Cover Story: Putting Atlantans in Harm's way
For the Atlanta Harm Reduction Coalition, the state's only syringe exchange program, funding is harder to come by than a needle in a haystack
Additional reporting by Thomas Wheatley and Jim Burress
Editor's note: Some of the last names of the subjects in this story have been withheld.
On an unforgiving block in the English Avenue neighborhood known as the Bluff, just spitting distance from the future site of the Atlanta Falcons' projected $1.2 billion stadium, heroin has turned the world on its axis. Young dealers on one side of the street hug the corner like wayward old souls, while aged addicts on the opposite side seem stuck in a prolonged adolescence.
In front of the burned-out stone facade of a former church, the Atlanta Harm Reduction Coalition parks its recreational vehicle for a special type of missionary work. The nonprofit sets up its mobile needle exchange unit here twice a week, on Wednesday and Saturday afternoons. The clients run the gamut from functioning to crumbling. There's a former radio broadcaster turned homeless train hopper who bears an odd resemblance to Ted Williams, the man with the golden voice. A man near the front of the line wearing a permanent scowl says he sometimes gets his heroin by working as a middleman who steers new clientele to dealers in the Bluff, a notorious hub of heroin distribution. Behind him stands another man clutching a golf club handle in one hand and a fistful of used needles in the other. One serves as his walking cane; the other as his crutch.
Before exchanging their used needles for clean ones, they approach AHRC's Director of Advocacy Marshall Rancifer, who asks if they want "the works," a paper bag that includes tourniquets for tying off before shooting up, rubber tips for crack pipes to prevent cut lips, mini bottles of bleach, citric acid to help dissolve speedballs, mini cotton balls to strain the junk out of heroin while drawing it into a syringe, and condoms.
They all know Rancifer well, so well that when he asks how they're doing, they know the question is genuine enough to tell him the truth.
"I don't call them clients, I call them guests," Rancifer says. His high degree of empathy is based in part on his own backstory.
A recovering crack addict who served four and a half months in jail on a probation violation before becoming a drug counselor, Rancifer says he's "lived two lifetimes in one." While the first one found him living on the wrong side of the law, his current incarnation has him straddling the fence between the two.
That's because the work in which he and his harm reduction colleagues are currently engaged is illegal in the state of Georgia — although it barely earns a double take from the Atlanta police officers inside two separate squad cars that casually roll by over the course of the afternoon.
For nearly 20 years, AHRC has worked to prevent the spread of HIV/AIDS in Atlanta by providing wellness resources to substance abusers and sex workers. Last year, the nonprofit gave out 61,000 syringes to help combat needle sharing between intravenous drug users. The controversial needle exchange program is the only one of its kind in Georgia, where the distribution of drug paraphernalia is outlawed.
According to a 2011 report from the United Nations' Global Commission on Drug Policy, countries that implement tactics such as the AHRC's syringe exchange program (SEP) are lowering HIV rates among drug users more than countries attempting to eliminate drug use. Such studies acknowledge that SEPs are helping to slow the spread of HIV and hepatitis. But the stigma attached to drug use has earned the AHRC and similar organizations their share of critics who say SEPs enable drug users. That makes the nonprofit's public health mission a public relations nightmare when it comes to raising funds. With 60 percent of its $320,000 operating budget cut this year, Executive Director Mona Bennett says the nonprofit may not be able to open its doors in 2014 unless something drastic happens.
Cruise through English Avenue and it's clear this area has seen better days. In recent years, the neighborhood's houses have seen periods of more than 50 percent vacancy and bank ownership. On some blocks, nearly every third house is boarded up. And that doesn't account for the dope houses, hit houses, and trick houses scattered in between. For years, this west side neighborhood has been known as Atlanta's heroin hot spot. As if the area needed any more infamy, its underground legend expanded nationally with the 2012 DVD release of gritty hood film Snow on tha Bluff, a true-to-life tale in which the starring actor Curtis Snow portrays a version of himself as a drug dealer/armed robber. At least one good thing came from the film: After Michael K. Williams, the actor who played Omar on HBO's "The Wire," got attached as an executive producer, he and Snow made a YouTube tribute to Atlanta Harm Reduction Coalition.
To truly get a sense of AHRC's impact, one only needs to hang around the nonprofit's converted duplex headquarters at 472 Paines Ave. for a day.
"I'm sick, you sick — er'body sick," a client in the lobby raps while her boyfriend uses the phone to set up a doctor's appointment for her at a clinic on the MARTA line. "I'm sick, you sick — er'body sick." Another client takes a shower in the upstairs bathroom while a volunteer arranges AHRC's clothing closet down the hallway.
Downstairs, Darlene, 63, and her husband have arrived from Tennessee. They make the three-and-a-half-hour trip once a month because AHRC's program is the most convenient to them. If Darlene bought clean needles off the street, she says she'd have to pay $2-$5 per needle. As she stands in the shared office space just off of the client computer room, she tells the story of her addiction while holding a plastic grocery bag containing 107 used needles. A "so-called" friend turned her on to heroin at age 40 because she was suffering debilitating pain due to post-polio syndrome and the painkillers doctors were prescribing didn't suffice. Now she and her husband, who became addicted 40 years ago in Vietnam, use once to twice per day at $20 a pop. She prefers to have a clean needle every time, she says, because a syringe gets less sharp with each use. She pulls up her sleeve to show the many pockmarks and abscesses from dull needles and heroin with "bad cut."
To those who would point to Darlene as an example of someone whose habit is only being enabled by needle-sharing programs, Darlene points a finger back at the quote-unquote War on Drugs.
"It hasn't done anything," she says. "They're not stopping it by making it illegal; it'll still continue."
AHRC Outreach Coordinator Verna Gaines counts out Darlene's 107 needles two-by-two with a pair of serving tongs before tossing the used needles into a 19-gallon Sharps container. On average, the nonprofit can fill up to five containers per month. The AHRC'S fundraising coffers should be so lucky.
While AHRC's needle exchange program receives financial contributions and public praise from such heavy hitters as the Elton John AIDS Foundation, portions of its funding pool are earmarked specifically for other services, such as the 3,600 hot meals it served last year. AHRC provides HIV testing and education, hepatitis vaccinations, a job resource center, hot baths and showers, a clothing closet, and treatment facilitation for clients who are ready to quit using.
"We're Atlanta's health care bargain," Bennett says, noting a 2010 CDC study that estimates the costs of health care over the lifetime of an HIV patient to be $379,668. By helping to lower the spread of infectious diseases through its SEP, the organization is also helping to decrease the amount of taxpayer money going toward indigent care. "The federal funding ban on syringe exchange programs has got to go. It scares people."
Last year, about 20 percent of AHRC's total budget went toward operating the syringe exchange program. It's illegal for government grants to fund needle exchange programs, but they can go toward many of the other services AHRC provides. Even so, federal funds once distributed by the Georgia Department of Public Health are now allocated through Fulton County, which will require AHRC to start the grant-writing process over again. As a result, a lapse in funding has dealt the nonprofit a severe financial blow.
In the past year, AHRC's annual budget dropped from $320,000 to $120,000. An ideal annual budget would be $400,000, says Bennett. Normally, the organization gives clients a bonus of five to 10 needles per exchange. But due to the current budget shortfall, the organization has been operating on a "syringe diet," meaning it now doles out a maximum of 20-30 needles per client. The center has also gone from being open four days to three days a week.
Overall staff pay cuts have reduced pay for Rancifer's $15/hour position down to the equivalent of 70 cents per hour, he says, after calculating the number of hours he works and the $300 per month he currently makes as a contract employee.
"One thing I learned in recovery is, the only way you can keep what you have is by giving it away. So I give my time. God blesses me in other ways," he says.
In the meantime, AHRC continues to rely on grassroots fundraising efforts such as last June's punk rock benefit at 529 in East Atlanta Village. Though it only raised $180 in donated door proceeds, that money purchased several boxes of wholesale condoms.
For real proof of the difference the AHRC can make, one only needs to hear the story of a woman like Eleanor Hillman. A former crack addict for 25 years, she once ran a "bunk house" in the Bluff, where men could sleep for the night and do drugs. "And if they needed a date, I would date them," she says. After witnessing an eight-months-pregnant teen she'd watched grow up get murdered at her doorstep, she decided it was time for her to quit. While in rehab, she utilized the services of AHRC to take classes and get a makeover. Once clean, she began volunteering and eventually started working full-time at AHRC, where she started the clothing closet and specialized in raising in-kind donations for the nonprofit. Today, she's married and works for Georgia State University as a phlebotomist.
"If you want a chance and you want a change, AHRC is the place to go," she says.
Still, fighting the stigma that its efforts are at odds with drug prevention and treatment is an uphill battle.
"In the best of times, we're a hard sell," says Bennett. "We are not dealing with babies and kittens and puppies."
She also acknowledges that some clients are known to sell the clean needles AHRC provides to buy more drugs. "I would rather people sell our syringes and our condoms than to go out and risk arrest for stealing or risk getting a disease from going out and selling sex."
The South, in particular, is still in the dark ages on the issue of SEPs, which is largely due to staunch opponents framing it as an issue of morality. The ethical stalemate is an example of what happens when bureaucracy bumps up against public health and moralists win the day over humanists. While critics blame harm reduction proponents for enabling drug abuse, the flip side is that America's abysmal effort in the War on Drugs continues to enable the spread of HIV.
"When people ask me about the moral issue, I say, 'What's immoral about stopping the spread of infectious diseases?'" says Miriam Boeri, a professor emerita of sociology at Kennesaw State University, where she studied AHRC and other harm reduction programs around the world.
In France, syringe exchanges are easily available via vending machines the same way condoms are distributed here, says Boeri. While there are just fewer than 200 SEPs in the United States, most are located in the northeast and northwest. And many are closing due to decreased funding. Meanwhile, Washington pols play political ping-pong with the issue of syringe exchanges. In 2010, President Barack Obama lifted the federal ban on SEPs only to have House Speaker John Boehner reinstate it a year later. There are Georgia politicians on the national level who support AHRC's mission such as Congressman Hank Johnson, D-Ga., who served as the keynote speaker at AHRC's first annual World AIDS Day candlelight vigil. But under Georgia's Gold Dome, "what AHRC is doing flies just beneath the radar," says state Sen. Vincent Fort, D-Atlanta.
Atlanta City Councilman Ivory Young, who represents English Avenue, says it's hard to argue against AHRC's work, although he does think it "complicates the old issue of providing cures rather than enabling folks." He says the community would be better served if AHRC was moved from a residential area to a commercially zoned site so that revitalization could flourish.
"We've got major redevelopment efforts that are about to begin, and as they begin we have to make a case on every street why a family should buy a home or stay in the community," he says. "And whether they would be willing to stay next to Atlanta Harm Reduction is not one of the questions that you want to have them answer."
It's the convenience of AHRC, however, that makes it such a valued neighborhood institution for clients who live in the immediate area.
"We're in the belly of the beast," as the Ted Williams sound-alike, Bilal, puts it. Other employees of AHRC, including Outreach Specialist Verna Gaines and Executive Administrative Assistant Sheba Bonner, argue that without harm reduction in the neighborhood, English Avenue would return to the days when dirty needles littered the streets.
The AHRC's clientele isn't limited to the English Avenue and Vine City areas. The nonprofit, which tracks all of its clients by ZIP code, serves people throughout metro Atlanta. AHRC also provides Atlanta police with protective cases in which to place dirty needles when arresting addicts. As far as policing AHRC for running afoul of Georgia's drug paraphernalia law, the Atlanta Police Department provided the following statement: "Currently there have been no arrests as a result of the activities of the Atlanta Harm Reduction Coalition in the English Avenue area."
Boeri likens talk of revitalization in English Avenue to a "pie-in-the-sky" ploy to move developers in and current residents out. "From my view of that area, it's been neglected by politicians for years."
A couple of younger guys on the corner across from AHRC's mobile unit agree.
"It's backward as hell to me. They worried about the older people on drugs, what about the children? They ain't got nowhere to play and they keep wondering why they're getting in trouble. Where is the closest playground around here? Vine City?" a guy who only gives his first name, Keemo, says. "Then y'all want to build this stadium a mile away but we got all these abandoned houses up here where they started working on shit and quit. The shit is stupid."
By day's end, 47 people have exchanged 810 used syringes for 994 new ones at AHRC's mobile unit. "And this was a slow day," Gaines says, as she and Bonner drive the RV back to 472 Paines Ave. Until the federal ban on funding syringe exchange programs is lifted, such drops in the bucket will have to do. But the bigger issue, according to Bennett, is the country's perpetual state of denial.
"Quite frankly, Americans need to have more conversations on why people use drugs," she says. "When that starts happening, there will be huge changes."
For this series' final installment next week, CL and WABE look at two foundations that helped create a philanthropy network in metro Atlanta.