VOLUME 4, ISSUE 4 |Jan 27 — February 2, 2005
Reaching Crystal Meth Injectors
Lower East Side Harm Reduction Center seeing recent influx of gay and bisexual men
On a freezing Monday afternoon, some clients are standing outside the Allen Street offices of the Lower East Side Harm Reduction Center enjoying conversation and a cigarette.
Others are talking with friends inside the agency’s drop-in center, but they have to raise their voices to be heard over a rerun of “Law and Order” that is playing on a television nearby. Despite the noise, one or two clients have taken advantage of the warm, street-level center to get some sleep.
In the midst of all this, a tall black man quietly slips into the agency and steps into an alcove right beside the entrance. He requests three needles, pockets them and leaves.
This is a front line in the war against AIDS where unused syringes are given to drug injectors to prevent them from sharing needles and spreading HIV, the virus that causes AIDS, or hepatitis C, a virus that attacks the liver.
Increasingly, gay and bisexual men who inject crystal meth are stepping into that alcove and asking for needles though they are not staying at the drop-in center.
“They come and go,” said Sam Orlando, vital service care coordinator at the harm reduction center. “It’s very private. They’re not interacting with the other clients.”
Over the past year, the harm reduction center has seen roughly 30 gay or bisexual men come in for counseling on safe injecting and to get clean needles. Orlando has done 45-minute counseling sessions with them.
“I think that population is a little different,” he said. “A lot of gay men who come in here are housed. They have jobs.”
What those men do not have is complete knowledge about safe injecting. They do not share needles, but they do not necessarily know that sharing other items, such as the water used to clean a needle or a dish in which the meth is mixed with water before shooting, can transmit viruses and bacteria.
“There is still a high level of ignorance when it comes to injecting,” Orlando said.
Some of the men have questions about booty bumping where the needle is removed from a syringe, the meth is mixed with water in the syringe and injected into their ass like an enema. Booty bumping can damage the colon and make it easier to acquire HIV if it is followed by unsafe sex.
The gay men are mostly white and in their mid-30s. Just a few are in their 20s. The majority have been using meth for less than a year, according to Orlando.
“For the most part, they want to learn proper injection and how to prevent overdosing,” he said.
The 2001 state law that made it legal to possess unused syringes lets drug users purchase up to ten needles at a time at a pharmacy. The needles at the harm reduction center are free as is the counseling.
Orlando tells his clients to plan their use. If they are going to party for a weekend, they need to set time aside to eat, take vitamins or medications or rest for an hour or two. He cautions them to be careful when using different drugs at the same time. This is classic harm reduction practice that says that a user need not quit a drug to reduce the damage that drug can cause.
“That’s a very big piece of the puzzle,” said Orlando, who is gay. “I always talk about when are you going to start, when are you going to stop?”
Generally, these men say they are successfully managing their meth use.
“Some are better than others,” Orlando said. “Some, I question if they are just telling me what I want to hear.”
Among the men he has counseled, Orlando estimated that one third are HIV-positive. Three have first tested positive during the time they were clients at the harm reduction center. Less than five had said they had enough of crystal and sought a referral to another service provider to get help quitting the drug, according to Orlando.
“Some people may come to see me because they feel their crystal use has gotten away from them,” he said.
Orlando has visited a half dozen gay sex clubs and private parties to instruct men in proper injection techniques.
“I kind of knew they were hot spots,” he said.
At least one other staffer at the harm reduction center has also gone to gay sex clubs and private parties to deliver such instructions.
The city’s syringe exchange programs obtain waivers from the state that limit the areas in which they may operate. The harm reduction center has applied to the state to expand its waiver to include the West Village.
“As we are doing more outreach, we are bumping into more people,” said David Rosenthal, the center’s executive director. The West Village community board has been “very supportive” on expanding the waiver, according to Rosenthal.
“Usually in other parts of the city you get into the political belief that having a syringe exchange will increase drug use in that neighborhood,” he said. “The data doesn’t support that.”
While the agency is aggressively responding to meth, it remains a small part of their mission, though Orlando said he is now seeing straight meth injectors.
Founded in 1992, with a $1.3 million budget and a staff of 21, the harm reduction center served roughly 2,500 people in 2004, according to Rosenthal.
Last year, the agency distributed 600,000 needles and collected 550,000. Rosenthal showed a visitor the basement where boxes of syringes were piled ten feet high and stretched for roughly ten yards. They give out five different types to meet the preferences of their clients.
The agency offers massage and acupuncture services, six group counseling sessions per week and food and clothing “typically for those who are struggling the most,” Rosenthal said.
Posters in the drop-in center urge visitors to inquire about Narcan, a drug that is used to prevent opiate overdose. The hope is that injectors will carry a shot of Narcan with them and use if they overdose.
The harm reduction center also continues to explore new interventions for meth users. Rosenthal mentioned giving out clean straws to men who snort the drug, in order to avoid infection that can occur through the mucous membranes in the nose.
“While it sounds like a very minimal intervention it will raise awareness,” he said.