of three, and the slowest. David, 49, eyes bloodshot, turns in 58 syringes. Before him, Denise, 48, stick-thin, turns in 15 . It's controversial, giving David and Denise clean syringes, but Ron Daniels has a job to do. By 5:30 p.m., he's collected more than 3,000 dirty needles from more than 80 addicts.

The mobile unit stops in Wards 6, 7 and 8, mostly east of the Anacostia River, far from "official" Washington. But those who come for service are as much a part of life in the city and its suburbs as they are hidden from it: a Metro employee in his uniform, a carpenter on his lunch break, a social worker in a charcoal skirt and white top, a homeless man in his wheelchair. Of course, there are addicts who can afford to buy their own syringes. But these are the ones who show up, day in and day out, waiting in a relentless line to make these free exchanges. It's a weekly routine -- twice a week for some -- and faces, after a while, become familiar.

"We work year-round," says Daniels, one of two full-time employees of Prevention Works! "You can't stop being an addict 'cause the weather is bad."

He is 46, built like a gymnast, as agile and quick as he is focused and intense. As the only full-time employee in charge of the streets, he has a lot riding on his 5-foot-6, 150-pound frame. Here are some numbers: 9,856 District residents inject drugs, approximately 1 out of 20 has HIV, and the incidence of AIDS cases here is the highest among large U.S. cities, according to local health officials. Trace the root of those staggering statistics, Daniels says, and it leads to a shared needle for many.

"If these syringes weren't collected -- by someone, anyone -- where would they go? In backyards, trash cans? Parks? Somewhere in the monuments?" asks Daniels, surveying the crowd outside the mobile unit, talking and teasing and sitting around, some in the parking lot of the Shell station, others across the street outside the Payless Shoe Source.

He's a calming presence in the storm of their lives, the way he respectfully speaks, the way he carefully puts his hand over someone else's. "They've been in the heat all day," he says. "They're not eatin' right, not sleepin' right, not drinkin' enough fluids."

He pauses.

"Sometimes, you just fall down."

Hooked

Nothing matters when you're high. Not the job, the wife, the kids. Nothing.

Daniels needed four hits a day. He took two in the morning, two in the evening. Sometimes he took the last one as he looked for a place to sleep: parking lots, shooting galleries, basements, hallways.

Daniels got hooked at 15. First it was alcohol. Then came angel dust. Then marijuana. Then PCP. Then the big one: heroin.

"It started out bein' excitin'," he says. "I thought it was fun. I thought it was cool. The next thing I know, I was beyond what I asked for. . . . It was no longer 'I'm gonna stop.' It was 'I had to have.' "

For 22 years. But he got through high school and almost got through college, studying social science at the University of the District of Columbia until Gerildine, his girlfriend back then, got pregnant. He quit school and joined the Navy, completing two tours at sea before coming home in 1984.

The addiction worsened when he returned, he says. In 1989, after sharing a dirty needle, he tested positive for HIV.

He's the youngest of seven. His siblings didn't tolerate his addiction. Neither did his mother, Willette, who worked at the post office on North Capitol Street NE, or his father, John Sr., who left their two-story home on Sixth Street SE when Daniels was 13. Willette died when Daniels was in the ninth grade; John Sr. died when Daniels graduated from Ballou Senior High.

"Ron didn't have my father's iron fist coming down on him like we all did," says Phyllis Daniels-Peters, who is five years older. "Then having all these sisters, we babied him, gave him everything he wanted."

His only brother, eight years older, has a less understanding point of view.

"Ron was very weak during that time," says John Jr. "I never felt sorry for Ron. I felt that if he chose not to listen to what was being conveyed to him -- that he should quit, that he should stop -- then ultimately he'll be the one to suffer. He did. He suffered very much. "

"You have to understand that as an older brother, you have very little tolerance for weakness. You don't want to hear excuses. You don't want to look for reasons why your brother is not able to do something as simple as changing his lifestyle."

His younger brother couldn't keep a job. Not the one at the Boys Club. Not the one at St. Elizabeths Hospital.

"I would get a job, but I couldn't get to work," Daniels says. "I would get a job, but I couldn't grow in the job."

He broke promises to his kids. He was in and out of jail 15 times -- for using and, he says, for "rustling," selling drugs to support his habit. "I was too busy runnin' around to be bothered with anythin' else."

Then came that cold November day in 1997.

Daniels made it up a hill in Southeast Washington to get two dime bags of heroin but couldn't make it down. He was sweating profusely. Something was wrong.

"I was strugglin' in just walking. I had a hard time breathin'," he says. "Even when I took a hit, I still wasn't feelin' all right."

He fell face-down on the pavement of Valley Avenue. Luckily an ambulance was driving by, and he was rushed to Greater Southeast Community Hospital. Doctors told him the problem was a combination of things: the drug use, not taking his HIV meds, the general stress of his life. The doctors didn't think he'd make it, Daniels says, and started asking for his next of kin.

But which next of kin?

His 17-year-old daughter and 16-year-old son who rarely saw him? The mother of his kids, Gerildine, who was too afraid to let him in her house? His siblings, so frustrated that they allowed him in their homes only to take showers?

That did it.

"It wasn't that I felt sorry for myself," Daniels says, recounting that day. "I was a blamer for too long. Blamed my family. Blamed Gerildine. I cursed everybody out.

"When you don't face who you are, or what you're dealin' with, or what you're doing, then, yeah, you're a blamer. Because the bottom line is it all starts and ends with you."

Daniels went into detox. It wasn't the first time, but it was the last.

Organization Man

What's your first name?

What's your mother's first name?

What's your date of birth?

These are the questions the participants must answer in the 1992 Winnebago Adventurer. The information is typed into a laptop computer on the middle table of the vehicle, while Daniels or part-time health educators Henry Mallory and John Turner pack syringes and needles in a brown paper bag. Turner, a robust man at 67, usually distributes fliers outside, urging participants to get tested for hepatitis C.

The motor home is meticulously organized, and Daniels keeps it that way. Shelves are labeled and relabeled. There are bandages, alcohol pads, towelettes, lube, needles and vitamins, in addition to bag after bag of syringes, condoms, dental dams and brochures that hang next to the front dining table: "HIV Mom-to-Be," "AIDS in the African American Community," "Hepatitis C," "S Is for Speed, C Is for Cocaine." The room in the back -- with a table, VCR and color TV -- is for testing and counseling. There are clothes back there, too, and food (fried or baked chicken, mixed vegetables, soup and salad) is given out on Tuesday and Thursday.

"This is more than just an exchange site," Daniels says.

There are no freebies. To get a clean needle, you have to hand over a dirty one. The "apples" and "blue heads" are the most popular, used by addicts who've been shooting for some time, while "groins" are for addicts who've been shooting for years. With no more "good" veins, the addict shoots wherever there's an artery. The neck. The groin. "That can get real dangerous," Daniels says of injecting into the groin. "You miss. Bam! You can bleed to death."

Daniels has been with Prevention Works! since it started five years ago. There used to be a full-time driver, but finding a dependable driver is tough. So he drives and supervises the Winnebago himself.

He does the work in the only city in the United States barred by the federal government from using its local tax dollars to fund a needle exchange program. In October 1998, Congress passed, and President Bill Clinton signed into law, a ban on government funding for any group that operates a needle exchange program for D.C. drug users. Rep. Todd Tiahrt (R-Kan.), the House of Appropriations Committee member who authored the ban, went further, threatening to revoke government funding to any agency that exchanges needles. Such a program, with four full-time staffers, was run by the Whitman-Walker Clinic, the largest provider of AIDS services in the Washington area. That program, exclusively funded by local dollars, turned solely private, and Prevention Works! was authorized by the D.C. Department of Health on Dec. 2, 1998. To be sure, the Whitman-Walker Clinic didn't want to endanger its government grants.

The organization's other full-time employee is Paola Barahona, the executive director, who works in the main office on 14th Street NW, busy with phone calls and e-mails and fundraising. The current budget is $393,000, "the most ever spent in this city for needle exchange," Barahona says. Inevitably, in this line of work, questions arise: Is giving clean needles encouraging drug use? Is it preventing the spread of sexually transmitted diseases?

"By handing out needles we encourage drug use," Tiahrt said in 1999. "It does not help the children of Washington, D.C., to take taxpayer money to fund these programs."

Daniels's reaction to such arguments is usually simple: "They just need to be educated," he will say. But one Wednesday morning as he sits in front of the laptop, he loses that cool exterior. "They need to come out and experience what we really do," Daniels says. "We don't give people syringes to use drugs. We give them syringes to reduce HIV, STDs and STIs [sexually transmitted infections].

The needle exchange work has its roots in the efforts of Jon Parker, a former injection drug user who nearly 18 years ago began distributing (then exchanging) syringes in the streets of New Haven and Boston. Now more than 125 needle exchange programs, privately and/or publicly funded, exist in the United States. Organizations including the Centers for Disease Control, the National Commission on AIDS and the American Public Health Association support exchange programs. Since heroin addicts will shoot anyway, they argue, it's better they do it with clean syringes.

Last year, Daniels helped give out 360,143 clean syringes to 3,180 participants.

His hours are from 9:30 a.m. to 5:30 p.m., but the work is never really over, at least not for him. He's quick to give out his cell phone number, and participants call him at home, looking for referrals or advice. Like the guy who learned he was HIV-positive and called to ask, "How do I tell my wife?"

Often, the faces stay with him all day, sometimes through the night, or while he sits at home, watching reruns of "Law & Order" with Barbara, his girlfriend of seven years.

"It's easy for people to say, 'Well, you use drugs. You should feel bad. You should feel guilty. You should live this way,' " says Daniels, driving to the second site, catching his breath. He was diagnosed with chronic obstructive pulmonary disease in 1998, a lung disease that killed his mother and one of his sisters.

The light turns red.

"But no. That's not the way. If she can't quit drugs right now, then, okay, fine, but use a clean needle. If he can't quit drugs right now, then, okay, fine, get tested for HIV or hepatitis C.

"Point is, you gotta stop looking down at them."

The light turns green.

"You gotta meet people where they're at."

Summerfield

It's 1:40 p.m. at the second site of the day. Summerfield steps into the mobile unit, turns in 25 needles.

"How you doin' today?" asks Daniels.

"Everythin' all right," Summerfield, 44, says. "Everythin' all right, Ron." Summerfield's hands have swelled to the size of oversized baseballs, the result, Daniels says later, of fluid buildup. "Too much heroin injections."

The two first met 22 years ago at a shopping center on Naylor Road and Alabama Avenue SE -- "at 6 in the morning," Daniels recalls. The two met to shoot dope, unable to do anything until they got their fix. Sometimes, they shared needles.

"Summerfield has come a long way," Daniels says, a host of questions left hanging in the dry air. If Daniels can quit, then why not his old friend? What makes the difference? How does Daniels come here every day like this, seeing his former running buddies? Does he miss the high? Is he ever tempted?

"Sure, I feel bad when I see him. Sure, I do. But you gotta look at where he was and where he is now, and you gotta look at that from his point of view," Daniels says.

These days, he says, Summerfield uses sterile water, new bottle caps (for cooking the heroin), clean syringes. To an addict like Summerfield who's been injecting heroin since 18, those are big steps, Daniels says.

"He is a model participant. He gets tested for everything now," he adds. "From a clinical standpoint, where I've seen him before, he's doing better."

"Look, I've been there before, I know what it's like to be on the other side, and, no, I don't miss the high, I don't miss that life I had."

He goes on. "I see the folks out here and it just breaks my heart -- does it break yours? You look at them the way I look at them, with that 20/20 hindsight, and the temptation goes away."

Full Circle

Daniels parks the Winnebago at Hechinger Mall and listens to 1230 AM. There's Lee's BBQ, Subway, McDonald's and Pizza Hut nearby. Safeway, in case he needs ice for the cooler, is only a few feet away.

Henry Mallory, the part-time health educator, comes in and sits on the front dining table, snacking on potato chips and soda. Mallory is transgender, and Daniels refers to him as "her."

"Let me tell you something about this man," says Mallory, 48, a former drug user and street worker who has AIDS. It was a little rough when they first met more than two years ago. ("Sometimes Mallory was rude in talking with some of the participants. Yelling at them. Telling them off," Daniels says later. "I had to take her to the back room and say, 'I will not allow you to talk to people like that. That's not what we do here.' ") "This RV is his addiction," Mallory continues. "Even when he's not supposed to be here, he's here. You just can't stop him from worrying about this unit and the participants. He's always telling people, 'I'm gonna do this and this for you.' You can't stop him."

Daniels sits quietly behind the steering wheel and looks out the window -- the morning's sunshine has been replaced by a light rain.

Moments later, he takes off, drives toward the last exchange site of the day. "What more can I ask for?" Daniels says, smiling. "I think I got another 15 years to live."

He is "in excellent health," he says; his CD4 count -- a measure of immune system health -- is over 500, a good sign. He is "very close" to his siblings, Paulette, Ora, Phyllis, Patricia and John Sr. The family makes it a point to get together for dinner and a movie once a month. He is "extremely close" to his children, Kevin and Kieyannia, and his grandchildren, 3-year-old Berry and nearly year-old Takayai. Recently he completed more than 1,200 hours (when only 20 hours were needed) to be a certified addiction specialist.

"This is the happiest I've been in twenty-somethin' years. It's sad to say that because there's no reason for me to be happy from the outside lookin' in," Daniels says. Four more hours until dinner. Barbara is waiting at their one-bedroom apartment in Southeast Washington.

"I didn't wake up one day, you know, and say I wanna be a drug addict. I didn't wake up one day, you know, and say I wanna be HIV-positive. But in the last 25 years, both of those things have been a part of me," he says. "Who would have ever thought I'd get here? That I'd come full circle? That after all those years I'd get to help people out, people who were just like me?

"It ain't no fun walkin' in this rain, in this rain that's comin' down now, not havin' no money, no place to go, no food. It ain't fun.

"Look at that man sittin' out there on the steps."

Daniels parks the Winnebago in front of St. Matthew's Baptist Church, where "All Are Welcome," the sign says at New Jersey Avenue and L Street SE, a few blocks from the Capitol.

Turner grabs his hepatitis C fliers; Mallory sits at the laptop.

The man waiting in the rain is Al, another old buddy. He and Daniels grew up just a few houses apart on Sixth Street SE, and Daniels idolized him. He played ball well. He got the pretty girls. He drove a nice white Caddy.

He's 49 now. His left eye is gone, lost in a prison fight. He's a regular at this exchange site, and says he's proud of the work that "Boo" -- as Daniels was once known -- is doing.

At the moment, Al is the only one waiting. But the man who used to be called "Boo" hurries out of the Winnebago and heads toward his old friend.

"How you doin' today?"

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