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Faced with an AIDS problem growing here at a rate 10 times the national average, Ron Daniels, the director of Prevention Works, the city’s only needle exchange program, is armed with a shoestring budget of $385,000 in private donations, a small fraction of what programs in other major cities receive in state and local money.

 

“For every person I help, there’re seven more I can’t reach,” said Mr. Daniels, 49, who describes his program as providing a thin wall between the city’s drug and AIDS epidemics. “But I’d be reaching a lot more if my hands weren’t tied.”

Critics of needle exchange programs argue that rather than reducing the suffering of drug users and preventing them from spreading diseases, the programs foster further drug use.

 

Intravenous drug use is the second-most-common way H.I.V. is spread among men in Washington, with unprotected sex being first, according to city health officials. For women in the city, sharing needles is the most common mode of H.I.V. transmission, city officials say.

 

A man arrives neatly dressed but with no needles to swap. He asks for a referral to an outpatient drug rehabilitation program. “I got a problem,” he says, explaining that the city’s in-patient drug programs last too long and his employer will not give him that much time off for “personal reasons” without asking questions. “I’d be fired if I tried to explain.”

Mr. Daniels estimates that he makes 50 referrals to drug treatment programs per month.

“I got the guy you need to call,” Mr. Daniels told the man. “But, look,” he added, looking him squarely in the eyes, “I will see you next week, and I’m going to check up on what you’re doing.”