There are few things, and fewer conundrums, that haven’t come through the door of the AHOPE needle exchange center on Albany Street in any given week.
The center is a classic needle exchange – founded by the Boston Public Health Commission in the South End area in 1993 to address the AIDS/HIV crisis – but with opioid epidemic has transformed it into a place of last resort where those on the streets can get wounds dressed, can find clean needles and can build long relationships in a world where so many come and go minute by minute.
It is often a place of last refuge for people, few of whom will find help.
“I can’t say there is a typical day to describe here,” said Sarah Mackin of AHOPE. “You could have a medical issue happen. You could have someone overdose outside. That happened today actually. You can have someone come in who lost their ID and we help them get a new one. We can have someone in with a mental health crisis. We do a lot more than just needle exchange…There is no typical day at AHOPE.”
The exchange is a drop-in center and Mackin, Director Devin Larkin and Program Coordinator Clare Schmidt are the main points of contact Monday through Friday as they welcome what is likely the most vulnerable – and sometimes frustrating – population in the state.
Right off the bat, a common misconception about AHOPE is that they no longer operate as an exchange, but simply hand out supplies. While they offer syringes, cotton balls, saline, rubber bands, and other supplies for intravenous drug use, they also take in quite a lot of exchanged syringes.
In fact, contrary to popular belief, they take in more than they give out.
Conservative figures show that they take in 1.16 syringes for every one they give out, and they give out several thousand per year.
“We get back 1.16 of all that we give out,” said Mackin. “One thing that’s hard and fast here is that drug users bring them back to us. There might be needles on the street, but they are bringing them back to us. We see a lot of active drug users that will pick them up and bring them here…The last thing we want is a needle in the community.”
Said Larkin, “Our motto is that no one is allowed to say that we don’t do that here. A lot of people who come here are barred from many places. So, if we don’t help them, they won’t be able to get help.”
As the numbers of needles have proliferated in the community while the crisis has ramped up – with Fentanyl taking hold and requiring more frequent use – Larkin and Mackin said it’s important not to lose sight of how successful AHOPE has been in combatting AIDS/HIV. New cases are almost non-existent, they said, in large part due to the needle exchange.
“The reason we need these services is because users will find alternatives on the street,” said Mackin. “Instead of using the cookers we have here, they’ll use a bottle cap. They’ll use cigarette butts as a filter. We tell them it’s not safe. Unfortunately, we have people injecting in the gutter. We’re trying to prevent infections before they begin.”
While AIDS/HIV is better, infections, and hepatitis B and C are on the increase. Those diseases, as well as HIV/AIDS, cannot be contained without clean needles and supplies, Larkin said.
“Without syringe access, you’re not going to be able to stop HIV infections,” said Larkin. “For us, HIV is a rarity. It’s down 90 percent.”
Added Mackin, “The most effective treatments for these diseases that affect drug users is access to clean needles…Syringe access has saved an uncountable number of lives.”
There is one thing that AHOPE employees, the City and the neighborhood are in alignment on, and that is the need to spread out the services to other parts of the City.
Southenders have long said the exchange draws people to the South End, and the services should be spread out to other neighborhoods to prevent the concentration of the problem.
“I think there are a lot of community health centers looking to do this,” said Mackin. “We are not the only needle exchange in town. There is one in BMC and one in JP. A lot of organizations want to do this and it should be that way. We should have a lot more. We need this in just about every neighborhood.”
Larkin said expansion is a priority of the City and something they would like to see happen.
But one certainly should not be fooled. No matter where the exchange might be, the work is hard and takes a toll on the staff.
Relationships are very important at AHOPE, and folks on the street live and die by them. Staffers can work hard to build the trust of someone coming in, get them to a point of where they’re almost ready for recovery, and then suddenly find out they’ve died of an overdose.
The stories amongst women of sexual assault and other heartbreaking situations also sting.
Sometimes the frustrations can mount, and Mackin said it can be hard to come to work every day and feel empathy. But in the end, it is loving people for where they’re at – and that is what makes the greatest difference.
It is, in fact, the centerpiece of the work done at AHOPE.
“Empathy is a very hard thing sometimes,” she said. “One of the hardest things about it is when you’re kind to someone and they burst into tears…They best form of love is accepting people where they’re at. It’s transformative to people here. Caring about people goes a long way. A lot of people here haven’t had anyone care or be kind to them in a long time.”
AHOPE is located in the Finland Building since 2013 on Albany Street, and is operated by BPHC.