Fifteen years ago George Williams gave up a profitable business selling meat to spend his time in the street with drug addicts, ex-offenders, and the homeless. "I made plenty of money in business," he says. "But it wasn't giving me the nourishment I needed." Before he went into the meat business, George was a dope fiend.
The years outdoors are lined in his face like the age rings in a tree trunk. He looks uncomfortable sitting in a meeting, arms folded across his chest, his gaze as direct and as fierce as that of a missionary. All that time squinting against the weather, peering around corners, and watching his back have made him nearly incapable of repose. He's one of the happiest people he knows.
George didn't get religion: he doesn't preach and he won't be preached to. Working in the social services has enabled many former drug users to cross the line back to the straight world; for many recovering drug addicts counseling other recovering drug addicts is the only kind of job they can get. George didn't have that problem; counseling drug addicts was a labor of love. He went back to the Tinley Park treatment center where he'd cleaned up, and offered his help. "Going back there was beautiful," he said. He took on a wide range of community service positions, simultaneously doing case management and street outreach, mostly in his old neighborhood of Englewood. Over the past couple of years, many of the people he met in the old neighborhood were infected with HIV. Many had AIDS. George studied HIV prevention, making contacts with workers in the AIDS organizations that he went to for information and help. Most of the people he'd met who were HIV infected or had AIDS had been IV drug users. The single biggest cause of the infections was needle sharing.
Just after Christmas in 1990 George got a call from one of his new contacts, Dan Bigg, who was just finishing a project writing courses about HIV prevention and addiction for the VA. Dan was thinking about starting a new outreach group. He was inspired. He'd gone to a conference in Minneapolis where a new group called the Minneapolis Recovery Alliance had formed. Dan said they were the first group he'd seen that brought the issues of sex, addiction, HIV, and recovery all together. "They're filling the gaps that need to be filled," he said. He thought Chicago could use something similar. After George agreed to come, Dan got the word out. About 16 people showed up at a meeting at Ann Sather's restaurant in January of 1991.
It was a mixed group that met that day, all the primary colors and some of the shades in between. Most of them worked in social services. Some were ex-addicts, some weren't. Some were ex-offenders, some were HIV positive, some had good paying jobs, some couldn't afford a meal at the restaurant. Nobody was pushed to order from the menu; the sweet rolls were free.
One of the former IV drug users, struggling with health problems caused by AIDS, told the rest of the group a story about the time he'd been denied treatment at three emergency rooms in Chicago. He was having trouble breathing, every breath feeling like a razor slicing inside his throat. He begged the hospitals to admit him, or at least to look at him. They wouldn't. Thinking he was a drug-seeking addict, they threw him out. He hadn't used in seven years, but he'd admitted his history, and he was still marked with old tracks. Struggling for air, he'd finally reached a hospital in Minneapolis that said it would take him, and he'd driven through a rainstorm to get there. The doctor there found herpes in his esophagus. He said that the hospitals in Chicago hadn't seen a suffering human being who needed help, they'd seen a junkie--and junkies were shown the door. He'd been fortunate to get treatment; the doctor had even taken his addiction into account when prescribing medication for him. Otherwise, he said, there'd be one empty chair at this meeting.
The people at the meeting had plenty of motivation, they just weren't sure what to do. "No intellectual masturbation," Dan said. Something direct. Led by the example of the Minneapolis Recovery Alliance, with whom they shared some goals, they named their group the Chicago Recovery Alliance. Some people proposed that the best service would be the most direct action they could think of. The group agreed to explore the possibility of a needle exchange program.
An exchange would allow drug injectors to obtain clean syringes and needles. But it wouldn't be a giveaway. The user must have a dirty set to trade. When the Chicago Recovery Alliance started working on setting up one here, there were 20 known needle exchanges in the U.S., mostly on the coasts. The figure is approximate because it doesn't count the operations that are so far underground that no one but the neighborhood junkies (and maybe the police) knows they exist.
In Chicago, AIDS service organizations and the state and local departments of public health had all noted the rising rate of HIV infection among IV drug users, but their hands were tied when it came to prevention. The organizations did what they could, warning against syringe sharing and occasionally providing needle-cleaning kits containing bleach and cotton, but none had even attempted to provide new needles for addicts. There was plenty of support for the idea of a street-based needle exchange program, but the support stopped short of practice. There were too many problems involved.
The AIDS organizations were already stretched to their limits with counseling programs and promoting safer sex and condom use. Due to Illinois state laws against drug paraphernalia and Chicago street laws against giving away for free something that another person sells, starting a street needle exchange program could be poison to an existing organization. Who wanted to risk arrest, or alienate a donor base, or drive off potential grantors for a cause as dubious as giving clean works to junkies?
Getting started wasn't going to be as simple as finding a corner, rounding up some volunteers, buying a box of syringes, and handing them over to anyone who asked for them. First they needed to set up a method. Some of the members of the Recovery Alliance had met two men who were already giving clean works to addicts they knew in their own neighborhood. With an estimated 60,000 drug injectors in Chicago, the two guys could barely make a dent.
The Recovery Alliance met regularly at Ann Sather's, wrangling with organization, terms, and goals over a period of nine months. Likening the needle-exchange idea to designated-driver programs, Dan said it was another form of damage control stemming from substance abuse. He asked, "If an alcoholic has a dirty glass, and you give him a clean one, are you encouraging him to drink? Possibly. But would he still drink if the only glass he had was the dirty one? Probably. And if there was a deadly disease in the dirt on that glass, would you want to give him a clean glass to drink from?" The problem with convincing others about that analogy was that while almost everyone knows someone who drinks (even from a dirty glass), a lot of people have never known someone who shoots drugs. Drug injectors live somewhere else, they have no voice, and practically no one speaks for them.
To determine how well the needle exchange would work, the group took pieces of the research designed for other programs and put together a system for evaluating the situation here. Adopting the slogan that working toward recovery is "Any positive change," they decided very early that they wouldn't judge or preach to the people using the exchange. In that spirit they opened membership to anyone who attended two meetings. They formed a board, but they shied away from too much structure. "We don't want to build another bureaucracy," George said. That philosophy led the meetings into several dead ends and blind alleys, but they stuck with open participation.
A major problem with the needle exchange was deciding where to put it. Other programs' experiences showed them that it would have to be located next door to dope. A couple of years ago the New York City health department had conducted a needle-exchange program, sticking it in a public building near Wall Street. Hardly anyone came. Very few injectors used either the stock exchange or the needle exchange. To do its direct service, the Chicago Recovery Alliance would have to go directly to the addicts.
George, Dan, and one of the other members of the Alliance scouted several locations, but they eventually opted for a sidewalk in Englewood, where George did street outreach. Englewood was littered with problems from the sidewalks to the rooftops. Dan mentioned that programs in other cities had determined where to set up by looking in the gutter. If they found piles of needles glittering there, they were in the right place. George showed Dan a street lined with enough dirty plastic syringes to make a short boardwalk.
When it came down to persuading the locals of the wisdom of the exchange, George did most of the talking. He talked it up with the people he already knew, and he talked it up with people he'd never met. George talked to ministers, he talked to junkies. He asked the owner of the small corner grocery store a few feet from where they planned to operate if he minded having the exchange so close to his business. His support was paramount. If he was against it, they'd have to choose another place. The man, towering over George (and George is pretty large himself), stroked his shaved head for a moment. He said hell no, he wouldn't mind. It wasn't as if there weren't plenty of dope addicts on the corner near the store already. Saving their lives was all right with him. It might even be good for business.
The Alliance was almost ready. There were still plenty of things to hash out and one last point preventing them from getting started. They had to find a way to acquire the new syringes, since access to them is limited. Dan took care of that. With the help of what he called "a little schnauzer" he was able to find a veterinary supplier who'd sell them syringes. No one in the Alliance bought the syringes, the schnauzer did. The schnauzer paid nine cents for each syringe.
During the year before they were able to start the exchange, Dan, George, and several others worked for free, laying out the costs from their own pockets. They put together some bleach kits, they brought referral cards, they bought condoms. To provide comprehensive HIV prevention they needed to cover everything. They'd hand out the condoms to any adults and teenagers who asked for them. They didn't think it necessary to exchange used condoms for new.
Dan took a bucket from his garage to collect the dirty works. "Never touch the used syringes," he told himself. After an addict dropped his syringes in the bucket he'd call the count to George, who'd then give out bleach kits and the same number of new needles. A third person would survey the addicts, and if an addict was interested would hand out information on treatment. The survey was fairly extensive. They had it checked out ahead of time by researchers at the University of Illinois at Chicago. The researchers said it was excellent. They'd be glad to use it in their own studies. George and Dan didn't yet know what the addicts would say.
They paid a courtesy call to the police and spoke with the neighborhood relations officer. Officially, he couldn't give them permission to do the exchange, but he wished them luck. George's friends in the community spread the word, and on one of the few bitter days this past January, their first customer was already waiting when they drove up. He pulled used needles out of every crevice in his bulky clothing. He waited while Dan got the bucket from the trunk of his car, then turned over 14 of them.
The CRA volunteers knew what their reception would be, but they hoped for the best and expected the worst. They kept a sympathetic lawyer waiting by his phone, ready to come and get them out of jail if he had to. A man came up asking for clean sets without any dirty ones to exchange. They couldn't give him any. A person leaning against a building told him to go find some. After digging in the snow for a couple of minutes, he came back with 20.
George and Dan looked around them as the wind swirled a funnel of litter. They glanced over at the shooting gallery across the street and saw people watching them through the torn sheets and knotted bath towels that draped its second-floor windows. A woman (who they later found out owned the needle concession at the gallery, selling works for $2 apiece) came outside and stood on the stoop.
The third volunteer with George and Dan that day, a nurse from Rockford, handled the surveys. Though the data gathered in the course of the research would be valuable to scientists, science would not be the only discipline served by its existence. The law that prohibits the distribution of drug paraphernalia, including syringes, allows it as part of scientific research projects. The CRA wasn't entirely sure the research would protect the people working the exchange from prosecution, but it would give them some leverage in case of arrest. If the state wanted to test the law, they could test it with them. But the situation did leave the people who used the exchange in a hazy legal state--Illinois hasn't decided yet whether or not the drug addicts who receive the needles will be open to prosecution for possession. They're open to prosecution for plenty of things already, but if the exchange opened the users up for arrest, they'd go elsewhere for their needles.
The volunteers asked everybody, both passersby and users, what they thought of the program. One man said that he thought it was "stupid," but everybody else they asked was strongly in favor of it. Standing out in the cold, users and nonusers alike patiently answered the survey's extensive list of questions. The users were asked about their drug habits and about sex. The nonusers were also queried about sex. One of the last questions asked was "What do you think of this syringe-exchange program?" They were told "thanks" and that it was "beautiful." They decided to continue.
The three of them went down to the spot near the corner every weekend through January. In February, George took a trip to the second annual Needle Exchange Convention in Tacoma, Washington, to gather more information and support material. Representatives of syringe exchange programs from as far away as Kathmandu attended the convention. Many programs are completely underground, supported only by the people doing them and the people using them. A couple of the programs, including Tacoma's, are run by health departments. Some of the groups sold T-shirts and jewelry to pay their way to the conference and support their projects. Most of the stuff being sold was handmade. People from a Seattle program called "Point Defiance" sold pins with hypodermics attached to them. "Pins and needles," George said, "I don't know who'd wear them, but I like it anyway."
A core group of CRA members had been working the exchange every Saturday, with the team usually consisting of Dan, George, and one other volunteer. After George returned from the conference, they agreed that for the operation to be most effective there should be five people present: two to conduct surveys and make referrals, one to count the used syringes dropped in the bucket, one to give out new syringes and bleach kits, and one to distribute condoms and prevention literature.
The group had made a commitment to be at the site every Saturday at the same time. Without stability the exchange would fail. If addicts showed up and the Alliance members didn't, most of the addicts wouldn't show up the next time. Feeding a heroin habit requires the addict to structure his time around when he can get dope.
Though a couple of the people who worked the exchange had at one time been at the other end of the needle's point, they learned something new each time out. They met afterward at a nearby KFC to discuss survey results and anything that happened during the two hours of the exchange that needed work. Items such as lending money to the clients came up. Should they or shouldn't they? They decided to talk about it later. (Eventually they voted no.)
George reminded everyone that the effort was a public health issue. "Don't just come out and say 'We got free needles here!' because if you just come out with free needles some folk are going to get upset. Tell them it's public health first." But public health was just part of the issue.
There are strong claims to morality on both sides of this issue; who you agree with depends on how that morality is defined. The main objection to needle exchange programs on the part of some authorities has been that giving clean needles to addicts looks like saying yes to drug use. There aren't any arguments with the program's objectives, at least not public ones. In fact, studies of existing programs have confirmed that HIV transmission rates go down among drug injectors with access to needle exchange programs. In a two-year study conducted in New Haven by researchers at Yale the rate of new HIV transmission was lowered by 33 percent among IVDUs in the first six months of the exchange program. The researchers, who had no connection to the exchange other than studying it, attributed the lower rate to the exchange program. They tested for traces of HIV on every dirty syringe that came back through the exchange. A similar study in Holland reported a 50 percent reduction.
No one who shoots drugs needs to be persuaded to use a clean needle; if they've got it, they'll use it. It would be a rare injector with a set who wouldn't gladly give it up for a new set. They want to live to get high another day, or maybe even kick someday. Certainly, there are some drug users who don't care one way or the other, just as there are many who still don't know that if they share a needle they have to rinse it out with bleach to clean it. Some of the people the Recovery Alliance surveyed thought that water would do the job. At the start of the program Alliance volunteers found that practically everyone they asked had shared works at some time or another during the previous week. But as the weeks went by with free needles available, they found that the regulars were sharing less. There's little argument over whether or not needle exchange programs can save lives; they already have.
No, it's the specter of seeming to encourage IV drug use that has kept the exchange on the legal equivalent of pins and needles. The argument carries some weight. There are even ex-junkies who feel this way. In fact, Dan says, "Addicts are some of the sternest opponents to these programs." The programs do, in a sense, condone drug use. They also tell junkies that somebody cares whether they live or die. Telling drug injectors "Don't share needles" without backing it up with action has so far been just about as effective in preventing needle sharing and HIV infection as "Just say no" and the war on drugs have been in preventing drug use.
Do the needle exchanges encourage people who'd never stuck a needle in a vein to start? The CRA's research shows the average user of the exchange has been injecting drugs for 20.1 years. That's not inconsistent with other studies. Most people who are shooting dope now, or have done so in the past, will tell you that they didn't need any encouragement while they were addicted. For an addict, when it's time to get high, it's time to get high.
If you've got the money to cop, you don't wait around for "Heroin Time." After you put together ten dollars for a bag, you have to go wait in a line to buy it. If you're lucky, the line will go quick. If you've got an extra two bucks for a new set, great, but if you don't, you don't spend extra time and money trying to get works if you don't have to. Two dollars? That's dope money. If you've already got a set, you'll share it with someone who doesn't. He may return the favor sometime. You don't have anything? The point broke, or you lost them on your last trip to lockup? There's Joe Blow, you've seen him around. "Yo, Joe, you got a set? Blue tip? Beautiful, man, let's get high. No bleach? No time. No money, either. I don't give a shit. Fuck that shit, let's get high. Let's get straight."
Anybody will tell you that dope fiends are the lyingest, thievingest, least trustworthy people around. Even dope fiends will tell you that. Each one lives in his or her own world of need. They're usually only dangerous when someone or something stands between them and drugs. Most heroin addicts (though many shoot coke with their dope, most IVDUs are addicted to heroin) are very calm when they're high. People who shoot coke are just as likely to be violent when they're high as when they're not. Injecting coke is like sticking an icicle into your brain. Every muscle jumps. The effect of injecting heroin is like a warm hand patting every nerve into place.
Among drug users, heroin addicts are in a class by themselves. For them, all the problems in the world have become just one problem: how to get dope. They spend a lot of time solving this problem. Addicts who have enough money and a steady connect can function for years without referring to the junkie network. But for most it is a network, one that's necessary to survival. When it comes to getting high, most addicts watch out for each other. If something good is out, one junkie will tell another about it. If what's out is garbage, they'll warn each other off and go look for something better. Brief partnerships are constantly formed and broken, either to share a cooker, or works, or information, or just for companionship. Junkies are some of the worst tellers of tall tales since the cowboys. They also believe almost anything they're told. It's like a side effect of the drug. Sitting around the cooker telling lies is another junkie habit.
Anybody who's been addicted to heroin for a number of years has probably kicked, physically, at one point or another. It takes three days (72 hours) for heroin to leave the system. Any addict who's done a long weekend in lockup has gone through physical withdrawal. Physical withdrawal is a lot like a very bad flu, but dope leaves the body much faster than it leaves the mind.
It also takes a while to attain a physical addiction; it doesn't happen in just one, two, or even three uses. To become addicted, a person has to open the door and invite heroin in. Once it takes up residence, it'll do practically anything to stay. After a while, an addict forgets everything else that ever gave pleasure.
It takes a tremendous amount of strength, willpower, and desire to get rid of dope, but plenty of addicts do kick, and kick for good. Some go on to help themselves; some, like George Williams, go on to devote their lives to helping others. If they live.
The Chicago Recovery Alliance is independent and doesn't represent authority. Its members understand that many drug addicts are ashamed of their addiction. They ask, they suggest, they act as if the addicts who use the exchange have minds of their own. They don't push anything on anyone. They made 114 referrals to treatment in their first four months on the street.
And the police left them alone. A May 25 Time magazine article about the New Haven study even suggested that the exchange there was helping to reduce heroin use by forging a link between the health department and the people on the street. More addicts sought treatment in New Haven during the study than ever had before. The New Haven police added that crime had gone down 20 percent since the exchange started. The chief of police believes the two were linked.
Groups doing needle exchange are a thin red line between drug injectors and non-drug injectors. In this country, AIDS has been introduced to heterosexuals in large numbers by IV drug users (more than by people infected through blood transfusions, sex with bisexuals, dentists). For the most part, the police don't want to bust the exchanges. Many, individually, have sympathy for junkies. They don't necessarily want to see them die, and besides, containment is part of police training.
The Recovery Alliance kept quiet about its efforts. One day a squad car cruised by the site. The officer inside called out to the group of do-gooders, "What are you, professional victims?" The lawyer who'd waited by the phone on their first day out was now out on the street. He went over to the officer and explained that they were doing AIDS prevention. Beyond that they weren't harassed. The woman who sold works in the shooting gallery across the street remained silent. And every week brought new people to the exchange, taking needles out of rolled-up socks or little bags hidden in their pants. The word was getting around. One of the members of the Recovery Alliance who works in the prison system said that some of the inmates he spoke with had heard of the exchange. Inmates have a particular interest in AIDS prevention. Not only are condoms not distributed by prison authorities, they're confiscated as contraband at the door when delivered by someone else. Prisons are well guarded; prisoners, when it comes to AIDS, are not.
They applied for grants and waited. Still paying out of pocket for everything, they were strapped for cash. They hustled when they could--xeroxing survey sheets at work, using their offices' postage meters. A safe-sex group agreed to donate half the cost of the condoms they were giving away. And every week the numbers rose.
The Chicago Recovery Alliance became the first Chicago organization to get a grant from AmFAR (American Foundation for AIDS Research) in May. The grant will provide the cash to start up a location on the north side, with a more extensive research component. AmFAR is funding needle exchanges in three other cities--New York, San Francisco, and Boulder. All those cities endorsed the programs. Dan and George and others met with representatives of the state's attorney and Judith Johns, newly appointed to head up the AIDS arm of the Chicago Department of Health. One of the state's attorney's reps took a look at the research, at the letters of support from researchers like Wayne Wiebel and Judith Levy at UIC, Don Desjarlais from Beth Israel Hospital in New York, and John Watters from the University of California, and said they were impressed. Judith Johns said that the CDOH supported the group's work.
Dan called the membership together. He told them that it wasn't yes, but it wasn't no either. Frustrated, George called out to him from the floor. "Mr. Bigg!" "Yes, Mr. Williams." "I submit that the other groups around the country don't give a shit about legal! They don't give a shit about legal in New York. They don't give a shit about legal in Washington, D.C. Why the hell should we give a shit about legal here in Chicago?" Dan answered, "Even though it might feel like we're pioneers here, we aren't. Remember Dave Purchase." (Founder of the needle exchange in Tacoma, Purchase worked with city authorities to establish it as a city-sponsored program.) "We'll be able to do more if we're legal," he added. George agreed. "We're going to see a lot of walls come tumbling down in the face of a strong response."
AmFAR sent out a press release announcing the grant. On a recent warm Saturday--May 16--the needle exchange made the front page of the Tribune. It didn't make any difference with the south-side regulars. Things proceeded as usual.
A man asked the group to put their bucket in the back of a jeep belonging to one of the volunteers. "It's not good for the kids to see this," he explained. They agreed. Seconds later a man drove up. He had 27 needles. A woman jumped out of another car. Dressed in a gown and a big floppy sun hat, she said she didn't have time to answer the survey. She was on her way to a wedding. Two young men walked by and asked for condoms. They got the condoms and a brochure explaining how to use them. The man who'd come to the exchange on its first day without any dirty needles to swap still didn't have any. This time it took him an hour to find one dirt-encrusted set. Streets cleaned of dirty needles have been common to every needle exchange.
A man drove up and left his family waiting in the car. He's on the waiting list for a treatment program. Someone remarked on the survey's statistic that most of the exchange's clients had been injecting for 20 years or more. George, kneeling on the sidewalk, busy giving out bleach kits and counting out new syringes, noted that they were just starting when he stopped. When a surveyor asked one of the exchange users, "What can we do to improve this program?" he paused before answering. "I don't know. Maybe give out dope with it?" The surveyor didn't think the answer was appropriate, but George told him to write it down. "Hey, it's a real response, right?"
A man who lives next to the shooting gallery jogged over from across the street. All the people who work the exchange know him. His eyes were spinning in their sockets, a cloud of alcohol was on his breath. He was built like Conan the Barbarian. His forearms bulged like Popeye's. He told one of the volunteers, "I spend about a week every two months in a mental hospital. Now, how do you think that makes me feel?"
The volunteer eyed him, "I don't know, how?"
"It makes me feel great," said the man, jabbing himself in the chest. He was wearing a yellow T-shirt that read "Don't Worry, Be Happy." "It sustains me."
The volunteer said that was good. Noting the veins cabling the man's arms, thick and numerous as the rigging on a sailboat, he added, "You look clean."
The man peered at him. "What's wrong with that?" he asked. Then he realized it was a compliment. He leaned closer to the volunteer. "I used to do it," he confided, "over in Vietnam. They had skag, they kept it under the streets! I don't do that anymore. But I still have a drug problem. I smoke crack."
"Oh great," the volunteer thought, "a drunken, crack-smoking lunatic with the strength of ten men."
The man's face fell as if he'd read the volunteer's thoughts. He looked like he was about to cry. "I just want someone to listen to me," he said.
The volunteer listened.
Art accompanying story in printed newspaper (not available in this archive): photos/Mike Tappin.