Reggie Jackson spends much of his day inside a Winnebago, riding through the city's hard-scrabble neighborhoods to hand out clean syringes in exchange for dirty ones.
"We're saving lives, man," Jackson says. He's on a mission to protect drug addicts from HIV, which Jackson learned he had in 1990 after years of sharing needles to shoot heroin and crack cocaine.
District of Columbia officials are counting on Jackson and others like him as they try to tackle an AIDS crisis so severe that one report has called it a "modern epidemic."
Despite such alarms, little has changed over the years as city leaders struggle to reverse a startling statistic — one in 20 residents in the nation's capital is believed to be infected with HIV, a rate worse than any American city and one that rivals some developing countries.
But there is reason for optimism, officials say.
Congress lifted a decade-long ban in December prohibiting D.C. from using local tax dollars to support needle-exchange programs. Critical funds are now starting to reach these groups, allowing them to increase outreach efforts and add workers like Jackson.
It remains to be seen, though, how much of a dent will be made in slowing the virus, which has touched nearly every cross-section of Washington.
"There is no silver bullet," said Walter Smith, the director of the D.C. Appleseed Center for Law and Justice, an advocacy organization that is monitoring the city's efforts to reduce HIV infection. "There are multiple factors that have produced our high HIV/AIDS rate and it will take multiple factors to bring it down."
The reasons include unstable leadership at the city's HIV/AIDS prevention office, which has had 12 directors in just over 20 years. That has slowed strategies to get a handle on the disease.
Washington also has a high population of black and gay residents — groups where the rate of infection has been high historically.
Still, one statistic has particularly frustrated D.C. officials: More than one in five of Washington's HIV cases were transmitted through intravenous drug use, according to a report released last year by the city's HIV/AIDS Administration.
Needle exchanges are being used in 36 states, D.C. and Puerto Rico to slow the spread of the disease through IV use, according to the North American Syringe Exchange Network. Many of the programs are financed with state or local money.
In 1998, however, Rep. Todd Tiahrt, R-Kan., and then-Sen. John Ashcroft, R-Mo., inserted language in the federal spending package that blocked D.C. from funding such programs because of concerns about drug abuse. They were able to do so because Congress approves the city's budget.
D.C. needle exchange advocates say the ban left them without an important tool in a city where roughly 10,000 residents are believed to be injection drug users.
"If you want to reduce the spread of HIV ... you put more syringes out there," said Ken Vail, executive director of PreventionWorks!, where Jackson works.
The program, which serves the city's residents through a roving Winnebago, survived during the congressional ban mostly on private donations.
During that time, PreventionWorks! was able to reach roughly 2,000 of Washington's intravenous drug users annually, Vail said. He is hoping to double that number now that D.C. has agreed to give PreventionWorks! about $300,000 a year for the next three years.
The money is the largest share of nearly $700,000 the city is allocating annually for needle exchanges. Other organizations receiving help include those that work with specific high-risk groups such as sex workers and the homeless.
Critics include the White House Office of National Drug Control Policy, which argues the needle-exchange programs may actually increase disease infection rates because they fail to curb risky behaviors associated with needle-sharing.
Advocates such as Sharon Hader, who leads the city's HIV/AIDS Administration, note that such programs are about more than handing out needles; they also counsel users about rehabilitation services, provide HIV testing and offer supplies such as condoms.
"Needle exchange is not a standalone intervention," Hader said. "It's bundled with a lot of wraparound services."
On a recent day, about a dozen drug users lined up outside the PreventionWorks! Winnebago to trade in dirty needles. Most were unemployed men in their 40s and 50s. Some were rail-thin, and others had arms covered in pockmarks from years of drug abuse.
As they stepped inside, Jackson sat at a computer and typed in data while his colleague, Hazel Smith, handed out syringes — "blues" and "apples" for those who have been injecting drugs for shorter periods and "groins" for longtime addicts whose veins are badly damaged.
"Need some condoms, baby?" Hazel Smith asked as she handed eight blues to Deborah Jones, an unemployed woman from southeast Washington.
"You can give me two packs," replied Jones, 46, who said she has been coming to PreventionWorks! for the past five years. So far, Jones said, she has not been infected with HIV.
"I'm blessed, not lucky," Jones explained.
Hazel Smith then stuffed the supplies into a brown paper bag and, before sending Jones on her way, offered some parting words. "Be safe, be careful."
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