amfAR, The Foundation for AIDS Research

Syringe Exchange Transforms Lives in Harlem 

Pioneering Program Reduces Harm, Increases Hope

by Carolyn Hanson


August 29, 2008—The two trailers sit in the shadow of the commuter train tracks, which rise above street level in New York City’s East Harlem, carrying suburban residents to and from their Manhattan offices. On a sunny Tuesday morning, the corner of Park Avenue and 110th Street is relatively quiet except when a train rumbles overhead, and most of the people who stop at this mobile syringe exchange site stay only minutes, to exchange used syringes for clean ones, or to pick up safe injecting supplies, condoms, and literature from the folding table set up on the sidewalk.

These brief interactions are part of a much larger trend: the dramatic reduction of HIV infections among injection drug users (IDUs) in New York, as well as lasting, visible change within communities like East Harlem. Kathleen Schroeder, a referral specialist at New York Harm Reduction Educators (NYHRE), which runs the site at 110th and Park, described the positive changes she’s observed in the seven years she’s been working there.

“You’d find syringes in the street back then,” she explained. “Now you don’t. We see that a lot of clients have grown,” she added, stressing that the program’s primary purpose is not to insist on abstinence from drug use but to encourage safer lifestyles. “They’d be using really bad; they were homeless.” Through harm reduction, she said, “they got housing, they got on meds, treatment for hepatitis C.”

Syringe bus
NYHRE’s mobile syringe exchange sites provide lifesaving services to communities throughout New York City.

Working closely with amfAR, which has administered the distribution of harm reduction supplies to all syringe exchange programs (SEPs) in New York State since 1992, NYHRE—one of the 17 authorized SEPs in the state—provides a range of harm reduction services to IDUs at mobile trailers around New York City and at its offices in the Bronx and Manhattan.

In 1992, when SEPs were legalized in New York State as part of a harm reduction initiative to reduce the high rates of HIV/AIDS among IDUs, many community leaders and officials feared that the programs would encourage drug use and lead to an increase in crime. These debates continue today; organizations in several states are still fighting to legalize SEPs, and a longstanding ban on federal funding for the programs remains in place. After 16 years, however, legal syringe exchange in New York has been shown to be an unqualified success.

The efficacy of syringe exchange in preventing the spread of HIV has been well documented through research that includes several amfAR-supported studies. The incidence of new infections among IDUs in New York City, where most of the state’s SEPs are located, dropped from four percent per year in 1990–1992 to one percent per year in 1999–2002, and HIV prevalence among IDUs in the city decreased during that period from 50 percent to 15 percent, according to studies published in the American Journal of Public Health and the Journal of Acquired Immune Deficiency Syndrome. In the same period, the number of syringes exchanged per year in the city increased from 250,000 to 3 million.

amfAR has played an integral role in syringe exchange in New York since before it was legal, funding early studies showing the benefits of harm reduction, which prompted state officials to consider legalizing the programs. The Foundation provided seed funding for the first legal SEPs in New York City, including NYHRE, which grew out of the Bronx-Harlem Needle Exchange Program. Since 1992, amfAR has received funding from the state to distribute supplies to all the state’s SEPs, in cooperation with the state department of health’s AIDS Institute.

Kathleen Schroeder first came to NYHRE as a client to exchange syringes and, spurred by a desire to help others, made the transition from client to volunteer, eventually joining the staff. Many other staff members and volunteers who work at 110th and Park each Tuesday have followed a similar path. Miguel Ramos, a syringe exchange specialist who has worked at NYHRE for five years, explained, “I’ve been homeless and in prison, so I figure I have to give back to the community, and this is what I love doing.”

Like Schroeder, Ron Thomson was an injection drug user who came to NYHRE for injecting equipment. He has been drug-free since he began volunteering nine years ago. Now he hands out condoms and informational flyers and talks to people in the neighborhood—sometimes as many as 40–50 in a day—about the importance of reducing their risk of infection and getting tested for HIV.

Personal experience helps give these staff members and volunteers insight into how to connect with clients. “The people who use drugs, they’re somebody’s daughter, brother, son—they’re human beings first,” said Jerome Sanchez, an IDU education specialist. Sanchez, who also visited NYHRE as a client before joining the staff, compared his job with public relations. In talking with clients and community members, he tries “not so much to win people over, but just to give them a little food for thought. I’ve been doing this for three years, and I’ve noticed a lot of people who walk by, then come back a few weeks later for services, and they tell their friends.”

Sanchez provides clients with information about overdose prevention and addiction treatment, including buprenorphine, a newer, less addictive alternative to traditional methadone maintenance. He is encouraged by success stories from people he’s counseled. “People come back; someone was just here a few minutes ago,” he recounted as he stood outside NYHRE’s trailer. “For about a year I was telling him about buprenorphine and he finally went to this doctor at Metropolitan [Hospital] who prescribes it. The guy said he’s almost kicking himself for not going earlier.”

Rapid oral test
A NYHRE staffer administers a rapid oral HIV test to a client. 

While syringe exchange has significantly lowered rates of HIV infection among IDUs, more remains to be done to protect their health and that of their families. In addition to providing sterile syringes and injection supplies in exchange for used syringes, NYHRE offers HIV testing, acupuncture to treat pain and addiction, vaccination against hepatitis B, neighborhood outreach and education, support groups, and referrals to services such as Medicaid, housing and food assistance, drug treatment programs, detoxification, and medical care. But according to the AIDS Institute, only about 20 percent of IDUs in a community enroll in local SEPs, which means that needle-sharing and other unsafe practices continue. Even among those who do utilize SEPs, sexual transmission of HIV remains a concern, as does the rise of hepatitis C among IDUs.

Despite the ongoing challenges of reaching drug users, SEPs have proven to be one of the most effective public health tools in curbing the spread of HIV. According to a major study published in the November 2006 issue of Medical Care, the projected lifetime cost of treating a person with HIV is approximately $400,000–$600,000. Thus, even the highest-funded SEP in New York State—which receives $287,000 per year plus supplies—pays for itself by preventing only one new infection each year.

But the lasting benefits of harm reduction extend far beyond financial considerations, as NYHRE’s staff and volunteers have witnessed. Miguel Ramos described the gratification of talking with former clients who had made significant changes in their lives. “They come back to us saying ‘We got our family back thanks to you guys; I’m going to college now; I have an apartment.’ It’s a beautiful feeling.”