This document summarizes the work of PreventionWorks!, a needle exchange program in Washington DC. A team of Georgetown medical students worked with PreventionWorks! to reduce HIV/AIDS and other diseases among injection drug users. PreventionWorks! operates a mobile van that provides clean needles in exchange for used ones, as well as medical referrals and supplies. It aims to reduce disease transmission through harm reduction services. The program has exchanged over 330,000 needles since 1998. A typical day involves the van stopping in areas with high drug use and infection rates to exchange needles and provide other assistance.

1. PreventionWorks!PreventionWorks!
2007-20082007-2008
Needle exchange in the District of ColumbiaNeedle exchange in the District of Columbia
1407 S Street, NW1407 S Street, NW
Washington, DC 20009Washington, DC 20009
202.588.5580202.588.5580
www.www.preventionworksdcpreventionworksdc.org.org

2. Service Learning Team MembersService Learning Team Members
Georgetown Medical StudentsGeorgetown Medical Students
– Ahmad DaherAhmad Daher
– Michael HsuMichael Hsu
– Alessandra IntiliAlessandra Intili
– Jane KimJane Kim
– Brittney LewisBrittney Lewis
– Patrick NailerPatrick Nailer
– Mfon OkonMfon Okon
– Brian RenardBrian Renard
Faculty Team LeaderFaculty Team Leader
– Mary Beth LevinMary Beth Levin
Key Community Partner:Key Community Partner:
– Yvonne Green, Project ManagerYvonne Green, Project Manager

3. HIV/AIDS in the District:HIV/AIDS in the District:
An Ongoing Problem…An Ongoing Problem…
DC has theDC has the highest ratehighest rate of new AIDS cases in the country.of new AIDS cases in the country.
One in 20 adultsOne in 20 adults in DC is living with HIV.in DC is living with HIV.
At leastAt least 1 in 7 African American men1 in 7 African American men in DC is HIV positive.in DC is HIV positive.
Women, people of color, and DC youthWomen, people of color, and DC youth continue to havecontinue to have
the fastest growing rate of infection.the fastest growing rate of infection.
Over one-third ofOver one-third of new AIDS casesnew AIDS cases are drug-related!are drug-related!
30% of new AIDS cases30% of new AIDS cases can be traced to a re-used needle.can be traced to a re-used needle.
Drug use costs DCDrug use costs DC $1.2 billion each year$1.2 billion each year..
Every $1 spent on treatment saves over $7Every $1 spent on treatment saves over $7 in lawin law
enforcement costs!enforcement costs!
Every $1 spent on treatment saves $12Every $1 spent on treatment saves $12 in health care costs!in health care costs!

4. PreventionWorks!PreventionWorks! MissionMission
Our Service Learning Team worked with PreventionWorks! to minimize the spread ofOur Service Learning Team worked with PreventionWorks! to minimize the spread of
HIV and other blood-borne diseases among injection and other drug users, theirHIV and other blood-borne diseases among injection and other drug users, their
partners, and their newborn childrenpartners, and their newborn children
– Reduce the risk of contaminated needle use among drug addicts in DCReduce the risk of contaminated needle use among drug addicts in DC
– The main goal isThe main goal is harm reductionharm reduction. Although needle exchange is sometimes seen. Although needle exchange is sometimes seen
as controversial, PreventionWorks!as controversial, PreventionWorks! does not encourage drug usedoes not encourage drug use
– Needle exchange provides a safe way for drug addicts, who would be using theNeedle exchange provides a safe way for drug addicts, who would be using the
drugs regardless of this program, to inject drugs. These efforts have led to adrugs regardless of this program, to inject drugs. These efforts have led to a
decrease in the spread of HIV/AIDS and other diseasesdecrease in the spread of HIV/AIDS and other diseases
The PW! mobile van offers a gateway toThe PW! mobile van offers a gateway to FREEFREE services other than just clean needles:services other than just clean needles:
HIV Counseling and TestingHIV Counseling and Testing
Safe sex kits (condom, lubrications, instructions, education)Safe sex kits (condom, lubrications, instructions, education)
Drug Treatment referrals, informationDrug Treatment referrals, information
Harm Reduction education/training/outreachHarm Reduction education/training/outreach
Overdose PreventionOverdose Prevention
Support GroupsSupport Groups
HEP C referrals for testing/prevention education/support groupHEP C referrals for testing/prevention education/support group
Protection for non-injection drug usersProtection for non-injection drug users
Wound healingWound healing

5. About PreventionWorks!About PreventionWorks!
PAST & PRESENTPAST & PRESENT
1990: A federal law prohibits the use of public funds for needle1990: A federal law prohibits the use of public funds for needle
exchange programsexchange programs
1998: PreventionWorks! is created & supported by private funding1998: PreventionWorks! is created & supported by private funding
1998-2007: Washington, DC is the1998-2007: Washington, DC is the onlyonly city in the nation barred bycity in the nation barred by
federal law from investing its local tax dollars to provide needlefederal law from investing its local tax dollars to provide needle
exchange servicesexchange services
– Other major cities such as Boston, Chicago, Los Angeles, New York,Other major cities such as Boston, Chicago, Los Angeles, New York,
Baltimore, and Philadelphia are all supported by state and/or localBaltimore, and Philadelphia are all supported by state and/or local
government dollarsgovernment dollars
Late 2007: Congress passes a federal spending bill that removesLate 2007: Congress passes a federal spending bill that removes
the ban on federal funding for needle exchange servicesthe ban on federal funding for needle exchange services
Jan. 3, 2008: DC Mayor Adrian Fenty allocates $650,000 for needleJan. 3, 2008: DC Mayor Adrian Fenty allocates $650,000 for needle
exchange services in DC -exchange services in DC - $300,000$300,000 of which will be given toof which will be given to
PreventionWorks!PreventionWorks!

7. Community Served by PreventionWorks!Community Served by PreventionWorks!
PreventionWorks! believes thatPreventionWorks! believes that everyoneeveryone deserves thedeserves the
right to be treated withright to be treated with respectrespect andand dignitydignity..
– Clients from DC, Maryland, and VirginiaClients from DC, Maryland, and Virginia
– Predominantly injection drug users, crack users, and some sexPredominantly injection drug users, crack users, and some sex
workersworkers
– Young and oldYoung and old
– PW! van concentrates in 12 areas of Washington, DC, where thePW! van concentrates in 12 areas of Washington, DC, where the
incidence of HIV/AIDS and other blood-borne diseases isincidence of HIV/AIDS and other blood-borne diseases is
highesthighest
– Exchange needles, clothes, food, condoms, HIV testing, andExchange needles, clothes, food, condoms, HIV testing, and
referrals for drug rehabilitationreferrals for drug rehabilitation
– New members are given a PreventionWorks! card that allowsNew members are given a PreventionWorks! card that allows
them to carry the clean needles (supported by DC police)them to carry the clean needles (supported by DC police)

8. Accomplishments since 1998Accomplishments since 1998
Provided 2,156 participants with life-Provided 2,156 participants with life-
saving education, referrals, and cleansaving education, referrals, and clean
needlesneedles
Made 350 referrals to drug treatmentMade 350 referrals to drug treatment
Received 11,979 client visitsReceived 11,979 client visits
Administered 83 anonymous HIV testsAdministered 83 anonymous HIV tests
Distributed over 112,000 male and femaleDistributed over 112,000 male and female
condomscondoms
Exchanged 330,202 needles and syringesExchanged 330,202 needles and syringes

9. A Day in the Life of…A Day in the Life of…
Ride the metro to Northeast or Southest DCRide the metro to Northeast or Southest DC
Meet the PreventionWorks! mobile van in a Safeway parking lotMeet the PreventionWorks! mobile van in a Safeway parking lot
Stop at the first site:Stop at the first site:
-Turn on the laptop-Turn on the laptop
-Open the computer database-Open the computer database
-Set up the exchange kits-Set up the exchange kits
-Put out the food containers-Put out the food containers
-Get the flyers and referral forms ready to distribute-Get the flyers and referral forms ready to distribute
The first client walks in and sits. Ask his/her birth date and first name. Ask him/her toThe first client walks in and sits. Ask his/her birth date and first name. Ask him/her to
count and dispose of his/her needles in the biohazard sharps containercount and dispose of his/her needles in the biohazard sharps container
– ““What types and how many of each do you want back?”What types and how many of each do you want back?”
– Apples? Blue heads? Diabetics? Groins?Apples? Blue heads? Diabetics? Groins?
Enter the exchange and ask “Is there anything else I can do for you?”Enter the exchange and ask “Is there anything else I can do for you?”
– Some want more, some want less, some just want to talk – On the PW! Mobile vanSome want more, some want less, some just want to talk – On the PW! Mobile van
every client receives as much time as needed and complete, undivided individualevery client receives as much time as needed and complete, undivided individual
attentionattention
Serve the community as they line up outside the van’s door (One client at a time)Serve the community as they line up outside the van’s door (One client at a time)
Shut down the exchange, shut down the computer, put away the needles, clean theShut down the exchange, shut down the computer, put away the needles, clean the
van, off to the next stopvan, off to the next stop
2-3 stops and 3-4 hours per shift2-3 stops and 3-4 hours per shift
Take the Metro and return to GeorgetownTake the Metro and return to Georgetown

10. Other ProjectsOther Projects
Safe Injection Resource (Ahmad and Mfon)Safe Injection Resource (Ahmad and Mfon)
– One-page safer injection drug use flyer listing the proper techniques forOne-page safer injection drug use flyer listing the proper techniques for
sterile injections, symptoms that could be indicative of an infection, andsterile injections, symptoms that could be indicative of an infection, and
reasons to seek medical treatment for an infected woundreasons to seek medical treatment for an infected wound
Water Drive (Jane and Michael)Water Drive (Jane and Michael)
– Dehydration is a problem often faced by the needle exchangeDehydration is a problem often faced by the needle exchange
participants (can increase the occurrence of injection site wounds)participants (can increase the occurrence of injection site wounds)
– PW! mobile unit makes bottled water available to the participantsPW! mobile unit makes bottled water available to the participants
– A project aimed at collecting bottled water donations from localA project aimed at collecting bottled water donations from local
businesses and a bake sale to raise funds for the bottled water drivebusinesses and a bake sale to raise funds for the bottled water drive
Medical Mapping (Alessandra and Brittney)Medical Mapping (Alessandra and Brittney)
– List of clinics in serviced areasList of clinics in serviced areas
– Updated information (phone #s, locations, hours)Updated information (phone #s, locations, hours)
– Insurance coverage (types accepted?, treat uninsured?, fees waived?)Insurance coverage (types accepted?, treat uninsured?, fees waived?)

11. Lessons & ReflectionsLessons & Reflections
Personalized a problem beyond the classroomPersonalized a problem beyond the classroom
Larger context (environment, economics)Larger context (environment, economics)
Challenged prior assumptionsChallenged prior assumptions
– Messy vs. organized, grumpy vs. gentileMessy vs. organized, grumpy vs. gentile
– Enabled drug useEnabled drug use
– Type of personType of person
““Audacity of hope”Audacity of hope”
Quality improvementQuality improvement
– Further engagementFurther engagement
– Show me the $$$Show me the $$$

12. ““I am very appreciative for the time I got to spend on the mobile unit. I
not only got a chance to dispel my preconceived notions, I also got a
chance to see the hard work and dedication that goes into making a
program such as this a success. “