Public health as a corner store.
(As aired on All Things Considered, July 10, 2002)

 

I got my start in health work a long time ago now by handing out condoms on corners and getting people into workshops to talk about how to make their sex lives safer. At the end of the day, maybe I'd know that someone had liked a workshop or had learned something new, but it was always hard to know for sure whether my work would add up to actually stopping the spread of HIV.

And so I got more and more excited about the idea of an HIV vaccine that could protect people even if they're not 100 percent safe. Then I got a job promoting HIV vaccine research. This wasn't about a few people in my neighborhood changing their sex lives. If we succeeded, this would be about billions of doses of vaccine; this was about changing the world.

But as I continued in the field, I learned that vaccine development is not just science, but also economics. And even more importantly, I began to understand the extraordinary difficulty of figuring out scientific problems. Vaccine trials that we thought would start up didn't. Vaccine ideas that sounded like works of genius looked weaker as they went through further testing. And looking back at my own initial enthusiasm, I began to suspect that I'd been looking for a magic spell to wipe out the difficulties of fighting AIDS.

This year I've returned to street corners. As a volunteer, I'm part of a crew of health workers that drive an RV through a set of scheduled stops. People who inject drugs meet us with their used needles. They count out the needles and we drop the needles into biohazard containers, and then we give them an equal number of clean, sterile needles in return. It's a beautifully simple system.

The scientific journals reassure me that when I exchange a clean needle for a dirty one I'm helping the larger community. If needles are scarce and costly, people keep them and share them and pass them around. But if clean, new needles are easy to get, they become more valuable than used, dirty, dull needles. That slows down the virus at what could be an epicenter of infection. And without the epicenter, you don't have as much HIV infection even among people who don't shoot up.

When I was on street corners trying to get people to come to safer-sex workshops, I gained a lot of sympathy for the unfortunate people who pass out fliers for nail salons and pizza joints. A needle-exchange site, on the other hand, is mostly a friendly and even enthusiastic community. People come to us. And if we're late, we hear about it.

Once we open the doors to the RV, I say hello to the regulars, make jokes, check in. "You like you've had a long day," I say to a woman who looks more tired and weary than usual after she counts out her needles. And she says, "You better believe it." I say, "All right now, take care," as an old man steps gingerly down and out the door. "Have a good weekend," he says back to me, waving goodbye.

When I first started working in HIV vaccine research, I got so obsessed with the big picture that I think I'd almost forgotten about the necessity and the pleasure of helping people one person at a time. So for the future, I hope to be spending time on street corners, in neighborhood clinics, in vans parked in alleyways. "How you doin'? Nice to see ya." It's public health as a corner store.

Not that I've given up on an HIV vaccine; in fact, when we get a good one, I hope to take that vaccine out to those very same street corners. "How you doin'? Nice to see ya. Now this vaccine's not perfect, so you still got to take precautions, OK? All right. Have a good weekend. Take care."

 

copyright 2002 joe wright
broadcast and transcript, copyright 2002 national public radio