A series of sensationalistic articles in the San Francisco Chronicle over the past two weeks highlighted the problem of discarded needles near one of the city's needle exchange programs. The series appears -- on the surface -- to have prodded city officials to act on the problem. More accurately, it informed the public of planning that had been going on behind the scenes, though without informing readers of that. While the articles posed as muckraking, civic-minded journalism, they smeared needle exchange workers -- they failed, most importantly, to ask the most basic questions needed to actually determine the programs' impact on needle discarding -- and unnecessarily contributed to public fears about the programs.

The Chronicle series began Sunday July 29 with "The Situation at Golden Gate Park; Sunday in the Park -- With Needles," where the paper reported that the park was "littered" with discarded syringes. The reporting made it seem as if the discarded syringes were the fault of needle exchange programs:

"They tell us he was steaming, but San Francisco Mayor Gavin Newsom shouldn't have been too surprised when The Chronicle reported that Golden Gate Park was littered with used drug syringes.

"After all, his own Public Health Department spent $800,000 last year to help hand out some 2 million syringes to drug users under the city's needle exchange program -- sometimes 20 at a time.

"Although Health Department officials say 2 million needles were returned, the fact is they don't count them and can only estimate how many are coming back.

"And from the looks of things, a lot of them aren't."

That same article was also shocked to report that drug users can actually buy needles without a prescription:

"Under legislation passed in 2005 by the same Board of Supervisors whose members now decry the needle problem, anyone over 18 can walk into a Walgreens or Rite Aid and buy as many as 10 needles -- no questions asked."

[inline:syringes.jpg align=left caption="syringes"]Like needle exchanges, non-prescription syringe access is a harm reduction measure designed to save lives and improve the public health by reducing the spread of disease through making needle access easier. Its beneficial impact, however, is blunted by a California statute defining syringe possession as a violation of the paraphernalia law. Hence, users anxious to avoid trouble with law enforcement may be rendered more anxious to get rid of their needles once done with them, and less likely to save them long enough to take them back to a program.

In that article and a same-day companion piece, "Golden Gate Park sweep -- can city make it stick? 'March of junkies': Haight's residents fume over needles," the Chronicle described finding needles in Golden Gate Park and interviewed neighbors upset with finding discarded syringes in the area. It made for compelling reading, but left several critical questions unanswered:

• How many needles were being discarded in the park before there were needle exchange programs?
• How many of the needles found by the authors of the neighborhood residents they quoted came from the needle exchange program?
• What is the risk of HIV or Hep C infection from being pricked with a discarded needle? What was it before there were needle exchange programs?
• How many needles not returned to the program are actually being unsafely discarded?
• Overall, how significant is the threat to public safety from discarded syringes, and how does it compare with the threat from pre-needle exchange days?

If advocates and researchers are right, the answers to those questions don't support the premise of the Chronicle stories. "Nobody wants dirty syringes lying around," said Hilary McQuie, Oakland-based Western Director for the Harm Reduction Coalition. "But there were syringes everywhere in San Francisco before we started needle exchanges here in 1988. There is no recognition [in the Chronicle story] that there was a problem with discarded syringes before needle exchange came around, or that needle exchanges help reduce the problem."

The Chronicle also seemed to go out of its way to paint one program, the Homeless Youth Alliance, and its director, Mary Howe, in an unflattering light:

"Finding the needle exchange in the Haight isn't easy. Walk west on Haight Street, take a right at Cole, and turn in the first doorway. There's no identification, just a blue sign that says, 'entrance.'

"Walk up the hall, which smells of urine, and then knock on the scratched and battered wooden door. After two or three tries, someone might open the door a crack to see what you want.

"Welcome to a city drug needle exchange and HIV prevention facility.

"When then-Mayor Frank Jordan signed legislation endorsing needle exchanges in 1992, it was a high-minded, civically progressive program to slow the spread of HIV and hepatitis C. Drug users would get a needle, use it, then return it for a clean one. That's still the idea -- and it is a good one -- but somewhere along the line the concept went low-rent.

"Today the Haight facility looks more like a hole in the wall. The neighbors, many of whom say they have never been told what's going on up the street, find syringes in their gardens. And the original idea -- a one-for-one exchange -- is largely ignored.

"The exchange is run by the Homeless Youth Alliance, which gets a yearly budget of $275,000 from the city Department of Public Health. As the alliance's program director, Mary Howe, admits, they make no more than a rough count of the incoming needles. If someone says he returned 40, they hand over 40 new ones. And, if he doesn't have any, they give him 20 as a startup stash.

"'The point for a needle exchange is not to get every needle back,' says Howe. 'The majority of users dispose of needles in a respectful manner.'

"And those who don't?

"'That's not my responsibility,' Howe said. 'I can't hold everyone's hand and make everyone put them in a bio bucket. If someone has a liquor store, and they sell liquor to someone who gets into an accident, is it the store's fault?'"

"The Chronicle totally attacked Mary Howe," McQuie complained. "She's one of the few people who has a good relationship with the homeless users in Golden Gate Park, and the Chronicle didn't mention that her staff does regular clean-ups [collections of discarded syringes] there."

"That's right, said Peter Davidson, board chairman for the Homeless Youth Alliance. "We go out there monthly and clean up dirty needles," he said. "It's a large park, though, and I have to wonder why we are blamed for every needle in it. Picking on a small, poorly-funded needle exchange program doesn't seem particularly productive," he said.

"We're a little bit frustrated with the Chronicle coverage," said Davidson, "but we hope this whole kerfluffle will cause some movement."

Of course, no one wants people getting stuck with discarded needles, but some research can help to put that problem in perspective too. Infections from needle sticks are quite rare outside medical facilities, according to Dr. Robert Heimer, a professor in the Division of Epidemiology of Microbial Diseases at Yale University and an expert on HIV survival in syringes. "While HIV will survive for weeks inside a syringe, needle sticks are not likely to transmit the virus since virus on the surface of the needle, which would be introduced into the body of the person being pricked, loses viability quickly upon drying. Supporting this are the data from hospital needle stick transmission, which were strongly associated with fresh blood," he said.

A 1998 review of the literature on needle stick infections agreed. It found no HIV infections contracted via needle sticks among garbage disposal workers in one study reviewed. Other studies found low numbers (less than 15) cases of hepatitis infections contracted through needle sticks.

In the third article (so far) in the series, "Needles talk of town; SF officials promise system of drop boxes," the Chronicle patted itself on the back for prompting the city to act with its "exposé" of the dirty needle problem:

"City officials and nonprofit agency leaders, responding to an outcry over used syringes littering parks, promise to reform San Francisco's needle-exchange program -- including locked, 24-hour syringe drop boxes and technologically advanced syringes."

Indeed, both city officials and needle exchange program heads were quoted as saying they would be acting soon to install drop boxes where dirty needles could be dropped off. San Francisco currently doesn't have any, which probably goes a long way toward explaining why the city's return rate is only around 70% instead of the 90% reported in some cities that do have drop boxes. But it is not that the city and the exchanges suddenly woke up because of the Chronicle's reporting. According to insiders, planning for drop boxes has been ongoing, and the first ones will appear shortly. What the Chronicle's reporting really did was goose city hall and the exchanges to let the public know what was already underway.

[inline:needle-exchange-logo.gif align=right caption="popular needle exchange logo"]"Mary has been meeting with the public health department, the AIDS Foundation, and the police on disposal boxes for the last year and a half," said Davidson. "Everyone agrees it's a good idea. She's been shopping a written proposal around, but when it came to needles in Golden Gate Park, Parks and Recreation didn't want to get involved."

"We've been talking with the city public health department for awhile about disposal boxes, and I think this series and all the uproar it has aroused will make it happen," said McQuie. "That would be a good public relations move, but people don't want to carry their syringes around because of our paraphernalia law here in California." In the face of the assault on the NEPs in San Francisco, McQuie went on the offensive. "What we really need is to change the needle law so people don't feel like they have to get rid of them. We need syringe exchange machines like soda machines, where you put one in and take one out. And we need safe injection sites," she said.

Heimer also had some observations and suggestions about reducing the number of dirty needles strewn about in public. "Our studies comparing Springfield, Massachusetts, where there is no legal access to syringes, to New Haven and Hartford, where there is, found far more unsafe discarding in Springfield (44%) than in Connecticut cities (13.5%)," he pointed out. His unspoken conclusion was obvious: remove restrictions to needle access if you want to lower rates of unsafe discarding.

"We need publicly accessible drop boxes," Heimer suggested, "along with training injectors to use proper containers, training police to not harass people who carry syringes (then people won't have to chuck their rigs when approached by police), and expanding syringe exchange hours and, counter-intuitively, liberalizing exchange policies," he said. "We found that syringe return rates in three US cities -- Oakland, Chicago, and Hartford -- were highest (nearly 90%) in the city with the most liberal policy (Chicago) and lowest (only 50%) in the city with the most restrictive policy (Hartford).

But such fine points apparently did not interest the self-styled crusaders at the Chronicle. While the newspaper may have done a public service by reporting on the discarded needle problem, the way it did so was a disservice to the hard-working, dedicated people who run these programs for the public health. One would think the citizens of San Francisco deserve better than shabby, sensationalized reporting when it comes to critical public health issues. We only hope that the Chronicle's botched job leads to advances, not setbacks, for harm reduction and needle access in California.