PATRICK STONEHOUSE spends the better part of his day waiting for drug addicts. They come into his workplace, the Drop-in Center on Front Street in Santa Cruz, hand him a collection of drug-tainted, sometimes HIV- or Hepatitis C–infected needles, and in return he smiles and hands back an equal number of fresh, clean needles.

Most of the time this is just the beginning of the interaction. The client might look through the donated clothing, take a breather on the cushy couch, grab some clean cookers and alcohol swabs or just stay to talk with Stonehouse and the other volunteers at the center. Sometimes the talk will turn to drug addiction, but often the client is just happy to hear a friendly voice.

Up until a month ago, Stonehouse was completely reliant upon donations from local community members and private foundations to fund the center that he directs, despite its being one of the few places in the county where intravenous drug users can get any sort of health-related advice—and without anyone dropping the term "rehab."

But then came a surprise. In a precedent-setting move, on June 1 the California Office of AIDS supplied $75,000 per year for three years to Stonehouse's needle-exchange program, although the money cannot be used for the syringes themselves. This marks the first time the center and nine other programs like it throughout the state have received government money. The total amount handed out by the Office of AIDS was $2.25 million, all of which came out of the general fund and could have been used for other programs if government staff had so chosen.

Stonehouse, whose organization operates under the umbrella group Santa Cruz AIDS Project (SCAP), plans to use the money to open up a new office in Watsonville, provide the supplies necessary for addicts to clean the abscesses that form when the needle misses the vein, provide free acupuncture sessions and increase education and outreach efforts to both north and south County.

Not long ago, this would have been unthinkable. The last decade has witnessed a slow but steady shifting of perceptions on needle-exchange programs in the political sphere. Once considered an enabler of dangerous drug use by many politicians, needle-exchange programs are now gaining acceptance as a legitimate public health measure in even the most conservative corners of the nation.

In California, the programs, part of a larger harm-reduction movement that advocates less focus on punishment for drug users, have gained important legitimacy in the lower echelons of state government. While $75,000 a year may seem like small potatoes, needle-exchange advocates say the symbolism of a California Department of Health Services office throwing its support behind historically illegal programs is enormous.

In fact, a call to the Office of AIDS reveals that a growing number of state health agency officials are advocating for even more support of these programs, despite potential resistance from the governor.

Kevin Farrell from the Office of AIDS helped analyze the grant proposals and says his office had to turn away more programs than it could fund.

"I think the fact that we had 10 successful candidates but 18 unsuccessful candidates speaks to the pent-up demand for this in the state," Farrell says. "Many of those programs could have been funded. They were very tightly bunched, the quality of the applications was very, very high and it was tough making those choices."

The only hurdle remaining is a ban on using state money to purchase the needles themselves. The current monies can be spent by needle exchanges on staff, rent, nonsyringe supplies—anything else except syringes.

But that could change before the year is out. Assembly Bill 110, sponsored by Santa Cruz Assemblyman and former SCAP Executive Director John Laird, would free up state money to be used on the purchase of syringes, something that is also illegal on the federal level. A.B. 110 has passed the Assembly and the Senate Health Committee and will be heard by the Senate Appropriations Committee after the summer recess in August.

Since this is the first time the state has funded needle-exchange programs, all of them have gathered funding from other sources. Local entities, such as the city of Santa Cruz, often support them; in Santa Clara, the county government decided to pick up the tab in 2000 because there was no better way to reach injection drug users. Kevin Hutchcroft of the Santa Clara Public Health Department believes that while needle-exchange programs currently subsidized by the county will continue to thrive regardless, A.B. 110 could help out other jurisdictions where the programs are still politically marginalized.

"In terms of managing these budgets, it would be helpful to us," Hutchcroft says. "But I think it's even more important to counties that don't have syringe exchange programs and are trying to get something launched."

Gov. Schwarzenegger has rejected previous versions of the bill twice already but refuses to take a position on the current bill until he reads the final copy.

Stonehouse and other harm-reduction advocates believe the establishment of needle exchange programs as a legitimate, proven method of reducing HIV and Hepatitis C transmission could help accelerate changes on the national stage.

"I think as with what happened on the county level in California, one moves another in a hierarchical system," says Stonehouse. "In California you had 'This county said yes, and this county said yes, but the state still says no.' So we're getting to the point where we're having more and more states say yes, but the federal government still says no. The idea is that you get enough of the constituents to say yes, and then it's going to effect the grand change."

It's already starting. In May, the state of New Jersey authorized cities to set up and operate needle-exchange programs, and this year Washington, D.C. may relax its longtime ban on public money for exchange programs.

In what may be the most surprising development of all, the Texas House of Representatives held a public hearing on implementing a pilot needle-exchange program, and not a single public comment from the Republican-controlled district was lodged against the idea. The House swiftly approved the bill in late May.

While there are still a number of needle-exchange programs across the country struggling to scrape together sufficient funding and forced by law enforcement to operate in the shadows, those days may be numbered as the myths that surround injection drug use fade away.

"I'd like to think the stigma is falling away as people get more educated and knowledgeable about addiction," says Hilary McQuie of the Harm Reduction Coalition's Oakland office. "It involves the efforts of a lot of people to shift that public perception."

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