San Francisco Chronicle - Thursday, August 2, 2007
C.W. Nevius

Walk up the hall, which smells of urine, and then knock on the scratched and battered wooden door. After two or three tries, someone might open the door a crack to see what you want.

Welcome to a city drug needle exchange and HIV prevention facility.

When then-Mayor Frank Jordan signed legislation endorsing needle exchanges in 1992, it was a high-minded, civically progressive program to slow the spread of HIV and hepatitis C. Drug users would get a needle, use it, then return it for a clean one. That's still the idea - and it is a good one - but somewhere along the line the concept went low-rent.

Today the Haight facility looks more like a hole in the wall. The neighbors, many of whom say they have never been told what's going on up the street, find syringes in their gardens. And the original idea - a one-for-one exchange - is largely ignored.

The exchange is run by the Homeless Youth Alliance, which gets a yearly budget of $275,000 from the city Department of Public Health. As the alliance's program director, Mary Howe, admits, they make no more than a rough count of the incoming needles. If someone says he returned 40, they hand over 40 new ones. And, if he doesn't have any, they give him 20 as a startup stash.

"The point for a needle exchange is not to get every needle back," says Howe. "The majority of users dispose of needles in a respectful manner."

And those who don't?

"That's not my responsibility," Howe said. "I can't hold everyone's hand and make everyone put them in a bio bucket. If someone has a liquor store, and they sell liquor to someone who gets into an accident, is it the store's fault?"

But this is a little different. Even Tracey Packer, interim director of the Health Department's HIV Prevention Program, thinks that's too strong.

"It is our responsibility," she says. "We all have to participate to make sure everyone is safe."

The public health danger posed by used syringes got my attention during a visit to nearby Golden Gate Park last month to check out homeless campsites. I found so many discarded and new needles it raised the question of where they all came from. To the neighbors on Cole, it is obvious - they are being given out by the double-handful at the needle exchange.

Howe, a true believer who is a recovering addict herself, feels the debris is an unfortunate byproduct of a necessary initiative. To her, the single, most-important issue is stopping the spread of infectious disease. If that means giving out a double-handful of needles to someone who might leave them scattered in Golden Gate Park, so be it.

But Les Silverman, who has lived on Cole Street since 1973, feels the fact that there are plenty of needles available increases his chances of finding used needles in his garden. He doesn't think that's a coincidence.

"Why, especially, would our block have needles in our gardens?" he says. "Like my neighbors, we believe in the concept of needle exchange. What we take issue with is location, transparency and oversight."

Silverman and other Cole Street residents have become familiar with "The March of the Junkies." In the early afternoon they trudge up the street to the corner, then turn and hike back down to the Panhandle portion of Golden Gate Park. Somewhere along the line, needles and condoms can be tossed in the bushes, and the homeless people turn their gardens into rest rooms.

"To me," says Grace Hersh, who lives across the street from Silverman, "it is just this stream of (a) dreadful element. It's disturbing."

Howe admits that there hasn't been much outreach to the neighbors. Newcomers like Jeff Goldsmith, who has two children - Ariane, 6, and Simon, 9 - says he just recently learned about the needle exchange up the street. He's found only a few needles in the last few months, and when your kids are involved, that's too many.

"I'm actually in favor of needle exchange," he says. "But if you are finding needles, they are not being exchanged."

Packer, at the city Health Department, strongly disagrees that the availability of needles is what is contributing to dirty discards in nearby Golden Gate Park. But doesn't that seem logical? If needles can be acquired by the handful, why bother to keep track of the one you just used?

A lot of people say this is a homelessness problem or an addiction problem. But for those who are trying to make a life for their families in San Francisco homes, it is simpler than that.

Consider the case of Ken Stevens, a lifelong resident of the city. Three years ago he took his 5-year-old son, Michael, to the playground at Corona Heights - a park we visited earlier this week.

Michael climbed up on the play structure, then turned to his dad and said, "Ouch." He'd been poked by a needle left on the slide.

"You talk about a parent's worst nightmare," Stevens says today. "I think I went out of my mind for a couple of hours."

Michael turned out to be fine, but it took three months of blood panels to establish that. By then, Stevens had reached a decision.

"As soon as that happened, it was pretty much an instant disconnect," he says.

In a matter of months, Stevens had moved his family to Los Altos.

C.W. Nevius' column appears regularly. His blog C.W. Nevius.blog can be found at SFGate.com. E-mail him at cwnevius@sfchronicle.com.
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