Pauli Gray, Volunteer and Community Educator, began as a volunteer at the San Francisco AIDS Foundation over 10 years ago.

As an SFAF staff member Pauli trains and supervises needle exchange  and California HIV/AIDS Hotline volunteers, does HIV/AIDS education through public speaking engagements, trains staff members at other AIDS service organizations - most recently visiting Ethiopia to support improvements to their national HIV/AIDS hotline, and Pauli is a longtime staffer at HPP needle exchange sites.

You might know Pauli from the site on  6^th street between Mission and Howard. Pauli is the rock and roll looking dude with all the tattoos. 

So Pauli, how did you get involved doing needle exchange?

Pauli: I came to the AIDS Foundation as a volunteer 10 years ago, and was hired as an employee 9 years ago. Shortly after I started with the foundation they asked me to shift my responsibilities to be a full time needle exchange staffer- but I am a needle user in recovery. My sponsor has 33 years clean- he knows what he's talking about- and he thought needle exchange would be too risky to my sobriety as a full time gig, so I stayed with my part time job because I wouldn't be able to do shit for anybody if I wasn't clean. In my personal life I help people who are trying to get clean, other addicts. Helping other people is something I do as part of my own program. 

So when you first started doing needle exchange, what about doing it made it appealing to you?

I am HIV negative only because of needle exchange, although I didn't always make it to the exchange myself and I did share rigs when I was using. But I would have done it a whole lot more without needle exchanges. I shared rigs with people who are HIV+ and I shared with people who had AIDS and I am negative...which is kind of a miracle.  One of the reasons I got into volunteering at the AIDS Foundation was because when I tested negative for HIV I thought it was some kind of message and I decided that no matter what I was gonna go back and help other people. I have Hep C, but I am HIV negative.

When you first started doing needle exchange, even though you had life experience with injection drug use, did you have any misconceptions about what injection drug users are like?

I have experienced a lot personally; I was a homeless gutter junkie at one point. If you haven't experienced walking up the street and having a mother pull her children closer and steer her kids around you...when you know you're a good person, then you don't know what its like. I've been on the street and it's a really fucking hard life. Exchangers remind me that it is a hard life. Most of the people who come to the exchange are dealing with daily survival issues and so I have to remember that. It reminds me of what I have been through and I am able to put that to use. Treating people who come to the exchange decently is the most important thing. Treating exchangers like valued clients is so important.

What are some of the most common health problems that you see at the exchange?

Mental health issues and obviously substance abuse issues. The thing is, if you were living on the street you'd want to be high too and living out there will make you crazy even if your not, that's not politically correct- but living on the street combined with all the hardships and the "no hope" thing, they all feed each other. Medically I see abscesses and a lot of problems with infections in general because it's hard for people to keep clean. I also see injuries because people don't inject properly.

What are some of the barriers as you see them, to injection drug users achieving or maintaining better health?

Stigma.  I still think that the broader community acts like there's something seriously wrong with injection drug users. The thing is, a lot of people do drugs, you know. Injection drug users face a lot more stigma.

I think that keeping clean/showered, that's a huge barrier to health.

Obviously, the lack of services impacts people's health.

I think that injection drug users and crack users are underserved and there is not enough effort being made to get out there and reach people.  

Also it's really disgustingly& painfully obvious that there are hardly any options available for people who are ready for drug treatment. There's not enough detox beds, you know. People who want to get clean need a detox. Detox is a part of harm reduction, so are methadone and Buphrenorphine-this stuff should be available all the time. People who use heroin and want to make a change should have a choice of 4 things: get clean, get harm reduction therapy, try buprenorphine or methadone. Whatever they can do. And none of it is as available as it should be.

They make people jump through hoops, you have to show up at 7 in the morning and wait around all day. It's hard to survive out there and unfortunately the current treatment system makes people jump through impossible hoops.  There's just not enough medical detox in the city, there's not enough funds, there's not enough attention to it, and I think that we should have these services available in San Francisco . There should also be treatment on demand and detox for substance use in general. At it is they don't provide detox for speed users.

How do you see different substances of choice like heroin, speed, crack having different impacts on health? Do you think the story is different depending upon what kind of drugs you are doing?

I think people who do speed tend to have more mental health issues due to sleep deprivation and how the crystal works in the brain, everything happening really fast. People on heroin seem to have a more fatalistic attitude towards "the end" or towards the future and stuff working out.  With heroin you have to do it just to be well (not suffer withdrawals) and you are not necessarily getting high.

I think people combine drugs a lot, I think most people use more than one drug. People look at all these drugs like they are separate and they are kind of not.  And, different people do different drugs at different times in their lives. Almost everybody titrates. I think that crack is as dangerous as any other drug or more so.  I think that most people out there use multiple substances and have one primary drug or preferred drug, the drug that they have to do to keep going in many cases- a favorite, or preferred state of being. 

With crack you have to cop more, meaning, you have to engage in many dangerous activities more often... among that might be performing acts that are risky sexually more often.  It is a binge drug and you will do anything to avoid the crash so you keep going and going and going.

You know, heroin or speed you can do some and you don't need to do anymore for a little while. Not necessarily that you won't... but it's not mandatory.

 What do you like about working with drug users?

 Everybody's got a story and these are interesting stories that don't get heard at all....I like to be out there in the world where the stories are a little different. I don't know how to put it. Plus, I felt like I was a worthwhile human being when I was strung out and walking up the street and mom would see me and make sure her kids didn't walk near me- I remember that feeling and feel like it's important that we treat everybody like a human being. It's really important. I think drug users are some of the most obviously marginalized people in our country.

What do you find challenging about working with drug users?

If you don't see people for awhile they could be clean-they could be dead. Most of the time you don't know, so you don't get that immediate gratification, you don't get a lot of success stories.  People just disappear. It's a challenging thing.  Also, you can't do nearly what you want to do to help someone out because you gotta make due with the resources you have. We do our best to get people supplies, but the whole health picture in the city-working with drug users goes beyond the immediate interaction of needle exchange- there are so many needs that aren't being met.

What can exchangers do to help you do your job better?

Its very helpful and important to let us know about the word on the street-whether exchangers are hearing about wound botulism or they are hearing about dope that's bad or something, come tell us.   That's really important because otherwise the health department people won't know what's up until its too late in a lot of cases. 

If you could teach people who inject one thing that would help them, what would it be?

I'd teach them to lower the angle of the syringe as they put it in. People stick through their veins all the time.  I'd ask them to remember that cleanliness is really important. People already know not to share works, when they do share it its usually because they have to- there's not enough rigs around. So I guess, visiting the exchange often so they have what they need.  For people who won't go to the exchange, you know it's up to us to find a way to reach people we are not reaching, to go to them and get equipment to them; I think that's on us.

Specifically around shooting speed, Is there anything you would like to share with speedometer readers?

When you are injecting speed be careful, it's bad to miss with it. Usually speed users don't draw through cotton-they cold shake. It's not filtered and that can be hard on veins- injecting un-dissolved particles. I think that people are oftentimes shaky and don't inject well-that causes vein damage and when you miss with speed that's a big deal...If you miss, put a hot compress on it. I would go to the 6^th street needle exchange and see the doc there, just get it looked at for a second. Take care of it and be careful. And if you are having trouble with injecting don't feel less than because you need help with it. If you have questions go to the speed project, ask Terry she'll tell you, or come talk to me, Pauli. Also, drink lots of water and try to keep an eye on mental health. Your mind set.  Drink a lot of water, try to get some sleep, try to eat something even though you don't feel like it, when you are wasted try not to let people ejaculate/cum inside you.  Do the basics first.  I don't know... I am available to help support the speed project in any way I can. 

 

Thanks Pauli! You rock!