I want to share the fact that something that was such a negative and shaming and destructive force in my life, has been turned around into something that’s sweet and helpful. I want to share just how desperately alone and isolated people who inject drugs are and how we’re stigmatized even amongst drug culture.David Duffield
Texas HIV Syndicate member and co-founder of the Houston Harm Reduction Alliance and the ShapeShifters needle exchange program, David Duffield, was living and working in Houston in the early 80s as a hairdresser, while also living as a person who injected drugs. David, who has been sober since 2015, shares his story now as a “trade-in that gets me in the door and into meetings, and drives the force behind my passion for organizing the needle exchange in Houston…from that moment injecting into my arm, look where we’re at.”
I was shooting meth in the 80s in Houston, but I ran away to San Antonio for a while because of the “gay plague” and everyone was dying and there was so much shame and no one back in those days talked about not sharing syringes…I had thousands of sexual partners over 25 years of injecting meth and engaging in Chemsex; I let go of all of my values and gave into abandonment…I’m negative, maybe because I was so isolated within my own drug use and I would hide it, but had I been positive, it would have been easy to infect thousands of people.
There is a hierarchy among people who use and/or inject drugs in our community; at the top: non-injecting drug users, then injecting heroin users, and finally injecting meth users. This hierarchy pushes you into isolation and to break through that hierarchy, isolation, and loneliness, I had extreme amounts of unprotected sex over the years. I would denigrate myself to get clean needles…I was spit on by pharmacists…that shame and guilt sent me digging around in the trash can trying to get my needles back…I’m HIV negative, but the only reason that I probably didn’t get HIV is because I became a top and I was isolated in my shooting at first…my boyfriends didn’t even know I was doing it. Also, as a hairdresser, I would use peroxide to clean needles, but I was never actually sure it was working. (For best practices in cleaning needles see: https://www.cdc.gov/hiv/pdf/library/factsheets/cdc-hiv-clean-your-syringes.pdf)
For a long time, I assumed I was HIV positive and I was afraid to go get tested because I didn’t want to hear that answer and when I did go get tested, I wasn’t going to tell them how it was the drug use that worried me. It was easier to say I was having unprotected sex. I also didn’t want to know my status because what was I going to do with that information when I was high? I was just trying to get high. I didn’t want to be distracted by anything. It wasn’t a priority until I sobered up.
I first got tested for HIV at the very first Legacy Community Health Houston back in the 80s. The first time I got sober it was because of Legacy in 1991: I could go buy syringes from them without feeling shame. This is where the inspiration for the Houston needle exchange started for me because for the very first time I didn’t have to feel so much shame about the needles and I could have plenty of them. I could walk away from injecting drugs because I felt so much less stigmatized by the process and I felt that the community was supporting me. I could buy syringes there and they didn’t shame me and no one looked down on me…they created this environment and culture that was so inviting, but it was still part of the ‘system.’ I then went into Legacy’s mental health services and got back on my anti-depressants. That is why I was shooting meth – I was so depressed. At that appointment, they did a physical and tested me for HIV, and I found out I was negative.
In 2003, I relapsed for eight years and I was shooting with all kinds of people, but I tried my best not to share needles because once again, I was sure I was HIV positive…after spending two years in jail, I didn’t get tested again until 2015.
After meeting others and making connections through AA, David and his colleagues decided to start the Houston Harm Reduction Alliance. After working with Legacy to first get clean needles then get sober, David says that part of his goal with the Houston Harm Reduction Alliance was to partner with organizations in Houston to promote harm reduction principles. He also wanted to encourage support from partner organizations “so that when we do bump up against people (or authorities) in our work, they can see that these organizations are involved and that feeds our goal of getting a mobile unit that provides integrated care that encompasses all of the available services. So, when we roll up and people who inject drugs see all of these services, they feel supported. That is how it worked for me and I know it can work for other people.”
David and his colleagues started a needle exchange program in Houston in addition to advocating for harm reduction approaches in May 2018 after connecting with the Austin Harm Reduction Coalition. He and his colleagues also took lessons from the initial needle exchange program in San Antonio. In addition to operating a needle exchange out of his Jeep as ShapeShifters (they handed out approximately 1,300 clean needles in August 2019 alone), the Houston Harm Reduction Alliance now has a physical space in Houston where they can store supplies and host meetings and they are working with the Austin Harm Reduction Coalition and hoping to start working with the Texas Harm Reduction Alliance. They also hope to eventually run a full-service mobile unit with wrap-around services for people who inject drugs.
David also gives talks around Houston about harm reduction and overdose trainings. “We need to speak to doctors and researchers about cultural sensitivity and competency around people who inject drugs…if you want people to come into your studies and clinics, you have to change your ways…we have been working with a local university on a study where we’ll train data collectors how to interact with people who inject drugs in a culturally-competent manner… We have to teach practitioners and clinicians that people who inject drugs have their own culture that is hidden on purpose because there is stigma and criminalization of this culture.”
The Alliance is also currently adding HIV prevention to their menu of services: “We know that it is easy to come up with one-sheet on HIV, but how do we provide wrap-around services of getting people tested and getting them in treatment in a non-traditional way? People who inject drugs will not just roll around, wait, and come back for follow up. We want to figure out how we can fast-track people into meaningful HIV testing, prevention, and treatment…we’re not here to make people get abstinent – if you want to get high, get high, but let’s get you a clean needle.”
David says that he was inspired to join the Texas HIV Syndicate because he wanted to see the group embrace syringe access programs, and he sees it as a great way to network and get support on the surveillance data he and his colleagues are attempting to collect on people who inject drugs in Houston as part of their work to reduce HIV transmission and advocate for the rights and dignity of that community.
Currently in Texas, approximately 1 in 10 new cases of HIV are among people who inject drugs, and while a number of communities have needle exchange programs, they must operate underground, as the Texas Controlled Substance Act of 1989 prohibits the possession or distribution of “a hypodermic syringe, needle, or other object used or intended for use in parenterally injecting a controlled substance into the human body.” However, in September of this year, “The Bexar County [San Antonio] Commissioners Court approved $80,000 in September to fund [a] needle exchange program” representing the state of Texas’ first officially-sanctioned needle exchange program. While this is a small amount of money, it does represent a first step in officially providing support and dignity for people who inject drugs.
The Achieving Together Plan addresses substance use and advocates for providing support for those who inject and/or use drugs. While there is a long way to go towards creating dignity and safe access and spaces for this community, to end the HIV epidemic, we must do more to support these communities, and to ensure that prevention strategies – like clean needles – are available and easily accessible and that the needed treatment and care for those living with HIV is provided without stigma, condemnation, or discrimination.