Reggie Jackson spends much of his day inside a Winnebago, riding through the District’s hardscrabble neighborhoods to hand out clean syringes in exchange for dirty ones.
Mr. Jackson is on a mission to protect drug addicts from HIV, for which he tested positive in 1990 after sharing needles to shoot heroin and crack cocaine.
“We’re saving lives, man,” Mr. Jackson says.
D.C. officials are counting on Mr. Jackson and others like him as they try to tackle an AIDS crisis so severe that one report has called it a “modern epidemic.”
With one in 20 D.C. residents thought to be HIV positive, the District struggles with the country’s worst infection rate and one that rivals that of some developing countries.
But there is reason for optimism, officials say, eight months after Congress lifted a decade-long ban prohibiting the District from using local tax dollars to support needle-exchange programs.
Critical funds are now starting to reach groups that run those programs, but it remains to be seen how effective they will be.
“There is no silver bullet,” said Walter Smith, the director of the D.C. Appleseed Center for Law and Justice, which monitors the city’s efforts to reduce HIV infection. “There are multiple factors that have produced our high HIV/AIDS rate, and it will take multiple factors to bring it down.”
The reasons include unstable leadership at the city’s HIV/AIDS prevention office, which has had 12 directors in just over 20 years. The District also has a high population of black and gay residents, who historically have had high rates of infection.
Intravenous-drug use is the second most common way HIV is spread in Washington, after unprotected sex, according to a report released last year by the city’s HIV/AIDS Administration.
D.C. needle-exchange advocates say the ban left them without an important tool in a city where roughly 10,000 residents are thought to be injection-drug users.
“If you want to reduce the spread of HIV … you put more syringes out there,” said Ken Vail, executive director of PreventionWorks, where Mr. Jackson works.
PreventionWorks has had to scrape by mostly on private donations, but now that the ban has been lifted, the District has increased the group’s budget by $300,000 over three years, Mr. Vail said.
That is the largest share of nearly $700,000 the city is allocating annually for needle exchanges. Other organizations receiving help include those that work with specific high-risk groups, such as prostitutes and the homeless.
Needle-exchange critics include the White House Office of National Drug Control Policy, which argues the programs may actually increase disease-infection rates because they fail to curb risky behaviors associated with needle-sharing.