It could be a lemonade stand, with the pair of folding tables in the street, a steady walk up business, a quick-to-banter staff, and tiny speakers blasting music.

“Have a good night,” a twenty-something female volunteer says to a client as she hands him a paper bag.

“You too,” he tells her, momentarily catching her eye as he takes the sack and turns to walk away.

A few feet behind the folding tables, a white full-size van is parked across the middle of a dead-end street. Its side doors are open. A guy steps into the van, a man who moments earlier introduced himself with his real name before saying, “But everybody calls me Hollywood. I’m a junkie.”

This isn’t a lemonade stand.

It’s a needle exchange.

Hollywood says he volunteers at the mobile exchange a few times a week. His teeth are nicotine yellow. The gray skin of his face is wrinkled not with age but more like he soaked too long in a bath tub. He wears baggy jeans and a baseball cap cocked to one side.

He picks up a red plastic garbage can filled with dirty needles. You can tell which ones were used to shoot heroin, he tells me, because of the black residue inside them. We see only one or two of these among the hundreds. Hollywood jiggles the can, then puts his hand inside to point out ten or fifteen more tar-filled syringes, his fingers coming within an inch of the needles.

“There aren’t that many,” he says. “Most of these needles weren’t used to shoot heroin. They were used to shoot meth.”

Hollywood’s garbage-can observations hold true. This year, at least two-thirds of the clients at this Eugene, Oregon, needle exchange are shooting meth, not heroin. A method once reserved for hardcore meth addicts, injecting or “slamming” meth is now becoming commonplace. It delivers a quicker and more intense high than smoking or snorting.

Now the growing ranks of meth injectors are straining budget-strapped needle exchanges across the country. Designed to slow the spread of HIV among heroin addicts in mostly urban areas, needle exchanges have become key components in programs designed to minimize the damage of methamphetamine.  The exchanges at western outposts from central Oregon to New Mexico are the cornerstones of an effort to slow not only the spread of HIV, but also hepatitis C, a sometimes lethal liver disease many say is spreading fast.

If just one uninsured person tests positive for HIV or hepatitis C, treatment costs passed on to taxpayers can run into the hundreds of thousands of dollars. Yet for $150,000 a year in public and private grants, the Eugene exchange has all but stopped the spread of HIV in its community of roughly 7,000 users.  Nobody who reports injection drug use as his sole HIV-risk factor – that is, he is not a man who has sex with men – has ever tested positive for HIV at the exchange or with the HIV Alliance, a non-profit which operates the exchange.

Still, every year it’s a battle to persuade local governments and health care agencies to pump money into exchanges. The Eugene exchange is Oregon’s largest – and it’s getting bigger. If the 2006 pace continues, it will trade 720,000 needles this year, a 20 percent increase since 2005. 

The spread of meth across the West has contributed to warnings from a handful of doomsday public health officials who forecast a hepatitis C epidemic which in coming decades will force cities to import laborers because of a generation weakened and killed by the ravages of the liver condition. Hepatitis C is transmitted through bodily fluids, similar to the way HIV is passed on. But unlike HIV, which dies in minutes when exposed to air, hepatitis C can survive weeks in a syringe or on a bathroom ceiling splotched by shots from addicts’ syringes. In 70 percent of cases, hepatitis C leads to chronic liver disease. It’s estimated that more than 60 percent of Americans with the disease are injection drug users. In fact, injection drug users have as high as an 80 percent chance of catching hepatitis C within five years of the time they begin shooting drugs.  

Researchers at Tufts University recently estimated that taxpayers will spend $10.7 billion on hepatitis C cases between 2010 and 2019. According to the Hepatitis C Caring and Ambassadors Program, an Oregon-based education organization, roughly eight to ten thousand Americans die every year from conditions related to hepatitis C. Some expect that number to triple over the next twenty years. Yet no federal funding is available to support nationwide establishment of hepatitis C counseling and testing services. Right now, needle exchanges like the one in Eugene are among the most effective means of slowing its spread.

A few years ago, when a needle exchange in a major city in the Northwest received a one-year grant to fund hepatitis C testing, so many people tested positive that they didn’t know what to do.   “Hep C is the one nobody thinks about. It could wipe out a generation,” says Eugene needle exchange organizer Forrest Headley.