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Needle exchanges have also been the victims of their own successes as rates of HIV/AIDS infections have dropped, Raymond said.

“Especially in the last years with the economy, where states have had to cut back their budgets a lot, we’ve had them take a look at needle exchange programs and say, ‘We’re not seeing a lot of new HIV cases, so we probably don’t need to spend the same amount of money that we spent back in the 90s on these.’”

The state of Minnesota’s funding for needle exchanges is highly integrated with HIV prevention programs because the CDC doesn’t hand out prevention grants for hepatitis C, according to a Minnesota Department of Health representative. The agency estimates that it allocated a total of $22,361 for syringe exchange and disposal last year.

Colleen Bjerke, director of programs for the Minnesota AIDS Project, said their needle exchange program costs about $130,000 a year. In 2013, they distributed 230,000 clean needles to 3,251 people. The exchange also accepts and destroys hundreds of thousands of dirty needles every year.

“It’s not an inexpensive program to do. You have to purchase syringes and you also have to have a way to dispose of syringes, and that’s an expense as well,” Bjerke said. “There’s just not a lot of funding available, as a result I think that it would be something that an organization that didn’t have appropriate funding should be reluctant to get into.”

Just three standalone needle exchanges operate in the state. That’s partly due to lack of funding, but needle exchanges have also faced some public pressure that advocates say is fueled in part by stigma against injection drug users.

An attempt to open a needle exchange in downtown Duluth was initially batted down last year by worried elected officials, police and neighbors. The Duluth-based Center for Alcohol and Drug Treatment and the Rural AIDS Action Network proposed the exchange for the neighborhood that also included Last Place on Earth, a head shop that once sold synthetic drugs.

Duluth City Council President Linda Krug opposed the proposal. She said the controversy was largely a misunderstanding of what needle exchanges do amid the city’s fight against Last Place on Earth.

“There was some concern about the needle exchange coming in and nobody knew about it,” Krug said. “The perception is that we’re going to have people hanging around and doing drugs and shooting up.”

The needle exchange found a new place to operate elsewhere in Duluth in the fall of last year. Since then, Duluth police say the exchange has not drawn any crime. Krug said perceptions of the center have changed.

“Like other communities, heroin is an issue here, and I think we’re talking about ways to try to deal with it,” Krug said. “We do have an HIV and hepatitis C problem in this area, and I think needle exchanges are very valuable.”

Rural Minnesotans have access to clean needles through the Minnesota Pharmacy Syringe Access Initiative, which was passed in 1998. It allows pharmacies to sell up to ten syringes, which advocates say helped keep down HIV infections in the state. But because it’s voluntary, some rural counties, like Cass and Big Stone, don’t have any participating pharmacies.

“We have a few in this area that we definitely send some people to who are really proactive and engaging and willing to do this,” Warden of Mainline syringe exchange said of pharmacies participating in the program. “More often than not, there is a very awkward social pressure there of what the reaction from the pharmacist will be.”

Warden said one couple routinely drives down from North Dakota, where there are no needle exchanges, and exchange 200 used syringes they’ve collected for clean ones.

Gary Olson, executive director of the Center for Drug and Alcohol Treatment, said the controversy over the Duluth needle exchange fostered a healthy debate that the community needs to continue if it’s going to lower rates of hepatitis C.

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