Fair Exchange Is No Theft

RI defunds its only needle exchange

by Andrew Deck & Will Weatherly

Illustration by Dorothy Windham

published October 28, 2016


On October 2, a group of monsters, superheroes, and drag performers gathered at The Dark Lady, a gay bar on Snow Street. They huddled outside its front doors, smoking cigarettes and turning the sidewalk into a vision of Disneyworld in the hours after its performers’ shifts end. The performers were there to support a Cartoon Couture fundraiser hosted by AIDS Care Ocean State (ACOS), a Providence organization which provides outreach, prevention, and care services for people at risk of or affected by HIV/AIDS infection. The event catered to a powerful cross-section of audiences: it drew upon the city’s queer community as well as partygoing young people, whom ACOS identifies as likely to mobilize around the issue of HIV/AIDS. George Marley, ACOS’s development director, collected the cover charge at the door dressed as Harley Quinn. Performers Onyx and Crystal Mess expressed doubt that the attendees were aware of what the event was for. Crystal Mess told the Independent that they had initially taken the job as just “another chance to perform.” The event, like the people at it, was putting on a costume, celebrating cartoons and queerness to gather under the rallying cry of supporting ACOS. 

That call for support became more urgent this past June, when the General Assembly failed to renew state funding for ACOS’s needle exchange program, ENCORE. ENCORE works to provide sterilized syringes and disposal of used ones for intravenous drug users through outreach teams in communities across the state. For several years, the supplies for these services had been funded by the state's community service grant program. Totaling $65,000, ACOS’s community service grant represented 60 percent of the organization’s state funding for the 2017 fiscal year, according to the Providence Journal. ACOS now faces the task of seeking other funding or drawing from resources allotted to its other services, including its outreach, education, and programming efforts.

Established in 1994, ENCORE has purported to be an integral force in the state’s drop in HIV/AIDS transmission rates among intravenous drug users, from 17 percent in 1994 to 1 percent in 2015. Given the necessity of ENCORE, the only program in RI of its kind, and its increasing relevance amidst the state’s rise in both opioid overdose and Hepatitis C (HCV) mortality rates, the General Assembly’s decision seems deeply misguided, if not harmful. And for some members of the queer community represented at Cartoon Couture, the state’s lack of AIDS prevention as a funding priority echoed the start of the AIDS epidemic in the US during the 1980s, when a combination of policymakers’ apathy, queer marginalization, and lack of accessible care fatally intersected for 362,000 people in the span of fifteen years between 1981 and 1996. An attendee at the event dressed as Wonder Woman fumed that “to cut off requisite health care to a minority group that is already so marginalized is a slap in the face to the people [the state] claims to believe in and support...People are saying it didn’t have anything to do with the gay community, it was just about cutting back. Well, why cut back that?” 




 In the past year, the General Assembly’s community service grants have faced public scrutiny, restructuring, and a federal investigation. Last spring, the former Bristol Representative Raymond E Gallison Jr., Chairman of the House Financial Committee at the time, resigned after he was found to be on the payroll of an education nonprofit receiving a community service grant. In effect, for 10 years, the nonprofit’s annual $70,000 grant was a part of Gallison’s salary. An FBI and state investigation were launched into the claim, alongside embezzling and solicitation charges. 

Gallison’s affair affirmed criticisms that the Assembly’s allocation of grant money wasn’t transparent. The criteria used in the grant selection process wasn’t publicly known, and in effect community service grants put several million dollars into the hands of the Speaker of the House and President of the Senate to dole out, often to build goodwill and bolster reelection bids. Last year, House Speaker Mattiello was heavily criticized for directing a $125,000 grant to sports, youth and community programs in Cranston, his home district. But it was only after “Gallison’s misdeeds that the Speaker and Senate President thought it was time to tighten up the community service grants program,”  Larry Berman, communications director for the office of the Speaker, told the Independent in a phone interview. While the allocation process was changed slightly—in addition to the grants awarded by the Assembly, some of the money is now pooled and given out to state agencies to distribute—The House Speaker and the Senate President still decide (with input from their staff) who gets funded. The primary response was not a procedural overhaul, but a slashing of the grant program entirely. The budget for grants was cut in half, from $11.6 million in the 2016 fiscal year to $5.1 million for this coming year. It was in this funding void that ACOS saw its anticipated financial resources disappear. 

26 community service grants were awarded last June under the new budget. AIDS Care Ocean State was off the list, as were nearly one hundred other organizations accepted the previous year. Even after “tightening up” the program, the reasoning used to approve certain grants and deny others remains murky. “If the service could be duplicated somewhere else or it wasn’t significant enough, we just deleted it,” House Speaker Nicholas Mattiello told the Providence Journal in June, soon after announcing the 2016 fiscal year grant recipients. That reasoning falls short in the case of ACOS. As the only needle exchange service in the state it stands distressingly alone in the statewide efforts to combat HCV and HIV transmission. Further, Rhode Island law actually mandates that the Department of Health maintains a needle exchange program. When asked why ACOS didn’t make the cut, Berman attempted a “unique need” argument similar to Mattiello’s, before acknowledging that this didn't necessarily apply to ACOS. Instead, he reasserted that ACOS was just one of many organization facing funding cuts. “They pretty much scrapped the entire community service grant program,” he said. 

While it’s true that ACOS joins a large group of worthy community service organizations turned away at the door this year, the grant program wasn’t entirely scrapped. RI Coalition Against Domestic Violence, Meals on Wheels, and Rhode Island Legal Services, all received funding. Alongside these critical services organizations was John Hope Settlement House, who the House had planned to offer a $300,000 community service grant before the legislature’s audit of the organization this past June when the organization’s chairwoman was found to be an RI state representative—a near repeat of the Gallison scandal. If there are some standards to the ways organizations prove themselves to be worthy of community service grant funding, they seem broad enough to value a range of organizations, and even some that are questionably deserving. 

ENCORE has proven itself to be a valuable service, especially for the intravenous drug users it serves. ACOS's website reports that in 2015 alone, the program distributed 57,783 clean needles and collected 43,308 contaminated ones. The program also distributed 108 kits of NARCAN, a medication which counteracts the effects of an opioid overdose. 25 individuals were given NARCAN kits during an opiate overdose by the ENCORE outreach team, likely saving their lives. But while in the same fiscal year the General Assembly allocated $375,000 to WaterFire, it couldn’t find a justification for the $65,000 ENCORE needed for supplies like NARCAN. For AIDS Project RI, a Providence organization which provides HIV/AIDS testing and education, the needle exchange is an integral element of AIDS prevention in Rhode Island. Its executive director Stephen Hourahan stressed to the Indy the extent of ENCORE’s impact with the little money it needed for its success: “It’s very small dollars, $65,000, ultimately. To be that effective and to save that many lives is a huge impact.”




ACOS isn’t the only organization serving queer Rhode Islanders that saw a loss of funding this fiscal year. Youth Pride RI, a queer youth advocacy and community group, saw its state funding of $50,000 entirely eliminated following the budget cut. Youth Pride is the only organization of its kind in the state, yet Speaker Mattiello justified the cuts to RIFuture because he felt “those services, needs, potentially are being serviced elsewhere,” including by “guidance counselors in the school[s].” 

“I’m not really sure that’s the case,” Youth Pride RI Executive Director Christopher Lauth told the Independent. “The truth of the matter is that LGBTQ folks in our society have special needs... the mainstream kinds of services don’t support the needs of our folks and the people in our community… there’s a need for training and education that’s also ongoing. We know that for some of these specialists in their education program, there’s not enough that is covered for underserved and underrepresented communities.”  

This was the state’s approach to ACOS as well. The General Assembly dissolved the support for ENCORE’s specialized purpose, while hoisting its responsibilities on a broader infrastructure that doesn’t yet exist for the communities it serves. For people like the Wonder Woman at Costume Couture, the erased needs are those of the LGBTQ community, as the needle exchange program has worked to prevent HIV/AIDS, a disease intractably connected with queer history. “It really wasn’t so long ago that the whole outbreak started, and I think [the movement] has come such a long way,” she said to the Independent. 

But even this narrative reduces the nuance of what needs ENCORE seeks to address, and whose needs those are. Which is troubling, because despite Mattiello’s assumption that those needs are being met elsewhere, more populations are in need of clean needles with every passing year. “We often get grouped with LBGTQ organizations because we’ve always been serving that population,” said ACOS development director George Marley in an interview with the Indy. “But as technologies enhance and medications are more readily available, effective, and less expensive (theoretically), the population we serve takes on a new look.” 

That “look” for ENCORE is not necessarily characterized by queerness, but rather populations who can’t afford clean needles for intravenous drug use. In Rhode Island, this financial insecurity increasingly puts individuals at risk of HCV more than HIV, a detail that the typical AIDS-focused queer narrative might ignore. With an estimated 4-7 percent of Rhode Islanders infected with HCV, the disease surpassed the number of people infected with HIV/AIDS, at around 1 percent of Rhode Islanders infected. Its resulting mortality rates have multiplied fourfold over the past decade, with 102 HCV-related deaths in 2014. Though HCV can be transmitted sexually, it doesn’t carry as close of an association with queer sexual practices; the RIDOH report identifies ENCORE as a priority for prevention, but it doesn’t single out “men who have sex with men” as a population experiencing higher risk.  

What it identifies instead is alarming: the extent to which the spread of HCV dovetails with Rhode Island’s opioid epidemic. “[RIDOH] researchers laid two maps side by side: one, the location of the diagnosis of hepatitis, the other, the location of the state’s opioid overdose deaths,” reported RIPR. They found that the maps nearly “perfectly overlap,” and that HCV infection is “highest in areas with the highest rates of opioid overdose deaths.” 

The populations suffering at the confluence of these two crises are varied; public health officials and HCV activists identified women and people of color as particularly at-risk. “When you’re talking about the situation with our needle exchange program,” Hourahan explained, “you’re talking about IV drug users who are most likely not gay and not queer, so I think that there’s a question [about whether] there’s a perception of others that are impacted.” 

The absence of this perception emphasizes the importance of considering the needle exchange as not only a fight against HIV/AIDS. If it was, ACOS’s fight would seem to be more finished than it is; both Thomas Bertrand, the chief of RIDOH’s Center for HIV, Hepatitis, STDs and TB, and Amy Nunn, Director at the Rhode Island Public Health Institute, credited ACOS for nearly eradicating HIV/AIDS transmission via intravenous drug use. And considering the growth of HCV infections, the financial vulnerability of the populations it touches, and its pernicious spread through increasing opioid use in Rhode Island, these factors only serve to emphasize the needle exchange’s continuing necessity. 

Placing ACOS’s work in a continuity with the mainstream narrative of the AIDS epidemic of the 80s partially reduces the nuance of current epidemics in Rhode Island. Part of the project of emphasizing the value of programs fighting these diseases to supporters is to emphasize them in all their complex, modern urgency, honoring the needs of the populations affected in ways the General Assembly failed to do. Ironically, many of the people doing this are queer people like those at Costume Couture; they may be drawn to their passion about AIDS through its queer legacy, but they’re also the ones who organizers rely upon most frequently for support in developing movements. Hourahan reported that, for AIDS Project RI,  “our most vocal people and most people associated with the AIDS organizations around the country are mostly queer, and therefore there’s a clear connection between those two.” This was the strength of Costume Couture’s overt queerness: people like Onyx and Crystal Mess, who assembled their fellow performers after a single call. The costumes that night might have disguised the grim realities of increased infection and opioid overdoses beyond the Dark Lady, but they also brought and showed queer support, a demonstration of loyalty to a cause that has grown far beyond them.  

Even so, Yolandi Fizzure, a drag performer and Cartoon Couture’s organizer, expressed hope that these efforts wouldn’t always fall on queer shoulders, or be seen as only queer issues. “For the gay community, its charity event after charity event,” they sighed, watching people trickle into their event. “There’s a lot of problems that are affecting our community… we should get, y’know, some straight people in, and some of their straight money,” they joked, and laughed through a Maleficent face mask. 


ANDREW DECK B’17 and WILL WEATHERLY B’19 want RI’s straight money to return to ENCORE.