He’s working hard to ensure needle exchanges will help prevent new infections and save lives.
The following is a transcript of the conversation between Karl and David.
DAVID
The level of trauma that’s experienced there is extreme.
KARL
Welcome to “PlusTalk” On Plus Life. We’re all about turning positive into a plus. Now we talk about HIV and sex a lot on “PlusTalk.” Today we’re gonna talk about HIV, risk and substance abuse. And in Florida, in Miami in particular, there is the IDEA Miami Syringe Services. It’s a needle exchange basically. Let’s talk about it with the man who knows a lot about it. David Forrest, he’s the program director. Good to see you sir.
DAVID
Great to see you.
KARL
David, as I said, you know, so often we talk about HIV, and we, for a lot of people, they tie it back to sex. But we do know substance abuse, especially if people are injecting, is the other big way that HIV transmission happens. You’ve been working in this field for over 20 years. Just break it down in the simplest terms, I guess, on just how much risk there is, when it comes to people who are injecting.
DAVID
Yeah, so blood to blood transmission of the HIV is one of the most direct ways you can get HIV. So other than a blood transfusion, which is fairly safe these days, because they’ve eliminated that through testing, but sharing of syringes or rejection equipment is one of the the next easiest ways to get HIV. It’s still not a direct one-to-one. Like every single time a positive person shares a syringe with a person, they don’t get it. But it’s a much, much higher rate than for instance, unprotected sex between two people.
KARL
Yeah, I mean it’s a sort of a Russian roulette. I think people get uncomfortable talking about substance abuse, especially in this country. We kind of like to sweep it under the rug. But these are not things that are just gonna go away. So how does something like a needle exchange, or in some parts of the world, they call them safe injecting centers. How does something like that help curb, not just the spread of HIV, but I guess also in the long term, stigma associated with both HIV and substance abuse?
DAVID
Yeah, you’re absolutely right. HIV is a very stigmatized topic for a lot of people. And injection of drugs is very stigmatized in this country. Most people who use drugs, and there’s a fair amount of substance use in the US, they do not inject. So they look down on people who inject drugs, and really the most, some of the most stigmatized individuals are a lot of our participants, we call them, ’cause we feel like we’re engaged with them in a common endeavor here, our participants are living in homelessness. So not only are they injecting substances, but they’re living in homelessness. And so the stigma that goes with these individuals is extremely high. When they try to access services in the public hospital, for instance, they’re looked down on, not only for their substance use, but the fact that they are seen to be unclean, they don’t have proper toilet facilities or bathing facilities, you know, a bunch of things. So, one of the things we do at a syringe services program, is not only exchange their used syringes for sterile ones, trying to eliminate not only the reuse of syringes and sharing of syringes, to prevent an HIV and hepatitis C infection, but also bacterial infections of the individual themselves. So if you reuse a syringe that’s dirty, you get bacteria into your bloodstream, leads to bacterial infections, which are very dangerous. That person ends up in the public hospital. It’s very expensive for the taxpayer. So it’s kind of bad for everybody, bad for the individual, bad for the taxpayer that has to pay it, et cetera. So one of the things we do, is not only provide the sterile syringes, and try to protect people from getting infected to begin with, but after they are infected with hepatitis B, or C, or with HIV, or anything else, we try to treat them here on site. If we need to draw blood for your tests, we have a phlebotomist there. They can do it there. We store your medications here if you don’t have a proper safe place to store your medications. But the point is, we’ve really tried to say, “Look, we cannot change the fact, “that you are living in homelessness right now. “You are still very engaged in your substance use. “You’re injecting many, many times a day. “Let’s tackle your health first, “in terms of HIV, preventing it, “or keeping your HIV undetectable. “Let’s do that first, “and we’ll worry about all the other stuff later.” So it’s kind of a turning it on its head, from the typical model, which is you find out you’re HIV positive, you stop using drugs, you do it all the same day. Right? It’s just too much for many of these folks. They’re not going to be able to do all that at the same time. So we’ve just turned it around and said, let’s tackle the immediate problem first, which is the HIV, and trying to prevent the spread.
KARL
Yeah. And you guys opened this needle exchange. It’s the first, it was the first in the state of Florida on World AIDS Day in 2016. And I know it was a long arduous process to get this approved and get it signed. I think, you know, the sort of most common reaction I hear from people whenever I’ve talked about needle exchanges, or safe injecting centers, is, “Well, you’re just encouraging them “to keep doing their drugs.” And I think that’s sort of fundamental of people not understanding what addiction is.
DAVID
Correct. So if they don’t have a clean, sterile syringe or other injection equipment to use, they will pick up dirty stuff off the ground. They’ll use water out of a toilet, anything they can do, because they are trying to prevent their onset of withdrawal symptoms. So, it’s a very completely the opposite of what people think. All we’re trying to do is prevent the bacterial infections, and the spread of infectious diseases by the by the sterile syringes. The other thing that’s important that people don’t realize, as a one-to-one exchange, which is how the law is written in Florida, that is for every one syringe coming in, one can go out. We cannot just distribute syringes to a person. Unlike some other state laws that are written differently. So in Florida, we have to get the dirty things back, and dispose of them properly before other ones can go out. So even though we have already exchanged over 1.6 million syringes, we have taken in over 10,000 more syringes than have gone back out. So it basically has cleaned up the streets, the parks, the neighborhoods, the alleys. It is a completely different situation. So rather than compromising their health by using dirty things over and over again, or sharing with other people, they were able to get clean syringes. So, as you mentioned, it’s completely misunderstanding the nature of syringe exchange to think that it encourages drug use.
KARL
How does this program of knowing that they’ve got somewhere to go where their medicine is, that they can take, that they can exchange, where Narcan I think is offered, as well as other services if they want to talk about therapy, or things like that of getting off substances?
DAVID
Yes, absolutely. So, we spend an enormous amount of time with motivational, interviewing with our clients, trying to do positive reinforcement for positive behaviors. So even though we are a syringe exchange, which which is very, treats people very equally in terms of of their autonomy, and making their own decisions, we constantly try to move them forward toward a healthier kind of existence. So that means encouraging them to use only sterile water to inject with. Don’t use water from a faucet, for example, which is not clean enough to inject in your body. You know, things like this. When they are ready to go into substance abuse treatment, we do all that on site. We have free, we have programs that can pay for the buprenorphine, the drug that is used to replace opioids, street opioids for people. We have programs to do that. We have direct links with multiple inpatient residential treatment programs. We have really changed the nature of the pathways into those programs, as opposed to going to court and saying, “The judge is going to send you to jail or to treatment, “which one do you want to do?” They largely now come from us. You know, they come to our program, and they say, “I’m ready to stop.” We say, “Okay, we need to get you “through your withdrawal period first. “Let’s do these steps, these steps, these steps. “We need to get you housing, “because you can’t really go back onto the street “with that same group of people selling drugs, “using drugs, injecting drugs in the street, “if you’re now in recovery. “That’s not really going to work.” So we have to work all this out with them. So as you said, we really try to move people forward. So even though we respect their decision about when it happens, it usually does happen at some point. And earlier I mentioned about the HIV treatment, our initial, you know, desire to just say, “Look, let’s deal with the HIV right now. “Let’s try to stop the spread of HIV. “This person has a high viral load. “We need to get their viral load suppressed.” And we’ve had great luck in having those people still living under a bridge, still injecting multiple times a day, virally suppressed within a month or so.
KARL
Well, you’re empowering people. And when people are empowered to look after themselves, and take care of their own health, and then they see steps such as being diagnosed HIV, and in a month’s time becoming undetectable, they see that progress, that’s a win for them, and I think it empowers people. David Forrest from IDEA Miami Syringe Services, thank you so much for taking the time to talk about this really important topic.
DAVID
Thank you so much. Thank you for having me.
KARL
Of course. That’s gonna do it for this episode of “PlusTalk.” If you want more information, check out the website, pluslifemedia.com. And remember, you can follow us across social media platforms. We are @PLUSLIFEMEDIA. Until next time, be nice to one another. We’ll see you soon. Bye-bye.