Long before anyone had even heard of COVID-19, Atlantic City — like Philadelphia and other metro areas — was battling the twin epidemics of HIV infections and injection drug use.
Now, health advocates warn, the seaside resort’s desire to make its storied Boardwalk and the surrounding neighborhood more appealing to tourists is imperiling the very service that helped abate the HIV crisis and has saved the lives of people in addiction. Later this month, most of the City Council is expected to vote in favor of an ordinance to close Atlantic City’s syringe exchange.
“I think all public health people understand how important syringe access is,” said Carol Harney, the head of the South Jersey AIDS Alliance, which runs the city’s Oasis syringe exchange. “How folks, when they’re using clean syringes, don’t transmit [HIV]. It’s the first step for people who are taking care of their health — the first step of harm reduction is recognizing you want a future.”
Unlike in neighboring Pennsylvania, syringe exchanges are legal in New Jersey. (Philadelphia and several other larger cities have established exchanges anyway.)
But the intense stigma around drug use means persuading communities to open them — and keep them — can be a hard sell. Only six other exchanges have opened in New Jersey since Oasis was founded in 2007. Camden’s needle exchange, the next closest, was closed for years after an energy company took over the lot where it used to sit, leaving desperate clients to trek across the bridge to Philadelphia for clean needles — or to reuse used ones, risking infection.
“Like so many things today, it’s a lot about politics,” said Lewis Nelson, the chair of emergency medicine at Rutgers New Jersey Medical School. “It’s not necessarily objectively about health care. There’s no question that needle-exchange programs reduce morbidity from drug use — from overdose, from the risk of HIV and other infections.”
Even after the COVID-19 pandemic exploded infection control into the public consciousness, people such as Nelson aren’t surprised that politicians might threaten another public health measure.
“We live in difficult times, and memories are short,” he said. “Look at the vaccination issue — we know vaccines for COVID are unbelievably effective, and yet, in sections of even our own state, the vaccination rates vary from low to high. Public health is a great concept, but people have to buy into it.”
Founded after years of high HIV rates in Atlantic City, Oasis was the state’s first needle exchange and is still its largest, serving about 1,200 clients. At a rally Tuesday, syringe exchange staffers and supporters from Atlantic City, around the county, and elsewhere in the state called on the city government to keep Oasis open.
“It is a grace to this town — a sacred access to this town,” said the Rev. Willie Francois III, pastor of Mount Zion Baptist Church in nearby Pleasantville. “It would be a sin for the City Council to discontinue these types of services. Sin is denying health care.”
At the crux of lawmakers’ objections to the site is the idea that Atlantic City needs to provide social services such as syringe exchanges that whiter, wealthier towns in Atlantic County wouldn’t tolerate.
Advocates for the exchange and their supporters say pressures from the casino industry have forced other social agencies to close or move from the downtown area over the last few years: a soup kitchen across the street from the Hard Rock Casino moved out of its dilapidated building after it was condemned, and the island’s only dedicated drug treatment center moved to the mainland.
Now, with summer tourism booming as pandemic restrictions have been lifted, seven out of 10 council members have voted to close Oasis, which sits in the tourism district, a quick walk from City Hall and the casinos.
“The powers that be see that one of the biggest issues in Atlantic City are the downtrodden who walk around the city. They make people uncomfortable,” said Moisse “Mo” Delgado, one of two council members who voted to keep the exchange open. “They make people see the harsh reality that they came to Atlantic City to avoid. And [politicians] are trying to eradicate our resources by pushing them out — not recognizing that what you’re doing is killing them off.”
In Atlantic County, fatal overdoses rose to 216 last year, after hitting 180 in 2019.
Kaleem Shabazz, the city’s Third Ward councilman, sponsored the ordinance in the interest of equity. “We still believe that Atlantic City should not be the only city in this area that deals with needle exchange,” he said in an interview.
The bill, which will have a second reading in the council later this month, would require Oasis to shut down within 30 days. Another wrinkle: Because the state oversees Atlantic City’s government, Gov. Phil Murphy — who has expressed support for syringe exchanges — could intervene on Oasis’ behalf.
Shabazz says the council is “not going to let anyone be harmed because of lack of services” and is engaged in talks “to come up with an alternative.” The current proposal includes no plans for relocation.
He admits it’s unlikely neighboring communities would accept a syringe exchange. “I can’t speak to what people are going to do in the future,” he said. “But if the past is any indication of what the future holds, you can probably make an educated guess that our sister communities are not going to rush to engage in this fight.”
Council President George Tibbitt said he is motivated by the needs of people who don’t use the exchange. “Visitors, tourists, having to see a hypodermic needle — it’s not fair to all the people who have done all the right things in life. My residents — my children, my seniors — it has to be one or the other.”
He added that boosting tourism is not his concern: Last summer was the city’s “best ever” for Boardwalk businesses and tourism, he said, and he is more concerned about people who use drugs in more residential areas of the city. He said his constituents have been complaining about discarded needles and are as “mad as hell.”
Harney countered that the exchange sends staffers out three to five days a week to pick up needles and that Oasis — which gives clients one needle for every one returned — has a 97% return rate.
Some exchange critics, such as Tibbitt, insist that it draws people from outside Atlantic City. Harney said that 60% of the exchange’s clients walk to Oasis from within a 10-block radius; 90% arrive from within two miles.
Oasis staffers are fine with moving out of the tourism district, she said, but the site has to remain accessible for its clients. At one point, she said, the city proposed relocating the exchange to a lot on the side of a highway with no access for pedestrians, an untenable offer.
“It’s not people who come down from somewhere else,” Delgado said. “The people that they deal with are people who are so lost -- it’s not a draw. It’s a comfort for people who are already stuck.”
Jorge Villafane, who started attending Oasis shortly after it opened, credits it for helping him get into recovery from injection drug use.
“Before the program was out there, it was hard to get syringes — people were sharing them. And they were spreading all that stuff,” said Villafane, who has lived in Atlantic City for nearly 50 years. “It’s unbelievable — if they shut that program down, AIDS and all that stuff is going to be spread all over the city again.”
The county’s HIV infections plummeted from 71 new diagnoses in 2007, the year the exchange opened, to 28 in 2018, the last year for which data are publicly available.
But Oasis does far more than simply exchange needles: It connects people in addiction with treatment; offers the treatment medicine Suboxone, wound care, and other health care; and distributes naloxone and education about overdoses.
“We are looking to help people that are taking the first step to drug treatment,” Harney said. “Without our intervention, there isn’t any other place for folks to go. Our folks are people. They’re not disposable.”