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Syringes and Needles on the Street in San Francisco: What’s Being Done?

, by Emily Land

Organizations based in the Tenderloin and Civic Center neighborhoods have joined forces with public health authorities to increase the safe disposal of injection drug equipment in the area. In response to an increasing number of public complaints and questions from concerned citizens, they are collaborating to combat the problem.

Read on BETA why unlimited syringe distribution is the best model to prevent the spread of infectious disease.

“There’s been an observed increase in the number of syringes left on the street in the last 18 months,” said Eileen Loughran, community engagement coordinator for the San Francisco Department of Public Health.

Needle sign

A sign at a San Francisco AIDS Foundation needle exchange site reminds clients to safely dispose of used needles (Photo: BETA)

Certain neighborhoods seem to be more affected than others. A report from the Department of Public Health Syringe Tracking Project notes the rise in improperly discarded syringes in the Civic Center/U.N. Plaza area. In October of 2015, ten organizations—including San Francisco AIDS Foundation, Glide, SFDPH, the Asian Art Museum, the San Francisco Main Library, the Department of Public Works and others—reported picking up a total of 2,964 discarded syringes in this neighborhood.

“San Francisco city dynamics are changing. There have been increases in construction and more displacement of homeless people. Tensions have arisen in some neighborhoods where expensive housing is located near homeless encampments or services for marginalized populations. These types of changes are resulting in increased complaints about discarded syringes. Disposal options we relied on previously are no longer sufficient, and need to be expanded. But we recognize the need to be proactive, which is shaping how we are responding,” said Loughran.

Because of the increase in discarded syringes—Loughran and others have had to work quickly and creatively to come up with solutions. Here’s what the San Francisco Department of Public Health (SFDPH) and other stakeholders are doing:

Working together in unlikely, yet effective, partnerships

“We’re using a ‘collective impact’ approach to address the issue of discarded syringes,” said Loughran. Collective impact brings people together, in a structured way, to achieve social change. This started out rather organically with some unlikely partners, until we realized that we’re all working on the same goal—to reduce the number of improperly discarded syringes.”

sharps container

Sharps containers are distributed to needle exchange clients (Photo: BETA)

She said that SFDPH funds San Francisco AIDS Foundation to provide syringe access and disposal for the city. The foundation, in turn, subcontracts with St. James Infirmary, Glide, the San Francisco Drug User’s Union and Homeless Youth Alliance to provide disposal services at 18 different sites. The Homeless Outreach Team, armed with disposal supplies provided by San Francisco AIDS Foundation, goes to homeless encampments to distribute disposal supplies and education about how to dispose of injection equipment safely.

As part of a strong partnership between SFDPH and the San Francisco Police Department, the department of public health is able to provide trainings at police stations about the syringe access and disposal program. SFDPH also provides bio-bins and tongs to the police station in the Tenderloin neighborhood so that all patrol cars are equipped with tools to dispose of syringes safely.

Since 1991 Walgreens pharmacies have been a disposal option. Walgreens will receive and dispose of 2.2 quart bio-bins and supply an empty bin in return; this is done as a “good neighbor” practice and is not overseen by SFDPH.

Even the Asian Art Museum and the San Francisco Main Library branch, which are located in the heart of the Civic Center/U.N. Plaza area, are involved.

“About two years ago, I received a call from facilities management at the Asian Art Museum who was concerned about the number of syringes outside the building. As we talked, the course of the conversation shifted dramatically. We developed a partnership, where San Francisco AIDS Foundation provided training to the museum facilities staff about the syringe program and how to property clean up syringes. Now, the foundation regularly drops off empty bio-bins for the staff and takes back the full bins,” said Loughran.

“The same is true for the library—they’ve been a great partner by participating in syringe disposal and cleanup. The Eureka Valley Branch Library has requested that a disposal box be placed in their parking lot. We are currently working with the social workers at the main library to provide disposal supplies to the homeless inside the library. Now, people that hang out inside the library are able to access disposal supplies,” she said.

“San Francisco Public Library is very much involved in community engagement and in finding solutions for the common good,” said Michelle Jeffers, chief of community programs and partnerships at the library. “As an already active partner with the Department of Public Health, it was a natural step to also work in partnership on syringe disposal and educating the community around this issue.”

Setting up permanent disposal boxes in neighborhood “hot spots”

Although the city says it’s not feasible or cost-effective to erect permanent outdoor disposal boxes all across the city, SFDPH has prioritized the placement of boxes in neighborhood hotspots where large numbers of syringes are discarded. There are currently 10, 24-hour disposal boxes located in the Civic Center and Tenderloin neighborhoods, near the 101 overpass in the South of Market neighborhood, and at the Navigation Center in the Mission.

Loughran said that it takes a few months to organize and get the approvals necessary to put up a disposal box. And that once one is put up, it takes the syringe providers and community members to educate people about where the boxes are so that they’re used.

Organizing community cleanup events

The Syringe Access Services (SAS) program of San Francisco AIDS Foundation, in collaboration with the Syringe Access Collaborative, recently organized a syringe cleanup event in the SOMA and Tenderloin neighborhoods. Thirty-eight people volunteered for the event, and were trained on how to safely dispose of injection litter, before going out to sweep alleys and side streets.

“The cleanup event was really successful. My hope is that we will have these on at least a quarterly basis, if not more,” said Loughran.

“When you have that many people out and about—cheerfully going about the neighborhood to pick up syringes—it kind of demystifies and destigmatizes syringes that get left on the ground,” said Kristen Marshall, SAS logistics coordinator. “I think it helps break down barriers that people have to talking about this issue. Events like this show that we can talk about this issue without fear-mongering, that we can come together and contribute to something that everybody wants—a cleaner, safer community.”

Regularly scheduled community cleanup events may be part of a longer-term strategy to get syringes off the street, said Loughran. She receives data reports from San Francisco city service 311 showing calls made about discarded syringes so that she can figure out if there are trends or changes in where syringes are being discarded, and to identify hotspots.

“Sometimes we’ll get a lot of calls about a particular area, but then people camped in that area may have to move somewhere else. So we keep an eye on those sorts of trends, so that we can figure out if we need to do more sweeps, more cleanups or if placing a disposal box is the best solution,” she said.

Funding a Rapid Response Team

In response to the observed increase in improperly discarded syringes, SFDPH has created a Rapid Response Syringe Clean Team. In addition to focusing on cleaning up syringes in the Civic Center and UN Plaza locations, the three-person team will respond to calls about discarded syringes in real time across the city.

Loughran reports that hiring for the three-person team is currently underway.

Increasing education about where to dispose of syringes

Community partners that help to distribute syringes are increasing efforts to educate people about where to dispose of syringes, and why it’s so crucial.

“Most syringe access service participants share the same concerns for community safety as homeowners, neighborhood groups, San Francisco families, and public health advocates.  Like other San Francisco residents, program participants do not want to see syringes on our streets. Improperly disposed-of equipment contributes to the further stigmatization of people who use drugs and can diminish community support for the many lifesaving harm reduction and syringe access programs in our city.  Harm reduction programming, HIV/HCV [hepatitis C] prevention, overdose prevention, linkage to health, mental health, and substances use services, and the disposal services our programs offer are good for the WHOLE community,” said Terry Morris, program manager for Syringe Access Services at San Francisco AIDS Foundation.

“We engage all of our syringe access visitors around safer disposal, include disposal containers in all of our pre-packed kits, do outreach to pharmacies so they link people purchasing syringes to safer disposal options, we walk San Francisco’s streets and alleys picking up discarded injection equipment, maintain community disposal boxes, safely dispose of tons of used injection equipment each year, and attend community workgroups and neighborhood group meetings to listen to neighborhood concerns and build alliances to work towards solutions to address disposal problems,” she said.

Read more about the history of health and needle exchange in San Francisco on SFAF.org. If you’re concerned about discarded syringes in San Francisco, and want to help, consider volunteering at a Syringe Access Services event or helping at a future community cleanup event. Email Jody Schaffer (jschaffer@sfaf.org) director of volunteer services at San Francisco AIDS Foundation to find out more or sign up for a volunteer shift through Bay Area Hands On.   

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