Bold Fury

Sarah Schulman, the AIDS activist and historian, has written that the “bold fury” of the ACT UP movement allowed for younger generations to live more ordinary, quiet lives, and that this is the way it should be. It takes some imagination to reconcile the monotony of my shifts with the heroism of the early days: to imagine both the scale of AIDS ripping across New York, and the immense effort, coordination, and risk of jail time it took to distribute syringes.

The overdose crisis and ACT UP’s needle exchange legacy

Rod Sorge in 1991. Photograph by Allan Clear. 

It’s a shady room, the windows to Allen Street frosted for privacy. Every week since my orientation two Januarys ago, I arrive by 10 AM, and my co-volunteer Grace comes bounding in around 10:20, 10:40, apologizing. We’ve developed this rhythm. One of us holds the clipboard and cheap ballpoint pen, logging the needles received and distributed, and the other bends to the cabinets full of syringes, finding the right size, and hands them to the client.

Grace is a painter. They are the kind of tall that is impossible not to remark upon, and it is remarked to them constantly. Dramatic shades of eyeshadow—bloody pinks and lime greens—color the pale skin beneath their bleached eyebrows, and tattoos peek out from beneath their shirt, under their hair. I met Grace within a few months of moving to New York, on my second volunteer shift, and, whether or not they knew it, Grace was one of the only people I spoke to with any regularity that year.

The same man always comes first. I didn’t know his name for nine months, just came to learn his anonymous code from logging it on our clipboard. He is always getting just one needle, always pulling pliers off his keychain to test the syringe. I’ve never understood what it is he’s testing, but he does something nimble with his pliers and the needle, and then leaves. He is usually curt with us, but recently has been speaking more: sharing that he just lost his wife, commenting on Grace’s height.

By 11, the AC comes on, and we pull on the long-sleeved layers we’ve learned to bring. This is our rhythm too. By 12, I am growing shaky from my coffee-to-breakfast ratio. By 1 I am cranky. By 2 I am gone.


In 1989, when one in two drug users in New York City was HIV positive, the Department of Health began a needle exchange pilot program at 125 Worth Street. The program was flawed, not only in its location, which was far from where activists had been distributing in the Bronx, the Bowery, and Williamsburg, but also in its requirement that participants enroll in treatment programs, dissuading many users from joining. Still, it was hoped that the program would expand into a larger social service to help prevent HIV transmission among the 200,000 New Yorkers using intravenous drugs.

In less than a year, Mayor Dinkins replaced Mayor Koch. Dinkins claimed to be “the toughest mayor on crime this city has ever seen.” He was unsympathetic to drug users. With New York’s Black communities reeling from the war on drugs—the government’s racist campaign to criminalize drug use, disproportionately policing and incarcerating Black communities—it was felt that increased access to syringes would only further devastate neighborhoods of color. Dinkins, the first and only Black mayor of New York City, sided with broader African-American political and religious leadership that all funding should be reserved for treatment programs, not for needle exchanges, which he saw as enabling drug use, and he ended the pilot program in 1990. This shutdown left New Yorkers to share blunted and infected needles, which threatened to expedite HIV’s spread.

By this time, ACT UP—the AIDS Coalition to Unleash Power—had been organizing effectively around the AIDS crisis for three years. The grassroots coalition staged regular demonstrations, raising the visibility of AIDS, condemning government inaction, and lobbying both for expanded access to the limited HIV medicines available and for clinical trials to test alternatives. The queer-run group’s original and largest chapter was based in New York City, meeting Monday nights at the Gay and Lesbian Center in the West Village. The room would fill completely, with the hundreds of attendees sitting in rows of folding chairs and standing along the walls of the room. Within the larger organization, there were dozens of committees and affinity groups, focused on everything from pressuring pharmaceutical companies to herbal medicine to media and broadcasting.

Majority Action, an affinity group centered on issues faced by POC and women, held meetings in a studio apartment on Elizabeth Street. They gathered around a red kitchen table. One night, shortly after Mayor Dinkins had halted the city’s needle exchange program, a young man with short dark hair stood and announced that he was going to start a replacement program, with or without the help of ACT UP. Being white, the man, Richard Elovich, didn’t usually attend Majority Action and had come in late. “I’m doing it, whether you guys want to or not,” he insisted, and there was a quiet lull in the apartment before a few volunteered to help him.

Richard, along with a small team, began recruiting volunteers from the larger ACT UP meetings for the new Needle Exchange Committee. There was some hesitation; despite the prevalence of HIV among people who used drugs, many organizers were reluctant to associate the HIV-positive community, which already faced rampant homophobia, with drug use. People were generally unwilling to volunteer for the affinity group.

“The least of us had been written off,” one of the initial volunteers told me, as “the lowest of the low,” and this anger motivated him to volunteer with Richard and his peers. Others who felt at the fringes of ACT UP were drawn to needle exchange, including a disproportionate number of women, and straight members who didn’t want to overstep within the queer focuses of the group. Some volunteers were active or former drug users, though within the committee this wasn’t always disclosed.


I find myself repeating the same language with the clients that I used with the customers at the coffee shop job I used to have. “Good morning, what can I get you?” I ask, and close with, “Thanks, have a good weekend!” Usually, syringe exchange clients are much nicer to me than my coffee shop customers, who interrupted my “good morning” with their orders and then didn’t tip me. At the exchange, some clients don’t speak English, but most do. Some are visibly experiencing homelessness, maybe half aren’t.

Each day, a client can have up to thirty syringes if they have none to return, or as many as they drop off, which sometimes means hundreds. We also give out glass stems for crack, pipes for meth, hygiene supplies for people living in shelters or on the street, first aid materials, and safer sex supplies.

I have developed a certain script in my trainings. I compare the fentanyl test to a pregnancy test, and the naloxone—a legal drug that reverses opioid overdoses—to an EpiPen. I show people which way the needle should be facing, miming on my own arm what angle at which to inject their drugs. I am often shown abscesses and give what advice I’m allowed to, after clarifying that I’m not a doctor. I ask people if they want to get tested for Hep C, HIV. I do not ask anyone if they’ve considered drug treatment.

“Take care of yourself,” I say sometimes, as clients head back out onto Allen Street, shoving paper bags of syringes into their backpacks or coat pockets, and they nod at me and say “you too,” as if it’s shared, what we’re up against.

Grace rushes in, apologizing, and I jump to sit on the edge of the counter, leaning my head against the cabinets full of tourniquets, cottons, and abscess care kits. In the break between clients, I convince Grace to try one of the flavored condoms we’ve just started stocking. They pick mint chocolate chip, and, unwrapping the foil, touch the tip to their tongue. They grimace, closed eyelids streaked with sky blue. “It tastes like oily sawdust, with a mint chocolate aftertaste.” Multiple men in a row tell us the condoms are too small, then a woman whispers to me, smiling, “No they’re not.”


Once I’ve gotten my yellow visitor badge and been sent up to the thirteenth floor of the federal building, I’m buzzed through a glass door into a carpeted lobby with an unmistakable bureaucratic gloom. I wait just a moment before he appears, breezing around the desk: Allan Clear. He was an organizer of the underground syringe exchange and, after legalization, the first official director of the Lower East Side Harm Reduction Center, where I volunteer. Now he works as the Director of the Office of Drug User Health at the New York DOH.

It’s something of a time warp. I have spent weeks in the New York Public Library and Fales archives with every document I can find on the early needle exchange. There doesn’t seem to be a gathered history anywhere, so I am rapidly filling a notebook and a forty-page timeline on my computer, trying to put things in order. Mostly I watch VHS tapes of ACT UP Live, the weekly public broadcast show that ran in the early ’90s, and of interviews with the first organizers and clients of the program. On these tapes, Allan is in his twenties, maybe my age, and now he’s standing in front of me, old enough to be my parent. As I go to shake his hand, Allan greets me in the muted British accent I’ve heard through the library’s bulky headphones.

He leads me through the cubical maze of the Department of Health, under fluorescent lights, until we round a corner and meet Donald Grove. Donald still has silver hoops in each ear, and I greet him with such warmth that he hesitates and asks apologetically, “Have we met?”

We haven’t—I just feel that I know him, because he hosted old episodes of ACT UP Live. He laughs and says, “You saw those?” He’s in his late fifties, his hair gone white, but he has the same clear eyes, the same effusive manner. He feigns embarrassment at my having watched the tapes, the once-aspiring opera singer gesturing his dismay with his hand, but is visibly flattered.

“Is that the one where I say the junkies are taking over the airwaves?” Allan asks. “I couldn’t say that now. . . . ‘The drug users are taking over the airwaves!’” He pauses, serious. “It doesn’t have the same ring to it.”

The interviews are wandering and nostalgic, names I’ve found in my research are repeated back to me, laughing, but we constantly butt up against death. When I tell Donald that he called himself “the biggest queen in harm reduction” on one of the tapes, Allan laughs and says that if that were true, Rod must have already been dead.

Allan and I sit at his desk, clicking through a file of old pictures. “I could go dead, dead, dead,” he says. And then he does. He points to the faces of the young men and women, and he says, “Dead, dead, dead. All of these people are dead. It’s a bit like being a war veteran.”


Volunteers would hand out bleach kits—assembled in apartments, basements, and Judson Memorial Church—and exchange syringes during weekly walks through multiple neighborhoods, including the Bronx, the Lower East Side, and Bushwick. The needles were sourced from other states, where they weren’t criminalized and could be bought in bulk, and were occasionally driven down from Canada. Boxes were shipped from the Pacific Northwest, where the first legal syringe exchange in the US was based, to Dr. Gay Wachman.

ACT UP volunteers were able to give out up to two syringes per client and accept any that had been used so that they didn’t end up being reused, abandoned in parks, or pricking trash collectors. The bleach kits were backups; if syringes had to be reused or shared, they could be sterilized by being flushed with bleach, then water. Infamously, the kits leaked bleach everywhere.

ACT UP’s syringe exchange was intended to be community-based, with active or former drug users—some from ACT UP, some not—leading the program. There were subgroups led by people who had injected drugs for decades, and a sex worker outreach program. Dan Williams, who was one of the lone Black needle exchange organizers from ACT UP, met with Black community leaders in the Bronx, insisting that while needle exchange was understandably contentious in communities that faced racist criminalization, the research showed that these programs, which had been active in Europe for years, saved lives and did not raise rates of drug use.

Stephen Barker led the Brooklyn group through Bushwick on their weekly walkabouts, mostly going to parks. “We were invisible,” Stephen says, when I interview him in his apartment on the Lower East Side. He chops vegetables for soup as he talks to me, and I try not to be distracted by the drawings of male nudes that wallpaper the living room.

“Nobody fucking cared,” he continues, looking across the counter at me. While the members of his troop weren’t from the neighborhood (“It wasn’t Brooklyn then. It was, ‘How do you get to Brooklyn?’”), they were well received, once people understood what they were doing. “If we were known,” Steven tells me, pausing his chopping to raise his knife in gesture, “it was sympathetic: ‘They’re not just protecting their own white asses.’”

Altogether, the troop was able to give out about two hundred kits a week, which included clean syringes, bleach sterilization supplies, and condoms. Stephen says two hundred packs a week could never have been more than a token in the epidemic. The scale of their impact was “pathetic.” But the point was to create a model the city could follow on a much larger scale: “We had to prove it could be done.”

The activists would fill water cooler jugs and trash bags with the dirtied needles they’d collected, walk straight into the Department of Health office on Worth Street, and drop the refuse on the workers’ desks, the message clear: You should be dealing with this, not us. The DOH staff was relatively supportive, grateful the syringes were being collected instead of turning up in parks. Eventually an ally of the exchange at the DOH set up a space where the needles could be dropped off.

It was Donald’s job to drop off the garbage bags of needles in the designated space, after the volunteers had dumped the used syringes on the floor to count the little paint marks on the barrels—each exchange marked the needles with a different color, to keep track of how many were returned—before reloading them for delivery. The city had no larger plan for the accruing syringe waste, so they deferred to the young activists to provide what was effectively the city’s only syringe disposal program. “That’s how unprepared the health infrastructure of New York was to address a health crisis,” Donald explains, “and that makes me want to cry.”

Soon, the syringe exchange volunteers were easily identifiable at the Monday night ACT UP meetings: bleach spots speckled their clothing.


I spend months in the archives watching tapes of the young organizers. All are in their twenties, thirties. They have piercings, Doc Martens, and high-waisted jeans. Or, in the courtroom, they dress more professionally, but she’s got some funky look, his hair needs cutting, loose tuft visible around the side of his neck. They speak eloquently about the work. Their brows harden as they describe the stakes, their hands gesturing to the urgency. And I become attached to them. Sitting bent over my notebook in the library, now accustomed to the skipping record effect of repetition I need to make notes, I build some one-way intimacy.

Then I go home and google the names that are available, or I send photos I take of the grainy television to Allan Clear, who can tell me who almost every person, clamped still in mid-sentence, is. RIP, Allan will write, when the person has died of AIDS, an overdose, suicide. Dead at 30. Dead at 37. And the other half, spared, are in New York, and here are their emails. And a few days later, I will walk through the lobby of the Department of Health or the Public Health building at Columbia University, and my young peer has grown middle-aged. And he, usually a he, of those I have found, has the same clear watery eyes, maybe the same hoop earring, I notice, as he shakes my hand, and asks what he can do for me.


On March 6, 1990, a group of needle exchange activists met at Katz’s Delicatessen. “It must have been 9 or 9:30, what time does it open?” Debra Levine asks me. She has fashionable, almost round glasses, fading brown hair. Now a theater professor at Harvard, she’s animated and apologetic about details she can’t remember, almost exactly thirty years later, when she meets me for a coffee.

In 1988, Debra finished her theater MFA at Columbia. Two years later, she received a $10,000 grant to make work about AIDS, and attended an ACT UP meeting as research. After her night at the Gay and Lesbian Center, in a room with hundreds of HIV-positive people and their allies, Debra saw that the political situation around AIDS was more complex than she’d realized, so she returned the grant money and joined the coalition. The Majority Action meeting at which Richard announced his plan to begin needle exchange was held at her kitchen table, and she’d become involved immediately.

Debra says that many months led up to that morning at the deli. Ten activists were preparing to be arrested for distributing syringes on felony charges—for possessing hypodermic needles. To build their defense, the underground needle exchange had been deliberate and steady—labeling and counting syringes, reliably appearing in the same sites each week—in preparation for this day: the arrest would spur a trial, and if the defendants won their case, it would be monumental for needle exchange in New York State. If they lost, they faced six months to two years in prison. “I thought I was going to Riker’s,” Debra tells me. No one expected to win.

Richard had recruited the group carefully. Mostly, they were people who could afford to stand trial—who could miss work, make it through a holding period without access to drugs, and, for the majority, be protected by their whiteness. It was also strategic in representation: Richard was explicit about his history of drug use; Dan Williams had become the spokesperson whenever the racial implications of needle exchange were discussed; Gregg Bordowitz was open about being HIV-positive. There were also a few surprises: “That nurse, Cynthia?” Debra beams. “I don’t think we’d ever seen her before the day of the action.”

Having finished breakfast, or too antsy to have eaten at all, the activists headed to the designated corner, on Essex and Delancey. They were met by about thirty members of the Guardian Angels, the red beret–clad nonprofit that ran safety patrols across New York City, policing subways and parks and conducting citizen arrests to prevent “street crime.” The Guardian Angels chanted, “No drugs, no needles,” and there was concern the activists would be beat up, but then they saw, across the street from the Guardian Angels, three hundred ACT UP demonstrators. “No,” Debra tells me, laughing, refuting the archival testimonies: “fifty.” There were also a couple dozen members of the media, and police, waiting.

Within ten minutes, before distributing a single syringe, the ten activists were arrested. There was chanting from both sides, and a lot of commotion, with the activists distinguishing themselves by waving syringes in the air and yelling “Who needs a needle!” Debra remembers that the police didn’t especially want to arrest her, and she had to insist, finding another syringe when the police confiscated the first and told her softly that she did not really want to be arrested. With the second needle, the police reticently arrested her, and they walked “The Needle Exchange Eight,” as they’d soon be called, to their patrol cars.

In custody, the men and women were placed in adjacent cells. Each, one by one, gave their name and birthdate to the cops, and one of the women, Monica Pearl, froze when she heard Gregg Bordowitz speak. She hadn’t realized that they were the same age, and for her this compounded the tragedy of his HIV-positive status, which in 1990 was seen as an imminent death sentence. “I was a sexual being at a time of crisis, and I was young, and so there were many things that I still may do that might be risky or not risky,” she recalls in her ACT UP Oral History interview. Gregg’s disclosure was the moment in which the HIV crisis, even after months of organizing, hit Monica in a different way, because, she felt, it could have been her. “You know, there’s no way to transform someone into an activist without making it personal for them, without making it a selfish issue,” she says. “There’s no way of saying this is something you ought to do for these other people. The only way to make it convincing is to make it personal.”


My favorite client, a Jewish man in his thirties from Queens, comes by. He’s been in decline. He looks worse every time I see him. He never recognizes me. I ask him where he went to Yom Kippur services and he lights up, asking me if I fasted. He’s proud that he did too.

I haven’t seen the man who tests his syringes with pliers in six weeks. I ask the staff, but no one’s heard from him. I can’t contact him; the program being anonymous, I know only his initials, birthday, and nickname. He’s in his fifties, and I think he’s stably housed, but I don’t know where. Up till now he has arrived like clockwork, and I don’t know if his sudden absence means he’s been getting needles elsewhere, started some kind of treatment, been arrested, or overdosed.

I’ve been told this is the nature of needle exchange work: people stop using, people return, people go missing. If I can be optimistic, I can take his absence as a sign he isn’t using, or just doesn’t need us anymore. But I don’t feel optimistic.


On days when Grace can’t come in, or before they race in late—“Sorry! Sorry!”—I stare at the clock above the doorway, and the hours pass in a slow crawl. The wall that separates the needle exchange booth from the rest of the harm reduction center stops two feet below the ceiling, so even while I sit alone, noise echoes from the drop-in center, where clients sit all day in plastic chairs around tables, bulky aged computers, and a television. During my shift the VOCAL Users’ Union meets, and as everyone gathers, the noise echoes off the center’s hard, easy-to-wipe-down surfaces.

A slight man in his fifties comes in and asks for fentanyl test strip instructions. As I take out a piece of printer paper and a pen I tell him, “This might not be helpful for you, but it actually works a lot like a pregnancy test.” I raise an eyebrow and he laughs. We lean together over the narrow metal counter, under the frame that displays all of the needles we carry, a bit like a menu. I write the steps in my cleanest writing, trying not to swirl my S’s the way I usually would. It occurs to me that the clarity of the instructions are life or death, literally, and I double check the numbers on a poster above the sink, though I know them by heart.

I explain that he should first prep his shot, then test the remnants in the cooker before injecting. It needs to be mixed with the little vial of sterile water in his kit. The test strip should be submerged for fifteen seconds, then left for five minutes. It will show one or two lines, positive or negative. “Remember,” I look up at him, pausing my dictation, “just because it doesn’t have fentanyl, doesn’t mean it’s what somebody told you it was.” He nods. At the bottom of the instructions I write, “Stay safe!” and draw a smiley face in a lopsided circle. I list his options if he’s going to use the heroin even if it tests positive for fentanyl: “Take less, make sure you’re using with someone, piggyback, do you have naloxone? Good.”

As I hand him the kit, I let our hands brush. I read that ACT UP members used to kiss on the mouth in greeting, to show they weren’t afraid of people with AIDS. In turn I have started, when I hand people their supplies, making casual contact, to show I’m not afraid to touch people who live on the street.

He thanks me and leaves. No one comes for half an hour, and I sit in the swivel chair and kill time. Sarah Schulman, the AIDS activist and historian, has written that the “bold fury” of the ACT UP movement allowed for younger generations to live more ordinary, quiet lives, and that this is the way it should be. It takes some imagination to reconcile the monotony of my shifts with the heroism of the early days: to imagine both the scale of AIDS ripping across New York, and the immense effort, coordination, and risk of jail time it took to distribute syringes. I yawn in my air-conditioned booth, holding a naloxone kit emblazoned with the NYC Health logo, and google the names of the early organizers, trying to find out who survived.


There are now approximately three hundred needle exchanges operating across the US, including those run by more than twenty organizations in New York State. These programs have played an enormous role in lowering and maintaining the city’s rates of HIV in IV drug users, down from the one-in-two rate at the height of the AIDS crisis to just under one in ten.

The New York syringe exchange programs were pioneers in what would come to be called harm reduction. Harm reductionists believe, essentially, that abstinence-only education is condescending and ineffective, and that people will use drugs and need resources to do so safely. Like accurate STI information or condoms in a safer sex model, harm reduction encourages access to the supplies and education that reduce the risks around drug use, which include sterile syringes, safe locations to use, and access to a range of options when and if a person should choose treatment. Harm reduction centers the knowledge and experience of drug users, and intends to follow a peer education model.

While HIV prevention continues to be a core value of the harm reduction movement, the main focus has shifted in recent years to the overdose crisis. In 2016, when fentanyl began appearing in non-pharmaceutical drugs, the rates of overdoses spiked. Fentanyl leaves no visible color, smell, or taste when cut into drugs like heroin or cocaine, but is about fifty times stronger. This poses a new threat for habitual users who intend to take the same amount as they usually do, and unknowingly take a dose that far exceeds their tolerance. It also puts at risk people who are more occasional drug users.

By 2018, there was an average of four fatal overdoses a day in New York City, with fentanyl testing present in about 60 percent of cases.

Now, in addition to providing sterile syringes and disposing of dirty works, syringe exchanges distribute tools like fentanyl test strips and naloxone (also known by the brand name Narcan), which, when dispensed in someone’s nostril, restarts their breathing. My own Narcan pouch has become something of a comfort object. I carry it with me almost every time I leave my apartment. I transfer the blue pouch from backpack to shopping bag, always superstitious that the time I forget will be the time I need it. I stop when I see people sleeping or nodding on the sidewalk or subways. I pause to see if their chests are moving, my own frozen as I wait, and if I can’t tell, I linger. I’m afraid to wake someone unnecessarily, and I’m afraid to keep walking. Other pedestrians sometimes shrug or glare when they see me frozen, staring, as if I’m not a good New Yorker yet, not having learned to keep moving.

 


I am on my way to the archives when I see, through the R train windows, an unconscious man on the subway platform. A second man is on his knees, arched over the first, hands on his exposed chest. We speed by them as our train brakes into the Times Square station. The air around me thins, and I stand up straight.

I tap the window of the train door with my fingernail, waiting for it to open, and then I run backwards down the long platform, dodging commuters, my hand digging in my bag for the blue pouch.

“I have Narcan!” I say to the kneeling man. He waves it away. He tells me he pulled the unresponsive man off the Q train. The EMTs are coming, but they’ve been waiting ten minutes already, and the man is barely breathing.

Standing over the man on the pavement, watching his chest for movement, I see that he is in his late thirties, maybe. A sparse beard curves under his mouth, which is open. Jackets lay under him, but I don’t see a shirt, and he looks like he’s been living on the street. He’s missing a shoe.

I repeat, urgently, “Are you sure he doesn’t need Narcan?” and the crouching man, realizing what I’m offering, says, “Oh! Narcan!” and accepts the first dose. As he reaches up, I am relieved to see that he’s wearing scrubs marked “RN.” There is a colorful tattoo emerging from the collar of his shirt. The nurse splits the blister pack open, and triggers the dispenser into the man’s nostril.

We wait. A woman standing beside me asks quietly what the nasal spray is, and I hear myself recite my script: “It’s Narcan, it’s basically an EpiPen for overdoses.”

“How long does it take?” The nurse asks me. Two minutes, but I can’t tell how much time is passing. We decide to give the second dose. The nurse rips open the second kit, administers it, and we keep waiting.

And then the man is taking deep breaths, his chest pulling up and down from the pavement. “There we go, buddy!” says the nurse, as the man begins to blink. The nurse takes a boxing glove from his backpack and places it under the man’s head. Then he pushes his knuckles deep into the man’s thigh, through his blue jeans, causing enough pain to keep him conscious, not relenting when the man tries to push his hand away.

The man sits up with great effort. I knew, abstractly, that Narcan works quickly, but I am surprised to see an almost dead man suddenly looking around curiously. The nurse leans close to him, asking his name, how much he took. His questioning seems well intentioned, but paired with the uniformed MTA employees beginning to circle us, must scare the man, who keeps repeating, “no problem, no problem,” in an accent I can’t place. I crouch low and say, “I’m glad you’re feeling a little better.” The man looks at me, smiling hazily, and I say, “you’re probably still feeling a bit rough.” Because Narcan triggers withdrawal, I’ve been warned that people can wake up feeling confused and confrontational, but we continue smiling at each other, holding eye contact.

I’ve been on the platform maybe fifteen minutes when the paramedics come with their confident, authoritative strolls. We’re told by the MTA employees, who are not carrying Narcan, that the ambulance was called to 14th Street instead of 42nd. “It’s been twenty-five minutes,” the nurse says. “He would have died without the Narcan.” The paramedics concur, casually, their thumbs tucked into their work belts, hands dangling. “He got lucky,” they shrug.


“RIP” writes Allan, when I send a picture of a young man sitting in the courtroom. The man’s small mouth is pursed above a severe cleft chin, his brow lowered, harsh. In his right ear are three thick hoops, and the profile catches long eyelashes.

I don’t recognize him until Allan captions the photo for me: Rod Sorge. “Rod Sorge had such a serious face!” I email back, so Allan sends me a series of pictures. “Serious Rod:)” Allan writes under a photo of his friend caught in exuberant laughter, his eyes closed. The stern face from the courtroom is transformed, playful.

In one of the photos, Rod is on the steps outside the courthouse. He wears a Wham! T-shirt, visible beneath the loose straps of his striped overalls. His teeth show as he grins at the woman next to him, and he stands casually with his hand in his pocket, where a visible bleach stain marks the fabric. His hair is buzzed short everywhere except his bangs, which have been gelled into two symmetrical curls.

Rod grew up poor in Chicago, and was private about his childhood and the family he wasn’t on good terms with. He dropped out of Vassar College and moved to New York City explicitly to join ACT UP, becoming one of its youngest members and thriving as a leader and activist. He held bleach kit assembly parties every Friday night at his apartment on Rivington Street. When they’d finished their work, the group would go for margaritas, sometimes staying up all night before their Saturday morning walkabouts. Rod would push a bleach kit–filled shopping cart along the Bowery, the metal rattling along the sidewalk. He was adored by the people who came to depend on the syringe exchange, especially the older women, because he remembered everyone’s names and tried to do larger case management, helping them in whatever ways he could.

Rod was one of the organizers of the New York arrest, as well as the similar actions in states across the Northeast. Rod wasn’t arrested in New York, but in the equivalent New Jersey demonstration. Still, he attended the New York trial, and I’d seen him on the courtroom tape, looking serious and attentive. These were his friends, the people with whom Rod drank margaritas and filled bleach kits; his boyfriend, Amador, cut Debra’s hair. He spent all of his twenties working with ACT UP and then in other harm reduction programs, but is not mentioned in any of the major ACT UP documentaries or articles.

Rod died at 30. He was HIV-positive, and he was actively using drugs, which impeded his ability to receive medical care. Many said afterwards that he could have pulled strings to get special treatment, through his connections in the AIDS organizing world, but Rod didn’t believe in that. “Saint Rod,” an obituary called him.

I finish my shift and I pass Rivington, where Rod lived, the Bowery, where he pushed his shopping cart. Rod attended the same college as my older brother, whom I live with in New York. He dressed like my friends from my own liberal arts college, and would have blended in seamlessly among us. Maybe Rod stands out to me because he died young, so I have not seen him as the fifty-year-old version, with wrinkles gathered around his eyes. He is frozen in time as my peer. The AIDS crisis feels so adjacent, and yet these people who look so much like my friends are not, in fact, my friends. I worry about projection, about my right to feel proximate to a crisis I didn’t experience.

Allan introduces me to his coworkers as “Hannah the Historian” when I return to the Department of Health, and I worry about this too, if it’s too easy an out. I’m told, “I’m glad you’re writing about Rod, people keep writing about the same people over and over again.” So I find urgency there, and I sit in the offices of these veterans, and I ask them to repeat their sentences, to make sure I can get them down right. In our second interview, once he’d pointed to the pictures of his friends, Rod among them, and gone dead, dead dead, Allan told me: “They’re not even gonna be footnotes.” 


The Sunday morning after I see the man overdose, I wake up from the nightmares I keep having, and I watch grainy ACT UP videos on my laptop. I am looking for instructions. How does one channel anger productively?

I watch demonstrators lunge to the floor for a die-in at St. Patrick’s Cathedral. Outside, ACT UP member Ray Navarro is dressed as Jesus, and is acting as the tape’s newscaster, winking campily as he makes a “second coming” joke. I watch activists in SILENCE = DEATH T-shirts climb an FDA building. “People with AIDS under attack, what do we do? ACT UP! Fight back!” they chant. They shake the locked doors until the glass blows out. I watch the political funerals, the artist and activist David Wojnarowicz’s first, as ACT UP members carried actual caskets through the streets, hundreds marching behind with protest signs: Died due to government neglect. “We have a dead body!” A man is screaming at police, who have parked their patrol cars to block the procession.

Forty minutes into a montage of clips, I see Rod. He is addressing the Monday night meeting, speaking about the next planned arrest, this one in Delaware.

The video, quieter than the protest tapes, is mostly shot from behind, and Rod’s shoulder blades move under the cotton of his shirt. Those thick rings in his ear, his narrow waist where his light-washed jeans are belted. Rod rocks on his heels and he bites his lip when he is not speaking. I watch this brief clip many times. I run a finger over the dark red heart tattoo on his right bicep, and then over the jut of his shoulder, leaving curved lines on my computer screen.

That night, I lean against the doorframe of Grace’s kitchen as they stir gurgling curry, waiting for chickpeas to soften. I rant: I don’t know if the man is okay, because he is going to be discharged from the hospital with a lower tolerance than he’s used to. Does he know that? I think about all that the man is up against, as a Black homeless man who is using drugs, and I think of his death as delayed, only.

Grace furrows their bleached eyebrows as I tell them that I’ve been having nightmares every night. I’m feeling sensitive and lonely, so I keep trying to go out, but end up stomping home early, having found all conversation at best mundane, at worst vapid. On a first date, I’d announced “Four New Yorkers overdose a day.” I haven’t heard from him.

“But you’re right!” Grace interjects.

“I’m unbearable,” I correct, “I’m mad all the time,” I try to say this half-laughing, but my voice spikes and breaks.

By the end of the evening, we have slunk down to the hardwood floor. Grace says I am being very hard on myself. I tell them what David Wojnarowicz said about there being a place for beauty even in wartime, amidst great calamities. We wonder how to hold both. I arch forward and press my forehead into Grace’s bare thigh, like a prayer, and they hold my head. I wonder if the man from the subway is still alive.


In the archives on 42nd Street, I begin the courtroom tapes of the Needle Exchange Eight. After their arrest, eight of the ten rejected the plea deal they were offered, and went to trial in April of 1991. Seven of these eight defendants were represented by two ACT UP members, the lawyers Jill Harris and Mike Spiegel—Mike was dating Debra, one of the defendants. Richard Elovich defended himself. He felt it was important to have a drug user actively interviewing the witnesses, standing in front of the judge.

The defendants were using the necessity defense. In short, this loophole means that if something illegal is done in good faith to prevent imminent harm, when no adequate legal alternative exists, the illegal action is permissible. The strategy almost never wins, which the defendants knew. Because there were so many of them, the eight defendants spent the weeks of the trial seated in the jury box. Debra would excuse herself to puke in the bathroom. She calls the necessity defense a “Hail Mary.” The stakes were even higher for defendants who would certainly face racism and transphobia within prison.

The testimonies dragged. The prosecutors would show images of the Essex-Delancey intersection and ask the defendants to clarify if this was NE, NW, SE, or SW. This was intended to trip up the defendants, undermining their credibility. Instead, the activists were confident and charming. Kathy Otter noted that she knew the area very well, because she bought all of her dresses there. The judge, Laura Drager, interrupted to say that she did too. The prosecutor waited as the two women—a trans activist and a cis judge—chatted casually, trading favorite stores. The defendants smiled in their booth.

On the day of the decision, thirty years ago this May, one of the defendants, Monica Pearl, was surprised to see her father standing in the courthouse in a suit. He’d been ambivalent about her ACT UP work, worried for the way her activism might limit her job prospects. Monica asked him what he was doing there, and he told her he’d come to say goodbye. Beside him, Monica’s mother stood in a SILENCE = DEATH shirt.

The defendants returned to the jury booth to hear the verdict, their families and ACT UP supporters filling the pews, and Judge Drager began to read. She spoke highly of the work of the activists, and they braced themselves for the inevitable “but,” to condemn them. It took several minutes for the group to realize that they had won. “Hundreds of thousands of lives are at stake in the AIDS epidemic,” Drager read, and said she believed that needle exchange was vital in saving New Yorkers.

The defendants and their supporters screamed. They hugged and kissed before Drager finished reading. When she did, and the formalities concluded, they spilled out onto the courtroom steps, where an ACT UP member filmed them with a handheld camera. “I’m speechless,” Monica says, her mother’s shirt visible in the crowd behind her. She kisses Richard on the mouth, and Debra appears in tortoiseshell sunglasses. They are all radiant, collapsing onto one another joyously, the lawyers announcing that this is the best moment of their careers.

Throughout the trial, Debra had gone to see Ray Navarro at Saint Vincent’s Hospital. When I picture the theater student and her peers gathered around Ray’s hospital bed, reenacting highlights of the trial, I can only imagine Ray in his iconic Jesus costume at the Stop the Church protest: Ray propped up in white robes and a gold crown, brown hair brushing his shoulders. When I say to Debra that I imagine him this way, she smiles. I ask about visiting him on the day of the verdict, what was it like to tell Ray they’d won? Did everyone come to share the news? Debra corrects me, gently: by then he’d died. He was 26.


In May 2018 Mayor De Blasio signed off on Overdose Prevention Sites (also known as Safe Injection Sites), saying they would open within six to twelve months, but, unsurprisingly, bureaucratic delays have stalled progress. The health commissioner of New York State, Dr. Howard Zucker, and Governor Cuomo are the main antagonists against the sites, which are designated spaces where people are able to use drugs with trained medical responders on site, in case of an overdose. Similar to needle exchanges, the sites also provide sterile supplies like tourniquets and cookers, as well as safety information. The only American overdose prevention site has just opened in Philadelphia, but there are over a hundred of them in ten other countries.

A few weeks after witnessing the overdose, I wake up at 5:30 to take a bus to Albany for a protest. Grace can’t come, so I go alone. I am relieved, after a three-hour ride I spend mostly asleep, my neck braced at sharp angles, to see a few faces I know from the Lower East Side.

Once the different delegations of the End Overdose NY coalition have gathered in the mall-like food court below the state capitol, we make our way through security. Sam, a social worker I know from my shifts, unlaces his steel-toed boots, which have set off the metal detector. He is bashful as he relaces on the other side, apologizing repeatedly as I wait.

At least 150 people fill the ornate, sandstone staircase in the state capitol, with cloth banners and signs shaped like tombstones, each with the name, photo, and age of someone lost to an overdose. “Dancer” reads one, “Dog lover, “Full of laughter, beautiful soul,” “Killed by NYS.” There are galleries from every direction over the staircase, and we fill them all, chanting in call and response with the demonstration leaders: “No More?” “Drug War!” Then, there is one adapted from ACT UP: “People who use drugs under attack, what do we do?” “Stand up, fight back.” The ACT UP version admittedly flows better, but the echo still moves me.

Reporters with cameras pool below us, and prepared speeches are given that we can’t quite hear. I catch some of what Shantae Owens, who also works at the LESHRC, says about the lack of treatment options he had as a poor, Black New Yorker facing homelessness. He is hugging a paper tombstone close to his face as he says, “We should not forget that we are standing on the shoulders of those who came before.”

After the speeches, we head to the health department, where we stage a die-in to symbolize the 23,000 overdose deaths under Governor Cuomo’s tenure. A VOCAL-NY organizer calls, and we echo in mass, that Health Commissioner Zucker should make no mistake that there are bodies, and that “we are willing,” “we are able,” “and we will fucking,” “bring them here.” We dutifully repeat her lines, amplifying them, but I’m caught off guard by this escalation. It must be intentional, I think, this nod to the ACT UP political funerals.

And then everyone moves to the floor. I am picturing the belly flops in Saint Patrick’s Cathedral as I lay on my stomach, arms folded under my head. I feel the cold linoleum on my hip, where my shirt has ridden up. Sam’s boots stick out from under the “#EndOverdoseNY” cloth banner we’ve been carrying. Security guards begin locking doors, closing us in, as more officers arrive, dressed like sheriffs with suede cowboy hats. I spend our thirty seconds of silence wondering if we’re going to be arrested, embarrassed by my own cowardice. Then the memorial ends. “We’ll be back!” everyone chants, as we stand, brush off our pants and coats.

Sam and I sit at a booth near the McDonald’s in the capitol food court, cheering along with everyone else when we see our action on New York 1, which is playing on the TVs lining the food court. After, I ask Sam if he’s seen the client I’ve been worried about, the one who tests his syringe with pliers. Sam hasn’t, but says since we know the man’s code, we could search the city-wide data to see if he’s switched sites. If we can’t find anything there, we can try searching public incarceration records with just his first name, which I can guess from the client’s nickname, and his birthday, which we know from his code. “And if that doesn’t work,” Sam says, “We can call the morgue.” I must make a face, because Sam looks at me and says softly, “It’s fucked up.”

Sam has intimidated me for months. He’s one of the only young people on staff at the center, and he has a tough, punk aesthetic, with a patch-covered jacket and a shaved head. Now, he shyly asks for the pretzels I’ve offered. It makes me think of Rod, who Allen thought was the most intimidating guy at ACT UP, with his thick piercings and his own big boots, until Allan got to know him and they became close.

Sam tells me about administering naloxone to someone on the Lower East Side last week, how it took three or four doses before the man woke up. I’ve already heard about this from another staff member, plus that once the man was clearly safe, Sam burst into tears in the office upstairs. Sam leaves this out of his retelling, then asks me if I’ve been okay since seeing my first overdose, and we both admit to nightmares. We sit with this, nodding.

I wish I had something besides pretzels to offer him. Sam mentions anger, and I ask how he deals with it. He hasn’t figured that out. Sometimes, he says, it’s all he can feel.


One night, again scouring online archival videos, I watch Charlie Rose read from a May 14th, 1992 New York Times article: “The Dinkins administration will permit drug addicts in New York City to receive clean hypodermic needles.”

Since Judge Drager’s positive verdict, needle exchanges had been operating across New York City. Her decision didn’t officially legalize the practice, but it sent a message to police, who allowed the activists to continue their work unimpeded. One year later, Mayor Dinkins decided to allow the syringe exchanges to operate legally. They would be funded by a $70,000 American Foundation for AIDS Research grant. The Dinkins administration wouldn’t help fund the exchanges, but they’d allow them.

Charlie Rose looks up from the newspaper, which is laying on the table, and places both hands palms-down in front of him. The host leans towards Allan Clear, asking him what to make of this article.

Allan looks pale ahead of the black backdrop. He’s almost thirty years younger than the man I know, but the mannerisms render him unmistakable. Official legalization should be good news, but Allan, even with that nervous half-smile-half-grimace, speaks with no celebration. He’s saying, “It’s nice that Dinkins has come around to the idea of needle exchange. It’s very late. You know, a lot of people have died, a lot of people are HIV-infected already.” His eyes flick up to meet Rose’s, then return to the table.

Rose has rested his head in his palm, and I get the sense that he’s trying to put Allan at ease. He asks why Allan became involved in needle exchange work, and Allan speaks about being in recovery himself. He talks about how many people he’s met through treatment who are HIV-positive.

He holds his right wrist with his left hand, then releases it to gesture, continuing. He’s seen people begin to bring needles back, become involved with the group, show a “fundamental change. It’s saving lives.” He’s more ardent, looking up. With the new funding, Allan says, “We’re gonna have a storefront maybe on the Lower East Side.” There, he hopes, they’ll hold meetings, have a chance to treat drug users with dignity.

Twenty-seven years later, Allan tells me, sitting in his office at the Department of Health, he finally took out his hoop earrings when his daughter, now eight, began pulling at them as a toddler. Her art is on the wall behind his desk, not far from the pictures of his ACT UP peers, some of whom I have now met.

Allan explains that ACT UP stepped back from the management of needle exchanges once the programs were operating stably—ACT UP being centered on direct action, not social services—and Allan stayed on at the Lower East Side’s program before leaving to run the Harm Reduction Coalition. Now, he’s moved into the public sector.

I always ask the same question last. I’m interested in longevity, in what it’s like to be angry for so long. Unlike so many organizations founded around hope or faith, ACT UP is “united in anger.” What toll does extended anger take on a person, on a body?

Allan smiles at me, seeming amused by the question. “I’m more angry than I was in the early ’90s.” Back then, he says, he was learning that the health system didn’t work. Now, with the overdose crisis, he’s seeing that “the system still doesn’t work. We didn’t learn anything from HIV. We have another epidemic.” Glancing up at the wall, where he’s hung photos from demonstrations, Rod’s face among them, he says, “I never really stopped being angry.”


We’re restocking. Grace is pulling apart cottons, placing them in piles of three, to go in individual baggies. I am separating single gauzes for the abcess care kits. It’s trance-like, and we keep our eyes on the delicate work of our blue, latex-free gloves.

Grace, when they pause to eat a piece of leftover Halloween candy, flips through my research and interview notes, dozens of single-spaced pages. I joke that we should go to the corner of Essex and Delancey after our shift, and pour one out in honor of our needle exchange elders. Grace agrees.

At 2, we head north on Allen Street. When we make it to the corner, four lanes of traffic rush by the McDonald’s, the Chase bank, an upscale market with glass walls. The intersection is nondescript, but I feel a buzzing excitement picturing the activists walking along this same sidewalk.

I pull out my notebook to read aloud the specifics. The cardinal directions—who was on the SW or SE corner—so agonized over in the trial, now allow us to visualize the scene. “It was noon,” I read from one defendant’s testimony. “Walking on Essex from north, heading south.” Grace and I flail our arms pointing north on Essex, then indicating southwards. “Guardian Angels were on NE corner.” We look across the lanes of traffic.  

Grace hands me their water bottle, and steps back to take my picture. I move so the green street signs, indicating Essex and Delancey, will be visible. To achieve this, tall Grace must crouch very low. Their naloxone pouch, clipped to their backpack, swings as they squat down. I raise the water bottle, giving Grace the thumbs up with my other hand. A man walking by laughs, confused by our tribute. I pour one out, dumping water onto the sidewalk.

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