Michele Brown lays three syringes on the table in front of a pretty, 27-year-old blond woman with a tattoo of Tigger on her upper right arm. One after another, Brown uncaps each of the syringes to show the younger woman the needle.
"This one has a long needle with a fine point," Brown says. "This one has a long needle but a thicker point. It's the sturdiest.
"And this one," she says of the last syringe, "this one has a short needle and a fine point. That's the one most people like."
The young woman elects to go with the popular choice, and Brown drops a dozen or more into a brown paper lunch bag. Next she dangles a tourniquet in front of the woman. "We recommend you use these rather than shoelaces or something like that. They're easier to get off and you can do it with one hand."
She shows the woman a "cooker" and cotton, and explains their uses. Then she pulls out two plastic bottles, one containing purified water and the other bleach. These are useful in killing some blood-borne germs but, she emphasizes, not HIV.
All of these items go into the paper bag along with a handful of condoms. "Have a good day, Hon," Brown says as she hands over the bag. "And protect yourself."
The companionable atmosphere in the Baltimore Needle Exchange van is like that of a neighborhood hardware store, brimming with solicitude and good will. Rather than delineating the attributes of drug paraphernalia, Brown might be suggesting woodmaking techniques to a customer. "Yes, sir. I recommend the brass wood screws. They don't rust."
Brown, a career drug counselor who helped start the Baltimore Health Department's needle exchange nearly six years ago, won't countenance any worker who isn't assiduously respectful of those who come through the door for clean needles. Here they are rarely referred to as "addicts" and never, ever as "criminals." They are simply "our clients."
The van represents one of the tragic paradoxes of contemporary American life. From this place are dispensed the instruments that at once save lives while also helping to destroy them. Brown doesn't waste much time on the ironies of her work.
She is 46 years old, has shoulder-length hair and bangs and favors duck pants and pastel-colored T-shirts and sneakers. She is ebullient but not the least bit naive. "I knew people who were dying from the virus. Most of them would tell me they got it from sharing needles. All the time, you'd hear someone say, 'How's so-and-so?' 'Well, he died.' 'How about so-and-so?' 'She died, too.' It seemed to me there was such a simple solution."
This afternoon, the van, a clumsy old Ford Gulfstream, is parked at the desolate corner of Monroe and Ramsey. Brown and her band call this spot "The Wild, Wild Southwest" owing to its location in Baltimore and its reputation as the busiest site visited by the city's two needle exchange vans.
True to form, when the van pulls up 15 minutes ahead of schedule, a line immediately forms outside its curbside door. Or maybe it is not so much a line as a grouping of souls. Some of them pace. Some smoke cigarettes or strike up half-hearted conversations. Still others stand motionless, as though afraid an extraneous movement will drain them of the last traces of fortitude.
Brown relents a few minutes before 1. "Let's get started," she says. John Harris, a handsome, 43-year-old health aide, pushes open the door. "OK," he calls to the crowd, now numbering more than a half-dozen, "first two, come on in."
The Baltimore Needle Exchange is open for business.
For the next two hours, there is plenty of business, enough to occupy Brown and three other workers. The regular clients know the routine. They sit across from Harris and lay their used syringes on the table. The veterans know to put elastic bands around groups of five. They also know to separate "program needles," which will be exchanged one for one, from the non-program needles, sometimes gathered from the ground, which fetch half as many. "We are an exchange, not a distribution," Brown explains several times during the afternoon.
Harris is careful not to touch the needles himself. He uses a tongue depressor to make his counts. When done, he asks the client to throw the old needles into one of the hazardous waste trash cans. Then Harris fills the paper bag with the new needles and whatever other supplies the client needs. The whole process can take less than 30 seconds.
Often it takes longer because of pleasantries. Brown recognizes many of the clients. "Hey, where you been? I haven't seen you in a while," she says to one young man with liquid eyes in a sweatshirt and shorts.
"I been in the penitentiary," he says evenly.
"How long you been home?"
"About a month."
She hands him his bag, and he smiles self-consciously at her as he rises to leave. "OK, Hon, good seeing you again," she says.
A few treatment slots
Those who arrive early have a chance to get one of the 390 treatment slots reserved for needle exchange participants (from a total of 6,498 publicly funded treatment slots in the city). It sounds like a lot, but with as many as 60,000 drug addicts in Baltimore, the slots don't go very far. Usually, Brown can offer only one or two at a given location each day. If you don't show up early, you have no chance of getting one. "I'm tired of the corner," a wan, 41-year-old, nearly toothless woman says plaintively when she learns there are no slots left.
"Don't give up, don't give up," Brown tells her. "The fact that you come here every week means you're trying."
Others, Brown knows, aren't trying as hard, like a stringy-haired young man who shows up nearly 45 minutes after the van opens and asks about getting a slot. He says he was caught in traffic. "Well that traffic can be a nuisance," Brown commiserates.
Later, she says he comes every week with a different reason why he was too late to get a slot. If she was disappointed, however, she was careful not to let him see it. Workers in the van don't nag. "If we did that, there's a chance people wouldn't come at all," says Brown. "They'd say, 'I'm not going to go there and be bothered.'"
Harris knows she's right. He had a habit himself for almost 15 years, starting when he attended North Carolina A&T;, where he was on a football scholarship as a promising cornerback. After suffering an injury, he left school and returned to Baltimore. That's when his addiction really took hold. He sunk lower than he thought possible. "All my 'nevers' started to come true," he says. "Robbery, burglary, conning people, stealing cars, taking things out of people's homes."
Eventually, he had a $150-a-day habit and an equal measure of self-contempt. He was also suffering from malnutrition and hepatitis. Then one day, he ran into an old drug buddy, who looked far healthier than Harris had ever seen him. He had cleaned up and convinced Harris he could do the same. That was 10 years ago. Harris hasn't used since.
He works in the van now, he says, as living proof to others that there's a way out. Same with Linda Alston, another worker in the van. She's 45 and a grandmother. Not so long ago, she visited this very van as a client with a decade-long habit. One day, she found herself in the emergency room at University Hospital after suffering an aneurysm. Three other women were also brought in that day with aneurysms. Alston was the only one to survive. She resolved to get off the dope.
Turned her life around
It was Brown who pointed Alston toward a treatment program. That was more than four years ago. Now she's an outreach worker herself, directing others to drug programs. She's also the one who administers free, on-site HIV testing in the van.
Of the workers, Alston is the most outwardly emotional. Her eyes fill when she talks about the people who come here for needles. "It's important for them to know there's someone who believes in them even when they don't believe in themselves."
As of last month, the Baltimore Needle Exchange Program had 10,548 registrants. That month, the program collected 43,507 syringes and handed out 37,800. Some critics still contend that needle exchange encourages drug use, but the Johns Hopkins School of Public Health, which has evaluated the program, says there's no evidence to suggest that is the case. The incidence of new HIV cases, says Steffanie Strathdee, a Hopkins epidemiologist, has decreased 35 percent in Baltimore since the beginning of the program, and fewer discarded needles appear in the areas where the vans visit. "The answer," she says, "is more needle exchange, not less."
As the day proceeds, all types of people come for their needles: white, black, lively, sullen, young, old, oldest. One woman barely out of her teens hands off a baby before climbing into the van to register for the first time. She puts seven syringes on the table and says she shoots up three times a day. A 22-year-old man with rings on eyelids that he is barely able to keep open, tells Brown he has been shooting up since he was 14. "How many times a day?" she asks. "As many times as I can" is his reply.
A little later, a gray-haired man with several days' growth of beard and a round belly arrives to register in the program. He has brought 35 needles with him. "Have you ever been in treatment?" Brown asks. He laughs. "I've been a drug addict for 48 years," he says, an answer of sorts.
A teen-age boy drops by. He tells Brown that he's starting treatment next week. "What about your twin brother?" she asks. "No, he ain't too interested," the boy says. "That's not going to work," she says later. "One brother getting treatment and living in the same house with a user."
After two hours, when the van is about to close up shop for the day, a young man with heavy-lidded eyes slumps onto the bench opposite Brown. He pulls from his pocket one syringe and lays it on the table. "That's all I got," he tells her.
"That's all?" Brown says. "I can only give you one back then."
He looks at her blankly. "I was hopin' I could get more," he says. "I was hopin' you could help me."
"I am helping you," she says. "I'm just not giving you what you want."