2018: Four As

Here’s a Thank You note:

Thank you 4as

Name of Non Profit: Alaskan AIDS Assistance Association (Four A’s)
Your Name: Amanda Moser

Short Project Description (less than 50 words):
The Four A’s Syringe Access Program (FASAP) provides clean syringes and supplies to
injection drug users to reduce the spread of HIV and Hepatitis C in this high risk
population. FASAP also disposes of used syringes, reducing the presence of potentially
contaminated syringes in Alaska.
The Big Why (less than 300 words):
Four A’s Syringe Access Program (FASAP) is the only syringe access program in
Anchorage and Juneau. Over the last 10 years, as the use of opioids has grown to
become a public health emergency, FASAP has been the primary resource to prevent the
spread of HIV, and Hepatitis C. The program works to reduce the harm associated with
injecting drugs by providing participants access to sterile syringes, clean works, rapid
HIV/HCV testing, used syringe disposal and harm reduction counseling. From 2009 to
2016, there were 925 opioid-related deaths in Alaska. Preliminary data for 2017 shows
that Fentanyl overdoses have increased again. FASAP sees 100-125 new injection drug
users a month access the exchange; this is in addition to a base of approximately 3,500
injection drug users. Demand continues to outstrip the financial resources available to
support the exchange.

Along with the increase of general drug use rates in Alaska, usage of the FASAP has
skyrocketed. The number of syringes provided to participants in FY16 was 479,177 in
16,193 individual exchanges. This number increased to 630,884 in FY17 in 23,062
individual exchanges. These numbers would be much higher if not for the FASAP cap of
50 syringes per visit. While not best practice, a cap of 50 syringes is necessary given the
limited amount of program funding. It is anticipated the number of syringes distributed
in FY18 will increase to over 700,000, even with the 50-syringe limit.
Success to Four A’s is the ability to continue to provide services to an ever-increasing
number of participants. Success for the community is a reduction in the number of new
cases of HIV and HCV. Conservative estimates suggest that each dollar invested in
syringe exchanges provides a return of nearly $10 due to averted HIV and HCV and the
associated costs of treatment.12

1 Kwon, JA, et al. AIDS. 2012 Nov 13;26(17):2201-10.
2 Nguyen TQ, et al. AIDS Behav. 2014 Nov;18(11):2144-55

The Bottom Line :
Funding for syringe access is incredibly limited, given a federal ban on funding for
supplies and the Alaska fiscal crisis. $3,200 would provide approximately 30,000
syringes and corresponding supplies, or about 2 weeks’ worth of supplies for our
Anchorage and Juneau locations. Sustaining necessary supplies keeps the spread of
Hepatitis C and HIV in our community in check, and makes us all healthier. Having a
safe place that incentivizes the return of used syringes means cleaner and safer parks
and streets for all of us.
Client Stories:
“Can I schedule an HIV and Hepatitis C (HCV) test for tomorrow”, Tara asked the
volunteer working in Four A’s Syringe Access Program. Tara was getting clean supplies
for herself and her “friend” who was waiting in the lobby just outside FASAP. Tara was
nervous and seemed distracted. “We are available to do testing right now if you want”,
the volunteered informed her. Tara leaned toward the volunteer and whispered, “I
would really rather schedule it for tomorrow. I’m not alone right now and he won’t let
me out of his sight.” It was obvious that Tara was afraid of the man she was with. The
quick thinking FASAP volunteer said loudly that she would need to talk her supervisor
about scheduling an appointment. The Four A’s HIV program coordinator entered the
small room and the volunteer quietly explained what was happening. “Do you need me
to call the police?” the coordinator asked. “No, that would only make things worse. He
sells me to men for drugs and cash and he doesn’t let me carry condoms If I have a
scheduled appointment to get tested, he will let me come in by myself”. It was clear that
Tara was being trafficked and she saw an opportunity to get help. An appointment was
made for the next day and a reminder card was given to her as proof. She was given
condoms which she quickly stuffed into her purse to hide. After Tara left, staff called
Standing Together Against Rape (STAR) and spoke to an advocate. A plan was made to
help Tara when she came in for her HIV testing appointment. The STAR advocate would
assume the role of a tester-in-training so she could join the program coordinator and
Tara in the testing room. Tara showed up for her appointment and spoke with the
advocate about her options and what the next steps would look like. Tara was tested for
both HIV and HCV and a safety plan was made with the STAR advocate. Tara’s
preliminary HIV test was negative, but she tested positive for HCV. Additional referrals
were given to Tara on getting an HCV confirmatory test done, treatment options, and
support groups. The STAR advocate took her upstairs to their offices to discuss what
they could do to help her. Staff haven’t seen Tara since that day, but she is often thought
of and we hope she was able to get out of the terrible situation she was in.
Jason and Mike would always come into the exchange together. One week, FASAP staff
noticed that Mike was no longer coming in with Jason. Staff asked Jason where his
friend was. Jason didn’t know and showed concern that something might have
happened to him. For Jason, there were three possibilities for his friend: he was in jail,
he got into treatment or he overdosed somewhere and died. Weeks went by and one day
Jason showed up with his friend Mike in tow. Mike said he had heard we were asking
about him and he wanted to drop by. He was one month sober and thanked Four A’s for
helping him until he was ready to get clean.