Several years ago, when I was told that my administrative position would be taking over the needle exchange department, my reaction was "no way, unh-unh, no sir-eee, there is not a chance in hell, say what???!!" I didn't want that department. I feared that department. I feared the clientele the department serviced. First, I thought I was way too judgmental and secondly, I'm not sure that I morally approved of the service (I had higher morals then). I looked for every excuse not to work in that department. Besides, the clientele would never be able to connect with me. Shortly thereafter, when I learned that my admin position was losing its funding, my morals suddenly changed. Thus I begrudgingly started my career as what I called "syringe technician and various and other sundried harm-reduction counselor." I could hear the conversation over cocktails now: "And what do you do?" I replied, "I'm a social worker who helps people with needles." "Oh, an acupuncturist?" Well, not exactly.

Test Positive Aware Network has operated a syringe exchange program in conjunction with Chicago Recovery Alliance for the past seven years. It's a free, legal and non-judgemental service that began as a study with Yale University and funding from the Chicago Department of Public Health (CDPH).

The program was begun to help further the proof that providing clean needles to injection drug users (IDUs) drastically reduces the rate of new HIV and hep C infections. Naturally, this harm reduction model is still considered controversial to some and though time and again studies have shown that the programs do not increase drug use, it still has its naysayers. The program is simple: bring in your dirty needles and we'll replace them with new ones. That's it. We will never tell a client that using is bad or that they should quit. Our focus is to teach them how to do it safer without being judgmental until they decide for themselves that it's time to get help. Only at that point do we start the process of referrals into addiction centers or counseling. If, along that road the client is open to a little education on safer injecting, or learning a bit about HIV or hep C, perhaps even going so far as to be tested, then we feel even more successful.

I entered into my new program with a not-so-open mind. The clients I saw were shockingly diverse to me. Everyone from suburban housewives (yes, very desperate housewives like the ones you've seen sobbing with Oprah), surprisingly young teens on heroin, transsexuals using hormones, corporate professionals on meth, hookers, students, bodybuilders, men on the down-low, women on the down-low, and one parent of a blind, aging diabetic Labrador named Sadie. Sadie needed insulin needles. Actually I believe each of these groups have had their time sobbing with Oprah, right?

The one common denominator among all the IDUs was that each one came through the door with a huge amount of shame. Most came to us with heads held low; some couldn't make eye contact, some so tweaked that they couldn't focus on anything. Each acted as if I was a vice squad member about to bust them.

Over the next few months, as the staff and I became more familiar to the clients, I could see that they were beginning to trust me a little. Perhaps they wouldn't wear the dark glasses each time, or they would chat for a minute and not rush right out. I'd even see a meek smile once in a while or perhaps a handshake. Each one began to express his appreciation of the service we were providing, but there was still a huge underlying element of shame. Shame in the way they walked, shame in the way they held themselves, shame in the way they talked or didn't talk, shame in their tired, weary eyes. A shameful "yes, sir" or "no, sir" to my few questions showed me that they still viewed me as an authority figure, an image I didn't want them to have. With each visit that window into their world opened a tiny bit, a good sign that we were making some progress with our service.

I've always had my favorites. Not that they were special, but because they began to trust me with compelling bits of information that gave a very slight bit of insight into who they were. Since our NEP (needle exchange program) is an anonymous service, I began imagining names, or more accurately, assigning "titles" for my favorite clients.

Mr. Clean

One of the guys who I always enjoyed seeing was a huge bodybuilder I silently named "Mr. Clean." Mr. Clean was huge! A big, friendly, strapping bald guy weighing in at about 260 lbs. of pure muscle with two big gold earrings. He was always a little flirty. Because he was a trainer he always wore a tank top and sweatpants. He would offer workout and diet tips and even go so far as to demonstrate what he considered to be highly effective push-up techniques on my office floor. This was almost more than I could handle. I would pretend that I didn't understand the correct form just to have him do it all over again. His huge triceps would begin to glisten with sweat and his shoulders would get more huge. I was definitely developing a little high-school crush on Mr. Clean. I felt like Carrie Bradshaw with Mr. Big.

Mr. Clean was there to get needles for his steroids and growth hormones and "other things." Over the next few visits I learned that Mr. Clean also had a very heavy heroin addiction, had been in and out of rehab, was a "hustler" (his words, not mine) who serviced a male and female clientele, was HIV-positive and HCV-positive and engaged to be married to an unknowing fiancé in a few weeks. He came in a few months ago and was trying rehab once again. A few weeks later he reappeared, this time feeling more guilty and ashamed than ever. He had dropped out of rehab for the umpteenth time. He cried in my office as his beeper continued to alert him that there was a client interested in his services. He dried up, wiped his face, popped a Viagra and dashed out. I've not seen him again and miss him. He called a few months later to ask if I had access to steroids. If I'd had access to them, I'd be doing push-ups on my office floor.

Lady Goodwill

Then there was "Lady Goodwill," a suburban housewife who claimed she was no longer a user herself and was only getting supplies for the other ladies in her neighborhood who were still using. Lady Goodwill would take needles by the hundreds, and yes, return them by the hundreds as well. She once mentioned that she was taking such a huge amount to give to prostitutes who were too afraid to come in themselves. I found it odd that Lady Goodwill was able to collect all of these used needles from the prostitutes to bring them back in. I applauded her efforts. She and I began to talk on a first name basis. She would call me before arriving to make sure I'd have enough supplies to trade her for the several Tide detergent bottles full of used needles she was returning. I liked her. It had become painfully obvious that she was actively using. Her behavior was extremely erratic and now she was forgetting to wear sleeves to cover her needle-tracked forearms. When I delicately suggested that we could provide medical care for her abscesses, she denied what the sores obviously were. Her shame was her barrier to treatment.

Double Logo Girl

One of my absolute favorite clients was someone I call "Double Logo Girl."

Double Logo Girl was employed by one of the high-end boutiques in the downtown area. You know, the type of shop you have to be buzzed in to. She was beautiful and sexy, like Nastassia Kinski (circa "Cat People" or the famous 1980s Richard Avedon snake poster). DLG made me question my homosexuality and that's hardly questionable. She would enter the doors dressed immaculately in the store's double logo couture. As if she were on a runway, her long dark hair was perfectly imperfect, but she had none of the confidence of a Naomi Campbell or Tyra Banks. She always looked sad, like one of the young girls in the old Margaret Keane paintings who had a huge head and huge tearful eyes along with a kitten or puppy with the same odd physical traits. She always wore double-logo sunglasses and never removed them. I later learned that one of DLG's big sad eyes was always blackened. She was so gorgeous I got nervous and tongue-tied when I talked to her. I remember one time, when I was trying to compliment her on how incredible she looked I blurted out, "Wow! You look great with clothes on!" God, what an idiot! Where did that come from? I could literally feel my already ruddy face become crimson as I frantically looked for a drawer to crawl into. Just like in elementary school, I'd made an idiot of myself in front of a girl again. Later I learned that this beautiful, fragile little girl was being beaten by her boyfriend any time she mentioned trying to give up heroin, thus explaining the sunglasses. I tried to talk about where she could get help, but she claimed to be double-parked and quickly darted out. Just like Lady Goodwill, her shame was her barrier to treatment for drugs and domestic abuse.

Crystal Meth Bi

Certainly you've been to a restaurant and asked the waitress for her opinion about a particular meat dish on the menu and her reply was "Oh, I don't eat meat ..." in a demeaning sort of "I'm-a-vegan-and-you're-not" tone. I found it best not to answer client's questions with this sort of attitude. Let them assume what they want about me. If they think that because I have a lot of answers I also have a lot of experience, that's fine with me. Most people also assume all of our staff members are HIV-positive because they work for an HIV agency. No one bothers to dispel that. It really doesn't matter. Everyone's here for the same reason.

I think because of assumptions like these I was occasionally invited to various drug and sex parties. One snowy Monday night a guy came in for supplies. He confided that he was bisexual and had spent the entire weekend methed up at several Boystown sex parties and was now returning to his wife and two young sons in the suburbs. He had stopped in for next weekend's supplies. His emotions were all over the map during our brief talk. His giddiness and laughter would quickly break into tears and desperation and then quickly back to flirting and giggling. I could tell he was about to experience a mean crash. At one point in our conversation he leaned over my desk just a few inches from my face and softly said, "You have the most beautiful eyes. Would you come out to dinner with me tonight?" I assured him that I was flattered but that "it was my night to wash my hair." His sobbing suddenly got heavier as if he'd heard the worst news possible. I really don't think he even realized that I'm as bald as an eagle and had responded that way so as not to embarrass him. I couldn't help to wonder what his wife and little boys would think.

A Few More Folks

Over the years we've seen some real characters come in for services. The cast features "T-Bone," a hillbilly-type who drives in from Wisconsin. T-Bone has the personality of an old, lazy hound dog and it takes him about 10 minutes to say a couple of words in his long, draaaawn-out dialect. Because his drawl reminds me of growing up in the South, I love talking to him, that is, if I'm not in a hurry. T-Bone can do some serious taaawlkin'. There was "Insu-Lady" who claimed that she, her husband, and their twin daughters were all diabetic and needed hundreds of needles for insulin. Curiously, on her following visits I would ask about her twins and she claimed she'd never had kids. There were many guest appearances by a gentleman I call "Summer-Teeth" because "sum-are" there, "sum-are" not. He always spat on me when he talked. One of my most challenging cameo players is a man who changes identities every week. I named him "Rapid Transit" because no matter what he calls himself that day he always claims that his used needles had been stolen by another passenger on the train ride in. He never has empties to return and never wants to play by the rules. We later learned that he was taking our free supplies and selling them on the streets.

Running Into DLG

I was recently on Michigan Avenue where I thought I saw the lovely Double Logo Girl shopping a couple aisles away. Due to confidentiality issues I couldn't approach her, so I was really pleased when, looking prettier than ever, she walked over to say hello. We decided to have coffee together. She in her Dolce and me in my Levi's, we were very unlikely companions, ordinary strangers. Sharing a tiny table in a corner, I'm sure others thought we'd known each other intimately for years. We behaved as if we did. I learned that her name was Bridgett (not her real name). I knew it would be. Over a couple of frappes she confided that she had left the boyfriend, was studying for her GED and was no longer using heroin. She wasn't wearing the sunglasses and hope and confidence had replaced the fear and sadness in her eyes, her face practically radiating with empowerment.

Strangers Leaving Shame

Unfortunately, our program recently lost its city funding leaving the total financial responsibility upon our not-for-profit agency and some support from Chicago Recovery Alliance. We are committed to continuing the program as long as we are able. For the sake of all the Mr. Cleans, the Lady Goodwills, the T-Bones and especially the Double Logo Girls out there, I hope we are able. They've made me think and learn, wonder and hope. They've given me insight to a world I may or may not have ever seen. They've given me strength to know how to deal when addictions have struck close to home. Each one of them has made an impact on us here at the agency, whether good or bad. I take that back, I suspect it's all been good.