ERIC WESTERVELT, HOST:
People who inject drugs risk contracting HIV and hepatitis C if they share used needles. As a prevention strategy, organizations in many cities give out clean syringes. And these clean needles sometimes wind up on a black market for drug users - one that appears to help prevent the spread of contagious diseases. Reporter Emma Jacobs has our story.
EMMA JACOBS, BYLINE: On Friday afternoon, several dozen people are lined up in the narrow hallway of Prevention Point in Philadelphia. Men and women of all ages hold onto paper and plastic bags of used syringes.
How many are you bringing back?
JACOBS: Silvana Mazzella, the director of programs of the services center for injection drug users, raises her voice to narrate the exchange taking place at the front of the line.
SILVANA MAZZELLA: We obviously have a space challenge, but people come in, they drop off their used syringes, and they ask for what they need.
JACOBS: Most people are coming in with just a few needles, but participants can get as many as they want as long as long as they turn in a dirty needle for every one above a small supply. One of the clients who exchanges dirty needles in bulk does business on a corner about half a mile away.
UNIDENTIFIED MAN: You can exchange pretty much one old needle off the ground for a new set right there. Some people come in 300, 400 works at a time.
JACOBS: We're not using his name because he's admitting things which are illegal, including selling needles. This is tolerated by the city, but still banned under Pennsylvania law. This man gets clean syringes from the exchange, but he resells them here for a dollar apiece, providing instant access a block from where users can buy drugs and close to the wooded train tracks were many go to inject. He says selling needles is a source of income for some.
UNIDENTIFIED MAN: Like, it's their hustle. It's how they survive and support themselves. So that's how I do it. So a couple of these - sell a ton of them, you can get a bag to get high.
JACOBS: This postindustrial neighborhood of North Philadelphia is dotted with empty factories and homes. It's one of the most active areas in the city where people buy and use cocaine and heroin at all hours. Paul Yabor says that makes it important that they can get clean needles right here, too. Yabor is an AIDS activist and educator at Prevention Point.
PAUL YABOR: It's 2 o'clock in the morning, and the guy's saying here's a syringe for a dollar. You know, there's a lot to be said for that.
JACOBS: Yabor was diagnosed with AIDS and hepatitis C years ago. He says some people don't feel comfortable picking up needles from the exchange. Others are looking to drop into the neighborhood, inject and get out fast. Needle distribution has always been controversial. Some people say it encourages people to use drugs. Yabor also acknowledges that when he sold syringes in the past, he used some of the money to buy drugs.
YABOR: Did it enable me? It did, but also, I mean, I was going get high anyway. And the cold, hard reality is that someone with a habit or under the influence of cocaine is going to go to extreme measures to inject.
JACOBS: One more extreme and even more dangerous way is risky sex work. Most city officials I talked with agreed they'd rather focus on keeping people healthy than policing people exchanging needles in bulk. Roland Lamb directs Philadelphia's Office of Addiction Services. He says there are people who manage shooting galleries in the neighborhood, acting as a dealer or bouncer who will exchange needles in bulk so they can sell or even give clean ones to their clients.
ROLAND LAMB: Folks who come in and who bring in syringes to exchange them are not looking - you know, are looking to actually, you know, have a cleaner place - have a place that - where there's not a chance for someone to accidentally stick themselves with a dirty needle.
JACOBS: He thinks the impact on health is significant. Without a dedicated study, it's hard for researchers to measure the effects of black market needles. But exchanges themselves reduce the spread of HIV. They get part of the credit in Philadelphia for a dramatic drop in new diagnoses. University of Pennsylvania researcher Philippe Bourgois studies how slight variations in drug use affect infection rates. He says Philadelphia's strong network of people spreading needles from the exchange plays a big role.
PHILIPPE BOURGOIS: You get this extraordinarily efficient distribution of needles exactly where they need to be at the right time. And so that's what, basically, I think prevents a much worse spread of HIV.
JACOBS: Bourgois takes the long-term view. He points out many of the people who hit rock bottom in this neighborhood will recover. If access to clean needles can keep them safe until they do, he hopes they'll be able to live the rest of their lives without the burden of another illness. For NPR News, I'm Emma Jacobs in Philadelphia.