1. Syringes in Paradise Over 20 Years of Syringe Exchange in Hawai ʿ i Heather Lusk CHOW Project hlusk@chowproject.org

2. Overview of Syringe Exchange in Hawai ʿ i Started in 1989 – first statewide program Initially 2 year pilot project, then Act 152 – HI legislature and Governor support –Allocated monies to HI Dept. of Health HIV/STD/hep program contracts out services to one agency through –DOH is ally and advocate –CHOW Project has been only recipient

3. [325-111] Sterile Needle and Syringe Exchange Established Establishes SEP through Department of Health (may be contracted out) Requires one-for-one exchange Extensive data collection and annual evaluation to demonstrate effectiveness Syringe Exchange Oversight Committee –Comprised of law enforcement, policy makers, Attorney General’s office, DOH

4. [325-114] Criminal Liability “Exchanges under the sterile needle and syringe exchange program shall not constitute an offense under section 329- 43.5 for the participant or for the employees of the department or its designees”

5. [325-21] Sale of Sterile Syringes for the Prevention of Disease Allows the sale of sterile syringes by: –Pharmacist –Physician –Healthcare provider –Authorized agent of pharmacy Must provide education about diseases, drug treatment and proper disposal “Sale or purchase of sterile hypodermic syringes under subsection (a) shall not constitute an offense under section 329-43.5”

6. Blessing and Curse Syringe Exchange Codified Blessing Long-term legitimacy Demonstrates wide support at the time Requires stakeholders to be involved Facilitates police support Helps related legislation Curse Required components –One-for-one Extensive data collection and research Director of Health has ability to end Opening up law for changes could go either way

7. Hawai ʿ i Syringes Exchanged 1993-2011

8. CHOW’s Old Mission Statement To prevent the transmission of HIV/AIDS and other blood-borne pathogens among high-risk drug users, especially injection drug users (IDUs) in the State of Hawaii.

9. CHOW’s Mission Statement The Community Health Outreach Work (CHOW) Project is dedicated to serving individuals, families and communities adversely affected by drug use, especially people who inject drugs, through a participant-centered harm reduction approach. CHOW works to reduce drug-related harms such as but not limited to HIV, hepatitis B/C and overdose. CHOW supports the optimal health and well-being of people affected by drug use throughout the State of Hawai ʿ i

10. Current CHOW Programs Outreach –hygiene kit distribution Harm reduction –Syringe exchange, wound care, overdose etc HIV and viral hepatitis prevention program –Includes testing for HIV and hepatitis C Referrals and linkage to care Drug treatment on demand –CHOW pays for drug treatment when person is ready and has no other way to pay

11. CHOW Operations Statewide –Maui –Kauai –East and West Hawai ʿ i –O ʻ ahu Honolulu –set mobile van on River street and Vineyard Individually scheduled syringe exchange services (ISES) across the island –Will meet clients where they are

12. New CHOW Participant Card Starting in July, 2012 CHOW will require participants to register and attain a participant card.

13. Data Collection Anonymous so people aren’t tracked Daily logs capture demographics and supplies distributed Act 152 requires annual research report to demonstrate effectiveness –150 participants randomly sampled –30 minute interview –Recently HIV and hepatitis C antibody testing added

14. “I really feel you guys are sincere and genuine and really care about us out here. I always feel comfortable with you guys and really appreciate you always being there for us.” -CHOW participant 6/16/09

15. Age of SEP Participants 1999-2011

16. Receptive Needle Sharing 1999-2011

17. Drug Use 1995-2011

18. Actual HIV Prevalence 2002-2011

19. Hepatitis C Prevalence 2010-2011

20. Lessons Learned Staff are the greatest resource Prioritize building bridges and community support – it is worth it! Just because its been done for 20 years, doesn’t mean it should continue –Program evaluation essential –Data collection important but why? Don’t reinvent wheel – best practices available –Adapt to local area/issues/needs

21. Lessons Learned People are much more than their drug use –Know participants, listen to their stories Harm reduction doesn’t mean lack of accountability Track drug, policing and other relevant trends in community HIV and hepatitis C are preventable –Support any positive change Manage and supervise from harm reduction perspective

22. Mahalo! For more info: hlusk@chowproject.org