Sterile Needle and Syringe Exchange Is Now Permanent in Delaware

On June 7, 2011, the Delaware Legislature passed a law to continue the needle exchange program without sunsetting.  

Senate Bill 13: An Act to Amend Title 29 of the Delaware Code Relating to Sterile Needle and Syringe Exchange makes the original pilot status of the program permanent. This Act directs the Director of the Division of Public Health to maintain a sterile needle and syringe program to help prevent the spread of AIDS and other diseases. Brandywine Counseling and Community Services will continue to operate the program, which offers HIV testing, health counseling, hepatitis C testing, and referrals to substance abuse treatment.

Every day, our staff sees the brutal impact HIV/AIDS has on men, women and children throughout Delaware. It seems to be so well hidden from the public eye. We are dedicated to preventing the spread of this disease.

Many of you are aware of the facts. The Centers for Disease Control and Prevention estimates that over one million Americans are currently living with HIV. Twenty-five percent of those cases are attributed to risk factors related to injection drug use. Our needle exchange program prevents the spread of HIV among injection drug users, and therefore saves lives.

Our state’s needle exchange program is not simply a needle distribution program. Injecting drug users are required to return a used syringe in order to obtain a new, sterile needle. The program creates a unique opportunity for our Prevention and Treatment staff to interact with active drug users who might want our help but are not knocking on our front door. We are meeting them where they are, going directly to the people that need us. By joining our program, they are taking the first step to break the cycle of addiction.

The staff who work on our mobile van offer every client education, counseling, referrals, HIV, hepatitis C and pregnancy testing services. We identify folks in crisis, and link them with the appropriate mental health care.

The needle exchange program works. It saves lives!

During the first five pilot years, we were able to accomplish the following:

• Incinerated over 68,000 potentially infectious syringes and removed them from the streets -- virtually eliminating the needle litter problem.
• On the needle exchange program van, we conducted 2,581 Rapid HIV tests and 138 Hepatitis C tests. 18 clients tested positive for HIV and 27 tested positive for Hepatitis C. 100% of the positives were connected to care and case management.
• Nearly 2,000 of those HIV tests were provided to community residents who access the van and are not enrolled in the program. Thus, we are reaching more than just injection drug users.
• 163 people (of the 261 formal referrals made) were successfully admitted to drug related treatment, a 62% success rate. BCCS is uniquely qualified to operate the exchange program because we also provide a variety of behavioral health services. We are able to quickly and seamlessly link people to the treatment they need.

Resource: Includes information from http://img.thebody.com/legacyAssets/37/76/needle_exchange.pdf

Bill Introduced to Continue Delaware Needle Exchange

Delawareonline.com reports that a bill has been released to the State Senate to remove the "sunset" provision from the Delaware Needle Exchange, which was slated to expire next year.

The program has moved over 200 people to drug treatment in 4 years, far exceeding its goal of five a year. It has a total enrollment of 1,025.

"Our needle exchange program saves hundreds of lives and saves the state millions in potential health care costs," said Basha Silverman, director of Prevention programs for BCCS.

Read the full story here.

Needle Exchange Credited with Reduced HIV Infection Rates in Delaware

The number of new HIV infections in Delaware has fallen from over 300 a year to about 155 in the past decade, and the state's pilot needle exchange program deserves some credit, according to the Delaware Division of Public Health.

Jim Dickinson of DPH made this statement at yesterday's meeting of the Delaware HIV Planning Council. As of September 30, there were 101 newly identified HIV cases in Delaware during 2010. In addition to needle exchange, improved education and outreach programs may also be contributing to the decrease, Dickinson said.

Also at Thursday's meeting, the Council heard from James Albino, senior program manager for the Office of National AIDS Policy, about the White House's national strategy to reduce new infections by 25% over the next 5 years. The strategy incorporates prevention, increased access to medical care, reduction of stigma, and increasing coordination.

Read the full article here.

Open Letter to the U.S Secretary of State: Release U.S. Funding for Global Harm Reduction

Brandywine Counseling has signed on to the following letter, urging Secretary of State Hillary Clinton to release U.S. funding for international syringe exchange programs before the International AIDS Conference in July.

June 28, 2010

Secretary Hillary Clinton
United States Department of State
2201 C Street NW
Washington, DC 20520

Dear Secretary Clinton,

We are concerned that the State Department has yet to release updated guidance for HIV prevention among injection drug users. Last December, the Office of the Global AIDS Coordinator (OGAC) released a new Five-Year Strategy for the President's Emergency Plan for AIDS Relief (PEPFAR) that underscored the importance of establishing prevention priorities necessary to combat the epidemic. Around the same time, Congress voted to allow federal funding for syringe exchange programs (SEPs) in the US, underscoring the importance of evidence-based prevention programming. Despite clear statements from the Administration in support of syringe exchange as part of a comprehensive program, without Administration guidance domestic and international programs are still prohibited from using federal funds for one of the most effective HIV prevention tools.

Outside sub-Saharan Africa one third of new HIV infections are due to injection drug use. In countries such as Russia, Ukraine, Georgia, Vietnam and China, more than half of infections are due to injection drug use. By implementing syringe exchange, some countries, like Britain, Australia and France avoided large scale epidemics among people who inject drugs. A review of data from 81 cities across Europe, Asia, and North America with and without SEPs found that, on average, HIV infection increased by 5.9 percent per year in the 52 cities without SEPs and decreased by 5.8 percent per year in the 29 cities with SEPs. This represents an 11 percent net difference in seroprevalence when comparing cities with and without SEPs. Programs could, right now, prevent thousands of new HIV infections at very little cost.

The upcoming International AIDS Conference in Vienna will have a special focus on Eastern Europe and the former Soviet Union where injection drug use is the cause of one of the world's fastest growing HIV epidemics. As the single largest donor for HIV/AIDS programs around the world, the United States will be in the spotlight. We urge you to release guidance that embraces syringe exchange in advance of that event.

Sincerely,

ACT UP Philadelphia, Philadelphia, PA
After Hours Project, Inc., Brooklyn, NY
Agua Buena Human Rights Association, San Jose, Cost Rica
AIDS Action Baltimore, Baltimore, MD
AIDS Action Council, Washington, DC
AIDS Alliance for Faith and Health, Atlanta, GA
AIDS Care Ocean State, Providence, RI
AIDS Community Research Consortium, Redwood City, CA
AIDS Education Global Information System (www.aegis.org), San Juan Capistrano, CA
AIDS Foundation of Chicago, Chicago, IL.
AIDS Foundation Houston Inc, Houston, TX
AIDS Policy Project, Philadelphia, PA
AIDS Project Greater Danbury, Danbury, CT
AIDS Project Hartford, Inc., Hartford, CT
AIDS Services for the Monadnock Region; The Cleve Jones Wellness House, Gilsum, NH
AIDS Taskforce of Greater Cleveland, Cleveland, OH
AIDS Task Force, Inc., Fort Wayne, IN
AIDS Treatment Activists Coalition, New York, NY
AIDSfreeAFRICA, Ossining, NY
Alaskan AIDS Assistance Association, Anchorage, AK
American Civil Liberties Union, New York, NY and Washington, DC
American Medical Student Association, Reston, VA
American Public Health Association, Washington, DC
amfAR, The Foundation for AIDS Research, New York, NY
Aniz, Inc, Atlanta, GA
Association of Nurses in AIDS Care, Akron, OH
AVAC: Global Advocacy for HIV Prevention, New York, N.Y.
AXIOS Eastern Orthodox LGBT Christian AIDS Ministry, New York, NY
Brandywine Counseling, Inc., Wilmington, Delaware
Brown University AIDS Program, Providence, RI
California Communities United Institute, Citrus Heights, CA
Caring Ambassadors Program, Oregon City, OR
Center for Health and Gender Equity (CHANGE), Washington, DC
Center for Health Justice, Los Angeles, CA
Center for Women Policy Studies, Washington, DC
Centre for Health Policy and Innovation, Johannesburg, South Africa
Chattanooga CARES, Chattanooga, TN
Chicago Recovery Alliance, Chicago, IL
Children With AIDS Project of America, Tempe, AZ
Circles of Fire Productions, Brooklyn, NY
CitiWide Harm Reduction, Bronx, NY
Common Ground – the Westside HIV Community Center, Santa Monica, CA
Community Access National Network (CANN), Washington, DC
Community Health Action of Staten Island, Staten Island, New York
Community Health Awareness Group, Detroit, MI
Community HIV/AIDS Mobilization Project (CHAMP), Providence, RI
Community Information Center, Inc., Portland, OR
DC Community AIDS Network (DC CAN), Washington, DC
Delaware HIV Consortium, Wilmington, DE
Delhi Network of Positive People (DNP+), Delhi, India
Dignity/USA National AIDS Project, Boston, MA
Divine Openarms, Port Harcourt, Nigeria
Downtown Manhattan HCV Support Group, New York, NY
Drug Policy Alliance, New York, NY
Eastern Maine AIDS Network, Bangor, ME
Education for Healthy Choices, Sacramento, CA
EL HAYET des personnes vivant avec le VIH, Paye, Algerie
Elton John AIDS Foundation, New York, NY
Family and Medical Counseling Service, Inc. (FMCS), Washington, DC
Family Services Network of New York, Brooklyn, NY
Fenway Health, Boston, MA
Foundation for Integrative AIDS Research (FIAR), Brooklyn, NY
Frannie Peabody Center, Portland, ME
Gay Men’s Health Crisis, New York, NY
Global AIDS Alliance, Washington, DC
Global Coalition of Women against AIDS, Kampala, Uganda
Global Health Strategies, York, NY
Global Justice Ministry, Metropolitan Community Churches, Metropolitan Community Church of New
York, NY
Grand Rapids Red Project, Grand Rapids, MI
Greater Love Tabernacle-HIV/AIDS Services, Dorchester, MA
Harm Reduction Action Center, Denver, CO
Harm Reduction Coalition, New York, NY
Harm Reduction Institute, Indianapolis, Indiana
Health GAP (Global Access Project), New York, NY
HealthReach Harm Reduction, Augusta, ME
Hep C Connection, Denver CO
Hepatitis Education Project, Seattle, Washington
HIV/AIDS Law Project, Phoenix, AZ
HIV/AIDS Resource Center, Ypsilanti, MI
HIV Education and Prevention Project of Alameda County, Oakland, CA
HIV Medicine Association, Arlington, VA
HIVictorious, Inc., Madison, WI
Housing Works, New York, NY and Washington, DC
Human Rights Watch, New York, NY
IDSA/HIVMA Center for Global Health Policy, Arlington, VA
Indiana Minority Health Coalition; Brothers Uplifting Brothers, Inc., Merrillville, IN
International Community of Women Living with HIV and AIDS-North American Region, Washington,
DC
International AIDS Empowerment, El Paso, TX
International HIV/AIDS Alliance, Washington, DC
International Women’s Health Coalition, New York, NY
Interpharm International Limited, Kenya
Intersect Worldwide, New York, NY
Laramie Reproductive Health, Laramie, WY
Liberty Research Group, Rochester, NY
Life Foundation, Honolulu, HI
LifeLinc of Maryland, Baltimore, MD
Lilitan Research and Consultancy, Accra, Ghana
Lower East Side Harm Reduction Center, New York, NY
MCCNY Charities, New York, NY
Mendocino County AIDS/Viral Hepatitis Network, Ukiah, CA
Mennonite Central Committee U.S. Washington Office, Washington, DC
Metropolitan Community Church Key West, Key West, FL
Michigan Positive Action Coalition, Detroit, MI
Minnesota AIDS Project, Minneapolis, MN
Minority Health Coalition of Marion County, Indianapolis, IN
MOCHA Center, Inc., Buffalo, NY & Rochester, NY
National AIDS Fund, Washington, DC
National Alliance of State and Territorial AIDS Directors, Washington, DC
National Association of Social Workers – USA, Washington, DC
National Forum of People Living HIV/AIDS Networks in Uganda (NAFOPHANU), Kampala Uganda
National Hepatitis C Advocacy Council, Brooklyn, NY
National Viral Hepatitis Roundtable, Decatur, GA
National Youth Advocacy Coalition (NYAC), Washington, DC
Needle Exchange Program of Asheville (NEPA), Asheville, NC
Network of Zambian People Living with HIV/AIDS, Lusaka, Zambia
New Destiny Recovery Ministry, Inc, Baltimore, MD
New York Harm Reduction Educators, Inc., Bronx, NY & New York, NY
North American Old Catholic Church, Washington, DC
North Carolina Harm Reduction Coalition, Winston Salem and Chapel Hill, NC
North Shore Health Project, Gloucester, MA
NYC AIDS Housing Network (NYCAHN), Brooklyn, NY
NYU Medical Center Hepatitis C Support Group, New York, NY
O'Connor Hospital HCV & HBV Support Group, Delhi, NY
Open Society Institute, Washington, DC
Philadelphia Global AIDS Watchdogs (GAWD), Philadelphia, PA
Phoenix Center, Springfield IL
Physicians for Human Rights, Cambridge, MA & Washington, DC
Population Council, New York, NY
Positive Health Project, Inc., New York, NY
Positive Outreach Foundation, Ota, Ogun State, Nigeria
Positive Voice, Athens, Greece
Praxis Housing Initiatives Inc., New York, NY
PreventionWorks, Washington, DC
Project Inform, San Francisco, CA
PSI (Population Services International), Washington, DC
Public Health - Seattle & King County, Seattle, WA
Safe Nepal, Kathmandu, Nepal
SafeGames Project, New York, NY
Salud Latina/Latino Health, Chicago, IL
San Francisco AIDS Foundation, San Francisco, CA
Sexuality Information and Education Council of the U.S. (SIECUS), New York, NY and Washington, DC
Sisters and Brothers Helping Each Other, Kankakee, IL
SLO Bangers Syringe Exchange, San Luis Obispo, CA
Sonoma County Commission on AIDS, Santa Rosa, CA
Sonoma County Hepatitis AIDS Reduction Program (SHARP)/syringe exchange, Santa Rosa (and
surrounding areas), CA
Spokane AIDS Network, Spokane, WA
St. Ann's Corner of Harm Reduction, Bronx, NY
Status C Unknown, Medford, NY
Support on AIDS and Life through Telephone Helpline (SALT) Uganda, Kampala
Tapestry Health, Florence, MA
The AIDS Institute, Washington, DC & Tampa, FL
The Brown Global Health Initiative, Providence, RI
The Center for Prisoner Health and Human Rights, Providence RI
The Foundation for Research on Sexually Transmitted Diseases, Inc (FROST’D), New York, NY
The Global Forum on MSM & HIV (MSMGF), Oakland, CA
The Miriam Immunology Center, Providence, RI
The Space at Tompkins, New York, NY
The Women’s Center, Bronx, NY
Timi Hami Ani Hamro Nepal, Kathmandu, Nepal
Total Health Awareness Team, Rockford, IL
Transexuales y Transgeneros en Marcha (TTM), San Juan, PR
Treatment Action Group, New York, NY
Treatment Education Network, Denver CO
Triangle Health Collective, Durham, NC
Tri-County Health Coalition of Southern Indiana Inc., New Albany, IN
Trust for America’s Health, Washington, DC
2 God B The Glory, Inc Women Supportive Housing Program, Baltimore, MD
25 Messengers, Indonesia
Uganda Integrated Community Based Projects, Kampala, Uganda
UHAP -- Upstate New York Hepatitis Awareness Project, Delancey, New York
Universal Fellowship of Metropolitan Community Churches, Abilene, TX
Urban Coalition for HIV/AIDS Prevention Services (UCHAPS), Washington, DC
Voices Of Community Advocates & Leaders (VOCAL), Brooklyn, NY
Vortex Consulting, LLC, Wenonah, NJ
Washington Heights CORNER Project, New York, NY
Wateree Aids Task Force in Sumter, SC
West County Health Centers, Inc., Guerneville, CA
Women in Motion, Inc., Indianapolis, IN
Youth Empowerment & Human Development Initiative (YEHDI), Kano, Nigeria

CC:
Senator John Kerry, Chair, Foreign Relations Committee
Senator Richard Lugar, Ranking Member, Foreign Relations Committee
Senator Inouye, Chair, Appropriations Committee
Senator Leahy, Chair, State, Foreign Operations Appropriations Subcommittee
Senator Gregg, Ranking Member, State, Foreign Operations Appropriations Subcommittee
Senator Tom Harkin, Chair, Labor, Health and Human Services Appropriations Subcommittee
Senator Richard Durbin, Majority Whip
Representative Nancy Pelosi, Speaker of the House
Representative Howard Berman, Chair, Foreign Affairs Committee
Representative Ileana Ros-Lehtinen, Ranking Member, Foreign Affairs Committee
Representative Waxman, Chair, Energy and Commerce Committee
Representative David Obey, Chair, Appropriations Committee
Representative Nita Lowey, Chair, State, Foreign Operations Appropriations Subcommittee
Representative Kay Granger, Ranking Member, State, Foreign Operations Appropriations Subcommittee
Representative José Serrano, Chair Financial Services Appropriations Subcommittee
Representative Donald Payne, Chair, Foreign Affairs Africa and Global Health
Representative Michael Castle
Representative Elijah Cummings
Representative Jesse Jackson, Jr.
Representative Barbara Lee
Representative Lucille Roybal-Allard
Ambassador Eric Goosby, Global AIDS Coordinator

3 Years of Needle Exchange in Delaware: Saving Lives and Saving Dollars

The pilot Delaware Needle Exchange Program has had three very successful years. Over 700 people are enrolled, and over 38,654 needles have been exchanged. These potentially infectious syringes have been incinerated and destroyed. Not only have new infections been prevented, but participants have been successfully connected to substance abuse and HIV treatment services. Here are some more highlights, which we are also sharing with legislators today at the Joint Finance Committee budget hearings.

• 150 people have been referred to drug treatment, with an incredible follow up/success rate of 60%. Referrals have been made to methadone treatment, outpatient and inpatient drug treatment, and detoxification.


• Over 1200 people have been tested for HIV on the van. More than half were not needle exchange participants, but took advantage of the service being brought to their neighborhood. Testing has identified new HIV positive infections, as well as positives who know their status but are not in treatment. We are linking them to medical care and case management, which further reduces their risk of transmitting the virus.


• We have begun Pregnancy Screening on our van. Our goal is to reduce the infant mortality rate in Delaware by connecting drug abusing pregnant women to treatment immediately. This will ultimately save both the mother and the baby’s life. Delaware has an extremely successful record of preventing HIV infection among infants born to HIV infected mothers, with only one HIV-positive birth in the last 4 years. Expectant mothers with HIV in Delaware have access to comprehensive, high-quality care; yet, it remains imperative that we encourage them to be tested for HIV and to seek drug treatment.


• The needle exchange has made a difference for so many individuals in the past three years. Here is just one of those stories:
  
  "Cecilia" is a 24 year old Hispanic female who joined the needle exchange a little more than a year ago. She was an active drug user but was not ready for treatment. One day, after she had been with us about 6 months, Cecilia came on the van, tired and crying. She had finally had enough of the drug using lifestyle. We made her an appointment at the methadone clinic. She was having trouble signing up for Medicaid to handle her payments, so we helped her with that, and she was successfully admitted. At time of admission, she had a pregnancy test and found out she was 4 months pregnant. She stayed in treatment and gave birth to a healthy baby. Today Cecilia is still active in treatment and is also employed.


• Lastly, we would like to share with you the cost benefit of needle exchange. Delaware’s program receives $211,000 from the Division of Public Health each year. We know from a recent CDC study that preventing one new HIV infection saves $221,365 in treatment costs. So, the prevention of one new HIV infection pays for the Needle Exchange Program for one year. In three years, Delaware’s needle exchange has prevented an estimated 10-12 new infections by connecting nearly 20 people to HIV care. Therefore, we saved an estimated $2 million that would have been spent on treating those individuals - and that is a modest approximation that does not include the infections prevented when someone is admitted to substance abuse treatment.

The success of the needle exchange is thanks to the inclusive and considerate work of our program staff at Brandywine Counseling, along with incredible support from the City of Wilmington, neighborhood associations, the Faith Community, the Division of Public Health and the Wilmington Police. This is an excellent example of what can happen when a community mobilizes.

We must keep up the work we’re doing. This epidemic remains a challenge, but we are making progress. 3,489 people are living with HIV/AIDS in Delaware. The Black community accounts for 20.9% of the state’s population, but 66% of our HIV/AIDS cases. While the number of new infections each year has declined, in Delaware, 1 in every 83 Blacks has HIV/AIDS.

Delaware’s Needle Exchange remains dedicated to the following goals:

• We must encourage HIV testing for all those who are at risk.
• We must encourage all of those that are infected to seek treatment.
• We must encourage those not infected to take measures to ensure they remain uninfected. Until then, many will continue to pass the virus without knowing it.

Tom McLellan on Who's Winning the War on Drugs

Tom McLellan, Deputy Director of the White House drug czar's office, is interviewed in this article from The New Republic. He discusses a wide range of topics, including needle exchange, medical marijuana, and prescription drug abuse. We found it very interesting. It's long, so you might want to read it over coffee.

Needle Exchange Update

Can you believe it will be 3 years in February since we started needle exchange in Delaware? Here's an update on the program:

• 653 clients are enrolled in the City of Wilmington's Needle Exchange Pilot Program, exchanging more than 28,000 needles. This means that we have incinerated over 28,000 potentially infectious syringes and removed them from our streets. Since it is a one-for-one exchange, there is virtually no needle litter problem anymore.
• 402 participants self-reported that they were referred by another NEP client. This proves that word-of-mouth advertising is what works with this population. 4 people reported that they were referred by law enforcement.
• Caucasian clients make up 69% of the membership; however, we are working on increasing the participation of African Americans using the social networking strategy called the LINK program. We are asking existing members to refer their peers. Since it began in February, LINK has 97 members, 79 of them recruited by existing members.
• We've made 72 formal referrals to drug treatment, of which 46 have successfully entered treatment. This does not include informal referrals we make all the time and at just about every instance of exchange.
• 1711 rapid HIV tests have been completed on the van. 84 of those were people tested for the first time. 14 of them were newly identified positive individuals. Almost 300 of the 1711 HIV tests were NEP clients, but more than 1300 of the tests were provided to members of the community where the NEP operates. These individuals accessed HIV testing because we brought the service to them. As a result of our success at reaching these residents, we are planning to begin offering the combination hepatitis A and B vaccine on the NEP in the coming weeks.

Out Of the Dark, A New Dawn

On a bus stop bench on a frigid February morning, a young couple sat together shivering, and counting down the minutes until 9:00.

“How much longer?” Dawn asked her boyfriend.

“Four more minutes.”

Dawn broke into a smile in spite of the stinging cold. “Oh, I can’t wait! Soon they’ll open up… it’ll be so warm inside!”

He smiled back. “In four minutes, I’m gonna be layin’ on that comfy couch and gettin’ some sleep!”

A miserable, exhausting night neared its end. They had spent it at the bus stop on Lancaster Avenue, with all their belongings in their backpacks, and only their coats to keep them warm. But at 9:00, right behind them, they had a place they were welcome in the Brandywine Counseling Outreach Center. Dawn watched the buses come and go, full of people with places to go and things to do. Her plans today were simple: Get warm. Find some food. Hide from probation. Then, find some more heroin. Tomorrow, she’d do it all again. It wasn’t always this way. Six years ago, she had a normal life, a job, and a place to live. But one seemingly innocent car ride led her off course.

“I was working in a restaurant, and one of the other employees was asking me for rides. When he was getting out of the car, he was picking up drugs. I got curious about what he was picking up, and he let me try the heroin just by sniffing it one time. Eventually, he ran out of money to pay me for the rides, so he would start giving me drugs instead of gas money. I started to get sick if I wouldn’t use it, so I started to use it every day.”

“For a little while, I was okay. I could afford it. I started to be late for work. I started spending all my money on only drugs. I had to move back in with my parents, then I started to steal from them. I lost my job. I started stealing from cars and people’s houses, and ended up on probation.”

Dawn’s choices had led her down a destructive path of addiction, homelessness, and being on the run at age 27. She met her boyfriend and they stuck together, but there seemed to be no way out. They weren’t looking for help; only to survive. It was rare to find a friendly face that understood where they were. BCI case manager Sharon Brown was one who did.

“Hey, guys. Need a light?”

“Nah, we smoked our last cigarette hours ago.”

“Here. We’re not supposed to do this, but go on, take it.”

“Oh, thank you so much!”

“It’s too cold for y’all to be out here. Why don’t you come inside? There’s coffee and donuts. I can get you warm clothes, a place to wash up. You can crash on the couch, watch TV, read some books…”

Since that day, the pair became regulars at the drop-in center. “It became like a little home to us,” Dawn recalls. “We would go inside during the day, and sleep in there, and at nighttime we would just stay outside all night.” She began to trust the outreach staff. She began using their services, taking HIV tests, and visiting the needle exchange van. She learned about other services she wasn’t yet ready for.

“They would let us know that the methadone clinic was there, but they never seemed like they were judging us, or trying to push us into anything we didn’t want to do. They knew that we knew the services were there, and that we would use them when we were ready to.”

One day, a probation officer came to the bus stop. He took Dawn into custody, and she served six months in jail. In July 2008, she was released and reunited with her boyfriend. They were both free of drugs for a while, and even found themselves an apartment. But by September, they had relapsed and were using heroin again. They returned to the needle exchange.

“When we started coming back, they knew we were using again. They were a little more adamant this time. ‘You guys really need to try methadone this time, before you end up back in the situation that you were in.’” The couple faced a difficult decision.

“No way I’m gettin’ on methadone. It’s just another way to get high. It’s just as bad!”

“Well, I’ve heard those stories too, but what about the people we know who got on it? Seemed like it was working for them.”

“That’s true. They do look better. They’ve got jobs, they look stable.”

“Why don’t we try it? It’s the only thing we haven’t tried.”

With that, a window of trust had opened. The next morning, Dawn and her boyfriend went in to BCI, and they both started on methadone. She knew it would be a challenge to make her daily dosing, individuals, and groups, but she committed to getting clean as strongly as she had committed to getting drugs. Sharon Brown continued supporting her as her Safety Net Services case manager. Safety Net specifically targets two high-risk groups, women and recently released ex-offenders, often living on the streets. Knowing that willingness to accept help comes and goes, case managers meet clients where they are, ready to connect them to services they need when that window opens.

“Sharon was a big help,” says Dawn. “She’s always checked on us, made sure we have everything that we needed. I’m glad the outreach really latched on to [us].” But there was a big surprise for Dawn on her intake day. Nurse Barbara Garrity gave her the news at orientation.

“Now just to let you ladies know, when you get on methadone, it seems like it’s a lot easier to get pregnant. But Dawn, you’re already pregnant!”

“Oh! Really? Wow, that’s quite a surprise!”

“Yes! But we have a program just for pregnant women."

Dawn was 4 weeks along. Her surprise quickly turned to motivation to stick with treatment. She was determined to deliver a healthy baby. She was transferred to the pregnant and parenting women's program, which assists over 20 clients every year to deliver drug free babies. Her counselor, Aja Redmond, linked her with prenatal care, helped her identify her triggers for drug use, and taught her about FAS and nutrition. Four months into treatment, Dawn was staying abstinent. Things were going well. It was then that the couple received another surprise.

“We’re having twins! Oh, wow… two babies? How are we going to do this?”

“Don’t worry, Dawn, we can deal with it. Just one more obstacle in our way.”

“This is so difficult… I’m staying clean and doing what I need to do, but every day something else comes up.”

“Yeah, it would probably be easier to go back to the streets and start gettin’ high. But look at all the good things we’ve accomplished. We’ve come too far to throw it all away.”

And so, preparing for twins became the latest challenge in their shared journey to recovery. “We were already together when we were looking to get clean. We weren’t willing to separate for any reason, so we had to do it together.” Dawn recalls. “[It helped,] having somebody to walk through it with you, share all the ups and downs, and remind you how far you’ve come and where you still want to go.”

Dawn had support not only from her boyfriend, but from Aja and the women's program. She redoubled her efforts to set and achieve goals, worked on her parenting skills, and cut back on smoking. As her due date approached, a case manager made a home visit, making sure they had food, clothes, and baby furniture. On May 15, Dawn gave birth to healthy, identical twin boys.

“Being in a relationship and having the babies helped me get clean, because it gave me a reason to want to move forward in life,” she says. “Having the children and having a partner that loves you and is there for you, gave me my life back.”

Today, Dawn’s children are 4 months old, and she is nearing one year clean. She is a picture of composure as she tells her story and tends to her sons at the same time. She shifts one baby from her arms into a stroller to pick up the other, then reverses again. As they fuss, she remains calm and soothing, wiping mouths, giving them their bottles, even laughing cheerfully to herself as her son’s expression changes from restless to content. She shows no trace of her former life on the streets, sleeping at bus stops. She looks like a mom.

“I think for the two of us to go from where we were, to where we are now, it’s all pretty much thanks to Brandywine. This is the longest period of clean time either one of us has had. Being able to come up here every day and be accountable for your actions, and have people checking in on you, along with the medication that you get, has made us successful.”

Dawn sees a bright future ahead for her family. Life is not simply about surviving anymore; it’s about building a future for herself and for them. They’ve moved into a relative’s house, and they have a car. She hopes to one day own a home, put the children in a good school, and go back to school herself. For now, she wants to stay clean and sober, enjoy family life, and continue to build her support system. She’s on the right course again, and it all started with a friendly face offering food and shelter, no strings attached.

“It feels like a blessing. It feels that God was with me all along, and He’s looked out for me, and that He made a way for me to get better, and as long as I continue to follow it, things will continue to get better. It hasn’t been easy for us at all, but we’ve been able to get through it. I’m very happy with the way things are now.”

Brandywine Counseling services are funded by the U.S. Dept. of Health and Human Services, SAMHSA/CSAT; and Delaware Health and Social Services, Division of Substance Abuse and Mental Health. For more information, please call 302-656-2348.

Delaware Needle Exchange Enrollment Reaches 500

As of today, we have 507 unduplicated clients enrolled in the City of Wilmington's Needle Exchange Pilot Program, who have exchanged more than 17,450 needles in two years and some change. This means that we have incinerated over 17,450 potentially infectious syringes and removed them from our streets. Since it is a one-for-one exchange, there is virtually no needle litter problem anymore.

231 participants self-reported that they were referred by another needle exchange client. This proves that word-of-mouth advertising is what works with this population.

Caucasian clients make up 71% of the caseload; however, we are working on increasing the participation of African Americans.

1087 Rapid HIV tests have been completed on the van. 182 HIV tests were NEP clients. The other 905 were community members who accessed HIV testing because we brought the service to them. As a result of our success with reaching the community residents where we target injection drug users, we are planning to begin offering the combination Hepatitis A and B vaccine on the NEP in the coming weeks.

Other noteworthy numbers:

• 11 HIV Positives have been identified on the van.
• 40 formal referrals to treatment.
• 25 confirmed linkages to drug treatment.

Basha Silverman's Testimony at State Budget Hearings

My name is Basha Silverman. I am the Director of HIV Prevention programming at Brandywine Counseling in Wilmington. I am here to call your attention to the importance of the Needle Exchange Program on behalf of the Division of Public Health and the many individuals at risk of contracting HIV in Delaware. I understand you have some very difficult decisions to make this year, so I wanted to arm you with some information that may help you.

The Needle Exchange program does not only provide access to sterile equipment; it is a bridge to other services.

• In just 2 years, this mobile program has been extremely successful at identifying at-risk and HIV-infected individuals, and connecting them to medical care and substance abuse treatment.


• We are reaching a very, very hard to reach population that might not receive or follow through with services if the services were not brought to them.


• We have tested over 900 individuals on the van.


• To date, we have identified approximately 20 HIV positive individuals, and linked them to HIV treatment and case management.


• Additionally, we have successfully linked 62% of those ready for substance abuse treatment to a treatment center.


• Almost 40% of participants are women. When we connect a woman to treatment, especially a pregnant woman, we increase her chance of giving birth not only to a healthy baby, but one that is not HIV infected.

Why Needle Exchange?

• In Delaware, it took over a 10 year battle to pass such a significant piece of legislation.


• In the late 80s, methadone treatment was our best intervention known to combat HIV/AIDS. Today, needle exchange is the most widely studied and has proven to be most effective intervention to combat the spread of HIV.


• Needle exchange is not just HIV prevention, it is pre-treatment.


• Studies also show that once a person learns they are HIV positive, they are approximately 60% less likely to infect another person. Therefore, the testing efforts on our van are unquestionably a significant service that should not be cut.


• Lastly, just a reminder of the cost benefit. The needle exchange program costs roughly $200,000 a year to provide services on the van and make linkages to other services and programs designed to increase the overall health of Delawareans. In comparison, the estimated cost to treat ONE individual infected with HIV over their lifetime ranges from $300,000 to $600,000, depending on how long he or she lives. In two years, we prevented an estimated 10-12 new infections by connecting nearly 20 people to HIV care. Therefore, for $200,000, we saved an estimated $3 million that would have been spent on treating those individuals - and that is a modest approximation that does not include the infections prevented when someone is admitted to substance abuse treatment.

Thank you for listening. Thank you Senator Henry!

Needle Exchange and Law Enforcement: The Secrets of Our Success

Last week, BCI's Basha Silverman was a co-presenter at a symposium by the Yale Center for Interdisciplinary Research on AIDS called "Aligning Criminal Justice and HIV Prevention: From Conflict to Synergy." Allan Clear of the Huffington Post has written a detailed recap, which I encourage you to check out.

Here is the portion pertaining to Brandywine:

"From the service provider and government sector, Basha Silverman from Brandywine Counseling, a drug treatment/ needle exchange program in Wilmington, Delaware and Maxine Phillips and Mary-Ellen Cala from the New York State Department of Health AIDS Institute explained the secrets of their success in working with law enforcement. Strategically speaking the tactics are simple; relentless relationship building comprised of community and civic association meetings, meetings with police chiefs/captains and their support staff, joining sub-committees and inviting police onto advisory boards, arranging visits to treatment and exchange programs, working with community relations police, and training, training, and more education. Ideally, these efforts would foster the creation of feedback loops so that it is clear what works, what does not work, and would aid in the establishment of a strategy for furthering more effective community partnering. At all times it is critical to acknowledge law enforcement's own perspective on community drug issues and to emphasize the benefits that they can derive in supporting syringe exchange, such as minimizing risk from a needle stick. The relationship between providers and police can, and should, be a bi-directional initiative."

5 Questions for Tom Bell, Outreach Worker

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: Tom Bell
Job: Outreach Worker, HIV Prevention and Needle Exchange
Time with BCI: 7 years

1. What’s your job at BCI and what do you enjoy about it?
I’m a member of the team doing outreach and needle exchange. The mission is to help reduce the spread of HIV/AIDS, targeting injecting drug users, and then also offer harm reduction education and information. We’re out there in the community 4 days a week, which is Tuesday-Friday. We also do HIV rapid testing on that van. It’s totally confidential. And one doesn’t have to be in the needle exchange program to receive testing, one can just come on, get an HIV test. If they need referrals, then we’ll make those as well, give them help wherever we can. Also pass out condoms, to help slow down the spread of STDs. Right now we’re trying out a new pilot program. It's called the LINK program, and we offer some incentive, as far as introducing drug-injecting people to the program.

And I kind of like it, because it’s out there helping the community and trying to change their thinking. We understand most people will do what they’re gonna do, but not being knowledgeable of what they’re doing. [So] we try some education in that area, because we know that we can’t stop folks from doing what they do. I like doing it, because I myself was drug dependent at one time. I went through an organization, and aftercare, and a 12 Step program to get my life back, and change my mindset, and become a productive member of society. So we try to instill hope in them that they don’t always have to live like this.

2. The Delaware Division of Public Health announced recently there are now fewer new HIV infections in the state and more HIV tests being done, thanks in part to the needle exchange. What’s your reaction to this news? Do you think progress is being made?
Yes I do. My take on that is, the word is spreading, and it’s a plus.

3. What would people be surprised to know about your job?
It’s not just drug and alcohol related; we help out wherever we can. We help with clothing, food, shelter, referrals, whatever way we can help. I can remember the times when I was drug dependent, and I was just wishing and hoping someone could just help, just not knowing where to go or how to ask for help. And now with this outreach program, we’re out there meeting folks just where they’re at, so some of the things they might not want to ask, or don’t have the courage at that time, or maybe they think it’s gonna take too much time, we’re there to step in and kind of reevaluate their thinking.

4. What’s the fun part of your job?
(Laughs) You say the fun part… Being in this field, the fun part is in the beginning. Maybe meeting someone for the first time, and they don’t really like you, because sometimes you have to be stern and practice a little tough love at some point. But the gratitude is when you see them later on down the line, and they have changed their mindset, and [are] starting to do different things, starting to become a productive member of society, not so much drug dependent, and starting to get their life back together. That’s the joy, you know, that’s the reward, in all. And I love that.

And then, I also have those same individuals come up to me later on, maybe a month or a year later, and say, “Why, thank you. Thank you for being there, thank you for puttin’ up with all that you put up with.” And I in turn say, “You’re welcome, and thank you for puttin’ up with all that you put up with.” (Laughs) So, that’s the fun part.

5. Since you joined the Outreach team, you’ve been working side by side with your wife. What’s that like?
(Laughs) Well, actually, it’s good and it’s bad, you know, to be honest. Because I, too, have to have an outlet. And, like I stated, I was drug dependent, and I attend a 12 Step program, and sometimes I have to talk about some of the things that go on with me working with my wife… And I’m grateful to be able to work with her, because I didn’t have the opportunity [before]. We were in the same field, but different areas, different times, so I didn’t get a chance to spend as much time like I do now.

She’s been in the outreach program [longer], and she knows more than I know in the outreach area, and so I’m humbly taking my stand. And sometimes it gets frustrating when she has to be stern, and then sometimes I don’t like it… But I understand that it’s for the best for the program and the organization, and I keep an open mind. And it’s actually good. We have our bad times, but it’s more good times than bad. I think that it could work. It’s life!

Prevention Works in Delaware

In case you missed it, this editorial ran Saturday in the News Journal. There are improving numbers on HIV/AIDS in Delaware, made possible by the work of organizations like BCI.

Some highlights:

• No babies born with HIV in 3 years
• New infections are down while the number of tests is up.
• Community support continues for the needle exchange and is helping it be successful.

This means we need to keep up the work we’re doing. It’s making a real impact.

BCI LINK: A Social Networking Approach to HIV Prevention

One of our biggest challenges in meeting the goals of Delaware's Needle Exchange is how to reach those most at risk for HIV. With 12 positives found in two years, we know there are more yet to be discovered. As it was reported last summer, fewer minorities are enrolled in the Needle Exchange despite their disproportionately high risk. Typically, these injection drug users are mistrustful of law enforcement, have never been tested for HIV, and are not involved in any treatment program. As resourceful as our outreach workers are, we can never elicit everyone’s trust. So if someone won’t listen to an indigenous outreach worker, who will they listen to? We think the answer is their own peers who are already participating in the Needle Exchange.

Brandywine Counseling has launched a new recruitment strategy based on peer to peer networking, called BCI LINK. We will use existing social networks to promote HIV awareness, the Needle Exchange program, and drug treatment. Specifically, all participants in the Needle Exchange will be offered an incentive to recruit others in their social networks. The approach is evidence-based and has shown that that the incentives also increase adherence to the program.

The great thing is, we assume we already have people who collect and exchange used syringes from their peers. BCI LINK will train these individuals as “Connectors” to reach out and draw in their peers (“Crew Members”) who otherwise would not enroll. The effect will be that BCI reaches greater penetration levels within the community. Every Connector and Crew Member is required to be tested for HIV. We will also learn more about trends in needle-sharing, intravenous drug use, and HIV infection in Wilmington.

What’s more, because BCI LINK takes advantage of established patterns amongst Wilmington’s injection drug users, it has the potential to grow exponentially, reaching ever-larger groups of at-risk drug users. The graphic above shows the results of a similar program in Philadelphia that showed great success after a year and a half.

We began BCI LINK one week ago, and have already enrolled 6 Connectors and 5 Crew Members. We are truly excited to bring this approach to Wilmington. Stay tuned as we report on our progress and results.


Graphic c/o Howard Wasserman for Prevention Point Philadelphia.

Needle Exchange Update

Hello Everyone,

We just wanted to let you know that as of this afternoon 1/14/09, we have 402 un-duplicated members on the Needle Exchange Program. Today is roughly the two year mark since we started on 2/1/07. I thought you all would be happy to celebrate this milestone with us. We are touching, changing, and saving lives-one sterile syringe at time!

Thank you all for your continued support. Please feel free to share this news,
Basha and Rochelle

How Might the Presidential Election Impact Needle Exchange in Delaware?

Our friends at Prevention Point Philadelphia are featured in a recent Philadelphia City Paper article, "Hope and (Ex)Change: What the Election Means for Heroin Users." The article describes how Philadelphia’s needle exchange faces limits in its funding, and consequently, on its effectiveness. Due to a federal ban on funding needle exchange, Prevention Point operates with city funding alone. This amounts to much less support than other AIDS prevention programs.

However, a new Presidential administration brings a possibility that the ban could be overturned. What would this mean for programs like Prevention Point, and for Brandywine Counseling in Delaware? What would it mean for injecting drug users?

The most obvious answer is that if federal funds became available, programs would have one more funding source to pursue. It could mean more staff, more supplies, and increased hours of operation.

Besides an increase in available dollars, there is another potential effect. Needle exchange programs would have increased freedom to partner with other community organizations. Imagine that BCI’s van could offer mobile screening or vaccines for infectious diseases besides HIV, and thus combat several dangerous public health epidemics at once. This is not possible under the ban, because the agencies that would do this work are federally funded. Although their staff would not exchange needles themselves, they are not permitted to provide ancillary services to needle exchange participants.

But perhaps the greatest impact would be on another level altogether, and that is to reduce the stigma associated with syringe exchange. Federal funding would be symbolic as a stamp of approval for the practice, from the highest level of government. It would legitimize what we do. It would substantiate the science that has proven the effectiveness of needle exchange at reducing HIV risk. The ripple effects might even extend into substance abuse treatment, lending credibility to harm reduction in general, and allowing providers to follow its principles alongside cognitive behavioral therapy.

Most likely, needle exchange isn’t the foremost issue on our minds as we head toward November 4. Even so, for heroin users here in Delaware, the ramifications are potentially far-reaching.

Volunteer Spotlight: Felecia Doyle, Outreach Support

My name is Felecia Doyle. I am doing my internship at BCI HIV/AIDS Outreach Program. I first learned about the program from seeing the sign on Lancaster Avenue. I started researching what programs they offered and was interested in how much the staff helps the community. Being a Delaware Tech student in the Drug and Alcohol Degree program we are required to complete 200 hours of unpaid internship. Not only am I learning from my experience here, I am helping the staff achieve their goals by offering my support.

Before I started at BCI, I figured the staff had to have a heart in working with the community that is at risk for HIV. Once I started, the staff welcomed me with open arms. Since the facility is under renovations, the staff is working out of one room. Even though the space is tight, they all work together like one family.

I am currently working on data entry for the NEP, Needle Exchange Program. This program manages the clients who are new to NEP and who have utilized NEP as repeat clients. These clients are given numbers to use as their identification. Another program I am helping with is the CSAT GPRA, Center for Substance Abuse Treatment Government Performance and Results Act. This is through SAMHSA, which funds grants to provide substance abuse and mental health services to states and communities. This program monitors clients for a year.

I have learned a lot with the needle exchange program. I believe that this is a great program to help the community. The outreach workers go out into the community to promote the program, give out safe sex kits, bleach kits and let clients know about the rapid free HIV testing.

What I would take away with me from the experience is to have had the pleasure of meeting such great people who work at the HIV Outreach. All of the staff have hearts of gold and give so much to the community. I like to help people and bring smiles to their faces. If more people would open up their hearts it would make such a big difference.

Ten Thousand Needles Off Delaware's Streets Through Exchange

Delaware's needle exchange program passed another huge milestone recently when we exchanged our 10,000th syringe. What an accomplishment for a program now entering its twentieth month of operation. Six months ago, our total was at 3,500.

Every syringe has been exchanged for a clean one, meaning ten thousand dirty ones are no longer on the streets of Wilmington. Because it's a one-for-one exchange, there is incentive for participants to bring every clean one back after it’s been used. So although we’ve given out ten thousand syringes, they are being returned. The effect is not needle litter, but the opposite.

Here’s some more impressive numbers:

• We’ve enrolled a total of 353 participants.
• A total of 1697 exchanges have taken place.
• 132 participants were referred by another needle exchange participant.
• 17 participants have entered drug treatment.
• Since November 2007, 621 rapid HIV tests have been done on our van. 7 positives have been identified.

5 Questions for James Harrison, Site Director

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: James Harrison
Job: Site Director, Lancaster Avenue
Time with BCI: 20 years

1. How did you get started working in the addiction treatment field?
I think mine was a unique situation. I was actually finishing up a three [year] mandatory prison term, and Kay Malone and Linda DeShields came to the Plummer Center in 1988, and at the time, the American Red Cross was providing HIV education in the prison. They had a gentleman that came in, and none of the inmates would respond to him. They were rowdy, they were disruptive. And so, the warden asked me if I would co-facilitate the group. And I agreed to it. And after his first presentation, I actually took control of the presentation.

All the inmates were extremely receptive. It was like hearing it from one of their peers. And this was a time when HIV and AIDS was at truly epidemic proportion in our city, and folks were dying within five years. And so I hollered out, “Listen up, people! I have some life-saving information!” And people were quiet. People listened. And that kind of opened the door for me to start doing some prevention education, after I was released. Of course, Kay and Linda DeShields agreed to hire me after I was released, waited five months for my release, and I’ve been here ever since.

Many people would be surprised to know that I’ve actually had a 30 year history with Brandywine. So, many folks, especially newcomers, oftentimes will not realize that I’ve spent ten years on the other side of the fence. And so, I’ve seen the changes we’ve made as an agency, particularly around process improvement and access, and just being kinder and gentler to the addict. I think what folks will not realize is that ten years as a consumer embedded an advocacy in me that will never leave. And so I carry with me, day to day, having to straddle both fences. I’m still in recovery, I will say that. I can always see the client’s view clearer in my head as I’m also trying to move our agenda, and move the agency to the next level. So when you first look at me, you don’t see the old James, and so that’s the piece that I carry with my job that many folks don’t know about.

2. What changes have you seen in your 30 years with BCI?
Part of what I’ve seen is a growing trend, that we’re seeing a younger, sicker population. And I look at all of the old-timers, for loss of a better analogy. They are the dying breed. I recall one consumer I saw yesterday, who has been with Brandywine [for] a 30 year history, is actually wheelchair bound, and blind. And that same person, I used drugs with, I hustled with, I participated in drug addict behavior with. And now this person is barely struggling to survive.

And I see on the other spectrum, young white females and young black males chronically addicted to opiates, but now struggling with HIV, mental illness, and addictions. And I think the most obvious change has been the severity of folks’ addictions and their problems, coupled with the social ills as well: increased gas prices, food, housing shortage. All those other issues, where I think years ago, folks could make it off of a year’s income of about $12,000, but now, that’s starving. And so, couple that with addiction that’s more severe in its nature, we’re seeing sicker and more violent individuals as well.

3. BCI was in the news last week because of the challenge of reaching black drug users with the needle exchange. What do you think it will take for this population to access these services?
There was a workshop I went to, years ago, that addressed this very issue. The name of it was, “Beyond Tuskegee.” And if you remember the Tuskegee experiments, blacks historically had a fear of public health systems, and the whole notion that, “This is suspect, in terms of, the government has its hands on it, and that law enforcement may use this as a vehicle to further disenfranchise us.” So getting beyond Tuskegee would say that, “No, this is not true. There’s not a great conspiracy theory around accessing needle exchange, or providing services in an outreach effort.”

I think we have to build a comfort zone for African Americans. It’s like, if they see me drink the water, then the water’s okay. But until they see it and watch me be okay, many times they won’t access. So I think the most valuable tool we’re going to have is our African American peers who currently work on the [needle exchange] van. For [drug users] to see, again for loss of a better analogy, that they too have drunk the water and the water’s okay. So there’s got to be a comfort level in saying, “You know what? Needle exchange is a good thing. It saves lives, it’s not connected to law enforcement, it’s not some sort of drug inside the syringes.” The belief that it is a good thing has to be kind of penetrated throughout the community.

And accessibility -- going into what we call the “red light district” of the city of Wilmington is challenging, especially with all the shootings. I don’t know if African Americans are truly the population who are now injecting at an alarming rate. Certainly we do have some folks injecting, but I also believe that this is a dying population as well. And more people, because of drugs being purer, are smoking and sniffing. And so, there may not be as great a need for syringes as we first thought. So I think a collective kind of effort with our Senator Margaret Rose Henry, who’s birthed this project, our community leaders, our naysayers, our people who advocate for this population, we all have to collectively come up with a strategy to keep pushing the message that the water’s okay.

4. You can tell a lot about a person from their office. Tell us what you have in your office.
My office is very eclectic. I sometimes am embarrassed about it! But I have jazz artwork here. I have New Orleans. The Nanticoke Indians, which never really got recognized during Mardi Gras, but they too decorated, and had the same kind of celebration, but never recognized. But then I also have one section that’s dedicated to family. I have pictures of my son who graduated from Villanova. I also have a collection of articles of the work we’ve done here at Brandywine, the projects where I grew up in as a kid, and articles saying, “A $10 bag of heroin approximate to the 95 exit [for] sale,” “Fewer resources spent on prevention,” and then one of Basha [Silverman] and a syringe-filled shooting gallery, which reminds me of the work that we do. And that’s in addition to the Comprehensive Accreditation Manual from Joint Commission, books around licensure, and policy and procedure manuals.

But I also have a snake to unclog many of the restrooms, and a quart of oil for some of our vehicles. And so, you can find anything from a light bulb to the 2007-2008 Delaware Psychiatric Residency program’s pictures, of which I’m also a part, doing some training with the residency. So I like to think of it as eclectic. I think there’s times when it’s more orderly than others, especially when visitors are around, but for the most part, it really depicts my work here at Brandywine. One minute I might be the janitor, one minute I am the clinical supervisor, the next minute I’m an administrative person, the next minute I am a client advocate. So it really depicts the changing roles I play.

I just recently described my job here at Brandywine to someone, and I said, “I can’t call it work, because it’s something I like to do.” Now, it just so happens I get paid for it, but even [in] absence of money, I would still be doing this type of work. So while the paycheck helps with the mortgage and the car payment and travel, absent of that I would still be doing the same thing I’m doing. So I’m fortunate and blessed that I can come and do something I was going to do anyway for the rest of my life, but get a paycheck for it.

5. If you had $30,000 to donate to BCI what would you do with it?
I think I would go to a learning institution and ask that we start a program specifically for addictions counselors to grow the work field. The major challenge is a workforce that’s declining. [BCI senior staff] will be leaving in a few years. We have a younger workforce, that I think for the most part, is not prepared for the challenges of a more sophisticated system, in terms of licensure, accreditation, and just maintaining a quality level of services.

So I would go to a Lincoln University, a Del State, or University of Delaware, and say, let’s have a name for a program specifically to grow the field. So I think that’s what I would do. While another clinic would be nice, a transitional house for recovering people would be nice, but I think if we don’t grow the field, we’re going to miss the opportunity to help people get better.

The Most At Risk Are The Hardest To Reach

The News Journal details the extent of our challenge in reaching a hidden and mistrustful population with the needle exchange. Though blacks remain hesitant to access the services, it's important to note our successes and how far we've come.

Before Wilmington got a needle-exchange program of its own, some addicts went to Philadelphia to get clean syringes from the exchange program there. In addition to needles, they brought back stories about police harassment near the vans that distribute them.

Those experiences make it hard to trust the Wilmington program, even though the relationship between its workers and police here has gone better than anyone could have expected, officials say.

...

"It's a fact that a needle-exchange program cannot reach the people it's trying to if there is not cooperation from the police department," Silverman said. "The cooperation we've had here has been outstanding. They're not using our vans as a mouse trap. No one has been arrested near the vans and no one has been followed and arrested down the block."

...

The program has exceeded its goals for clients and getting people into drug treatment centers.

And we have new strategies to reach those most at risk.

Silverman said she is formulating a plan, which she hopes to implement in the fall, that would get the program's current clients to go to shooting galleries and drug houses to recruit new members.

"Our team of workers are former addicts, former sex workers or have some connection to the communities we serve, but there are still places we can't go," she said.