For the past three years, public health activists have been trying to convince Florida lawmakers to support a needle-exchange program to fight the HIV epidemic in South Florida, and for the past three years they’ve been turned down.
One Miami activist refuses to wait for lawmakers. George Gibson is an ordained minister. Nearly everyone calls him Elder as in a church elder.
He says his needle-exchange program is related to his religious work.
“I see it as being an AIDS ministry,” he said.
But he used to wonder if handing out clean needles and condoms to drug addicts was promoting risky behavior.
“A lot of times people may ask how could you be involved with something like this if you’re a minister,” he said. “I see it as, my first and foremost is abstinence, but I know that’s not going to happen with everybody and I have to deal with reality.”
Elder started his needle-exchange program with a $1,500 grant from the North American Syringe Exchange Network, or NASEN, in Washington state. Now he buys syringes from NASEN out of his own pocket. And sometimes people donate unused needles.
Elder often conducts business outside busy, big-box stores in Miami-Dade County. That’s where he meets Donna, one of his regular clients, in her SUV. At first glance, she looks like a typical soccer mom. But Donna is a drug addict with hepatitis C.
She says for the past four years, she’s been shooting up Dilaudid, a prescription pain medication that’s supposed to be taken orally.
“If it wasn’t for Elder, I don’t really know what I would do,” she said. “I might resort to dirty needles. I might keep using dull needles and really mutilating myself.”
She says that’s what she used to do.
“I don’t know if you can tell, but I just, like, mutilated my whole arm,” she said. “Sometimes you only see like a little dot, dot, dot, dot, dot. Mine’s a big, wide scar, just trying to get the needle in.
Hepatitis C is on the rise in South Florida and throughout the state. The liver disease is spread through contact with infected blood. Intravenous drug users who share needles or other drug-injecting tools face an increased risk for the disease.
Florida also has one of the highest rates of HIV in the country.
The Medical Side
“We have a real, a real epidemic here,” said Dr. Hansel Tookes, a second-year resident at Jackson Memorial Hospital.
Tookes works in Jackson’s HIV clinic. He’s been trying to convince state lawmakers to implement a needle-exchange program since he was a medical student at the University of Miami and points to Indiana’s emergency needle-exchange bill.
“It’s interesting,” said Tookes. “They had a substantial number of cases, but this is every day at Miami, this is every day at Jackson Memorial Hospital. In any other place, what happens here every day would be a public health emergency."
Last year, Miami-Dade had more new HIV infections than any other county in the state. Broward came in second.
Tookes says he’d like to see a needle exchange program go statewide, but in a concession to the conservative nature of the Legislature he decided to push for a tiny, pilot program in Miami-Dade. He doesn’t need lawmakers to fund this. It would be supported by private money. But he does need their approval because needle-exchange programs are against Florida law.
He just hasn’t been able to get legislators to see things his way.
“I understand that it might not feel right to give drug users needles, and you might have a moral objection to this type of program,” said Tookes. “But it’s more morally reprehensible to have a proven treatment known to prevent disease and withhold it from people.”
Tookes also stresses that a needle-exchange program would save money. He says it would only cost a little over $150,000 to implement, while last year Jackson spent more than $11 million on hospitalizations related to injection drug use. And that does not include treatment for HIV and hepatitis.
This year the bill hit a major roadblock in the state House, when a Republican lawmaker from Miami refused to schedule it for a hearing. Michael Bileca told the Miami Herald the information in the needle exchange proposal “didn’t provide a compelling need for it.”
Despite being turned down by lawmakers for three straight years, Tookes says he’s not giving up. He calls the work of people like George Gibson “honorable” and says he’s been encouraged to join other underground needle-exchange programs.
“Of course, I could lose my medical license for doing so,” said Tookes. “So it definitely takes an altruistic person like Mr. Gibson to be doing this in Florida. I’m fighting to make what he’s doing legal.”
Delivering drug paraphernalia is a third-degree felony in Florida. It carries a maximum prison sentence of five years.
Gibson, the man whose clients and friends call him Elder, doesn’t seem to mind that his underground needle exchange is illegal. He says he sees his work as civil disobedience in the vein of Gandhi and Rosa Parks. And he has no plans to stop.
“I plan on doing it, I guess, until it’s a cure,” he said.