Pubdate: Thu, 24 Oct 2013
Source: Creative Loafing Atlanta (GA)
Copyright: 2013, Creative Loafing
Contact:  http://www.atlanta.creativeloafing.com
Details: http://www.mapinc.org/media/1507
Author: Rodney Carmichael

PUTTING ATLANTANS IN HARM'S WAY

For the Atlanta Harm Reduction Coalition, the state's only syringe
exchange program, funding is harder to come by than a needle in a haystack

Additional reporting by Thomas Wheatley and Jim Burress

Editor's note: Some of the last names of the subjects in this story
have been withheld.

On an unforgiving block in the English Avenue neighborhood known as
the Bluff, just spitting distance from the future site of the Atlanta
Falcons' projected $1.2 billion stadium, heroin has turned the world
on its axis. Young dealers on one side of the street hug the corner
like wayward old souls, while aged addicts on the opposite side seem
stuck in a prolonged adolescence.

In front of the burned-out stone facade of a former church, the
Atlanta Harm Reduction Coalition parks its recreational vehicle for a
special type of missionary work. The nonprofit sets up its mobile
needle exchange unit here twice a week, on Wednesday and Saturday
afternoons. The clients run the gamut from functioning to crumbling.
There's a former radio broadcaster turned homeless train hopper who
bears an odd resemblance to Ted Williams, the man with the golden
voice. A man near the front of the line wearing a permanent scowl says
he sometimes gets his heroin by working as a middleman who steers new
clientele to dealers in the Bluff, a notorious hub of heroin
distribution. Behind him stands another man clutching a golf club
handle in one hand and a fistful of used needles in the other. One
serves as his walking cane; the other as his crutch.

Before exchanging their used needles for clean ones, they approach
AHRC's Director of Advocacy Marshall Rancifer, who asks if they want
"the works," a paper bag that includes tourniquets for tying off
before shooting up, rubber tips for crack pipes to prevent cut lips,
mini bottles of bleach, citric acid to help dissolve speedballs, mini
cotton balls to strain the junk out of heroin while drawing it into a
syringe, and condoms.

They all know Rancifer well, so well that when he asks how they're
doing, they know the question is genuine enough to tell him the truth.

"I don't call them clients, I call them guests," Rancifer says. His
high degree of empathy is based in part on his own backstory.

A recovering crack addict who served four and a half months in jail on
a probation violation before becoming a drug counselor, Rancifer says
he's "lived two lifetimes in one." While the first one found him
living on the wrong side of the law, his current incarnation has him
straddling the fence between the two.

That's because the work in which he and his harm reduction colleagues
are currently engaged is illegal in the state of Georgia - although it
barely earns a double take from the Atlanta police officers inside two
separate squad cars that casually roll by over the course of the afternoon.

For nearly 20 years, AHRC has worked to prevent the spread of HIV/AIDS
in Atlanta by providing wellness resources to substance abusers and
sex workers. Last year, the nonprofit gave out 61,000 syringes to help
combat needle sharing between intravenous drug users. The
controversial needle exchange program is the only one of its kind in
Georgia, where the distribution of drug paraphernalia is outlawed.

According to a 2011 report from the United Nations' Global Commission
on Drug Policy, countries that implement tactics such as the AHRC's
syringe exchange program (SEP) are lowering HIV rates among drug users
more than countries attempting to eliminate drug use. Such studies
acknowledge that SEPs are helping to slow the spread of HIV and
hepatitis. But the stigma attached to drug use has earned the AHRC and
similar organizations their share of critics who say SEPs enable drug
users. That makes the nonprofit's public health mission a public
relations nightmare when it comes to raising funds. With 60 percent of
its $320,000 operating budget cut this year, Executive Director Mona
Bennett says the nonprofit may not be able to open its doors in 2014
unless something drastic happens.

Cruise through English Avenue and it's clear this area has seen better
days. In recent years, the neighborhood's houses have seen periods of
more than 50 percent vacancy and bank ownership. On some blocks,
nearly every third house is boarded up. And that doesn't account for
the dope houses, hit houses, and trick houses scattered in between.
For years, this west side neighborhood has been known as Atlanta's
heroin hot spot. As if the area needed any more infamy, its
underground legend expanded nationally with the 2012 DVD release of
gritty hood film Snow on tha Bluff, a true-to-life tale in which the
starring actor Curtis Snow portrays a version of himself as a drug
dealer/armed robber. At least one good thing came from the film: After
Michael K. Williams, the actor who played Omar on HBO's "The Wire,"
got attached as an executive producer, he and Snow made a YouTube
tribute to Atlanta Harm Reduction Coalition.

To truly get a sense of AHRC's impact, one only needs to hang around
the nonprofit's converted duplex headquarters at 472 Paines Ave. for a
day.

"I'm sick, you sick - er'body sick," a client in the lobby raps while
her boyfriend uses the phone to set up a doctor's appointment for her
at a clinic on the MARTA line. "I'm sick, you sick - er'body sick."
Another client takes a shower in the upstairs bathroom while a
volunteer arranges AHRC's clothing closet down the hallway.

Downstairs, Darlene, 63, and her husband have arrived from Tennessee.
They make the three-and-a-half-hour trip once a month because AHRC's
program is the most convenient to them. If Darlene bought clean
needles off the street, she says she'd have to pay $2-$5 per needle.
As she stands in the shared office space just off of the client
computer room, she tells the story of her addiction while holding a
plastic grocery bag containing 107 used needles. A "so-called" friend
turned her on to heroin at age 40 because she was suffering
debilitating pain due to post-polio syndrome and the painkillers
doctors were prescribing didn't suffice. Now she and her husband, who
became addicted 40 years ago in Vietnam, use once to twice per day at
$20 a pop. She prefers to have a clean needle every time, she says,
because a syringe gets less sharp with each use. She pulls up her
sleeve to show the many pockmarks and abscesses from dull needles and
heroin with "bad cut."

To those who would point to Darlene as an example of someone whose
habit is only being enabled by needle-sharing programs, Darlene points
a finger back at the quote-unquote War on Drugs.

"It hasn't done anything," she says. "They're not stopping it by
making it illegal; it'll still continue."

AHRC Outreach Coordinator Verna Gaines counts out Darlene's 107
needles two-by-two with a pair of serving tongs before tossing the
used needles into a 19-gallon Sharps container. On average, the
nonprofit can fill up to five containers per month. The AHRC'S
fundraising coffers should be so lucky.

While AHRC's needle exchange program receives financial contributions
and public praise from such heavy hitters as the Elton John AIDS
Foundation, portions of its funding pool are earmarked specifically
for other services, such as the 3,600 hot meals it served last year.
AHRC provides HIV testing and education, hepatitis vaccinations, a job
resource center, hot baths and showers, a clothing closet, and
treatment facilitation for clients who are ready to quit using.

"We're Atlanta's health care bargain," Bennett says, noting a 2010 CDC
study that estimates the costs of health care over the lifetime of an
HIV patient to be $379,668. By helping to lower the spread of
infectious diseases through its SEP, the organization is also helping
to decrease the amount of taxpayer money going toward indigent care.
"The federal funding ban on syringe exchange programs has got to go.
It scares people."

Last year, about 20 percent of AHRC's total budget went toward
operating the syringe exchange program. It's illegal for government
grants to fund needle exchange programs, but they can go toward many
of the other services AHRC provides. Even so, federal funds once
distributed by the Georgia Department of Public Health are now
allocated through Fulton County, which will require AHRC to start the
grant-writing process over again. As a result, a lapse in funding has
dealt the nonprofit a severe financial blow.

In the past year, AHRC's annual budget dropped from $320,000 to
$120,000. An ideal annual budget would be $400,000, says Bennett.
Normally, the organization gives clients a bonus of five to 10 needles
per exchange. But due to the current budget shortfall, the
organization has been operating on a "syringe diet," meaning it now
doles out a maximum of 20-30 needles per client. The center has also
gone from being open four days to three days a week.

Overall staff pay cuts have reduced pay for Rancifer's $15/hour
position down to the equivalent of 70 cents per hour, he says, after
calculating the number of hours he works and the $300 per month he
currently makes as a contract employee.

"One thing I learned in recovery is, the only way you can keep what
you have is by giving it away. So I give my time. God blesses me in
other ways," he says.

In the meantime, AHRC continues to rely on grassroots fundraising
efforts such as last June's punk rock benefit at 529 in East Atlanta
Village. Though it only raised $180 in donated door proceeds, that
money purchased several boxes of wholesale condoms.

For real proof of the difference the AHRC can make, one only needs to
hear the story of a woman like Eleanor Hillman. A former crack addict
for 25 years, she once ran a "bunk house" in the Bluff, where men
could sleep for the night and do drugs. "And if they needed a date, I
would date them," she says. After witnessing an eight-months-pregnant
teen she'd watched grow up get murdered at her doorstep, she decided
it was time for her to quit. While in rehab, she utilized the services
of AHRC to take classes and get a makeover. Once clean, she began
volunteering and eventually started working full-time at AHRC, where
she started the clothing closet and specialized in raising in-kind
donations for the nonprofit. Today, she's married and works for
Georgia State University as a phlebotomist.

"If you want a chance and you want a change, AHRC is the place to go,"
she says.

Still, fighting the stigma that its efforts are at odds with drug
prevention and treatment is an uphill battle.

"In the best of times, we're a hard sell," says Bennett. "We are not
dealing with babies and kittens and puppies."

She also acknowledges that some clients are known to sell the clean
needles AHRC provides to buy more drugs. "I would rather people sell
our syringes and our condoms than to go out and risk arrest [for
stealing] or risk getting a disease from going out and selling sex."

The South, in particular, is still in the dark ages on the issue of
SEPs, which is largely due to staunch opponents framing it as an issue
of morality. The ethical stalemate is an example of what happens when
bureaucracy bumps up against public health and moralists win the day
over humanists. While critics blame harm reduction proponents for
enabling drug abuse, the flip side is that America's abysmal effort in
the War on Drugs continues to enable the spread of HIV.

"When people ask me about the moral issue, I say, 'What's immoral
about stopping the spread of infectious diseases?'" says Miriam Boeri,
a professor emerita of sociology at Kennesaw State University, where
she studied AHRC and other harm reduction programs around the world.

In France, syringe exchanges are easily available via vending machines
the same way condoms are distributed here, says Boeri. While there are
just fewer than 200 SEPs in the United States, most are located in the
northeast and northwest. And many are closing due to decreased
funding. Meanwhile, Washington pols play political ping-pong with the
issue of syringe exchanges. In 2010, President Barack Obama lifted the
federal ban on SEPs only to have House Speaker John Boehner reinstate
it a year later. There are Georgia politicians on the national level
who support AHRC's mission such as Congressman Hank Johnson, D-Ga.,
who served as the keynote speaker at AHRC's first annual World AIDS
Day candlelight vigil. But under Georgia's Gold Dome, "what [AHRC is]
doing flies just beneath the radar," says state Sen. Vincent Fort,
D-Atlanta.

Atlanta City Councilman Ivory Young, who represents English Avenue,
says it's hard to argue against AHRC's work, although he does think it
"complicate[s] the old issue of providing cures rather than enabling
folks." He says the community would be better served if AHRC was moved
from a residential area to a commercially zoned site so that
revitalization could flourish.

"We've got major redevelopment efforts that are about to begin, and as
they begin we have to make a case on every street why a family should
buy a home or stay in the community," he says. "And whether they would
be willing to stay next to Atlanta Harm Reduction is not one of the
questions that you want to have them answer."

It's the convenience of AHRC, however, that makes it such a valued
neighborhood institution for clients who live in the immediate area.

"We're in the belly of the beast," as the Ted Williams sound-alike,
Bilal, puts it. Other employees of AHRC, including Outreach Specialist
Verna Gaines and Executive Administrative Assistant Sheba Bonner,
argue that without harm reduction in the neighborhood, English Avenue
would return to the days when dirty needles littered the streets.

The AHRC's clientele isn't limited to the English Avenue and Vine City
areas. The nonprofit, which tracks all of its clients by ZIP code,
serves people throughout metro Atlanta. AHRC also provides Atlanta
police with protective cases in which to place dirty needles when
arresting addicts. As far as policing AHRC for running afoul of
Georgia's drug paraphernalia law, the Atlanta Police Department
provided the following statement: "Currently there have been no
arrests as a result of the activities of the Atlanta Harm Reduction
Coalition in the English Avenue area."

Boeri likens talk of revitalization in English Avenue to a
"pie-in-the-sky" ploy to move developers in and current residents out.
"From my view of that [area], it's been neglected by politicians for
years."

A couple of younger guys on the corner across from AHRC's mobile unit
agree.

"It's backward as hell to me. They worried about the older people on
drugs, what about the children? They ain't got nowhere to play and
they keep wondering why they're getting in trouble. Where is the
closest playground around here? Vine City?" a guy who only gives his
first name, Keemo, says. "Then y'all want to build this stadium a mile
away but we got all these abandoned houses up here where they started
working on shit and quit. The shit is stupid."

By day's end, 47 people have exchanged 810 used syringes for 994 new
ones at AHRC's mobile unit. "And this was a slow day," Gaines says, as
she and Bonner drive the RV back to 472 Paines Ave. Until the federal
ban on funding syringe exchange programs is lifted, such drops in the
bucket will have to do. But the bigger issue, according to Bennett, is
the country's perpetual state of denial.

"Quite frankly, Americans need to have more conversations on why
people use drugs," she says. "When that starts happening, there will
be huge changes."
- ---
MAP posted-by: Matt