Thousands of used needles are deposited every day through Baltimore's needle exchange program. (Newsline Photo by Fanen Chiahemen)

By Fanen Chiahemen and Amanda Karr
Maryland Newsline
Friday, May 9, 2003

BALTIMORE - It's 9:30 on a Tuesday morning and Jeff Long, a health counselor for Baltimore City’s needle exchange program, is at work in an RV parallel-parked along North Caroline Street.

“Hold up the needles so I can see them. Don’t put anything on the table,” he tells the habitual intravenous drug users who one-by-one climb into the RV.

One man, who is well-groomed but casually dressed, pulls eight needles out of the front pocket of his sagging blue jeans. Another removes a single needle from a brown paper lunch bag he’s carrying. Both drop the needles into a blue plastic bucket beside them.

Long hands each person who turns in dirty needles five fresh ones.

Baltimore’s needle exchange program is just one of a growing number of ways HIV is being combated in a city that accounts for slightly more than half of all of Maryland’s cases of AIDS and HIV-- and where drug use feeds the epidemic.

According to Maryland AIDS Administration statistics released last year, 12,292 people in Baltimore were living with HIV or AIDS, out of 24,480 in Maryland. Of those in Baltimore, roughly 55 percent were infected through intravenous drug use.

Statewide in 2001, about 46 percent of HIV and AIDS cases were attributed to infected needles, according to AIDS Administration statistics.

Since the outbreak of the epidemic, both in Baltimore and statewide, intravenous drug use as a means of exposure to HIV has increased steadily, becoming the most common means of transmission in 1991. 

In 1986, 65 percent of AIDS cases were attributed to men having sex with men. Drug use accounted for only 16 percent of the cases.

“We unfortunately have a very significant drug problem in Maryland,” says Maryland AIDS Administration Director Liza Solomon  “That’s a problem we are grappling with.”

More Money, More Programs

The state and the city have responded to both the drug and HIV problems by lobbying for more funds. 

In March, for instance, Baltimore was awarded more than $21 million in federal grants through the Ryan White Care Act to help provide more care to low-income residents with HIV and AIDS. The funds --about $3.5 million more than last year -- will be allocated to primary care and substance abuse programs, mental health services and medication.

Treatment programs have been tailored to meet the needs of the city. 

Lamont Cogar, assistant director of the city’s needle exchange program, says drug treatment slots have increased from 5, 000 in 1997 to somewhere between 20,000 and 30,000 today. Drug treatment programs include counseling, testing and needle exchange.  

The city's response to the epidemic has yielded some successes.

In the late 1990s, northwest Baltimore was the only area of Maryland showing declines in new cases of HIV, Solomon says. City officials say it was due to prevention programs like needle exchange, which is funded through the city, state and private foundations.

"We realized we really had to focus on prevention activities, and focus on communities and risk practices," Solomon says.

In fact, there was a 24 percent decline in the number of new HIV cases in that area from 1999 to this year, Solomon says.

Struggling to Reach People

Nonprofit organizations have also pitched in, establishing substance abuse and prison outreach programs to people affected by HIV or AIDS.

At Health Education Resource Organization Inc, a resource center for people living with HIV and AIDS, 70 percent of clients are recovering substance abusers or have a history of substance abuse, says Indira Kotval, deputy executive director.

At the center, substance abuse counselors try to couple HIV treatment with substance abuse treatment, and workers go out on the street to inform people about the organization and its services.

Chase Brexton Health Services, a nonprofit health organization, offers outreach programs with the prison system, since many inmates in Baltimore prisons have been incarcerated for drug-related activities, says Vickie Adams, acting director of program development specialists.

Warren Connor, assistant director of case management and outreach, says outreach workers meet inmates who have “identified themselves as being HIV positive” within two weeks of their release date and try to transition them into healthcare at the clinic.

However, these support groups and treatment centers say outreach to injection drug users remains a challenge.

"When they are actively using drugs, they are not interested in anything but getting drugs," says Kotval. "The need for drugs becomes so great it overrides everything. Only when the sickness gets really bad do they come in."

Adams says health care organizations face a huge challenge.

"It's still pretty overwhelming," Adams says. "We're never going to reach everyone ... because no treatment center is big enough. We serve only about 5,000 clients.... That's just a fraction of the number of people who need us."

'Not Condoning Drug Use'  

Michele Brown directs the Baltimore City Needle Exchange Program. (Newsline photo by Fanen Chiahemen)

About 15,000 of Baltimore's 59,000 illicit drug users are registered with the needle exchange program and are seen on a weekly basis, says Michele Brown, the program director. 

The program launched in 1994 as a pilot, says Peter Beilensen, the city's health commissioner. In 1997, it became permanent, and by 2000, its staff saw about 10,000 clients and had an annual budget of just over $500,000.

Brown and her co-workers drive the program's $35,000 RV to 12 sites around the city six days a week, and they hand out thousands of needles a day. 

Brown says the program -- now with an annual budget of $600,000 -- has been embraced by its clients as something they really need. However, she makes it clear that the organizers in no way condone drug use.

“If we stopped the needle exchange program tomorrow, people would still get high,” she says. “We would just have more HIV and more infectious diseases floating around.”

And that's just what Brown and her staff, as well as the city of Baltimore, don't want to see.

After Long hands each person a new set of five needles wrapped in a rubber band, he asks if they'd like bottles of bleach and water. 

With that, each client ducks back out the van door, leaving Long and Brown sitting in the small vehicle, bagging supplies and keeping an eye out for the next visitor.