In the face of community opposition, a longtime syringe exchange program is considering a gradual move away from its operation out of a van in Chinatown to a more permanent brick-and-mortar location. 

The program allows drug users to pick up clean syringes in exchange for used ones to help prevent the spread of bloodborne diseases like HIV and hepatitis. 

Already, the program has been operating two days each week from van at a city property in Iwilei, about a mile away from its longtime location on Kukui Street. But getting to a more permanent location is not as simple as shifting sites. 

One big challenge is ensuring that current clients aren’t lost in the move. To find out if that would be an issue, the syringe exchange operator Hawaii Health and Harm Reduction Center has been tracking statistics over the past few months to see if clients have been following them to Iwilei.

“Consistency and access is really important,” executive director Heather Lusk said.  

Another challenge is finding a permanent home, since operating out of a van is not ideal, according to program manager Joshua Derrig.

“In my mind, if we’re going to move somewhere, I’d love for it to be a brick-and-mortar space,” Derrig said.

The discussion of moving to a more permanent space was fueled largely by recent opposition from community members. But it’s a move that the center also supports, in theory.

The tricky part is just finding a good location that doesn’t disrupt current clients’ routines. City officials including Managing Director Mike Formby have gotten involved, and multiple community meetings have been held over the past year or so to figure out a solution. 

Community Complaints

When the syringe exchange program started in 1989, it did so with a focus on reducing the spread of HIV. Drug users receive one new syringe for every used syringe they bring to the van. 

The restriction prevents the van from indiscriminately giving away new syringes to anyone who wants one, though the Centers for Disease Control and Prevention recommends boosting the availability of clean syringes by getting rid of the one-for-one requirement altogether.

Hawaii’s syringe exchange is overseen by the state Department of Health, which contracts the service to Hawaii Health and Harm Reduction Center.

The program is active in each county and does more than solely exchange syringes. It also gives away condoms, the overdose drug Narcan and extra items like food and rain ponchos. On Thursdays, the Chinatown van offers HIV and hepatitis C testing, and the team always offers to connect people to treatment.

In addition to its van in Chinatown, Honolulu has another van that does mobile outreach around the island at beach parks or wherever its partner organizations direct it.

Clients are expected to receive their clean syringes and then leave to inject drugs elsewhere. But that doesn’t always happen.

“I was getting a bunch of complaints from the community, who sent photos in and documented that many times after the people exchanged their needles, they actually sat in the community near the van and injected and then fell asleep or became just sort of incoherent,” Formby said. 

Kids walking to and from Keelikolani Middle School — across the street from a methadone clinic for drug users weaning off of harder opioids — would pass by these people, Formby said. 

Formby said that he and other city officials started paying closer attention about a year ago when they heard from residents at community meetings in Chinatown. That’s about when he reached out to Hawaii Health and Harm Reduction Center to talk about options.

Employees at the center said they appreciate Formby’s involvement. 

“Formby has discussed the possibility of seeing if they could find us a fixed site, where we could operate out of that meets the needs — our needs — but also meets the community’s needs. And obviously that would be a win-win,” Lusk said. 

Starting last fall, the organization reached an agreement with the city and Chinatown community members to operate out of Punawai Rest Stop in Iwilei every Wednesday while remaining near the intersection of Kukui Street and Nuuanu Avenue in Chinatown every Monday, Tuesday and Friday. The program operates from both locations on Thursdays.

Even just picking Wednesday as their pilot program day required a lot of thought.

“In case somebody didn’t make it there from Chinatown, they would still get a Tuesday and a Thursday in Chinatown to get their treatment,” Lusk said.

The city is awaiting Hawaii Health and Harm Reduction Center’s ideas for relocating so that it can help the center find a new brick-and-mortar spot, Formby said. The center might, for example, decide to lessen its presence in Chinatown and move to a permanent spot in Iwilei. 

“I would have to have a conversation with the Iwilei community about their acceptance and agreement to that and how we could make it work, and I would do that and I would find them a place in Iwilei,” he said. 

But the program says it is waiting for the city to act.

“We would love to stay here as long as we possibly can,” Derrig, the syringe exchange program manager, said. “So we’re not pushing to move anytime soon. We will kind of take the direction of the city and obviously work in collaboration with them.” 

Moving into a permanent space would provide more privacy to the program’s clients, Derrig said. But he added that finding a suitable spot will likely require city assistance to deal with neighborhood concerns.

“We don’t just want to move into a space willy-nilly and then have the same types of opposition or issues that we’re having,” Derrig said. 

Location Is Important

A busy day at the Iwilei spot sees about 30 people show up between the scheduled hours of 9 a.m. and 2 p.m., while a busy day at the Chinatown spot sees closer to 100 to 120 people, Derrig said. Sometimes the line can be 30 minutes.

Kamui Cseais was one of these people on Friday afternoon. He said that he often sleeps on the streets about a five-minute walk away, and that prior to visiting the van he used to buy packs of new syringes from Walgreens but had no safe way to dispose of them.

“So I just kind of stockpiled a shit-ton of needles for a long time, until I finally found out where these guys were and started coming to them,” he said. Cseais estimated that he turned in at least a thousand needles during his first visit a few years ago.

Camie Sandridge, who has been sober for about five years and now lives in Kahauiki Village with her husband and two children, said that she used to sleep on the street around the corner from the van and started going there just before starting treatment.

“I know the van had helped me save my life more than once. I could have possibly picked up a disease. Somebody could have come across a dirty needle. So I know that it really helped me when I was at that point in my life — and they helped me get into treatment when I was ready,” she said.

For her part, Sandridge said that she understands why some community members didn’t like the van’s prior location closer to the river since it made the area feel sketchier. But she also said that some community members will oppose it no matter where the program is located.

And even though it wouldn’t have been as convenient, if the program were to have moved to Iwilei when she was still using it, she said that she would have made the walk.

“That’s how much my life depended on it,” she said.

Civil Beat’s community health coverage is supported by the Swayne Family Fund of Hawaii Community Foundation, the Cooke Foundation, Atherton Family Foundation and Papa Ola Lokahi.