Throughout the history of HIV and AIDS, there are many moments that stand out as bold acts of courage that forever changed the course of the epidemic. Syringe access in San Francisco is certainly at the top of the list.

The city’s first needle exchange program began in 1988 when a group of people recognized they needed to do something to stop the spread of HIV among people who inject drugs. Acting against the law, they created Prevention Point — an all-volunteer, street-based operation.

The program provided sterile syringes as well as other safer injection supplies such as bleach, cotton and alcohol wipes. It also offered condoms and referrals to drug-treatment programs and social services.

At the time, Californians were not legally permitted to possess syringes without a prescription. So in the beginning, syringe access operated as an act of civil disobedience. The founding members of Prevention Point were willing to take that risk to save lives, and in doing so they created a legacy of better health on the streets of San Francisco.

“What was started by Prevention Point continues to serve as a model for the San Francisco AIDS Foundation syringe access services program today,” said Pauli Gray, from SFAF. “By actively engaging users in the intervention process, we hope to compel them to examine the health risks of injecting drugs — and the underlying reasons for why they do it in the first place.”

For nearly four years, Prevention Point operated totally underground. Volunteers actually used a baby carriage to transport sterile syringes to neighborhoods that needed them most. They partnered with researchers and collected data to document health benefits of syringe access and its power to stop the spread of HIV.

In March of 1992, under the leadership of then-Mayor Frank Jordan, the City of San Francisco declared a public health emergency and committed $138,000 to Prevention Point. It was a bold statement from the city’s top elected official and became the first step toward the creation of comprehensive harm-reduction programs that include syringe access and other prevention tools.

“The actions that San Francisco took back in 1992 to move toward the legalization of needle exchange cannot be understated,” said Gray. “That was 20 years ago, and still in some California counties today people who operate syringe access programs face arrest for trying to distribute sterile syringes. San Francisco truly was a leader in this effort.”

In the years that followed Mayor Jordan’s emergency declaration, syringe access became an integral part of HIV prevention in San Francisco, and adapted to better meet the needs of participants and most effectively reduce new HIV infections.

When the program began, people were provided with 10 syringes with a one-for-one exchange above the 10 returned. In 1990, participants were allowed to access 20 syringes at one time instead of 10. In August of 1990, all limits on the number of syringes that could be accessed were lifted (with limitations only based on program resources).