MOTT HAVEN — At certain hours, a visitor to the CitiWide Harm Reduction center on East 144th Street could be forgiven for mistaking the syringe exchange and health clinic for a clubhouse.
The center’s clients, most of them active drug users and many of them homeless and suffering from chronic illnesses, can shower, do laundry, watch TV or eat a hot meal at the site, in addition to receiving counseling, medical treatment and sterile syringes.
Beginning next week, they will also be able to fill their prescriptions at a new in-house pharmacy.
When construction finishes this summer on a 4,000-square-foot suite of offices and meeting rooms on the building’s third floor, clients will be able to check email, join support groups, dine at a mini-café and get free haircuts.
"We just want to make life a little easier for them," said Roxanna Solano, a nurse at the center’s health clinic that opened last month and is run by HELP/PSI, a medical provider that specializes in treating drug users and people with HIV.
Brian Weil, a photographer and AIDS activist, founded CitiWide as a syringe exchange program in a South Bronx church in 1995. Weil died of a heroin overdose the following year, but the agency survived.
Today, CitiWide distributes about 500 clean syringes and injection kits daily from its drop-in center and at nearby single-room occupancy buildings. The center also offers rapid HIV and hepatitis C testing, counseling, case management, housing assistance and even ear-point acupuncture, which can reduce drug cravings.
"To me, it’s like a home," said Edward Harris, 41, who has relied on the agency’s help in managing his HIV infection since 1996.
As soon as the center’s health clinic opened in March, Harris made an appointment with one of its doctors. When the pharmacy launches in May, Harris plans to fill his prescriptions there.
"Why not get everything in one place?” said Harris, who lives in an apartment a case worker found for him.
Evers Pharmacy, which is based in Jamaica, Queens, will operate the full-service pharmacy on the second floor of the CitiWide Harm Reduction center.
This population "needs a lot of attention," said Evers pharmacist Bobby Rallakis. "They need that living touch."
Rallakis expects to confront a challenge that the health clinic already faces: getting patients who lead tough, often chaotic lives to adhere to their prescribed treatments.
Three-quarters of the agency’s roughly 3,000 clients arrive at the center homeless. Half have hepatitis C and one-quarter are infected with HIV. Their average annual income is less than $9,000.
"It’s hard enough for those of us who have a lot of resources to keep track of everything," such as doctors’ appointments and medication schedules, said Dr. Barbara Zeller, HELP/PSI’s chief medical officer.
Zeller said bundling various medical and social services in one building helps the staff coordinate their efforts and keep track of their shared clients.
But still, she said, there is a limit to the center’s reach.
"It can become heartbreaking when you know you can help someone better, but it’s hard for them to take medication on a regular basis," Zeller said.
One way the agency tries to keep clients coming back is to create a calm, inviting space for them.
The walls of the health clinic and pharmacy are transparent, the manager on duty sits at an open podium and often chats with clients, and the new café will feature furniture from an old restaurant rather than a hospital supply store.
"We’re not shooting for the institutional look here," said Robert Cordero, the agency’s executive director.
Cordero also noted that many staffers can relate to their clients’ lives: 90 percent live in the Bronx or Harlem, one-third are openly HIV-positive and one-fifth are former agency clients.
The agency’s emphasis on getting and keeping its clients healthy, without pressuring them to quit their drug use, can be controversial. Congress recently reinstated a ban on federal funding for syringe-exchange programs.
But Cordero and others pointed to studies that show that syringe exchanges can curb the spread of HIV without increasing rates of injection-drug use.
Cordero also said his staff regularly details the health risks of drug use to clients and describes tools to help them kick the habit.
"The focus is on improving their health," said Cordero, who served as the deputy director of AIDS policy in the Bloomberg administration. "You’re not directing; just listening."
Johnny Santiago lived on the streets of the South Bronx and often shared needles with other drug users when he encountered a CitiWide outreach team two years ago.
Since then, he has accessed clean syringes, treatment for hepatitis C, help with housing and warm meals at the center, where he said he feels welcomed as he is.
"They know how to talk to people," said Santiago, 44. "Nobody’s judging you."
