Every month, a dedicated team of ten San Francisco residents distribute about 30,000 sterile needles and syringes to people who inject drugs in our community. (They also collect used syringes so they can be disposed of properly—with a very successful rate of return). These community member volunteers, known as Satellite Syringe Exchangers (SSEs), help the San Francisco AIDS Foundation Syringe Access Services team blanket the city with essential supplies that prevent the spread of infectious diseases such as HIV and hepatitis C. They also provide harm reduction counseling and linkage to services to some of our community’s most marginalized people.
Each SSE targets a different segment of the San Francisco community. Aaryn Harrison, who has served as an SSE with the foundation for three years, provides safer injection supplies primarily to gay men who inject meth. Many of the people he distributes supplies to are part of the young gay professional world and members of the main stream adult entertainment industry—people he says who wouldn’t want to be seen buying needles or going to a needle exchange.
“There’s a lot of stigma associated with injection drug use,” said Harrison. “But it’s a problem if people can’t get the supplies they need. That’s what I help with.”
Harrison started doing satellite syringe exchanging because he would see people at parties trying to inject drugs with old needles that were dull.
“I’d see people sitting right in front of me, trying to jab themselves over and over again,” he said. “I’d hear, ‘I’ve been using this needle for over a month,’ and I would be like, ‘Are you serious? I’ll take care of you. Just let me know what you need.’”
Other SSE volunteers target homeless encampments—going from tent to tent on a daily or weekly basis to distribute and collect supplies. A few provide supplies to the single room occupancy (SRO) hotel communities where they live. All SSEs are trained to administer (and carry with them at all times) naloxone (Narcan), which is an opioid receptor antagonist medication that can bring people out of an overdose in potentially fatal situations. In addition to being able to use and carry Narcan, SSEs are certified to prescribe Narcan, so that they can train their own clients to use and administer it.
“The program started about seven years ago as a grassroots initiative,” said Hannah Cohen, the Satellite Syringe Exchange coordinator for San Francisco AIDS Foundation. “People who come into the program are recruited because they are regular participants at the exchange and who are coming in and already doing big exchanges. We start conversations with them and find out that they’re not just exchanging for themselves, but for other people in their networks. These are people who care about the community, who are activists, and are interested in public health. They recognize the importance of getting people access to supplies—and that’s why the program works.”
This summer, six members of the team received funding to attend the Peer Network of New York annual conference in New York City. The conference, organized for community members or “peers” of people who inject drugs, is designed as a space for people to connect, share best practices and learn from each other. Panel discussion at the conference focused on hepatitis C, women who inject drugs, the transgender community, voices from outside of New York, and young people.
“The peer-based syringe exchange model of program is not common,” said Cohen. “It’s up-and-coming, though. Harm reduction programs have recognized it as a best practice—as a way to reach folks who can’t or won’t access services on their own for whatever reason. But because there aren’t many cities with peer-based syringe exchange programs, it is very valuable for us to connect with other programs and share what works and what doesn’t work.”
The SSEs are offered a small stipend for their time and services. Mostly, though, the group members are intrinsically motivated to do what they can to help their communities. Harrison, who has been an SSE with San Francisco AIDS Foundation for three years, started doing satellite needle exchange many years prior—for about 20 years total now.
“I’m continually being referred to new clients,” he said. “Now, it’s gotten to the point where people find me. We do a lot of after-hours work, and all of our exchanges are private. I don’t think I’ve had a night to myself in months!”
Aaryn doesn’t consider the distribution and exchange of supplies, however, to be his primary and sole concern. He has found that as he sees people again and again, relationships develop. He serves as a source of support for people in time of need, and as a resource when people need access to other kinds of medical, legal or social services.
“Aaryn does full-time case management for people,” said Cohen. “The needle exchange is just a small aspect of the work he does. He has a reputation for being a lifesaver. He’s the person you can trust and go to for anything—he won’t judge you or get you in trouble.”
At weekly planning meetings held by Cohen, the group reviews logistical information about their program and brainstorms solutions to challenges they encounter. They also use the time to discuss more personal things going on in their lives—friends that have died, for example, or problems with their housing situation. At the last meeting, a representative from the Department of Public Health presented information about a hepatitis C clinical trial, and group members took time to discuss their hepatitis C status and treatment options. Guests, and trainings held at these weekly meetings are beneficial for the group, said Cohen, because they bring valuable information, connections and resources to SSEs. They also help SSEs develop professional training, education, and referrals that they can pass on to their clients.
“Our group is amazingly diverse,” said Cohen. “People come from different communities and backgrounds and networks. We get to witness the power we have when we come together and unify. Drug users encounter stigma no matter what. But this program recognizes the status of being an active or former drug user as a source of value, and that is so validating.”
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