3 Years of Needle Exchange in Delaware: Saving Lives and Saving Dollars

The pilot Delaware Needle Exchange Program has had three very successful years. Over 700 people are enrolled, and over 38,654 needles have been exchanged. These potentially infectious syringes have been incinerated and destroyed. Not only have new infections been prevented, but participants have been successfully connected to substance abuse and HIV treatment services. Here are some more highlights, which we are also sharing with legislators today at the Joint Finance Committee budget hearings.

• 150 people have been referred to drug treatment, with an incredible follow up/success rate of 60%. Referrals have been made to methadone treatment, outpatient and inpatient drug treatment, and detoxification.


• Over 1200 people have been tested for HIV on the van. More than half were not needle exchange participants, but took advantage of the service being brought to their neighborhood. Testing has identified new HIV positive infections, as well as positives who know their status but are not in treatment. We are linking them to medical care and case management, which further reduces their risk of transmitting the virus.


• We have begun Pregnancy Screening on our van. Our goal is to reduce the infant mortality rate in Delaware by connecting drug abusing pregnant women to treatment immediately. This will ultimately save both the mother and the baby’s life. Delaware has an extremely successful record of preventing HIV infection among infants born to HIV infected mothers, with only one HIV-positive birth in the last 4 years. Expectant mothers with HIV in Delaware have access to comprehensive, high-quality care; yet, it remains imperative that we encourage them to be tested for HIV and to seek drug treatment.


• The needle exchange has made a difference for so many individuals in the past three years. Here is just one of those stories:
  
  "Cecilia" is a 24 year old Hispanic female who joined the needle exchange a little more than a year ago. She was an active drug user but was not ready for treatment. One day, after she had been with us about 6 months, Cecilia came on the van, tired and crying. She had finally had enough of the drug using lifestyle. We made her an appointment at the methadone clinic. She was having trouble signing up for Medicaid to handle her payments, so we helped her with that, and she was successfully admitted. At time of admission, she had a pregnancy test and found out she was 4 months pregnant. She stayed in treatment and gave birth to a healthy baby. Today Cecilia is still active in treatment and is also employed.


• Lastly, we would like to share with you the cost benefit of needle exchange. Delaware’s program receives $211,000 from the Division of Public Health each year. We know from a recent CDC study that preventing one new HIV infection saves $221,365 in treatment costs. So, the prevention of one new HIV infection pays for the Needle Exchange Program for one year. In three years, Delaware’s needle exchange has prevented an estimated 10-12 new infections by connecting nearly 20 people to HIV care. Therefore, we saved an estimated $2 million that would have been spent on treating those individuals - and that is a modest approximation that does not include the infections prevented when someone is admitted to substance abuse treatment.

The success of the needle exchange is thanks to the inclusive and considerate work of our program staff at Brandywine Counseling, along with incredible support from the City of Wilmington, neighborhood associations, the Faith Community, the Division of Public Health and the Wilmington Police. This is an excellent example of what can happen when a community mobilizes.

We must keep up the work we’re doing. This epidemic remains a challenge, but we are making progress. 3,489 people are living with HIV/AIDS in Delaware. The Black community accounts for 20.9% of the state’s population, but 66% of our HIV/AIDS cases. While the number of new infections each year has declined, in Delaware, 1 in every 83 Blacks has HIV/AIDS.

Delaware’s Needle Exchange remains dedicated to the following goals:

• We must encourage HIV testing for all those who are at risk.
• We must encourage all of those that are infected to seek treatment.
• We must encourage those not infected to take measures to ensure they remain uninfected. Until then, many will continue to pass the virus without knowing it.

Tom McLellan on Who's Winning the War on Drugs

Tom McLellan, Deputy Director of the White House drug czar's office, is interviewed in this article from The New Republic. He discusses a wide range of topics, including needle exchange, medical marijuana, and prescription drug abuse. We found it very interesting. It's long, so you might want to read it over coffee.

Needle Exchange Update

Can you believe it will be 3 years in February since we started needle exchange in Delaware? Here's an update on the program:

• 653 clients are enrolled in the City of Wilmington's Needle Exchange Pilot Program, exchanging more than 28,000 needles. This means that we have incinerated over 28,000 potentially infectious syringes and removed them from our streets. Since it is a one-for-one exchange, there is virtually no needle litter problem anymore.
• 402 participants self-reported that they were referred by another NEP client. This proves that word-of-mouth advertising is what works with this population. 4 people reported that they were referred by law enforcement.
• Caucasian clients make up 69% of the membership; however, we are working on increasing the participation of African Americans using the social networking strategy called the LINK program. We are asking existing members to refer their peers. Since it began in February, LINK has 97 members, 79 of them recruited by existing members.
• We've made 72 formal referrals to drug treatment, of which 46 have successfully entered treatment. This does not include informal referrals we make all the time and at just about every instance of exchange.
• 1711 rapid HIV tests have been completed on the van. 84 of those were people tested for the first time. 14 of them were newly identified positive individuals. Almost 300 of the 1711 HIV tests were NEP clients, but more than 1300 of the tests were provided to members of the community where the NEP operates. These individuals accessed HIV testing because we brought the service to them. As a result of our success at reaching these residents, we are planning to begin offering the combination hepatitis A and B vaccine on the NEP in the coming weeks.

Out Of the Dark, A New Dawn

On a bus stop bench on a frigid February morning, a young couple sat together shivering, and counting down the minutes until 9:00.

“How much longer?” Dawn asked her boyfriend.

“Four more minutes.”

Dawn broke into a smile in spite of the stinging cold. “Oh, I can’t wait! Soon they’ll open up… it’ll be so warm inside!”

He smiled back. “In four minutes, I’m gonna be layin’ on that comfy couch and gettin’ some sleep!”

A miserable, exhausting night neared its end. They had spent it at the bus stop on Lancaster Avenue, with all their belongings in their backpacks, and only their coats to keep them warm. But at 9:00, right behind them, they had a place they were welcome in the Brandywine Counseling Outreach Center. Dawn watched the buses come and go, full of people with places to go and things to do. Her plans today were simple: Get warm. Find some food. Hide from probation. Then, find some more heroin. Tomorrow, she’d do it all again. It wasn’t always this way. Six years ago, she had a normal life, a job, and a place to live. But one seemingly innocent car ride led her off course.

“I was working in a restaurant, and one of the other employees was asking me for rides. When he was getting out of the car, he was picking up drugs. I got curious about what he was picking up, and he let me try the heroin just by sniffing it one time. Eventually, he ran out of money to pay me for the rides, so he would start giving me drugs instead of gas money. I started to get sick if I wouldn’t use it, so I started to use it every day.”

“For a little while, I was okay. I could afford it. I started to be late for work. I started spending all my money on only drugs. I had to move back in with my parents, then I started to steal from them. I lost my job. I started stealing from cars and people’s houses, and ended up on probation.”

Dawn’s choices had led her down a destructive path of addiction, homelessness, and being on the run at age 27. She met her boyfriend and they stuck together, but there seemed to be no way out. They weren’t looking for help; only to survive. It was rare to find a friendly face that understood where they were. BCI case manager Sharon Brown was one who did.

“Hey, guys. Need a light?”

“Nah, we smoked our last cigarette hours ago.”

“Here. We’re not supposed to do this, but go on, take it.”

“Oh, thank you so much!”

“It’s too cold for y’all to be out here. Why don’t you come inside? There’s coffee and donuts. I can get you warm clothes, a place to wash up. You can crash on the couch, watch TV, read some books…”

Since that day, the pair became regulars at the drop-in center. “It became like a little home to us,” Dawn recalls. “We would go inside during the day, and sleep in there, and at nighttime we would just stay outside all night.” She began to trust the outreach staff. She began using their services, taking HIV tests, and visiting the needle exchange van. She learned about other services she wasn’t yet ready for.

“They would let us know that the methadone clinic was there, but they never seemed like they were judging us, or trying to push us into anything we didn’t want to do. They knew that we knew the services were there, and that we would use them when we were ready to.”

One day, a probation officer came to the bus stop. He took Dawn into custody, and she served six months in jail. In July 2008, she was released and reunited with her boyfriend. They were both free of drugs for a while, and even found themselves an apartment. But by September, they had relapsed and were using heroin again. They returned to the needle exchange.

“When we started coming back, they knew we were using again. They were a little more adamant this time. ‘You guys really need to try methadone this time, before you end up back in the situation that you were in.’” The couple faced a difficult decision.

“No way I’m gettin’ on methadone. It’s just another way to get high. It’s just as bad!”

“Well, I’ve heard those stories too, but what about the people we know who got on it? Seemed like it was working for them.”

“That’s true. They do look better. They’ve got jobs, they look stable.”

“Why don’t we try it? It’s the only thing we haven’t tried.”

With that, a window of trust had opened. The next morning, Dawn and her boyfriend went in to BCI, and they both started on methadone. She knew it would be a challenge to make her daily dosing, individuals, and groups, but she committed to getting clean as strongly as she had committed to getting drugs. Sharon Brown continued supporting her as her Safety Net Services case manager. Safety Net specifically targets two high-risk groups, women and recently released ex-offenders, often living on the streets. Knowing that willingness to accept help comes and goes, case managers meet clients where they are, ready to connect them to services they need when that window opens.

“Sharon was a big help,” says Dawn. “She’s always checked on us, made sure we have everything that we needed. I’m glad the outreach really latched on to [us].” But there was a big surprise for Dawn on her intake day. Nurse Barbara Garrity gave her the news at orientation.

“Now just to let you ladies know, when you get on methadone, it seems like it’s a lot easier to get pregnant. But Dawn, you’re already pregnant!”

“Oh! Really? Wow, that’s quite a surprise!”

“Yes! But we have a program just for pregnant women."

Dawn was 4 weeks along. Her surprise quickly turned to motivation to stick with treatment. She was determined to deliver a healthy baby. She was transferred to the pregnant and parenting women's program, which assists over 20 clients every year to deliver drug free babies. Her counselor, Aja Redmond, linked her with prenatal care, helped her identify her triggers for drug use, and taught her about FAS and nutrition. Four months into treatment, Dawn was staying abstinent. Things were going well. It was then that the couple received another surprise.

“We’re having twins! Oh, wow… two babies? How are we going to do this?”

“Don’t worry, Dawn, we can deal with it. Just one more obstacle in our way.”

“This is so difficult… I’m staying clean and doing what I need to do, but every day something else comes up.”

“Yeah, it would probably be easier to go back to the streets and start gettin’ high. But look at all the good things we’ve accomplished. We’ve come too far to throw it all away.”

And so, preparing for twins became the latest challenge in their shared journey to recovery. “We were already together when we were looking to get clean. We weren’t willing to separate for any reason, so we had to do it together.” Dawn recalls. “[It helped,] having somebody to walk through it with you, share all the ups and downs, and remind you how far you’ve come and where you still want to go.”

Dawn had support not only from her boyfriend, but from Aja and the women's program. She redoubled her efforts to set and achieve goals, worked on her parenting skills, and cut back on smoking. As her due date approached, a case manager made a home visit, making sure they had food, clothes, and baby furniture. On May 15, Dawn gave birth to healthy, identical twin boys.

“Being in a relationship and having the babies helped me get clean, because it gave me a reason to want to move forward in life,” she says. “Having the children and having a partner that loves you and is there for you, gave me my life back.”

Today, Dawn’s children are 4 months old, and she is nearing one year clean. She is a picture of composure as she tells her story and tends to her sons at the same time. She shifts one baby from her arms into a stroller to pick up the other, then reverses again. As they fuss, she remains calm and soothing, wiping mouths, giving them their bottles, even laughing cheerfully to herself as her son’s expression changes from restless to content. She shows no trace of her former life on the streets, sleeping at bus stops. She looks like a mom.

“I think for the two of us to go from where we were, to where we are now, it’s all pretty much thanks to Brandywine. This is the longest period of clean time either one of us has had. Being able to come up here every day and be accountable for your actions, and have people checking in on you, along with the medication that you get, has made us successful.”

Dawn sees a bright future ahead for her family. Life is not simply about surviving anymore; it’s about building a future for herself and for them. They’ve moved into a relative’s house, and they have a car. She hopes to one day own a home, put the children in a good school, and go back to school herself. For now, she wants to stay clean and sober, enjoy family life, and continue to build her support system. She’s on the right course again, and it all started with a friendly face offering food and shelter, no strings attached.

“It feels like a blessing. It feels that God was with me all along, and He’s looked out for me, and that He made a way for me to get better, and as long as I continue to follow it, things will continue to get better. It hasn’t been easy for us at all, but we’ve been able to get through it. I’m very happy with the way things are now.”

Brandywine Counseling services are funded by the U.S. Dept. of Health and Human Services, SAMHSA/CSAT; and Delaware Health and Social Services, Division of Substance Abuse and Mental Health. For more information, please call 302-656-2348.

Delaware Needle Exchange Enrollment Reaches 500

As of today, we have 507 unduplicated clients enrolled in the City of Wilmington's Needle Exchange Pilot Program, who have exchanged more than 17,450 needles in two years and some change. This means that we have incinerated over 17,450 potentially infectious syringes and removed them from our streets. Since it is a one-for-one exchange, there is virtually no needle litter problem anymore.

231 participants self-reported that they were referred by another needle exchange client. This proves that word-of-mouth advertising is what works with this population.

Caucasian clients make up 71% of the caseload; however, we are working on increasing the participation of African Americans.

1087 Rapid HIV tests have been completed on the van. 182 HIV tests were NEP clients. The other 905 were community members who accessed HIV testing because we brought the service to them. As a result of our success with reaching the community residents where we target injection drug users, we are planning to begin offering the combination Hepatitis A and B vaccine on the NEP in the coming weeks.

Other noteworthy numbers:

• 11 HIV Positives have been identified on the van.
• 40 formal referrals to treatment.
• 25 confirmed linkages to drug treatment.

Basha Silverman's Testimony at State Budget Hearings

My name is Basha Silverman. I am the Director of HIV Prevention programming at Brandywine Counseling in Wilmington. I am here to call your attention to the importance of the Needle Exchange Program on behalf of the Division of Public Health and the many individuals at risk of contracting HIV in Delaware. I understand you have some very difficult decisions to make this year, so I wanted to arm you with some information that may help you.

The Needle Exchange program does not only provide access to sterile equipment; it is a bridge to other services.

• In just 2 years, this mobile program has been extremely successful at identifying at-risk and HIV-infected individuals, and connecting them to medical care and substance abuse treatment.


• We are reaching a very, very hard to reach population that might not receive or follow through with services if the services were not brought to them.


• We have tested over 900 individuals on the van.


• To date, we have identified approximately 20 HIV positive individuals, and linked them to HIV treatment and case management.


• Additionally, we have successfully linked 62% of those ready for substance abuse treatment to a treatment center.


• Almost 40% of participants are women. When we connect a woman to treatment, especially a pregnant woman, we increase her chance of giving birth not only to a healthy baby, but one that is not HIV infected.

Why Needle Exchange?

• In Delaware, it took over a 10 year battle to pass such a significant piece of legislation.


• In the late 80s, methadone treatment was our best intervention known to combat HIV/AIDS. Today, needle exchange is the most widely studied and has proven to be most effective intervention to combat the spread of HIV.


• Needle exchange is not just HIV prevention, it is pre-treatment.


• Studies also show that once a person learns they are HIV positive, they are approximately 60% less likely to infect another person. Therefore, the testing efforts on our van are unquestionably a significant service that should not be cut.


• Lastly, just a reminder of the cost benefit. The needle exchange program costs roughly $200,000 a year to provide services on the van and make linkages to other services and programs designed to increase the overall health of Delawareans. In comparison, the estimated cost to treat ONE individual infected with HIV over their lifetime ranges from $300,000 to $600,000, depending on how long he or she lives. In two years, we prevented an estimated 10-12 new infections by connecting nearly 20 people to HIV care. Therefore, for $200,000, we saved an estimated $3 million that would have been spent on treating those individuals - and that is a modest approximation that does not include the infections prevented when someone is admitted to substance abuse treatment.

Thank you for listening. Thank you Senator Henry!

Needle Exchange and Law Enforcement: The Secrets of Our Success

Last week, BCI's Basha Silverman was a co-presenter at a symposium by the Yale Center for Interdisciplinary Research on AIDS called "Aligning Criminal Justice and HIV Prevention: From Conflict to Synergy." Allan Clear of the Huffington Post has written a detailed recap, which I encourage you to check out.

Here is the portion pertaining to Brandywine:

"From the service provider and government sector, Basha Silverman from Brandywine Counseling, a drug treatment/ needle exchange program in Wilmington, Delaware and Maxine Phillips and Mary-Ellen Cala from the New York State Department of Health AIDS Institute explained the secrets of their success in working with law enforcement. Strategically speaking the tactics are simple; relentless relationship building comprised of community and civic association meetings, meetings with police chiefs/captains and their support staff, joining sub-committees and inviting police onto advisory boards, arranging visits to treatment and exchange programs, working with community relations police, and training, training, and more education. Ideally, these efforts would foster the creation of feedback loops so that it is clear what works, what does not work, and would aid in the establishment of a strategy for furthering more effective community partnering. At all times it is critical to acknowledge law enforcement's own perspective on community drug issues and to emphasize the benefits that they can derive in supporting syringe exchange, such as minimizing risk from a needle stick. The relationship between providers and police can, and should, be a bi-directional initiative."

5 Questions for Tom Bell, Outreach Worker

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Tom Bell
Job: Outreach Worker, HIV Prevention and Needle Exchange
Time with BCI: 7 years

1. What’s your job at BCI and what do you enjoy about it?
I’m a member of the team doing outreach and needle exchange. The mission is to help reduce the spread of HIV/AIDS, targeting injecting drug users, and then also offer harm reduction education and information. We’re out there in the community 4 days a week, which is Tuesday-Friday. We also do HIV rapid testing on that van. It’s totally confidential. And one doesn’t have to be in the needle exchange program to receive testing, one can just come on, get an HIV test. If they need referrals, then we’ll make those as well, give them help wherever we can. Also pass out condoms, to help slow down the spread of STDs. Right now we’re trying out a new pilot program. It's called the LINK program, and we offer some incentive, as far as introducing drug-injecting people to the program.

And I kind of like it, because it’s out there helping the community and trying to change their thinking. We understand most people will do what they’re gonna do, but not being knowledgeable of what they’re doing. [So] we try some education in that area, because we know that we can’t stop folks from doing what they do. I like doing it, because I myself was drug dependent at one time. I went through an organization, and aftercare, and a 12 Step program to get my life back, and change my mindset, and become a productive member of society. So we try to instill hope in them that they don’t always have to live like this.

2. The Delaware Division of Public Health announced recently there are now fewer new HIV infections in the state and more HIV tests being done, thanks in part to the needle exchange. What’s your reaction to this news? Do you think progress is being made?
Yes I do. My take on that is, the word is spreading, and it’s a plus.

3. What would people be surprised to know about your job?
It’s not just drug and alcohol related; we help out wherever we can. We help with clothing, food, shelter, referrals, whatever way we can help. I can remember the times when I was drug dependent, and I was just wishing and hoping someone could just help, just not knowing where to go or how to ask for help. And now with this outreach program, we’re out there meeting folks just where they’re at, so some of the things they might not want to ask, or don’t have the courage at that time, or maybe they think it’s gonna take too much time, we’re there to step in and kind of reevaluate their thinking.

4. What’s the fun part of your job?
(Laughs) You say the fun part… Being in this field, the fun part is in the beginning. Maybe meeting someone for the first time, and they don’t really like you, because sometimes you have to be stern and practice a little tough love at some point. But the gratitude is when you see them later on down the line, and they have changed their mindset, and [are] starting to do different things, starting to become a productive member of society, not so much drug dependent, and starting to get their life back together. That’s the joy, you know, that’s the reward, in all. And I love that.

And then, I also have those same individuals come up to me later on, maybe a month or a year later, and say, “Why, thank you. Thank you for being there, thank you for puttin’ up with all that you put up with.” And I in turn say, “You’re welcome, and thank you for puttin’ up with all that you put up with.” (Laughs) So, that’s the fun part.

5. Since you joined the Outreach team, you’ve been working side by side with your wife. What’s that like?
(Laughs) Well, actually, it’s good and it’s bad, you know, to be honest. Because I, too, have to have an outlet. And, like I stated, I was drug dependent, and I attend a 12 Step program, and sometimes I have to talk about some of the things that go on with me working with my wife… And I’m grateful to be able to work with her, because I didn’t have the opportunity [before]. We were in the same field, but different areas, different times, so I didn’t get a chance to spend as much time like I do now.

She’s been in the outreach program [longer], and she knows more than I know in the outreach area, and so I’m humbly taking my stand. And sometimes it gets frustrating when she has to be stern, and then sometimes I don’t like it… But I understand that it’s for the best for the program and the organization, and I keep an open mind. And it’s actually good. We have our bad times, but it’s more good times than bad. I think that it could work. It’s life!

Prevention Works in Delaware

In case you missed it, this editorial ran Saturday in the News Journal. There are improving numbers on HIV/AIDS in Delaware, made possible by the work of organizations like BCI.

Some highlights:

• No babies born with HIV in 3 years
• New infections are down while the number of tests is up.
• Community support continues for the needle exchange and is helping it be successful.

This means we need to keep up the work we’re doing. It’s making a real impact.

BCI LINK: A Social Networking Approach to HIV Prevention

One of our biggest challenges in meeting the goals of Delaware's Needle Exchange is how to reach those most at risk for HIV. With 12 positives found in two years, we know there are more yet to be discovered. As it was reported last summer, fewer minorities are enrolled in the Needle Exchange despite their disproportionately high risk. Typically, these injection drug users are mistrustful of law enforcement, have never been tested for HIV, and are not involved in any treatment program. As resourceful as our outreach workers are, we can never elicit everyone’s trust. So if someone won’t listen to an indigenous outreach worker, who will they listen to? We think the answer is their own peers who are already participating in the Needle Exchange.

Brandywine Counseling has launched a new recruitment strategy based on peer to peer networking, called BCI LINK. We will use existing social networks to promote HIV awareness, the Needle Exchange program, and drug treatment. Specifically, all participants in the Needle Exchange will be offered an incentive to recruit others in their social networks. The approach is evidence-based and has shown that that the incentives also increase adherence to the program.

The great thing is, we assume we already have people who collect and exchange used syringes from their peers. BCI LINK will train these individuals as “Connectors” to reach out and draw in their peers (“Crew Members”) who otherwise would not enroll. The effect will be that BCI reaches greater penetration levels within the community. Every Connector and Crew Member is required to be tested for HIV. We will also learn more about trends in needle-sharing, intravenous drug use, and HIV infection in Wilmington.

What’s more, because BCI LINK takes advantage of established patterns amongst Wilmington’s injection drug users, it has the potential to grow exponentially, reaching ever-larger groups of at-risk drug users. The graphic above shows the results of a similar program in Philadelphia that showed great success after a year and a half.

We began BCI LINK one week ago, and have already enrolled 6 Connectors and 5 Crew Members. We are truly excited to bring this approach to Wilmington. Stay tuned as we report on our progress and results.


Graphic c/o Howard Wasserman for Prevention Point Philadelphia.

Needle Exchange Update

Hello Everyone,

We just wanted to let you know that as of this afternoon 1/14/09, we have 402 un-duplicated members on the Needle Exchange Program. Today is roughly the two year mark since we started on 2/1/07. I thought you all would be happy to celebrate this milestone with us. We are touching, changing, and saving lives-one sterile syringe at time!

Thank you all for your continued support. Please feel free to share this news,
Basha and Rochelle

How Might the Presidential Election Impact Needle Exchange in Delaware?

Our friends at Prevention Point Philadelphia are featured in a recent Philadelphia City Paper article, "Hope and (Ex)Change: What the Election Means for Heroin Users." The article describes how Philadelphia’s needle exchange faces limits in its funding, and consequently, on its effectiveness. Due to a federal ban on funding needle exchange, Prevention Point operates with city funding alone. This amounts to much less support than other AIDS prevention programs.

However, a new Presidential administration brings a possibility that the ban could be overturned. What would this mean for programs like Prevention Point, and for Brandywine Counseling in Delaware? What would it mean for injecting drug users?

The most obvious answer is that if federal funds became available, programs would have one more funding source to pursue. It could mean more staff, more supplies, and increased hours of operation.

Besides an increase in available dollars, there is another potential effect. Needle exchange programs would have increased freedom to partner with other community organizations. Imagine that BCI’s van could offer mobile screening or vaccines for infectious diseases besides HIV, and thus combat several dangerous public health epidemics at once. This is not possible under the ban, because the agencies that would do this work are federally funded. Although their staff would not exchange needles themselves, they are not permitted to provide ancillary services to needle exchange participants.

But perhaps the greatest impact would be on another level altogether, and that is to reduce the stigma associated with syringe exchange. Federal funding would be symbolic as a stamp of approval for the practice, from the highest level of government. It would legitimize what we do. It would substantiate the science that has proven the effectiveness of needle exchange at reducing HIV risk. The ripple effects might even extend into substance abuse treatment, lending credibility to harm reduction in general, and allowing providers to follow its principles alongside cognitive behavioral therapy.

Most likely, needle exchange isn’t the foremost issue on our minds as we head toward November 4. Even so, for heroin users here in Delaware, the ramifications are potentially far-reaching.

Volunteer Spotlight: Felecia Doyle, Outreach Support

My name is Felecia Doyle. I am doing my internship at BCI HIV/AIDS Outreach Program. I first learned about the program from seeing the sign on Lancaster Avenue. I started researching what programs they offered and was interested in how much the staff helps the community. Being a Delaware Tech student in the Drug and Alcohol Degree program we are required to complete 200 hours of unpaid internship. Not only am I learning from my experience here, I am helping the staff achieve their goals by offering my support.

Before I started at BCI, I figured the staff had to have a heart in working with the community that is at risk for HIV. Once I started, the staff welcomed me with open arms. Since the facility is under renovations, the staff is working out of one room. Even though the space is tight, they all work together like one family.

I am currently working on data entry for the NEP, Needle Exchange Program. This program manages the clients who are new to NEP and who have utilized NEP as repeat clients. These clients are given numbers to use as their identification. Another program I am helping with is the CSAT GPRA, Center for Substance Abuse Treatment Government Performance and Results Act. This is through SAMHSA, which funds grants to provide substance abuse and mental health services to states and communities. This program monitors clients for a year.

I have learned a lot with the needle exchange program. I believe that this is a great program to help the community. The outreach workers go out into the community to promote the program, give out safe sex kits, bleach kits and let clients know about the rapid free HIV testing.

What I would take away with me from the experience is to have had the pleasure of meeting such great people who work at the HIV Outreach. All of the staff have hearts of gold and give so much to the community. I like to help people and bring smiles to their faces. If more people would open up their hearts it would make such a big difference.

Ten Thousand Needles Off Delaware's Streets Through Exchange

Delaware's needle exchange program passed another huge milestone recently when we exchanged our 10,000th syringe. What an accomplishment for a program now entering its twentieth month of operation. Six months ago, our total was at 3,500.

Every syringe has been exchanged for a clean one, meaning ten thousand dirty ones are no longer on the streets of Wilmington. Because it's a one-for-one exchange, there is incentive for participants to bring every clean one back after it’s been used. So although we’ve given out ten thousand syringes, they are being returned. The effect is not needle litter, but the opposite.

Here’s some more impressive numbers:

• We’ve enrolled a total of 353 participants.
• A total of 1697 exchanges have taken place.
• 132 participants were referred by another needle exchange participant.
• 17 participants have entered drug treatment.
• Since November 2007, 621 rapid HIV tests have been done on our van. 7 positives have been identified.

5 Questions for James Harrison, Site Director

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: James Harrison
Job: Site Director, Lancaster Avenue
Time with BCI: 20 years

1. How did you get started working in the addiction treatment field?
I think mine was a unique situation. I was actually finishing up a three [year] mandatory prison term, and Kay Malone and Linda DeShields came to the Plummer Center in 1988, and at the time, the American Red Cross was providing HIV education in the prison. They had a gentleman that came in, and none of the inmates would respond to him. They were rowdy, they were disruptive. And so, the warden asked me if I would co-facilitate the group. And I agreed to it. And after his first presentation, I actually took control of the presentation.

All the inmates were extremely receptive. It was like hearing it from one of their peers. And this was a time when HIV and AIDS was at truly epidemic proportion in our city, and folks were dying within five years. And so I hollered out, “Listen up, people! I have some life-saving information!” And people were quiet. People listened. And that kind of opened the door for me to start doing some prevention education, after I was released. Of course, Kay and Linda DeShields agreed to hire me after I was released, waited five months for my release, and I’ve been here ever since.

Many people would be surprised to know that I’ve actually had a 30 year history with Brandywine. So, many folks, especially newcomers, oftentimes will not realize that I’ve spent ten years on the other side of the fence. And so, I’ve seen the changes we’ve made as an agency, particularly around process improvement and access, and just being kinder and gentler to the addict. I think what folks will not realize is that ten years as a consumer embedded an advocacy in me that will never leave. And so I carry with me, day to day, having to straddle both fences. I’m still in recovery, I will say that. I can always see the client’s view clearer in my head as I’m also trying to move our agenda, and move the agency to the next level. So when you first look at me, you don’t see the old James, and so that’s the piece that I carry with my job that many folks don’t know about.

2. What changes have you seen in your 30 years with BCI?
Part of what I’ve seen is a growing trend, that we’re seeing a younger, sicker population. And I look at all of the old-timers, for loss of a better analogy. They are the dying breed. I recall one consumer I saw yesterday, who has been with Brandywine [for] a 30 year history, is actually wheelchair bound, and blind. And that same person, I used drugs with, I hustled with, I participated in drug addict behavior with. And now this person is barely struggling to survive.

And I see on the other spectrum, young white females and young black males chronically addicted to opiates, but now struggling with HIV, mental illness, and addictions. And I think the most obvious change has been the severity of folks’ addictions and their problems, coupled with the social ills as well: increased gas prices, food, housing shortage. All those other issues, where I think years ago, folks could make it off of a year’s income of about $12,000, but now, that’s starving. And so, couple that with addiction that’s more severe in its nature, we’re seeing sicker and more violent individuals as well.

3. BCI was in the news last week because of the challenge of reaching black drug users with the needle exchange. What do you think it will take for this population to access these services?
There was a workshop I went to, years ago, that addressed this very issue. The name of it was, “Beyond Tuskegee.” And if you remember the Tuskegee experiments, blacks historically had a fear of public health systems, and the whole notion that, “This is suspect, in terms of, the government has its hands on it, and that law enforcement may use this as a vehicle to further disenfranchise us.” So getting beyond Tuskegee would say that, “No, this is not true. There’s not a great conspiracy theory around accessing needle exchange, or providing services in an outreach effort.”

I think we have to build a comfort zone for African Americans. It’s like, if they see me drink the water, then the water’s okay. But until they see it and watch me be okay, many times they won’t access. So I think the most valuable tool we’re going to have is our African American peers who currently work on the [needle exchange] van. For [drug users] to see, again for loss of a better analogy, that they too have drunk the water and the water’s okay. So there’s got to be a comfort level in saying, “You know what? Needle exchange is a good thing. It saves lives, it’s not connected to law enforcement, it’s not some sort of drug inside the syringes.” The belief that it is a good thing has to be kind of penetrated throughout the community.

And accessibility -- going into what we call the “red light district” of the city of Wilmington is challenging, especially with all the shootings. I don’t know if African Americans are truly the population who are now injecting at an alarming rate. Certainly we do have some folks injecting, but I also believe that this is a dying population as well. And more people, because of drugs being purer, are smoking and sniffing. And so, there may not be as great a need for syringes as we first thought. So I think a collective kind of effort with our Senator Margaret Rose Henry, who’s birthed this project, our community leaders, our naysayers, our people who advocate for this population, we all have to collectively come up with a strategy to keep pushing the message that the water’s okay.

4. You can tell a lot about a person from their office. Tell us what you have in your office.
My office is very eclectic. I sometimes am embarrassed about it! But I have jazz artwork here. I have New Orleans. The Nanticoke Indians, which never really got recognized during Mardi Gras, but they too decorated, and had the same kind of celebration, but never recognized. But then I also have one section that’s dedicated to family. I have pictures of my son who graduated from Villanova. I also have a collection of articles of the work we’ve done here at Brandywine, the projects where I grew up in as a kid, and articles saying, “A $10 bag of heroin approximate to the 95 exit [for] sale,” “Fewer resources spent on prevention,” and then one of Basha [Silverman] and a syringe-filled shooting gallery, which reminds me of the work that we do. And that’s in addition to the Comprehensive Accreditation Manual from Joint Commission, books around licensure, and policy and procedure manuals.

But I also have a snake to unclog many of the restrooms, and a quart of oil for some of our vehicles. And so, you can find anything from a light bulb to the 2007-2008 Delaware Psychiatric Residency program’s pictures, of which I’m also a part, doing some training with the residency. So I like to think of it as eclectic. I think there’s times when it’s more orderly than others, especially when visitors are around, but for the most part, it really depicts my work here at Brandywine. One minute I might be the janitor, one minute I am the clinical supervisor, the next minute I’m an administrative person, the next minute I am a client advocate. So it really depicts the changing roles I play.

I just recently described my job here at Brandywine to someone, and I said, “I can’t call it work, because it’s something I like to do.” Now, it just so happens I get paid for it, but even [in] absence of money, I would still be doing this type of work. So while the paycheck helps with the mortgage and the car payment and travel, absent of that I would still be doing the same thing I’m doing. So I’m fortunate and blessed that I can come and do something I was going to do anyway for the rest of my life, but get a paycheck for it.

5. If you had $30,000 to donate to BCI what would you do with it?
I think I would go to a learning institution and ask that we start a program specifically for addictions counselors to grow the work field. The major challenge is a workforce that’s declining. [BCI senior staff] will be leaving in a few years. We have a younger workforce, that I think for the most part, is not prepared for the challenges of a more sophisticated system, in terms of licensure, accreditation, and just maintaining a quality level of services.

So I would go to a Lincoln University, a Del State, or University of Delaware, and say, let’s have a name for a program specifically to grow the field. So I think that’s what I would do. While another clinic would be nice, a transitional house for recovering people would be nice, but I think if we don’t grow the field, we’re going to miss the opportunity to help people get better.

The Most At Risk Are The Hardest To Reach

The News Journal details the extent of our challenge in reaching a hidden and mistrustful population with the needle exchange. Though blacks remain hesitant to access the services, it's important to note our successes and how far we've come.

Before Wilmington got a needle-exchange program of its own, some addicts went to Philadelphia to get clean syringes from the exchange program there. In addition to needles, they brought back stories about police harassment near the vans that distribute them.

Those experiences make it hard to trust the Wilmington program, even though the relationship between its workers and police here has gone better than anyone could have expected, officials say.

...

"It's a fact that a needle-exchange program cannot reach the people it's trying to if there is not cooperation from the police department," Silverman said. "The cooperation we've had here has been outstanding. They're not using our vans as a mouse trap. No one has been arrested near the vans and no one has been followed and arrested down the block."

...

The program has exceeded its goals for clients and getting people into drug treatment centers.

And we have new strategies to reach those most at risk.

Silverman said she is formulating a plan, which she hopes to implement in the fall, that would get the program's current clients to go to shooting galleries and drug houses to recruit new members.

"Our team of workers are former addicts, former sex workers or have some connection to the communities we serve, but there are still places we can't go," she said.

Outreach Workers Become Visible

From delawareonline.com, some video of our outreach team in action as they prepared for last Saturday's educational block party.

New AIDS Infection Estimate Is A "Wake-Up Call"

About 55,000 Americans are infected with HIV each year, according to the Centers for Disease Control and Prevention. This number had been thought to be 40,000 a year, until a new, more accurate blood test was introduced. The new test can tell how long ago an infection occurred.

The CDC report also found that HIV infections are falling among injection drug users. Some experts are giving the credit to prevention efforts including syringe exchange, while at the same time calling for additional funding to expand them. Many populations continue to be at high risk, including gay and bisexual men, those under 30, and African Americans.

Whether more funding comes or not, the revised estimate clearly is a "wake-up call to scale things up," said Dr. Kevin Fenton, who oversees CDC's prevention efforts for HIV/AIDS.

For more information, see:
The full article
CDC HIV Fact Sheets

5 Questions for Dianna Dorsey, Outreach Worker

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Dianna Dorsey
Job: Outreach Worker, HIV Prevention and Needle Exchange
Time with BCI: 5 years

1. What is your job at BCI?
I work in the Outreach Department as an HIV Prevention Specialist, and the NEP program. And what we do is, we go out in the community, and pass out condoms, educate individuals on the street about HIV, the spread of HIV and Hep C, and different STDs. We also try to get them to come and do an HIV test, and let them know how important it is to learn their status. A typical workday is being out on the streets, going all across town, educating them, just letting them know how important HIV is, and how important it is to not to be sharing your works.

And the needle exchange, we have the van, and the clients come out and exchange their dirty syringes for clean ones to prevent the spread of HIV and prevent sharing. So when we’re in the community and we’re doing our outreach, that’s another target. We go and hand out flyers, and let them know we have the needle exchange, and we’re also doing HIV testing out on the street at this location and this time, and different locations that we have throughout the week.

2. What got you interested in doing this kind of work?
I actually had family members who went through the struggle of addiction. And just seeing them inspired me to understand addiction, to find out the triggers, and everything that comes along with that. So that was my main reason. As far as working with HIV, I just wanted to be more educated about it. And once I got the proper education, I just fell in love with it, and that’s my goal. I love what I do.

3. What is your biggest challenge in doing your job?
My biggest challenge is not having [clients] come through, as far as getting tested. Or, on the streets, trying to really really really educate these people out there, and they’re still saying no. So, we have to come from different angles at times, and that’s a challenge. Because you have some people that are out there that say, “Well, I don’t want to get tested.”

“Well, have you ever been tested?”

“No.”

“Tell us the reason you don’t want to be tested.”

“I don’t.”

“Do you understand the importance of being tested?”

So, when they tell us no, they don’t want to be tested, that’s a very big challenge to me, because I’m not accomplishing what I’m out here to do.

4. What would people be surprised to know about your work?
I think they would be surprised to know that I really care. And caring for the individuals on the streets, that’s a plus. That’s number one. Because if you’re in this addiction - and you have individuals that are out there that don’t have loved ones – [and] you really show them that you’re there, and that you’re supporting them regardless of what decisions they make, I think that surprises them a lot also. Because if you just go out and say, “Here, take this condom,” or, “Come to the exchange,” they’re going to feel some type of way about that, because they’re not feeling the love at all from us. So in order for us to engage with these clients, we have to show them that we care. We have to show them that we love them, and I think that surprises a lot of them.

5. What advice do you have for someone who would like to do the job you do?
Come with it with your heart. Don’t just do it for a paycheck, have it in your heart that this is what you want to do.

300 Participants

Today, Tuesday July 29th, we enrolled our 300th participant in the needle exchange. The exchange has been operating in Delaware for a year and a half.

2nd Annual Old Skool Outreach

Hi, this is Brandy Rodgers from the Outreach department.

It was a warm and bright afternoon on June 3, 2008 when Brandywine Counseling's Outreach team celebrated its 2nd Annual Old Skool Outreach event. It was a great time of fellowship and outreach as the NEP team and other staff at Brandywine such as our site supervisor James Harrison, and Chris Zebley and Joyce Bunkley who are nurse practitioners that work with HIV positive clients, joined us for the occasion. Last year’s event was such a success that we had to do it again, but this time Bigger and Better.

The NEP team, along with some of the staff at Brandywine Counseling’s HIV prevention programs, walked throughout Wilmington neighborhoods accompanied by some friends and family spreading knowledge about HIV prevention, rapid HIV testing, and ways to join the needle exchange program. We had a nice turn out at the event as the crowd enjoyed music while eating some wonderful BBQ done by Demitrius Bullock of the NEP team before going out into the neighborhood. The normal outreach team, which includes eight, grew to about seventeen people.

We had a great time spreading knowledge and interacting with the community. We would like to thank everyone who came out and showed their support for the event and we hope to see more next year!

More photos from the event

Join Us May 31 for "Old Skool" Outreach

Volunteer your time to save lives! It's our 2nd Annual "Old Skool" Outreach Blitz!

Please join BCI Saturday, May 31, 2008 from 11 am - 3 pm for a Mega Outreach Blitz in the City of Wilmington to promote the Needle Exchange Program. We need former outreach workers and people who have never done it before but want to give back. Walk through the city spreading a message of hope, recovery, health, and safety. Encourage drug users to enter treatment, enroll in the needle exchange program and most importantly get tested for HIV.

Refreshments will be provided.

Last year's event was a big success and we can't wait to do it again.

If interested please sign up with Rochelle Booker at 757-3821 or apply online.

Needle Exchange: 200 Enrolled!

The Needle Exchange team has enrolled our 200th client in the program. We now stand at 3,482 needles exchanged during 698 different exchange events. Over 80 referrals have been made, including 12 to methadone treatment. Five HIV positive clients have been identified on the needle exchange van.

Well done, team!

5 Questions for Claudette Bell, Outreach Worker

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Claudette Bell
Job: Outreach Worker, HIV Prevention and Needle Exchange
Time with BCI: 5 years

1. What makes community outreach different from seeing clients in a treatment center?
Every part of BCI is important, but actually going out in the community, when you go out in [drug users’] environment and see what they have to deal with on a daily basis, that makes it just a little bit different. It brings it more to life how people are actually living. When they come up to the clinic, you might see them for an hour if they have groups, or if they’re coming to get dosed, they’re no more than ten or fifteen minutes. But when you go out in the community and actually see how our clients are living, it brings a whole different light and more respect for them. It’s a struggle out there, it’s no joke. It’s rough out there.

2. What are the challenges involved in doing outreach?
We’re just like the postal service with outreach, we work in all kinds of weather. I think we have a good team. Even when we’re out there in the rain, people be like, “Y’all be passin’ out condoms and stuff in the rain?” I’ll be like, “Yo, we just like the postal service - we’re out there in all weather!”

Some of the communities that we go into are bad. We’re always told never to put ourselves at risk. But you never know what can happen, you could just be walking down the street and people start shooting or something. We don’t go out there putting ourselves at risk, but we know that, like they say, stuff happens.

3. What is it about this job that makes it worthwhile for you?
Some clients are here actually to get their lives together, and others are just here so they won’t be out on the street, trying to find dope. Sometimes when they come in, their intentions will be, “Well okay, I’m just going up there so I won’t have to be out on the street.” But something within the program, or something that somebody might have said to them, will turn them around, and then their purpose of being here is to be clean.

A couple clients, I was here when they came, I was doing their case management work, and now they actually work for BCI. And being able to instill in them that there is hope. Just because of where they were as addicts, you don’t have to always be an addict, because you can always turn your life around. It’s just a matter of, if that’s the road that you want to go, and how willing you are to fight for it.

And to me, that’s the joy of it, when you see clients get clean and become productive members of society. It’s just helping people. It’s not that you’re doing it to look for a reward or something like that, it’s doing it because it’s in your heart and that’s what you want to do.

4. You can tell a lot about a person by what they have in their office – tell us what you have in your office.
Oh Lord, I have everything! When I was over at the main building, they used to call me MacGyver. Anything they needed, I had it. Screwdrivers, plates, forks, napkins, feminine products. Anything they needed, I had it in my office. Like I said, it’s about helping people, so you never know what people may need. I go to the store and I’ll be like, oh, okay, here’s some safety pins, get a pack of safety pins. Never know, somebody’s button might pop, they need a safety pin.

5. What is the most fun thing you’ve done with your clients?
Oh, wow. When I was with the Hope program [as an Intervention Specialist], I used to do a lot of fundraisers and stuff, and cookouts, and barbeques. The funnest thing was when we went to Dorney Park. They had so much fun! Because I know, when I went into recovery, that was one of the first things that I’d done, and I’m like, “I haven’t been to an amusement park in so long!” So I kept on asking clients, “Well, when was the last time that you’ve been to an amusement park?” And a lot of them couldn’t remember. So to me, to take them to an amusement park and just to see how much fun they had. They was kids. They had a ball. So, to me that was great.

Celebrating 1 Year of Needle Exchange

Today is the first anniversary of Delaware’s pilot Needle Exchange Program in Wilmington. Some stats courtesy of John Kennedy from the Division of Public Health:

180 clients are enrolled in the program. We’ve exchanged over 2,700 dirty needles for sterile ones and we’ve referred 79 clients to treatment. We’ve identified three new HIV positives who hopefully won’t infect anyone else.

BCI has been using the new spacious van since November, and it now goes to 9 sites, including evening and weekend hours. Community and police support continues to be outstanding. New clients are being referred by word of mouth, from community members, political leaders, and the police.

Congratulations to our NEP team and DPH on a successful first year!

5 Questions for Chris Zebley, Nurse Practitioner

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Chris Zebley
Job: Nurse Practitioner
Time with BCI: 4 years

1. What is your job at BCI?
I’m a board certified adult nurse practitioner and HIV specialist. I actually work for Christiana Care Health System. My department is the Community HIV Program. I collaborate with Dr. Szabo, who’s an infectious disease physician, and we run an HIV clinic here at the Lancaster site every Tuesday morning. The whole idea was to allow a one stop shop to get your mental health, your substance abuse treatment, and if you’re HIV positive, to get your HIV medical care under one roof. We call it “nested services.”

2. What services do you provide to BCI clients?
A nurse practitioner can treat acute and chronic illnesses throughout the lifespan, along with having prescribing privileges. I can practice independently, whereas a physician assistant must have supervision.

The services I provide include case management and treating acute illnesses. The clients who come in to see me generally present with maybe a tooth abscess, bronchitis, a skin infection, sprains or strains. The client may be unable to see their primary care physician, or worse yet, because of their addiction, might not see it to be a priority to take care of their health. I make referrals to dentists, PCP’s, foot and eye appointments. On occasion I’ll refer them to the ER, and I can call people that I know in the emergency room. There’s many, many things that I’ve done for people as part of referrals and such.

In my HIV clinic I have around 35 clients. I get referrals from my department, from NSAFE upstairs, Outreach, or by word of mouth. The medical management of these clients is very intense, because the majority have “advanced disease,” so it’s my duty to assist them in maintaining optimal health. We treat patients with very, very heavy co-morbid conditions - Hepatitis C, heart failure, vascular problems. I may do pill planners to aid in the adherence of their medicines, treat any acute illnesses that may arise, and also provide health maintenance by making sure they have their necessary screenings, such as a colonoscopy, Pap smear, or mammogram.

On Fridays I usually do annual physicals for Dr. Glick, as well as intake physicals for methadone, Suboxone or Revia. I do part time work with the Medical Maintenance Level 2 program at Newark where the people come in once a month for their methadone.

I’ll be working hand in hand with Outreach on Safety Net Services. I’ll be providing case management, HIV medical care, and psychotropic medication management.

3. What drew you into a career in the addiction treatment field?
This is something that I grew into. In the hospital we’d always have people that were disadvantaged, and stigmatized in society - IV drug users, the homeless, HIV infected individuals. These were real people with real illnesses who never asked for anything, and were very appreciative of the care they received. And I always thought, I’d like to work with these individuals, because they had a lot of needs, simple needs, that could be fulfilled.

This was a job posting with Christiana Care. I was working in employee health as a nurse practitioner at the time. I happened to see this posting, and it was for the Riverfront. An HIV clinic, but you would be working in a methadone clinic. I didn’t even know what a methadone clinic was, really. I didn’t realize how many people actually go to these places.

There were many people telling me, “You’re not gonna like it. You’re gonna regret taking that job.” You can’t go on hearsay. If I’d really listened to people, I might not be here today. I would not even have taken the position. I had to experience that for myself. And from day one, it was fine, it was nothing like what people told me it was going to be. I enjoyed it from day one. Because we’re able to meet the people’s needs, that’s a big thing.

4. If you had $30,000 to donate to BCI, what would you do with it?
Certainly the Outreach. They’re the ones that get people in here. They do so much good, whether it’s the food closet, or the clothes closet, and to help for that needle exchange to grow. As we see the research and the data come down, I’m sure the federal government and the state will allow us to expand. But that’s been a plus here for Brandywine Counseling. I’ve done intakes and I asked them, “Well, how did you know to come here?” And they said, “Well, it was the needle exchange.” That’s an indicator that it’s working.

I’d also open more transitional housing, because recently the CDC announced that homelessness is now the single largest contributor to HIV infectivity.

5. What is it like to work with these clients?
You’ve really got to like people in their worst condition, and in their good condition. And that’s what nursing is about, the human response to illness.

These people are survivors. They’re very, very smart. They could be executives if they could put their mind to more positive things. Some of these people could have been very, very wealthy and rich, the way they’ve been able to hustle, to get money for drugs. People have written about, if we could only find out how these people, the disenfranchised, tick, and how they’ve been able to survive these harsh illnesses, without a lot of medicine, then we could treat a lot of other illnesses cost effectively without using medications.

My first patient that I ever saw [now] comes here for take-homes twice a week, so they’ve been drug free for almost two years. I have them come in for support, and they’re part of my HIV clinic too. To me that’s a success story, because they know that they can come in at any time, whether they can see their counselor or not. To really see this person get out of the deepest, darkest abyss, where they were constantly using, and she’s not now, so she’ll continue in her recovery. That was pretty cool, to actually see that.

Needle Exchange Van Ribbon Cutting Ceremony

Today Delaware dedicated a new needle exchange van fully equipped to serve injection drug users at risk in the City of Wilmington.

Since February, Brandywine Counseling, the contracted vendor for the Division of Public Health, has been using two small vans, including an ambulance donated from Wilmington’s Public Safety Department. Now, with the new 2007 Ford E450 van with a "Utilimaster" body, we'll be able to carry more supplies, and offer people more privacy and more services.

A client who wants to exchange needles will come to the door of the van. Inside the door is a container where they can drop their used needles. Staff will sit inside the door to dispense syringes and first aid kits. If the client wants to get tested or wants counseling, they will step into the back of the van, where there is seating and a table. Supply cabinets give us ample space to store first aid kits, personal sharps containers for clients, safe sex kits, and HIV testing materials. There are also restroom facilities. We expect that with this better privacy and safety, we will now see even more participants, and greater willingness to access more services like HIV testing.

At today’s dedication ceremony at Delaware Health and Social Services’ Herman Holloway Campus, several key figures spoke about the program. Director of Public Health Dr. Jaime Rivera called the program “incredibly successful. It’s the result of ten years of planning and pushing to make this happen, and we finally got it done.” Senator Margaret Rose Henry, who was primarily responsible for getting the bill passed, thanked everyone who helped convince the community it needed to happen. “Our goal is to have the best five years ever so that we can show the rest of the state this is a good thing, we need to do it statewide,” she said.

BCI Director of HIV Prevention Basha Closic recognized her Needle Exchange team: Rochelle Booker, Sharon Brown, Claudette Bell, Dianna Dorsey, Morris Gardner, and Lolisa Gibson. “Day in and day out they sit with people and they counsel them about the importance of taking a HIV test and knowing their status, and if they are positive, not infecting another person and taking responsibility. Those conversations are really hard to have, especially with strangers. These people have really, really amazing personalities and spirits. This who you hired to carry out the job.”

Delaware HIV Consortium Executive Director Peter Houle reminded us of how AIDS has left an indelible mark on Delaware and on the world over the past 25 years. He described how Delaware has become a model for other states in HIV service delivery, and now this pilot program has enhanced our already nationally acclaimed continuum of care.

The van was dedicated to the late Dr. Robert Jackson of the Division of Public Health, who was recognized at the ceremony for his strong support of needle exchange and advocacy for HIV prevention. The ribbon was cut by Senator Henry. Participants then had the chance to tour the van.

The van makes weekly stops to four sites in Wilmington, with more soon to be added. Since startup, we've enrolled over 140 clients, and they have exchanged over 1,800 needles. We've referred 31 clients to alcohol, mental health, or drug treatment centers for further treatment. Our goal is to enroll 200 clients by February 2008.

To view more pictures of the van and the dedication ceremony, click here.

BCI is truly grateful to have this van. We will continue to provide high quality, safe services for this five year pilot program and beyond. What a long way we've come in ten years!

Needle Exchange Reaches 100th Participant

Today the Delaware Needle Exchange Program signed up its 100th participant. Over 700 syringes have been exchanged since startup back in February.

Congrats to Basha, Rochelle, and the staff on this milestone.

I Wish We Could Ride Around Wilmington And Play That Story

Here’s one last audio clip from our needle exchange celebration, and it’s a good one.

The speaker’s cell phone rang just as he came to the podium. He answered it. “Yeah, I’m speaking at the needle exchange. No, I’m not using needles no more, I’m just speaking about it. I love ya!” (Hangs up.) “Grandmas are something!”

Fred is a former injection drug user. All joking aside, he came to deliver an important message. Years ago, he used to share needles. He described the desperation of a heroin addict, how when the craving would strike, it didn’t matter where the syringe came from, and how easily he could disregard his own safety.

“You ended up sharing needles with people, people that were infected. And at the time, nobody didn’t know they had nothing, until they got real sick, and everybody was lying about their situation.”

“That’s what the drug does to a person.”

Thankfully, Fred found a way out of his addictive habit. And that was only the beginning. He turned his life around. He gave up not just drugs, but cigarettes, and cursing, and became a deeply spiritual person. Today he works as part of a local HIV/AIDS outreach team.

Fred’s transformation amazes people he knew in his addiction. “It’s something that feels so good, when a person’s been knowing you for so long, and they come up to you and say, ‘Is that you? Is that you that looks so good?’”

Delaware’s needle exchange program will give today’s drug users the chance to do what Fred has done. It may mean the difference between leaving this world before their time, or living to fulfill their own potential. Fred understands this.

“I know that the day that I die, and you all come and look over me, I’m gonna have a beautiful smile on my face.”

Our thanks go out to Fred for sharing this powerful story. Our MC David Isaac said what we were all thinking. “I wish we could ride around Wilmington and play that story.” Well, here’s a start.

Old Skool Outreach

It was not just any other day of outreach. On this day, Brandywine Counseling was rollin' thicker than usual. On May 21, 2007, the existing team of 5 dedicated outreach workers grew to about 20.

Old Skool Outreach was a successful effort to bring former outreach workers, including James Harrison and Shay Lipshitz, together with the present team in order to promote Brandywine Counseling's needle exchange program. The approach was "old skool" in that we kept it simple and real.

We walked miles across the city spreading the message of hope, recovery, health, and safety. We encouraged drug users to enter treatment, enroll in the needle exchange program and most importantly get tested for HIV.

It was very exciting and we were greatly appreciative to work with all of the people that were willing to come out and show their care and concern for the people in the city they serve. We hope this successful effort will continue and this one be marked the "1st Annual Old Skool Outreach Effort."
We would like to acknowledge and thank the staff at Kirkwood Detox and Brandywine Counseling, Inc. for volunteering their energy and time.

QUICK FACTS

• 20 Outreach Workers
• 5 Hours of Outreach Work Completed
• 3 Neighborhoods Covered
  
• 150 People we talked to
• 400 Condoms and safe sex kits distributed
• 6 newly enrolled NEP participants
• 10 people who got tested for HIV
  

270 Syringes And Counting

Most of us, if we got our picture in the newspaper, might get a congratulatory phone call from our parents. That is, unless we were picking up dirty needles in an inner city “shooting gallery.” Basha Closic’s father was understandably alarmed at this sight. However, that same picture was credited with turning “no” votes for Delaware’s needle exchange into “yes” votes, enough to pass the bill.

Three months into the program’s operation, Basha gave our audience a progress report. As of May 24, 2007, 34 participants had exchanged 270 syringes. Most continue to come back. The majority of referrals are by word of mouth. “We’re moving along slowly but surely, and safely,” she said. Basha also pointed out that Delaware has the only NEP run by a drug treatment program. This means our participants get to talk to “the best hands out there… treatment-minded hands.”

Basha is always willing to go the extra mile to help at-risk drug users. We’re proud to have her at Brandywine, and we’re pretty sure her dad is proud too. Click below to hear Basha’s update.

Basha_Closic_Remarks.mp3 (4:58)

Like Being Pregnant for Ten Years

Senator Margaret Rose Henry addressed the audience briefly following the recognition ceremony. She thanked the advocates and all those who helped bring about needle exchange in Delaware. Working to get her bill passed was “like being pregnant for ten years,” she said. Now, at long last, she gets to watch that baby take its first steps.

“It does my heart such good to see something you’ve worked on really come to fruition. This is important. This is about saving lives.”

Click here to hear Senator Henry’s remarks.

Margaret Rose Henry Remarks.mp3 (2:28)

Recognizing the People Behind Needle Exchange

The centerpiece of our needle exchange celebration was the recognition of our guests of honor: 15 people and organizations who were integral in developing the program. As you will hear, each of them brought something unique and essential to the effort. After all the honorees came up to the stage, BCI Executive Director Sally Allshouse announced that a donation has been made in their honor to the Campaign to End AIDS.

Click here to listen as we pay tribute to the following individuals:

Recognition.mp3 (9:23)

Senator Margaret Rose Henry, for leading the ten year campaign in support of this program.
Representative Helene Keeley, who co-sponsored the bill with Senator Henry.
Secretary Vince Meconi of the Division of Public Health for making HIV and substance abuse related issues a priority.
Dr. Jaime Rivera, Director of Public Health, for assembling the oversight committee.
Mayor James Baker for his commitment to reducing HIV/AIDS in our community.
John Baker of AIDS Delaware, for his persistent advocacy and leadership.
Renee Beaman of Beautiful Gate Outreach Center, for tirelessly supporting this policy change for years.
The Delaware League of Women Voters for garnering support to pass the bill.
Peter Houle of the Delaware HIV Consortium for protecting the bill and combating opposition. (Sorry Peter - I had to change my tape in the middle of your introduction.)
Nicole Leighton of Prevention Point Philadelphia for sharing her expertise and knowledge with BCI.
The Red Ribbon Advocates, who organized a rally and told their stories at Legislative Hall.

In addition, these individuals could not be present but also deserve recognition:

Senator Nancy Cook has been a supporter of initiatives to promote treatment and recovery to Delawareans in need of substance abuse and mental health services. She has continued to help ensure services for Delaware’s vulnerable populations. She has undeniably played an important role in the implementation of the program.

Representative Pamela Meier is an important leader and fighter for Needle Exchange within her party. She is also the chairperson of the House Health and Human Development Committee. This committee was responsible for moving the bill to the House for voting.

Lamont Coger has been running the Baltimore City Needle Exchange for over 11 years. He was there for its inception and has led his organization to provide its service at 17 sites throughout the city of Baltimore mornings, afternoons, nights and weekends. Lamont was vital to the realization of our program here in Wilmington. He hosted our team several times and shared not only his resources and procedures but also his staff and expertise.

Debbie Hamilton has worked tirelessly as a lobbyist to defend and fight for Needle Exchange. The reality of this program is undeniably due to her hard work and diligence. Debbie was able to get legislators to talk about this issue that in the past closed a door to this bill’s advocates. Her knowledge of the legislative process and lobbying helped other advocates to plan appropriate activities and responses to questions. We applaud her efforts.

As Sally said, this is an extraordinary group of people and we in Delaware are very lucky that they came together to make this program a reality. We thank them and we salute them.

I’m Almost Ready To Take The Ride

Today’s remarks are from our Master of Ceremonies at the NEP Celebration, David Isaac. A member of Brandywine’s Board of Directors, David prepared for his hosting duties by spending a day with our outreach staff on the van for a firsthand look. What he took away from the experience was insightful and poignant, particularly a conversation he had with one client who was weighing his options about entering treatment.

I’m posting the full text of David’s comments instead of the audio because there was some background interference and I don’t want you to miss any of it. So, please enjoy:

“I’d like to deviate from the program here for a moment because I’d like to tell you about my experience the day before yesterday when I actually went out onto the needle exchange van. I wanted to do so because I wanted to stand before you tonight not just to speak about it, but to know exactly what I was talking about and having experienced it. It was really an honor and a privilege and educational all at the same time. I’m not unfamiliar with chemical dependency as a disease, but when it comes to heroin addiction and what it can do, I’m not unfamiliar with that either. I grew up in a neighborhood where that was everybody’s drug of choice. They didn’t smoke pot, they shot dope.

“My experience the other day was very, very broad. We went out for two hours and we were there waiting for the clients to come. One of the things that I observed which was remarkable to me was the cross section of the culture. This disease does not select lower socioeconomic people only. It does not discriminate as to whom it might grab. I witnessed, I think, a total cross section of our community.

“There was one gentleman who stuck out, actually two people who really stuck out. One was a guy who drove up in a late model automobile, and he was very well dressed. He had good clothes on, I don’t know that he was well dressed, because addiction limits us from being able to really take care of ourselves. And the sad part is, that he looked as though he could have been a professional type person, but he looked very washed up, very tired. And it stuck in my mind, because I think that some of us, until we see it, might have this image that isn’t necessarily accurate.

“And it spanned all the way to a person who was obviously very much hurting from heroin addiction. The last client that came up stood there and talked to me for about ten minutes, and we had some of the most intelligent dialogue that I had the entire day. And I thought to myself, he’s an expert. I had remarked to one of the folks in recovery, ‘Recovery - nobody is too dumb to get it, but there are some who are too smart.’ It really is a very, very nefarious disease.

“I firmly believe in the needle exchange program because of the benefits, the obvious consequences. But I asked a lot of questions, like, what if a client comes back the next day and wants to exchange needles? You know, I think from an addict’s perspective, there’s an opportunity here. When a client comes up and gets five needles, and he sells three, regardless of the fact that he does that, you’re getting dirty needles off the street. That’s the point.

“And there’s exposure for these people, that if they want treatment it’s available. Where otherwise, they would not know it’s available. And this fellow, who struck me as being intelligent, looked at me, and one of the last things he said to me was, ‘I think I’m almost ready to take the ride.’ And I thanked him and I said, ‘Well, I hope it’s tomorrow.’ In fact, I said, ‘I hope you’re ready. Because it really is a good ride.’ And that was my experience going out on the van.”

"I wanted to acknowledge the people who go out every day because I can tell you they go to the areas of the city that some would consider putting themselves in harm's way, because some of the activities that go on are unpredictable. But I have a sense that they're respected in the neighborhood. Rochelle, I think she would straighten them right out, regardless of what happens. I had met her, and five minutes later I said, I see the glue that holds this thing together."

You Can’t Hide Behind Closed Doors

We are so grateful that Pat was willing to share her story at our NEP celebration. She is someone who has struggled with addiction in her life and in her family. Listening to Pat, you can hear that her pain is very much still fresh, and yet, she has turned it into great strength and passion. With 34 years clean and 13 years sober, she feels an obligation to speak out in the community so she can help others.

“I believe that anybody that’s been through difficulty has got to get out there and give a hand up. My philosophy is, if you’re on that ladder in life, if you’re on the ninth rung of that ladder, you should be extending hands two ways: one for up to ten, and one down to eight to pull that person up to your position.

“You have to get out and say to people, ‘Do you understand what this legislation is that we’re trying to bring about?’ [You] try to get people to turn around and understand what an impact it makes when they call or write to the legislators and say, ‘Listen, we support this [needle exchange]. Our neighborhood supports this. We have people in our families who need this service.”

Pat speaks from experience. She watched as her daughter went through addiction and eventually recovery. Now she is watching her grandson go through criminal justice problems. Despite her own experience with recovery, and having worked as a drug and alcohol counselor, Pat was unable to keep her loved ones from making the same mistakes. It’s for this reason that treatment programs are so necessary – because even our best intentions are not enough.

“The only thing you can do for someone who’s an active addict is to love that person. Hold your pocketbook and your wallet, but love ‘em… You can still stop the car and put your arms around them when you see them on the street and let them know that you love ‘em, ‘cause they’re still people.

“First step in recovery is to recognize the powerlessness, that you can only control one person, and that’s you.”

Click above to listen to Pat’s full testimonial. Her words are truly important for Delaware to hear.