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Durham Needle Exchange/NCHRC Durham

During 2021, the Durham Needle Exchange partnered with the NC Justice Center’s Health Advocacy Project (HAP) on a Photovoice project to identify needs and challenges that affect the lives of participants of the Durham exchange as they try to get and maintain access to the healthcare system. The two major goals of this Photovoice project were; 1) to help the HAP advocate for the expansion of Medicaid, in concert with several other Photovoice cohorts across NC, and 2) to amplify the perspectives of some of our Durham neighbors who are often left out of community conversations on health. Photovoice is a form of advocacy through storytelling. Project participants take pictures to share parts of their life and community to raise awareness, tell a story, or educate others with authenticity through photography. We invited participants of the Durham exchange to take pictures that showed the challenges, strengths, and needs in their lives and communities, focusing on showing others what it means for them to try to stay healthy.

For example, some of our guiding questions for participants to consider were:

  • Who are you? What makes you, you?

  • How has COVID affected your life--what are some things you have to do differently?

  • What does health mean to you?

  • What does it feel like to not have insurance or access to the healthcare you need?

  • What do you do when you get sick or have an accident?

  • What are some things that help you be healthy?

  • What are some things that keep you from being healthy?


The majority of the Durham exchange’s participants are uninsured. Many have applied for and been denied Medicaid on one or several occasions. During the process of the Photovoice project, participants dealt with hospitalization, pregnancy, incarceration, overdose, and both gaining and losing housing and employment. They were all generous and insightful in their willingness to document their struggles and the barriers they face toward accessing the systems of care that they need and deserve.

The Durham Needle Exchange began life in 2013 as a small, underground, volunteer-run mutual aid project reaching a handful of people who use drugs (PWUD) based on volunteers’ personal social networks. After NC legalized Syringe Services Programs in 2016, the exchange became a program of the North Carolina Harm Reduction Coalition. Throughout the life of the exchange, all our staff and volunteers have been people with lived experience. We have invested many years of effort to build trust and demonstrate commitment to the well-being and autonomy of PWUD and others in Durham who experience structural barriers to health, including people who are transgender, people who do sex work, people experiencing homelessness, and people experiencing incarceration. The Durham exchange’s participant base and reach has grown steadily each year, and our scope as a program has also grown steadily over time, from a bare-bones, just-needles-and naloxone operation when we first started, to a comprehensive harm reduction program.

We offer access to:

  • sterile syringes and comprehensive injection supplies,

  • safe syringe disposal and biohazard containers,

  • naloxone and overdose prevention training,

  • fentanyl tests for drug-checking,

  • safer snorting and smoking supplies,

  • wound care and hygiene supplies,

  • peer support, resource navigation, and linkage to care,

  • safer sex supplies,

  • testing for HIV/HCV/HBV/syphilis,

  • masks, hand sanitizer, outreach vaccination, and other COVID-specific supports,

  • harm reduction-based support groups for people who are transgender and gender questioning,

  • outreach and jail support for people inside the Durham County Jail

The Durham exchange uses the principles and practices of harm reduction to create networks of relationship and support for people in Durham who are impacted by the war on drugs, gentrification, and other manifestations of white supremacy and structural inequalities.


As of our 2020-21 annual reporting;


  • Just over half of our participants identify as Black, 40% as white, 2.5% as multiracial, 1.5% as Latinx, 1% as Native American, and 1% as Asian-American.

  • 61% of participants identify as male, 37% as female, 4% as transgender or nonbinary.

  • The youngest enrolled participant is 18 and the oldest is 84.

Across these intersections, our participants experience many different impacts of the structural violence of the war on drugs and the pressures of escalating gentrification in Durham, which reduce access to housing and healthcare and increase criminalization and marginalization from systems of care.


A Poem

There’s a million demons playing house in my head.

I open my eyes but can’t climb out of bed.

I need a shot of that dope, it keeps me alive.

I’ve said that before right after I died.

I woke up alone in a run down motel.

I can’t remember sh*t and my body feels like hell.

The ones who came with me didn’t tell me goodbye.

It seems I’ve overdosed and they’ve left me here to die.

I guess that’s just part of this life that I choose.

Have to cover my arms cause now they are bruised.

Heroine and cocaine, prostitution and crime.

In and out of County time after time.

I’m so fucking tired I wish I was dead.

Tired of sucking dick just to sleep in a bed.

I’ve turned my back on everything but the streets.

But where were they at when it came time to eat?

I’ve slept outside alone, hungry and cold.

Just the clothes on my back and no one to hold.

I must be crazy; in fact I’m insane.

I can’t seem to stop playing this game.

My money and loyalty goes to these thugs.

All I get in return is cut up fucking drugs.

Then where were they at when I end up in jail.

After thousands of dollars they don’t even post my bail.

Over and over I’ve tried to quit and be brave.

But I probably won’t learn till I’m deep in my grave.

And that’s deep, but it aint deep enough to make me quit.

Because at the end of the day I just don’t give a shit.

I’ve been raped and abused and used and played.

Now my heart is so cold it’s another Ice Age.

I close my eyes at night ready for it all to end.

My millions demons just laugh, for in the morning they know it all starts again.

- T, May 2021


Because the people at the first ER had told me to just go and quarantine.

But had I quarantined, than I would have been quarantining and possibly fell over dead somewhere.

What got me into the hospital was I wasn’t feeling too good. I kept complaining to my wife that my chest was hurting and things of that nature. So I went to the ER. And they helped me. I was there for maybe six hours. And they came back and told me that I was COVID positive. And I said, ‘well it can’t be—I’ve been vaccinated.’ And they said, ‘well, your test came up positive.’ ...So I wanted another opinion, and my wife wanted another opinion. So, we got up that next morning and we went to a different ER. When we got to the second ER, they took my vitals and things of that nature. The doctor came back in and told me that I had pneumonia. And I knew I had a cough because I smoke—but I was just moving a little sluggish, you know. So he stated that I had pneumonia. And with me having the COVID, they wanted to keep me. So they transferred me from that ER to the main hospital. And once I got there, they gave me a CAT scan and X rays. And they saw that I had fluid on my lungs—on my right lung. I had fluid pockets on my right lungs, along with the pneumonia. And along with some other issues... I had a staph infection also, due to me shooting dope and not being clean with my intravenous shooting.

Meaning, you know, I don’t shoot behind nobody, or use nobody’s works, or nothing like that... But I use my same old cooker. And by me using this same cooker, and that same dirty cotton, you know, I caught a staph infection. And a staph infection is deadly. So they gave me an antibiotic because I had staph infection in my bloodstream. I had that going on, I had the pneumonia going on, and I had the COVID shit going on. So I was just one fucked up junkie, you know…