Lower East Side Harm Reduction Center
and Needle Exchange

Raquel Algarin: Director of Harm Reduction Services

          The LESHRC is probably the service organization with the most frequent contact with my subjects. I often hear the veterans on Crusty Lane explain the operating procedures, hours, and location of the needle exchange to new arrivals. Some of the regulars from the Living Room also visit their headquarters when they want to check into a shelter. Harm Reduction outreach workers often sweep though the park handing out free condoms and AIDS and hepatitis prevention literature. The workers are familiar with many of the regulars, and the two groups converse openly. Confidentiality prevents me from revealing specific details, but I know that three of my subjects are meeting with caseworkers at the Harm Reduction Center on a regular basis.
          When I first contact the HRC, they are somewhat apprehensive about granting me an interview. In years past the organization has received much negative press from journalists attempting to sensationalize the controversy between the needle exchange and neighborhood residents. When I visit the newly relocated headquarters on Allen Street in Chinatown, I question three local store clerks about the exchange. Two of them are unaware of its existence. The other has no complaints.
          When I was a little girl, the sidewalks of this neighborhood were covered with needles. Sometimes it was like hopscotch trying to walk to the corner. Now I haven't seen a needle lying on the sidewalk in years.
          Raquel Algarin was born in Cayey, Puerto Rico and grew up in the Lower East Side. She worked as a nurse in the area throughout the seventies and early eighties. In 1987 her brother Ruben Rodriguez tested positive for the HIV virus. Two years later he died of complications from AIDS. Emotionally devastated, Raquel began working for the City Health Department as an AIDS educator. She first became involved with the Lower East Side Needle Exchange in 1991 and is currently the Director of Harm Reduction Services.

           Forty percent of the people who contracted AIDS last year were either infected through a shared syringe or sexual contact with someone who had shared a syringe. We can't flip a switch and keep everyone from using drugs, that's not reality. The philosophy of Harm Reduction is to minimize the damage that these people are exposed to. It hasn't been the most popular philosophy, but it works. Dozens of studies have proven this.
          The first needle exchange in New York City opened in '89 as a pilot program run by the City Health Department. Mayor Koch didn't support the distribution of syringes, but the AIDS epidemic was exploding, and activist groups forced him into action. From the outset, the exchange was designed to be a failure. The office was located in Justice Canyon Right next to the courthouse and Police Plaza. It wasn't a place that many drug users would visit willingly. In order to receive one single syringe, the user had to sign a contract agreeing to enter drug treatment. Needless to say, they didn't distribute many clean needles, and the program was cancelled after one year.
       
As soon as the exchange closed, ACT UP (AIDS Coalition to Unleash Power) decided to take the project underground. Volunteers would cruise though the streets and exchange needles with anyone who needed them. Some workers actually went into shooting galleries.
          The biggest frustration in the early years of the exchange was that the city wouldn't provide disposal services for the used needles. Members of ACT UP started leaving bags of syringes right on the doorstep of the City Health Department. Pretty soon the city agreed to provide disposal services.
          I was first introduced to the exchange through a friend who was working with the Latino Caucus of ACT UP in the Lower East Side. I was really blown away by the relationships that these people had developed with the program participants. It was like they were old friends. A lot of that closeness was created because some of the folks who were doing the outreach were former addicts themselves. Others had lost someone close to them from AIDS.

          At first I was apprehensive about volunteering for the exchange. I still worked for the City Health Department and there were a lot of political tensions between my employer and ACT UP. It was still illegal to distribute syringes, and I was afraid that I would end up getting arrested.  I decided to take that chance.
          The underground exchange was about more than just exchanging needles. It was a comprehensive effort that gave people information about soup kitchens, rehabs, health care, shelters, and other services. If somebody needed a pair of socks or shoes, we would always bring it with us on the next sweep. Sometimes people just needed someone to talk to. I spent hours in Tompkins Square Park. It was like a city inside a city where everybody knew everybody.
           I continued working for the City Health Department, but gradually I became more attached to my volunteer work. Every needle that I handed out could mean the difference between life and death. Some people claimed that we were facilitating an unhealthy lifestyle, but without our program there is absolutely no doubt that people would be sharing needles. Where else would they get them?
          For the first two years of the underground exchange, ACT UP was working to legalize the program. Eventually they decided to force the issue to the table with a direct action. The press was notified, and members of ACT UP began distributing needles openly on the corner of Essex and Delancey. The police arrested eight people. When the case went to trial, the judge ruled in favor of the activists. Soon after, five programs received waivers from the New York State Department of Health, allowing them to operate. This also made it illegal to prosecute someone solely on the basis of needle possession if they were a member of a wavered exchange. That action turned everything around, because now we were considered legitimate.
          Up until then, private donors provided all the funding for the underground exchange. Now that we were able to operate above the table, we started to receive funding from external sources. In 1992 we received funding from the American Foundation for AIDS Research that allowed us to open a storefront headquarters on Avenue C between 3rd and 4th.
         Having a base of operations really expanded our ability to provide services. Instead of just exchanging syringes with people and recommending them to other agencies, we were able to provide some of those ancillary services ourselves. Gradually we were able to receive funding for case managers, counselors, and other professionals. I was officially hired full time by the exchange as an HIV educator and outreach worker.
         Our first few years on Avenue C were a time of huge growth, but we were also facing a lot of obstacles from the community and city government. The real estate boom in the Lower East Side had a very conservative influence on the local community board, and we faced a lot of opposition from people who wanted the heroin problem pushed under the rug. There were also a lot of people who were misinformed about our program. Some of them actually thought that people were using drugs inside the building. Additional friction came from the 9th Precinct drug enforcement officers. Sometimes officers would arrest our participants for possession of paraphernalia and tear up their ID card. Other times they would follow people who were leaving the exchange looking to make a bust. A few times police officers actually entered our building. That really created a negative image for our program and made people reluctant to visit our headquarters.
           Eventually the AIDS Institute hired a consultant to work as a liaison with the police. After that our relationship improved significantly. As our program began to show results, our relationship with the community board also improved. Finally in '98 they withdrew their official stance objecting to our existence.
 Even though we had made our peace with the community, we weren't immune to the forces of gentrification. In May of 2001 we were forced to move out of Avenue C, because our landlord decided to demolish our building and construct a high-rise co-op.
           Our move to Chinatown has been a difficult transition. Even though we're only half a mile away, it's made a lot of our participants less willing to stop by for a visit. But with the bad also comes the good. We have a lot more space down here, so we're looking to expand our programs. We're seeing a lot of new people.
          Since 1992 we've registered over 17,000 people at our needle exchange. Right now we offer services to over 6,000 people a year for counseling, casework, holistic healing, health services, peer programs, youth drop in, legal services, workshops, the list goes on and on. We also have programs aimed at specific populations. On Tuesday nights, we have a support group for sex workers where they can receive services, information, and condoms. We also offer support groups and services geared exclusively toward people who are HIV positive. There are a lot of federal programs aimed specifically at that population, so it's easier for us to get funding for those participants.
          How would you describe your typical day?
          There is no typical day. Our activities have to be centered around our participants needs. I divide my time between working as a counselor, a holistic healer, and an administrator.
         Our philosophy toward counseling is very nonjudgmental. Just because somebody is a user doesn't mean that deserve to be treated with less respect than any other human being. We meet people where they're at instead of right away trying to force them into a direction that they aren't ready to move in. We refer to the people we work with as participants, rather than clients, because they're the ones who choose their own goals. If they're going to change their lifestyle, that motivation has to come from within. If someone expresses an interest in going into detox or drug treatment, we let them know what the options are. But before getting to that point we have to prepare them for the pressures they'll face. It's a difficult process and we have to be realistic. If a participant can't at least learn to manage their addictions, they might not have a good chance at making it through a program. We also have to make sure that the people have a plan to provide for themselves once they exit the program. We're there to provide them with the information that they need to make that happen.
          Over the eleven years that I've been a counselor, we've had a lot of what people would call success stories. That's definitely one of the things that keeps me going, but if anybody deserves recognition it's the participants themselves. A lot of those people have gone on to become employees or volunteers at our program. That speaks for itself.
          In addition to being a counselor, I'm also certified to provide Thai Massage and Reiki (ancient Tibetan healing). All of our holistic healing services are available to any HIV positive person free of charge. Not everyone who receives it is a user, but studies have proven that traditional medicine is an extremely beneficial therapy for recovering users of all types. It's all done in a very secure environment, and it helps to build trust. Many of our participants have come to associate physical contact with violence. When I'm giving Thai massage or Reiki, it's like I'm helping the person to throw aside that negative energy.
          As a program director I also spend a lot of time overseeing our twenty-two staff members. The great thing about working with a nonprofit agency is that our workers are in it for the personal satisfaction and not the paycheck.
           One of the biggest focuses is communication with other agencies. We're connected with practically all of the service providers in the city. Right now the most critical service area is housing. If someone is HIV positive, we have a decent chance of finding a placement, but if they're negative, it's more difficult. It's practically impossible to find housing for an active user, so a lot of our participants are stuck in the perpetual downward spiral of the shelter system.
           I also spend a lot of time looking for funding. There are a lot of things on our wish list. One of the biggest is mental health services. Right now Ryan White federal funding pays for a mental health professional for our HIV positive participants, but we're still trying to secure funding for the HIV negative population. We'd also like to see some funding from the federal government for needle exchange programs. We've been fighting for that for years, and the Clinton and Bush administrations haven't supported that idea.
           Over the past eleven years I've seen thousands of people walk through our doors. Sometimes we're able to help them a great deal, and other times our impact is more limited. Regardless of the outcome, it feels good to have somebody feel comfortable enough to sit down and share their life with me. If I had never been involved in this field, I wouldn't have believed it was possible. I worked in nursing for years and only knew the diagnosis, the prognosis, and the medications. When someone knows that you're there to meet their needs, and you're not judging them, it makes such a difference.
 What do you see happening in the future of the Lower East Side Harm Reduction Center?
          My biggest wish, personally and professionally, is that we find ourselves at a point of not having to do this work anymore. Our goal is to eradicate HIV. Basically we're trying to put ourselves out of a job.
           If you would like more information about the Lower East Side Harm Reduction Center you can visit their website at www.leshrc.org. If you wish to make a donation, you can mail a check made out to Lower East Side Harm Reduction Center at 25 Allen Street, New York, NY 10002.
 

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