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'Just the beginning': How Miami's syringe exchange program plans to grow

A woman stands in front of a trailer.
Verónica Zaragovia
Emilie Ashbes works in community engagement at IDEA, the syringe exchange program in Miami.

Florida’s first syringe exchange program will mark its seventh anniversary on Dec. 1 and Emilie Ashbes is a testament to its success in helping people avoid contracting infectious diseases, like HIV and hepatitis C, and conquer drug addiction.

Ashbes, 34, overcame her drug addiction and is now helping others in Miami do the same through the program founded at the University of Miami Miller School of Medicine.

The program is named after the Infectious Diseases Elimination Act (IDEA), which Gov. Ron DeSantis signed into law in 2019.

Six IDEA programs are up and running across Florida to prevent people who inject drugs from deadly infections by allowing them to swap dirty syringes for sterile ones.

“Being able to be alive is a major thing and even just knowing people care is such a huge part of it — it can help people be willing to go on another day or two,” said Ashbes, who assists clients through her community engagement responsibilities.

She said the program, with a combination of medication and support, has enabled her to regain her health and pursue a career in caring for others.

“I think the goal of the IDEA exchange, which is what I love so much, is to meet people where they're at because dead people don't recover,” she said. “So you have to meet people where they're at. Everybody's different.”

The work of IDEA is especially critical in Miami-Dade, which has the nation’s highest HIV infection rate, with dirty syringes, in part, to blame. They work all over the county, including Overtown, Liberty City and Homestead.

Critics have expressed fears that syringe exchange programs increase drug use and crime into local communities, and do little to reduce illicit drug use.

A man poses for a photograph next to a display of needles.
Lynne Sladky
In this Monday, May 6, 2019 photo, Dr. Hansel Tookes, founder and medical director of the IDEA exchange, poses for a photograph next to a display of needles in Miami. The University of Miami pilot program allows users to exchange used syringes for clean ones in order to avoid the transmission of HIV, Hepatitis C and other blood-borne diseases. Since then, needle exchanges have come to other parts of the state under a law signed by Gov. Ron DeSantis.

The Centers for Disease Control and Prevention, however, says researchers have found such programs to be effective in curbing drug use and stopping the spread of infections like HIV and hepatitis C.

“There’s a tremendous risk to use of a needle after somebody else has used it, and we actually provide low-barrier high-quality care so we can treat HIV, cure hepatitis, and prevent HIV infection. We can do all of that here,” Dr. Hansel Tookes, who founded the program at UM and leads the staff, told WLRN.

He launched the first syringe exchange program on Dec. 1, 2016. It was also World AIDS Day.

In his latest annual report, Tookes said more than 2,200 people were enrolled in the program as of June 30, and that he wants to reach many more people, especially women and communities of color.

Hispanics make up 37% of IDEA's enrollees, while Black enrollees represent almost 11%. More than 70% of participants are male and women make up almost 30% of participants, according to Tookes’ latest annual report. White people make up almost 49%.

He said about 10% of people of IDEA participants have HIV, while more than 40% have hepatitis C.

At IDEA Miami, people can get access to PrEP (pre-exposure prophylaxis), which is highly effective in preventing HIV when taken as prescribed.

To address women’s needs, and to increase the percentage using the services, IDEA Miami now offers a women’s clinic on Fridays.

“Our ability to give things like Depo-Provera, which is birth control, here has engaged more women. A lot of women come during the day on Fridays when we're able to provide that low barrier access to medications for addiction,” Tookes said.

They provide mental health and family planning services, and people can receive care from female doctors who work at UM.

READ MORE: Syringe exchange programs could save Florida hospitals millions of dollars, study suggests

Emilie Ashbes works in community engagement at IDEA Miami, Florida's first legal sterile syringe exchange program.
Verónica Zaragovia
Emilie Ashbes works in community engagement at IDEA Miami, Florida's first legal sterile syringe exchange program.

IDEA Miami also hires staff, known as peers, who have been able to overcome a drug addiction and link people to essential services.

People like Ashbes.

She started working at IDEA Miami two months ago in community engagement. Her job involves setting people up with telehealth appointments, for instance, where they come to IDEA and see a UM doctor via the computer. She provides them with vital supplies – including Narcan, the brand name for naloxone, a medicine that quickly reverses an opioid overdose in the form of a nasal spray, or Suboxone, a medication that treats opioid addiction.

“I’ve loved being able to see [IDEA Miami] grow,” said Ashbes, who stopped using drugs in 2019, and credits IDEA Miami and its doctors for her recovery.

Like Ashbes, Mary Ann Flynn overcame her drug use and now is on the IDEA Miami staff as part of mobile outreach, bringing supplies to people who inject drugs.

“I’ve been there, done that,” she said. “That helps for them to trust me. There’s nothing they could do that I probably haven’t already done twice.”

A woman on a phone standing in a van.
Verónica Zaragovia
Mary Ann Flynn works in mobile outreach at IDEA Miami, Florida's first legal sterile syringe exchange program.

Flynn has been working at IDEA Miami for about a year and a half and says she’s learned that syringe exchange programs do not encourage drug use or enable addiction, as she used to think. She says 12-step programs or detox programs don’t work for everyone, so she wants to help people get care even if they’re still injecting drugs. Flynn said she’s passionate about disease intervention and prevention.

“If we can provide the medication for a lady who is pregnant and that baby is born without HIV – mission accomplished,” she said. “That is exactly what’s happening.”

Aside from the medical care, IDEA Miami helps people avoid the criminal justice system. Anyone in Florida caught with a syringe can avoid a criminal charge for possessing one if they’re enrolled in IDEA.

Tookes told WLRN that Flynn and Ashbes provide firsthand evidence of the program’s success.

“I hope that one day, IDEA is run completely by people who used to use our program,” he said.

Dr. Tookes told WLRN they’re also mentoring other counties to start their own exchange programs across the state.

"I am so proud of everything that we've accomplished here, but as Emilie [Ashbes] said, this is just the beginning," Tookes said.

Verónica Zaragovia was born in Cali, Colombia, and grew up in South Florida. She’s been a lifelong WLRN listener and is proud to cover health care, as well as Surfside and Miami Beach politics for the station. Contact Verónica at vzaragovia@wlrnnews.org
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