(Audio Slideshow Diane Jeantet & Hazel Sheffield / BRONX INK)

Mary Hall was still too shaken to speak. Steven, a former patient she hadn’t heard from for four years, had finally called. “I just heard his voicemail,” she said as she sat at her desk, holding a sheet of paper with names and phone numbers scribbled all over it. “He was so sick; I thought he was dead.”

The dusty stack of files piled up on Hall’s tiny desk carries the weight of the years she has spent working as a case manager at CitiWide, a needle exchange program in Mott Haven. The 62-year-old mother of two arrived in 1997, two years after the HIV activist, drug user and photographer Brian Weil opened the program in the basement of La Resurección United Methodist Church, in the South Bronx. Hall never left and is now CitiWide’s longest serving staff member.

Some critics argue that needle or syringe exchange programs, which aren’t aiming at stopping participants from using drugs like abstinence-based treatment programs, are a waste of time and money. Others believe that the decline in HIV infections is mostly, if not exclusively, due to those initiatives. But that debate often overlooks another important function of these programs. For people like Steven and other drug users and HIV positive residents of the South Bronx, these community-based centers are one of the only places they can turn to for solace and comfort – or just a human connection.

“For some of us this is the one and only meal we get in the day,” said Ruben Denis, a 56-year-old heroin addict, while rolling a cigarette outside St. Ann’s Center of Harm Reduction, another syringe exchange program only two blocks away from CitiWide. Denis has been going to both centers for the past 10 years and like many who have made a home at both facilities, Denis knows the pros and cons of each.

St. Ann’s is particularly popular for its homemade food. Behind the massive blue steel gates on 310 Walton Ave., on the second floor of a dated and unstylish building, hides a great Puerto Rican cook, who can bring Jose Luis, a heroin user, all the way back to his childhood kitchen. “It’s like mama’s food,” joked Luis.

The doors are open at CitiWide in the South Bronx. (Diane Jeantet / BRONX INK)

Over the years, the Bronx needle exchange programs, also called harm reduction centers, have become a central social network for addicts living on the edge. A former participant, who goes by the name of J-D, still comes and visits now and then. “These are my homies. It’s like when you go to school to see your friends you know,” he said as he was waiting outside the CitiWide’s opaque glass doors for his friends to finish their lunch.

Free food is just one lure. Aside from clean needles, participants can shower, get clothes and counseling, or just stop by to use the bathrooms. Both centers also provide free MetroCards each time participants join one of the many groups  offering a wide range of workshops from learning CPR to photography and other creative therapies. Involving participants so they become active members is at the heart of these centers.

It isn’t unusual to meet staff members who used to come to the centers to get clean needles before rushing back to their spots – substandard apartments or street corners. With time and motivation – and regular check ups with a social worker – participants can get a small stipend for helping with food and condom distribution during the weekly street outreach tours.  This helps bring participants back to some sort of working life and it also benefits the programs by turning participants into volunteers. Center directors say it’s hard to raise funds so they can use the help.

In 2009, President Barack Obama signed legislation lifting a 20-year-old ban on financial support for syringe exchange programs around the country, promising a brighter future for these centers. “But we haven’t seen a single penny of that yet,” frowns Robert Cordero, CitiWide’s executive director, who says no new money has been spent on syringe exchange programs in general. “So we have to continue our advocacy,” Cordero said. So far this year, he said he had raised more than $3 million in grants and donations.

Thanks to this money, CitiWide is now the only center open seven days a week in the Bronx. On the second floor, a medical health care unit is also under construction. “We want to be a one-stop shop,” said Valentino Hernandez, a 40-year-old case manager.

Like many other CitiWide staffers, Hernandez has a special passion for his job. He spends most of his lunch breaks chasing participants on their way out of the building with his hands full of oranges to make sure each one of them has some fruit. Hernandez quit his previous job at another public health facility because he said  that agency pushed case managers to meet weekly quotas. “But I can’t work like that,” Hernandez said. “I don’t like counting the minutes when I’m working with someone. I told them it’s either quantity or quality.”

The addicts who use the center appreciate that dedication. Valerie Cruz, a 46-year-old HIV positive mother of six has been addicted to cocaine since 1983. She has been coming to needle exchange programs for more than a decade and still goes almost every day. “This is also a way of getting your mind off the streets,” she said in between two group meetings. At night, when the centers close, Cruz goes back to her one-room apartment in East Tremont, where the rent is paid by the HIV and Aids Service Administration.

Drug users who aren’t HIV positive have a harder time finding a safe place to stay. At CitiWide, the average income of participants is under $9,000 and 75 percent are homeless. It often comes down to two options: sleeping in the streets or staying in a shelter.

For Robert Cordero, housing has become one of the top priorities. By 2013, CitiWide should own housing facilities to house both homeless and HIV positive people. At the moment, housing homeless people means dealing with a lot of bureaucracy – the city, real estate agents and real estate brokers. “We would like to be able to have our own housing so we can place people as we want,” said Cordero.

But harm reduction and efforts to prevent HIV infections among injection drug users remain the centers’ prime concern. Mary Hall remembers a time when participants used to die at a frightening pace of one or two a week. “When I first came here I was ready to leave because they were dying so quickly,” she said. But over the past 20 years, infection rates have decreased from more than 54 percent to a historically low 5.5 percent today.

“People still die,” said Hall behind a worn thick pair of glasses, “but it’s not a death sentence anymore. It’s a life sentence.” She still remembers twins who used to come at the center. Both were infected with the HIV virus; one of them died but she saw the other one a few days ago. “I said: ‘Oh God baby’ – I call them all baby – ‘You’re still around?’ And she said, ‘Yes, Miss Mary, I’m still here.’ And I think that’s the joy I get out of my work. When I see they’re still around.”