On a recent evening in a University District alley, two men in sunglasses sat behind a card table loaded with red bins of alcohol swabs, hypodermic syringes, and other supplies
for shooting up drugs. Every few minutes, someone would wander up the alley to turn in used needles, take a few items from the bins, and move on.
The table is King County's last privately operated needle-exchange site. But its clientele is growing faster than at any other site in the county.
The syringe exchange in the alley used to be operated five days a week by another group, Street Outreach Services (SOS), until SOS lost county funding last year for failing to submit an audit on time. After SOS went away, the People's Harm Reduction Alliance (PHRA) took over the exchange and expanded it to seven days a week. "We felt [drug users] needed more access in the north end," PHRA director Shilo Murphy says. The group now operates the table 365 days a year with the help of about 25 volunteers. By the end of the year, PHRA predicts it will have increased syringe exchanges by one-third to one million syringes—a 10 percent increase overall from last year for the entire county.
"My hope is that when drug users make the choice to be sober, that they can do it without having HIV or hepatitis C, which would affect them for the rest their of lives," Murphy says.
Spurred by the AIDS epidemic, the national movement for syringe exchanges started in Tacoma in 1988. The next year, the model was emulated by activists in Seattle, who operated an exchange from a table in front of Tower Records on University Way.
According to King County, where 2.1 million syringes were exchanged in 2007, the cities that implemented needle exchanges early in the HIV boom lowered infection rates among intravenous drug users. For example, in cities such as New York and Miami, which were late to adopt the once-controversial practice, the HIV rate among injection drug users hovers between 40 and 60 percent. In Seattle, it's 2 to 4 percent.
Nevertheless, only a fraction of the injection drug users here use clean needles consistently. Michael Hanrahan, who runs the county's needle-exchange program, says 20 million syringes would have to be exchanged annually to ensure a clean needle for every injection. "If our objective is to facilitate a clean, single use of equipment, the market penetration is about 10 percent of what the need likely is," he says.
The community-based University District group seems more nimble at reaching the target population than the five county-managed exchange sites, which operate under more restrictive rules. For instance, the county requires users to trade one dirty needle for each clean one—rules Hanrahan says are designed as an incentive to get old, dirty syringes out of circulation. The independent needle exchange, in contrast, allows users to bank and trade syringes, enabling more users to take as many syringes as they need.
However, the group struggles to stay afloat. It depends on donations from users who come to the table, and its supplies are provided by the county, which is facing a $68 million deficit. Countywide, syringe-exchange programs cost King County just under $1 million a year. In October, County Executive Ron Sims will send a funding proposal to the council that will reduce public-health appropriations by 33 percent a year for three years—eventually cutting the county's contribution to public health to zero [In the Hall, Erica C. Barnett, June 11]. King County Council Member Larry Phillips, who chairs the council's budget committee, says it's too soon to guess whether the needle-exchange program will be impacted, but he hopes to maintain it. "It has proven to be a tremendous public-health aid in King County," Phillips says.
As the syringe-exchange services strive to stay afloat, SOS has morphed into a new organization, Harm Reduction Advocates, which is building support to fund needle exchanges and allow anti-overdose programs. Executive director Tara Moss says the group was "getting to the point, with restricted funds, [that] it makes sense to advocate for the programs rather than provide services." 
