Injecting Awareness into your Life: A Lesson in Injection Supplies

Before coming to HIPS, I was blank canvas in terms of drug and hormone injection. I certainly knew that both existed, but how it was done? The safest way to do it? What needles were used for what? All brand new to me. I very, very quickly learned the difference between different uses, both from coworkers and superiors explaining it to me, but also from our extremely knowledgeable and well-versed clients. Most folks who we encounter, particularly those who use syringes to inject drugs, know exactly what they like, where to inject, and what to use to inject in a given spot. I wanted to take the chance to explain what some of our different supplies are and what the similarities and differences are between needles since I feel like it helps to normalize the perception of those who use drugs. Just as one person might go into a store and be looking for a very specific type of sock - a certain color, a distinct material, a given height, a specialized weave - so are people particular about their needle use.

On the most basic level, there are three major differences from one needle to the next: 1) gauge, or essentially how wide the needle is, 2) length, how long the needle is, and 3) body size, or how much of the substance it can hold. The latter two are pretty self-explanatory, but the first is slightly counterintuitive - the BIGGER the gauge number the SMALLER the size of the needle. So a 27 gauge needle is 1/27th of an inch, while an 18 gauge needle is 1/18th of an inch (aka much bigger). Kaput?

Our most popular needles are definitely insulin needles. These needles have heads (the needles) and bodies (the barrels) attached. At 27 gauge and 1/2 an inch deep, they are long enough to reach the shallow veins of the arms and legs, without being as mug as some of out other needles. We also have ones we call "baby dies" (and I always think of Princess Diana - is that bad??) or baby diabetics which are narrower at 28 gauge, the same length and hold half as much substance. Baby dies are usually used for "skin popping" which is when people inject just below the skin, NOT into a vein. This usually causes a more mellow, slower, less intense high, and might be te initial way that soneone gets into injecting. People who use diabetics - in my experience - do NOT like baby dies.


Then we have the tips that are separate from the bodies, all of which fit on the same body. We have blueheads (25 gauge, 1 inch long, they're blue! Surprise, surprise), apples (23 gauge, 1 inch long,  they're bluish-green, perhaps like a granny smith apple?), and then groins (21 gauge and 1.5 inches long, important for their purpose). All three are used to inject into veins, but as the needles get bigger, they get more intrusive into the body. In particular, the groins are usually used to shoot into the groin (surprise, surprise) which can be particularly dangerous, since the vein is buried very deep in the leg and is located close to the femoral artery. It's really easy to miss the femoral vein and accidentally stick something else. Most of the time, people only resort to the bigger tips and the riskier injections sites (groin, neck, in between the toes, etc.) when easy-to-reach veins in the arms and legs have collapsed or are difficult to find.

From L to R: Diabetics, blueheads, apples, and groins.

When it comes to injecting hormones for M-to-F or F-to-M transgender folks, we have two needles each for the butt (23 or 21 gauge, 1.5 inches long) and for the shoulder/thigh (23 or 21 gauge, 1 inch long). Hormones tend to be extremely thick, so a needle with a bigger opening (21 gauge) will hurt more but take less time to inject, while a needle with a smaller opening (23 gauge) might hurt less, but the individual will have to hold it there injecting the hormones longer.

The bodies used for drugs and hormones are also different - purple bodies (drugs) hold less substance, and pink bodies (hormones) are able to hold more. However, the tips have a universal attachment, so any tip can fit on either body. In addition to being larger, pink bodies also come with a massive 18 gauge needle that can be used to draw up the super thick hormones (it is then taken off and a smaller tip is attached for injecting).

From L to R: Purple body for drugs, pink body for hormones.

We've also got a bunch of safer injection supplies like alcohol swabs, bandaids, sterile water for mixing drugs, tourniquets, and cottons and cookers (sterile bottle-cap-like containers to hold the drugs, and mini cotton balls to filter the drugs).

Clockwise from top left: blueheads, alcohol swabs and bandaids, 23 gauge shoulder/thigh, 23 gauge butt, 21 gauge shoulder/thigh, 21 gauge butt, tourniquet, sterile water, groins, apples.

Cottons and cookers (with an alcohol swab)

We also have syringe exchange cards that we make for every person who gets needles. The card proves that they are part of a needle exchange program, and allows people to carry needles on them without fear of arrest by the police. We always say that if they're caught with other stuff on them, then we can't help them out there, but carrying needles with the card is fair game.

So there you have it, the most basic lesson on HIPS' injection supplies, and ones we give out weekly, if not daily. We also have a slew of different - perhaps "specialty?" - needles in our stockroom, but these are our most popular. Get ready for an upcoming post on our safer sex supplies! Finger condoms, anyone?

Elizabeth Pisani on Sex, Drugs and HIV

An awesome TED Talk that speaks heavily to what we're up to at HIPS. Check it out. Do you agree with her stance?

http://www.ted.com/talks/lang/en/elizabeth_pisani_sex_drugs_and_hiv_let_s_get_rational_1.html

Best quotation? When talking about how we like to think that people act rationally, she goes, "Well, if there are two things that make people a little bit irrational they are erections and addition." So true, Elizabeth, so true.

A Car-Chase-Filled Night of Mobile Outreach

I went out sporting my closed-toed shoes and long pants on Thursday night for my second overnight mobile outreach shift (see this link for more descriptions about my first night out and HIPS' mobile outreach services in general). As always, there were all kinds of mini-adventures that took place - interesting interactions, hilarious encounters, and huge learning experiences, but I want to focus on a few anecdotes that I found particularly frustrating, exciting, and compelling from Thursday night.

The first was just a short exchange - I was in the back seat packing bags of condoms and therefore not talking to people on the street - but the HIPS volunteer in the front seat asked an older woman if she wanted any free "condoms, candy or lemonade." The woman told us that we should be spreading the word of Jesus not giving out condoms, and that sex should only be reserved for married couples. Right, because no married couples ever use condoms, or because the pill works for everyone, or because all married couples want to have children, or because there is never an instance where one partner has something that they may not wish to pass to their partner... That's the cynic in my head going on and on, but my co-worker gently and tactfully pointed out that married people use condoms too. The woman did not want to hear it, but we left feeling as though we had stuck to HIPS' (and our own) values. While I might not agree with the older woman, I respect her right to express her opinion. We're not going to curb what we're doing anytime soon if we can help it though...

At about 2:30 or 3 AM we got to one of the main sex worker "strolls" in DC and immediately heard sirens. We looked around and saw nothing - where were they coming from? The street we were on usually has two lanes in either direction, but due to a ton of construction and attempts at gentrification, big concrete barriers narrow it down to two skinny lanes. Suddenly, a white Mercedes truck came careening through the middle of the road as we were stopped at a red light, and screeched through the intersection, skidding loudly about 5 feet. I swear, it looked like a stunt from an action movie. And let me remind you, this is a Mercedes truck, not a 1991 Toyota with bald tires.

The stunts continue: the truck swung into a wide parking spot at an awkward almost-head-on angle, got about two feet onto the sidewalk, was tilted up on its two left tires while the two right tires got about three or four feet of air, then smashed back down right next to a tree and on a little metal fence. Then two or three guys sprinted from the car, making a beeline in opposite directions and running at full panicked speed. At this point, the cops had just arrived and started taking off after the guys, while we sat there, flabbergasted, through several rounds of traffic lights. Once we all got our wits about us, we realized that we should probably get off this strip - you never know when a good old car chase is going to turn nasty.

We chatted with some folks on the strip later on in the night, and they told us that the car had been stolen (surprise, surprise), but I don't know many more details apart from that.

One of the highlights of the night happened much later on - at a time in the early morning when my father has already completed his workout for the day and is thinking about what's for dinner (I'm joking, kind of... it was late and he does wake up pretty early...). It was about 5:00 AM and we were just finishing and about to go back to the office, when we stopped to chat with an older gentleman. Slightly timid initially, we offered him our supplies and services, and when he realized that we were able to give him free condoms, his face completely lit up. We mentioned that not only were the condoms free, but we had all different types! And flavors! And lube! He was totally psyched, and we hooked him up with a mixed bag of regular and flavored condoms, regular and flavored lube, and then asked him if he wanted dental dams. He didn't know what they were, so we explained that they were a thin piece of plastic to be draped over the vagina or the anus if you wanted to eat either out. And ours are flavored! He blushed and looked shy for a moment when we asked if he wanted some, then kind of nodded, and once we were like, "Hell yeah, go for it! Try them out and see how you like it!" he broke into a full smile and accepted several. it was so freaking awesome to see a man of 47 exploring his sexuality and trying new things. He then said to us, "Y'all made my day! I know that my day is going to be wonderful because of all that you've given me. I'm going to be thinking about this all morning!"

If only I could make everyone's day each morning by giving them condoms, lube and dental dams. It might only be vocalized once and a while, but by saying that, he didn't realize the difference he made in my day.

Conflicted Witness - what to do when your values come up against your comfort zone?

Last Wednesday night, I was in a position that left me totally torn. Confused. Stumped.

After several glasses of wine and some dinner with a friend, I took the metro home at about 11:30. I was alone and buzzed slightly, although I certainly still had my wits about me - it was nothing wild and crazy. I got off the metro at my stop, and as I was traipsing toward the escalator I noticed a young man pressed up tightly and passionately against a phone booth on the middle of the platform. Normally I would have kept walking without a second glace and I don't know what made me act differently this time, but something made me do a double take; for some reason, I was compelled to look a touch harder. When I did, I saw him holding a syringe - the plunger depressed - at about waist height. It took me a few seconds to process what was going on: he had just shot up in the manicured DC metro stop.

I was immensely conflicted. Where does my "job" begin and where does it end? I hope to live what I preach, I would like to believe that I do, but at that moment I was completely flabbergasted and had no idea what action to take. Part of me was tempted to write our hotline phone number on my card and slip it to him, saying or writing, "We do syringe exchange if you ever want clean works." At the same time though, I wasn't sure what was appropriate - I was alone, I was buzzed, I'm a scrappy and tough cookie but by no means strong, and not only was he high, but he has just shot up - talk about buzzkiller, right? All these elements made me feel like it was inappropriate to approach him at that very moment. So I didn't. But then afterwards I felt guilty; I felt irresponsible; I felt like I hadn't held up my side of the bargain in being in my line of work. I was divided, and I still kind of am. We expect doctors to step in when someone gets hurt on the street or sick on a plane. We expect lawyers to observe and to testify if they see something against the law. But where do the rest of us come in? How do we live out what we stand for at work versus what is appropriate in day-to-day life? If we fail to live out what we claim to believe, can we really believe it at all? Tell me what you think - I'm genuinely curious to hear the opinions of others on this subject...

*            *            *

On another note...

Holy cow - the verdict is out! GOODmaker announced it Thursday, and HIPS After Dark is the winner of their mini-grant!! I am personally moved and overwhelmed by the incredible support of my friends and extended networks - the idea that a couple of clicks of a mouse can translate into true change for a community blows my mind. But THANK YOU for voting, for spreading the word, and for mobilizing for change in order to deliver essential harm reduction services to the streets of DC. You should all be very proud:)

Check out the "official" announcement at http://purpose.maker.good.is/projects/HIPSAfterDark

Much love,
Maxime, Jonathan, and the entire HIPS crew

LAST PUSH for the GOODmaker grant!

I'm so sorry to write annoying messages, but we're in SECOND PLACE for the GOODmaker grant - only ONE MORE SPOT and less than 24 hours to go, and we need your help!

Please vote for us and blast it to your networks - it makes a massive difference since this one is SOLELY based on # of votes!

http://purpose.maker.good.is/projects/HIPSAfterDark?sort=popular

Oh my goodness, Ms. Paula is the fierce-est. She's featured in HIPS' newest informational video on how to VOTE for HIPS on GOODmaker. Send Ms. Paula's message far and wide!

http://www.youtube.com/watch?v=pY5KWB-I574&feature=plcp

Rollin' in the HIPS Van - a first go at overnight mobile outreach

HIPS has been a wild ride so far, in the best way possible. You know that feeling when you're traveling somewhere new for the first time and you feel like you have four million things to write, three million things to process and two million extra things to consider? I feel like that, but I haven't been traveling all that far.

I went on my first mobile outreach about two Saturdays ago, and I have yet to write about it here. From 11PM to 5 or 6 AM on Thursday, Friday and Saturday nights, trained volunteers drive around DC in the HIPS van providing people with condoms, lube, safer sex supplies, safer injection supplies, candy, drinks, HIV testing, and emotional support often in the form of micro-counseling. We work with male, female and transsexual sex workers and with anyone else who we might happen to come across. My night out, most people were extremely open and receptive - some were thrilled to see us and chat, others just got their supplies and moved on - but I never felt threatened or unsafe. We stay in the car and have some strict protocols in place, so there are always ways out of potentially uncomfortable situations.

There are areas we go that are typically known as "trans strolls," and other areas that appeared to attract more cis gendered workers. Since it was my first shift, I had oodles to learn from my team members. Usually we're four to a shift, but this shift we were just three: the driver (and team leader), the one in the "hot seat" aka the passenger's seat, and me packing supplies and taking down some basic info like the number of people reached in a night. Watching the way my team members talked with our clients, engaged them, led them towards harm reduction conversations so naturally was super inspiring. I made sure to take note of how they opened conversations ("Does anybody want free condom, candy,  lube, clean needles, lemonade?!"), how they engaged our clients ("It's so great that you're taking care of your sexual health!"), and turned them towards talking about harm reduction ("What do you like about condoms/lube/flavored lube?"). The conversations progressed naturally from there.

The most memorable part of the night for me happened later on. It was about 5 or 5:30ish in the morning and after observing all night, it was my turn in the hot seat. This time we went to the cis gender female stroll, and pulled up to find one woman leaned over with her forearms on the window of a cop car, unclear if they were just chatting, if she was in trouble, or if it was something more. Another woman was standing far behind her looking wide-eyed and deer-like. I called out to her our night's catchphrase, "Free condoms, lube, clean needles!" and in keeping with the startled-ness of a deer in the headlights, for a moment she didn't seem like she knew where to go. The first woman - the one leaning over the cop car - established herself as the seasoned pro and waved her over in our direction. She came up to the car and I quickly saw that life's edge had done little to weather her pale blue eyes and blonde hair - she was very pretty and very young. Extravagant fake lashes only helped the wide-eyed look.

We talked a bit and I asked how her night was going. "Not good," she responded, "I'm still out here!" She mentioned that she was new to this and new in town, moving around to different cities. We gave her lots of condoms and lube and offered a bunch of our other supplies (dental dams, finger cots, flavored lube, etc.), then asked her if she wanted a bad date sheet. Our bad date sheet is a handout we update weekly detailing bad experiences sex workers have had with johns, and certain distinguishing characteristics (e.g. young white man, 30-35, dark hair, about 6 feet tall in a blue car. Goes by "___." Pulled a knife on her while doing it from behind.) She didn't know what it was at first, but after we explained it to her and handed her one, she went, "Ohhh, this is great - I wish they had this at the last place I was at..." trailing off towards the end

It didn't hit me until afterwards, but her statement was ominous and chilling; what happened where she was last? I wanted to support her, to ask if she wanted to talk about it or if she was okay, but she kept on and kept moving, and that was that.


On a last note, PLEASE vote for HIPS in these two contests - they're done on Wednesday and we have a very real shot at getting it, but only if you VOTE!

http://purpose.maker.good.is/projects/HIPSAfterDark?sort=popular
and
http://workonpurpose.echoinggreen.org/questions/4ffddbf24c41b00aee00020a/answers/5021d3ee4c41b04a84001eff

GOOD Grant

Happy Monday! One more pestering message - essentially the same proposal as what we sent earlier this week and it's a linked grant, but it's for double the $, which would allow HIPS to train even more peer educators, and guarantee that they would be able to spend more nights on the overnight outreach van! It genuinely takes about 30 seconds of your time, and is easier to figure out than the other link - just click the pink "Vote For This Idea" button at the top of the page, and connect with Facebook, Twitter or just your email address.


http://purpose.maker.good.is/projects/HIPSAfterDark?sort=popular

If nothing else, click here to watch an awesome YouTube video of two of our trans peer educators.

Lastly, if you haven't yet voted for the Echoing Green "Work on Purpose" Grant, please do here, and please check out the proposals of the other GHC fellows! 

http://workonpurpose.echoinggreen.org/questions/4ffddbf24c41b00aee00020a/answers/5021d3ee4c41b04a84001eff 

Thank you immensely - this REALLY makes a difference in HIPS' capacity and what we're able to provide for our client base.

Please pass this on to family and friends and encourage them to vote - this one is SOLELY based on # of votes, so the more the merrier!

Thanks!

Maxime, Jonathan and the HIPS crew


Check us out on Twitter @HIPSDC, "like" us on Facebook, follow us on Tumblr http://hips-dc.tumblr.com/, and peep at our website www.hips.org