On the 26th World AIDS Day, as groups across campus and organizations across the world pay tribute to activists who were instrumental in stemming the spread of HIV/AIDS, the Yale researchers who pioneered New Haven’s Needle Exchange Program are celebrating those who made the program possible — the substance users themselves.
Founded in 1989, the program — which led to a decline in annual HIV infections in New Haven by 33 percent — has been held up as the gold standard for needle exchange programs across the state and nation. These programs allow intravenous drug users to exchange used needles for clean needles.
“Both active [drug] users and people in recovery were integral in the movement to authorize [needle] exchanges in Connecticut and New Haven,” said Elaine O’Keefe, professor of public health and executive director of the Center for Interdisciplinary Research on AIDS at Yale.
O’Keefe, who previously served as the New Haven AIDS Director and managed the NEP, said that while the role of People who Inject Drugs in such programs is rarely discussed, those people best understand the needs of the PWID community and how to effectively reach out to them. Because of those skills, they were crucial to the success of New Haven’s Needle Exchange Program — now called its Syringe Exchange Program, as well as reducing deaths from Hepatitis C and HIV/AIDS.
Robert Heimer GRD ’88, professor of epidemiology and director of the Emerging Infections Program at the School of Public Health, highlighted the impossibility of running successful disease control programs without understanding the “psyche [of PWIDs], their wants, their fears.” He drew a comparison with similar programs that struggled to get off the ground in New York, noting that there were numerous stumbling blocks to getting help. PWIDs had to travel all the way to downtown Manhattan to a building opposite police headquarters and had to put their name on a wait list to even get into the methadone program.
According to George Bucheli, an employee of the syringe exchange van — which is stationed throughout New Haven so that IV drug users can exchange needles — who has worked for the program since 1993, even small barriers to access can have large impacts.
“As an addict, I empathize,” he said. “There has to be a bed available, they might need a photo ID, you need insurance — the stars need to align for you to get help.”
GAINING USERS’ TRUST
On the day the program launched in New Haven, 13 PWIDs showed up to the needle exchange van. But by the end of the first year, recovering and active substance abusers were spearheading the expansion of the program, assuring PWIDs that it was a safe place to go to. With their help, the program now supplies clean needles to nearly one in eight of all active drug users in New Haven.
The success of the program came as a surprise — O’Keefe noted that funding had only been allocated for one year, and it was not intended as more than a pilot program. In 25 years, the program has grown dramatically. It took more than 50,000 unclean syringes out of circulation in 2013 and returned the same number of clean ones.
Bucheli, who is recovering from addiction to multiple substances, explained that in the early days, a lack of discussion around HIV/AIDS and its link to IV drug use ignited a response from the PWID community, which began an underground syringe exchange program before it was legalized in Connecticut in 1990 and the NEP program began.
Bucheli noted that when the HIV/AIDS epidemic began, the substance-using community chose to go into survival mode, as opposed to panicking.
Ambritt Myers-Lypell, a current employee of the program who has been in recovery for nearly 30 years, explained that her motivations for getting involved with the program were centered on giving back to community. Losing relatives to HIV/AIDS inspired her to take a more active role in preventing its spread, she said. While Myers-Lypell had worked at drug treatment programs before, the time she spent in prison after killing her abusive husband opened her eyes to the destruction that comes with drug abuse. Today, she said, New Haven’s drug program is about more than disease prevention.
“It’s not just about clean needles — we also do drug treatment, food, clothing, HIV testing and linkage to people who are positive,” she said, referring to a practice in which newly positive patients are referred to other HIV/AIDS patients for support.
Heimer added that the program also receives funding for a subset program that refers addicts to drug rehabilitation programs. In the first two years, the rehabilitation referral services have reached 400 people.
PWIDs were also crucial in increasing the accessibility of the NEP services through stationing vans in visible places, said Kaveh Khoshnood SPH ’89 GRD ’95, professor of epidemiology at the Yale School of Public Health and program director of the Global Health Studies Program at Yale College. He noted that PWIDs extended the reach of the program to populations that researchers alone would not have known how to contact.
“Users gave clean needles to those who were too sick or had huge abscesses and couldn’t walk [to the van sites],” Khoshnood said, adding that drug users told the New Haven Health Department where to place vans to make them visible enough to be found by users, but not so visible that users would be too frightened to approach them.
Still, Myers-Lypell said, there is more to be done to cull the tide of HIV transmission among PWIDs.
“We need a cheaper, mobile van staffed 24 hours a day,” Myers-Lypell said.
While researchers said that stigma around needle exchanges has decreased significantly since the creation of the program, past users disagreed. Myers-Lypell said that despite its success controversy about the program remains. Bucheli pointed to the recent funding cuts in the Connecticut programs as evidence. In the last six months, a number of programs across the state have shut down because of financial constraints, he said.
Moving forward, Myers-Lypell expressed concern that the program’s reach simply is not large enough. She said she sees young professionals from the suburbs coming into the city to access clean needles — the vans do not make it out to the suburbs.
The Syringe Exchange Program operates five days a week and conducts home deliveries on Wednesdays.
Correction: Dec. 1
A previous version of this article incorrectly stated that only three or four people used the Needle Exchange Van on its very first day. In fact, 13 people made use of it.