History of Health: Needle Exchange in San Francisco

Throughout the history of HIV/AIDS, there are many moments that stand out as bold acts of courage that forever changed the course of the epidemic. Needle exchange in San Francisco is certainly at the top of the list.

The program began in the city in 1988 when a group of people recognized they needed to do something to stop the spread of HIV among injection drug users. Acting against the law, they created Prevention Point—an all-volunteer, street-based operation.

The program provided clean syringes in exchange for dirty ones, as well as other safer injection supplies such as bleach, cotton, and alcohol wipes. It also offered condoms and referrals to drug treatment programs and social services.

At the time, Californians were not legally permitted to posses syringes without a prescription. So in the beginning needle exchange operated as an act of civil disobedience. But the founding members of Prevention Point were willing to take that risk to save lives, and in doing so they created a legacy of better health on the streets of San Francisco.

“What was started by Prevention Point continues to serve as a model for the foundation’s Syringe Access Services program today,” says Pauli Gray, SAS logistics associate for the program. “By actively engaging users in the intervention process, we hope to compel them to examine the health risks of injecting drugs—and the underlying reasons for why they do it in the first place.”

For nearly four years, Prevention Point operated totally underground. Volunteers actually used a baby carriage to transport clean syringes to neighborhoods that needed them most. Eventually, noticing the health benefits of needle exchange and its power to stop the spread of HIV, the city caught up with the times.

In March of 1992, under the leadership of then-Mayor Frank Jordan, the City of San Francisco declared a public health emergency and committed $138,000 to Prevention Point. It was a bold statement from the city’s top elected official and became the first step toward the creation of a comprehensive harm-reduction program that included needle exchange and other prevention tools.

“The actions that San Francisco took back in 1992 to move toward the legalization of needle exchange cannot be understated,” said Gray. “That was 20 years ago, and still in some California counties today people who operate needle exchange programs face arrest for trying to distribute sterile syringes. San Francisco truly was a leader in this effort.”

In the years that followed Mayor Jordan’s emergency declaration, needle exchange became an integral part of HIV prevention in San Francisco. Eventually, Prevention Point became a part of San Francisco AIDS Foundation and has since grown into the nation’s largest needle exchange program.

Last year alone, Syringe Access Services (SAS) distributed 2.4 million clean needles at nearly a dozen different sites across San Francisco to stop the spread of both HIV and hepatitis C. Due to the tremendous success of the program, San Francisco has an HIV transmission rate among intravenous drug users that is far below the national average.

“This is such an important program to the health of our entire community,” said Katie Bouché, SAS manager. “People may have a perception of who an IV drug user is. But people of all demographics come to us for sterile syringes—people who live on the streets of the Tenderloin and people who work in high-rise office buildings. They develop a trust with our staff and volunteers, and when they decide to seek help with their drug use they come to us for referrals.”

San Francisco AIDS Foundation is also a leading advocate at all levels of government for needle exchange programs. The foundation co-sponsored a bill in California to allow people to purchase up to 30 syringes at a pharmacy without a prescription. Due to our successful lobbying efforts, the bill became law this year.

Today SAS collaborates with four other community partners to distribute clean needles across San Francisco. The program is supported by a dedicated group of nearly 70 volunteers.

What started as an act of civil disobedience nearly 25 years ago continues to thrive and transform lives today. Until there is an end to HIV/AIDS, there will always be needle exchange, which remains one of the most effective methods to stop the disease.


Black & white photos copyright Gary Wagner (garywagner.com)

Have you had a positive experience with our syringe access program? Considered volunteering as an exchanger? Or did you just appreciate this perspective on our work? Comment below to let us know! 

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