Nestled between nondescript buildings on historic northeast H Street is the headquarters for HIPS, an organization frequented by sex workers, intravenous drug users, and eager gender studies majors alike. Shortened from “Helping Individual Prostitutes Survive,” HIPS provides free safe sex materials to sex workers in the District. It’s also one of three providing organizations of the D.C.’s Needle Exchange program (NEX), a program which allows intravenous drug users to trade their used needles for clean ones at roughly a one-to-one ratio. HIPS extends its NEX services to clients who are using hormone injection as a component of gender transition.
NEX falls in line with the philosophy of harm reduction, the belief that if individuals will inevitably use injection drugs, it’s best if they do so as safely as possible. There are many opponents to syringe exchange and the philosophy of harm reduction, believing that they simply enable users to continue using. This sentiment is heightened because NEX is typically funded by tax dollars, in addition to private donations.
“People always try to present it as ‘well, just quit!’ But that’s definitely not how addiction works,” said Jess Sturges, formerly an intern and now a volunteer at HIPS. “When users know that they’re going to use, they want to learn to do it more safely.”
Evidence suggests that syringe exchange programs greatly reduce transmission of HIV among the communities they serve, and ultimately save taxpayer dollars as a byproduct. According to a study from The George Washington University, the rate of HIV transmission among District drug users has decreased by 70 percent since the program’s implementation in 2008. Because taxpayers will not have to support HIV treatment for these drug users, many of whose health plans are publically funded, taxpayers will save $44 million in lifetime costs for these clients.
“If it wasn’t for harm reduction programs, HIV would be rising sky high. People would be using each other’s needles, and they would be having more overdoses,” said Maurice “Moe” Abbey-Bey, Syringe Exchange Specialist at HIPS.
As a former drug user himself, Abbey-Bey is uniquely sensitive to the needs of the community HIPS serves.
“I come from the street, like anybody else,” he said.
Abbey-Bey spent time in prison earlier in life, where he began to mentor young men with similar backgrounds to his own. After prison, he was drawn toward work in syringe exchange. Because his relationships with the community HIPS serves prevail, Abbey-Bey has sharp insight into the needs of NEX clients.
According to Abbey-Bey, the reputation of HIPS as an NEX provider put the organization in a unique position to prevent overdoses from fentanyl, a dangerous substance with which heroin is frequently cut.
“We might have been the only organization out there when fentanyl hit the street—finding out where it came from, where it originated from. Tracking the dealers on it. Sometimes we were there with flyers before the dealers even got there,” he said.
In addition to interning and volunteering with HIPS, Sturges utilizes its NEX program for hormone injection purposes. Transgender individuals such as him often face barriers to receiving the materials they need for healthy and safe hormone injection. Sturges uses his own experience to demonstrate safe testosterone injection to HIPS volunteers, many of whom are college-aged millennials like himself.
“I think millennials in general are really feeling hopeless, and like they can’t see their impact,” said Sturges. “Volunteer work is really important to this generation. There’s just so much powerlessness in sitting back and observing oppressive social structures. People like direct service because it helps them feel connected, and it’s a good way for them to push back against some of their privilege.”
Sturges and the HIPS staff are pleased with the organization’s NEX work, their inclusive client base and substantial grassroots volunteer support, yet they still wish HIPS could provide more services. Chief among them is the distribution of Naloxone. This medication reverses the effects of opiate overdose, most commonly from heroine, and sends the user into withdrawal. HIPS has long awaited a government-issued standing medication order for Naloxone that would enable the organization to freely distribute it to clients.
Two other organizations in the District, Family Medical & Counseling Services (FMCS) and Bread for the City, also provide NEX services in similar capacities to HIPS. HIPS and FMCS are similar in that they both primarily operate NEX with a mobile service. Bread for the City, however, operates NEX only on location and focuses more commonly on clients who use NEX for intravenous drug use than hormone injection. Of the three organizations, only Bread for the City is currently is able to distribute Narcan, a brand name of Naloxone, to its NEX clients.
One Bread for the City NEX client, who requested to remain anonymous, said that he accepts Naloxone when it is offered to him at Bread for the City. Although he does not expect to use it himself, he knows there is a chance he or a friend may need the medication should they use heroin that is cut with fentanyl by mistake.
“My issue is a chronic pain issue,” the client said of his reasons for continued heroin use. He said that after having surgery to ease his chronic pain, the aftercare he received was insufficient. Now he chooses to self-medicate rather than rely on professional medical care he doesn’t trust.
According to Sturges, many clients of needle exchange simply aren’t in a place where giving up their use of highly addictive drugs like heroin or methamphetamine is possible.
“Frequently, people are just not in situations to quit,” he said. “They’re going to be around their friends and family who are going to use, and that will make it hard to stay dedicated to quitting. Addiction is real and scary.”
Sturges also addressed the role withdrawal plays in quitting. “If you don’t have a place where you can detox in peace, that’s going to make it really challenging. Withdrawal in general makes it challenging, because even if you do want to quit mentally, withdrawal affects your entire body.”
According to Sturges, the process of withdrawal can be particularly challenging for clients that are experiencing homelessness, commonly due to a lack of stable housing and a supportive network of friends and family. This makes NEX particularly important to these clients, who are less likely to have access to clean needles on their own.
While HIPS acknowledges the difficulty of quitting, its staff is also prepared to offer linkage to detox clinics and other medical care if the client expresses interest. This is true of Family Medical & Counseling Services and Bread for the City as well.
“If you are experiencing homelessness or experiencing poverty, we know what’s going to work best. And if you’re looking for something that’s trans-inclusive, we know what’s going to work best,” Sturges said. “HIPS is about making people feel seen, and not seeing them through the lens of a stigma, not seeing them as just a trans woman, or just a drug user, or just a sex worker.”