In the final part of a four-part series, KPBS Health Reporter Kenny Goldberg travels to New York to look into the situation.
When it comes to distributing clean needles, New Yorkers don't beat around the bush.
"Free condoms, free oral sex protection, free syringes, free services…"
On a rainy day in East Harlem, Ivonne Amador hands out her wares. They're designed to keep injection drug users from spreading diseases like hepatitis C and HIV. Amador says she and her partner give out a lot of clean syringes on a typical day.
"Well so far, we're doing like 4,000," Amador says. "And we do two sites: one on 198th street in the Bronx on Wednesdays, and we also do 104th and 3rd on Saturdays, from 10:30 a.m. to 1 p.m. So there's a great demand for it."
Amador is part of a growing number of New Yorkers who are involved in what's called peer exchange. These specially trained people go to parks, street corners, or wherever drug users hang out, and distribute equipment.
Unlike in San Diego, people in New York can buy syringes over-the-counter at local drug stores. And New York has a wide network of traditional syringe exchange programs.
In a different part of East Harlem, New York Harm Reduction Educators runs an exchange on Saturday mornings. IV drug users are allowed to take as many syringes as they can carry.
A woman named Maggie throws some syringes away, and grabs some clean ones.
"I come here maybe twice a month," Maggie says. "I drop 'em in the bucket, I show my ID card, they don't ask no personal information, you know, they get to know your face. They ask how many you need, you pick whatever, you know, your alcohol pads, the water, they got everything right here for ya."
Maggie has been shooting heroin on and off for 30 years. She says before New York had syringe exchange programs, it was much more dangerous.
"There was times where you had one set, and three or four people sat around a circle and everybody waited for the next guy to finish using, 'cause it got passed around," recalls Maggie.
Sharing needles helped fuel the HIV epidemic. In 1990, 54 percent of injection drug users in New York City were HIV positive.
To combat the disease, state lawmakers legalized clean syringe exchange programs in 1992. By 2001, the HIV rate among IV drug users in the city had fallen to 15 percent.
Today, health officials are hoping they can get a similar reduction in hepatitis C rates.
"Hi, my name is Melissa, and I haven't, I'm glad I'm in the hep C group because I've only been hep C positive for like, I found out two years, maybe I've been longer, maybe not. But when I found out I was really upset."
The Lower East Side Harm Reduction Center holds a hepatitis C support group a couple of times a week. It also runs a syringe exchange.
Daliah Heller is an assistant commissioner with the city's office of drug use prevention. She estimates more than 60 percent of IV drug users in New York are infected with hepatitis C.
"It's of paramount importance that we are able to help people get educated about their risk, or about their possibility that they're infected, and how to prevent transmission of that infection," Heller says.
Heller says clean syringes exchanges are getting the word out about hepatitis C. They provide testing and referrals to treatment, too.
There are 12 exchanges operating throughout the city. They're supported by a combination of public and private funds.
Heller says in a recent one-year period, exchange programs gave out 1.9 million syringes, and collected 1.5 million. She estimates there are between 40,000 and 110,000 IV drug users in the city.
"The truth is people who are injecting drugs are still human beings, and they have the right to stay alive," Heller says. "And you know, as they say, dead addicts can't recover. People deserve an opportunity to have a life, and that's the basic message of harm reduction and syringe exchange."
But are clean syringe exchange programs the answer to the hepatitis C problem? Maybe they would be, if all IV drug users used them. But they don't.
In New York City, officials estimate only about 10 to 20 percent of injection drug users go to syringe exchanges.
