Our syringe service program's goal is to connect people who inject drugs, particularly disproportionately affected communities, to necessary resources to reduce the risk involved with injection drug use in a setting that is welcoming, client-centered, harm reduction-focused, and nonjudgmental and in a way that reflects the needs of the community.
The RDC, part of Hennepin County's Public Health Clinical Services department, has been providing sexually affirming medical services since 1970. The clinic is in downtown Minneapolis and is on the light rail system and several bus lines and is in the epicenter of the HIV outbreak. The RDC is a multilingual, multicultural sexual health clinic which also includes Tuberculosis Control and Refugee Health Screening Services. Since 2013, the RDC has served an average of 11,314 clients a year providing an annual average of 20,560 clinic visits. RDC has approximately 50 diverse staff, including 11 nurse practitioners, 8 registered nurses, as well as various medical assistants and support staff. In addition to naloxone distribution and syringe services, RDC services include screening and treatment for sexually transmitted infections, partner notification/disease intervention services, HIV testing outreach services, HIV pre-exposure prophylaxis (PrEP), HIV post-exposure prophylaxis (PEP), and family planning services. Additionally, the clinic has Ryan White funded support services with specific focus on Black MSM, Latinx MSM, Transgender individuals, individuals who inject substances, as well as those living with HIV but not currently in care. To ensure cultural sensitivity and appropriateness, these services are supported by a team of community health specialists who are reflective of the priority populations served.
The variety of services offered in and around the RDC puts us in a unique and effective position to provide intersectional harm reduction services to the participants of our SSP. At RDC, we recognize that people who use drugs also have sex, and this can bring additional risk of infection. Our intake questionnaire lists additional services, including sexual health testing and treatment, incentivized HIV testing, vaccines, free condoms and lube, etc. with the intention of reducing barriers to receiving these additional services that the clinic offers. In 2022 we have connected over 400 participants to safer using resources and HIV testing, over 300 participants to Narcan education and STI testing, and many others with things like vaccines, chemical health assessments, (re)connecting to HIV care, MOUD, and substance use treatment.
The ability to serve diverse populations, regardless of physical ability, sexual orientation, gender identity, race, ethnicity, legal status, economic status, or native language is ingrained into the clinic culture and service delivery model. In line with ADA requirements, the RDC has accessible services for individuals with physical disabilities and provision of ASL interpreters. The clinic staff includes individuals who are fluent in Spanish, Somali, Hmong, and Oromo languages. Additionally, the RDC contracts with Language Line Solutions that can interpret over 100 languages.
We recognize and acknowledge that Hennepin County, as a government institution, has a traumatic history with local marginalized communities, including the Native American community. Staff and leadership at the RDC are committed to improving relationships with our target populations and community partners. We provide targeted nasal naloxone education and distribution at Little Earth, with an emphasis on families. The opioid epidemic, specifically the ubiquity of fentanyl, has severely affected Native American families in Little Earth, who report performing multiple overdose reversals in the community each week. To date we have distributed over 750 nasal naloxone kits to families living in Little Earth.
In our partnership with ICWA, we provide targeted nasal naloxone education and distribution to consenting ICWA clients with OUD. These clients include parents living with young children, parents whose children are in the foster care system, and youth experiencing risks related to chemical dependency and sexual exploitation whose families have open child protection cases. In Minnesota, opioid and methamphetamine use in families affects the disproportionate number of Native American youth in the foster care system. We know it is important that we provide age-appropriate education and distribute nasal naloxone to Native American families. Community members tell us that youth and elders increasingly need training to revive adults and that they are uncomfortable using syringes for intermuscular naloxone.
We continue to strengthen our relationships with Little Earth and ICWA and serve Native American families in Hennepin County by offering culturally specific care coordination and wrap-around services. Starting in March 2020, the RDC SSP assisted Health Care for the Homeless (HCH) nurses with distributing naloxone at encampments and drop-in shelters for Native American residents. Additional referrals are made via our long-term relationships with other state and community-based organizations, including Southside Harm Reduction, AGATE, Rainbow Health, the Native American Community Clinic (NACC), Indigenous People's Task Force, and the Aliveness Project.
In addition to the internal county connections of the RDC, staff members are embedded in the community and actively participate in local pop-up events and meetings, furthering our reach and creating meaningful partnerships.
The RDC SSP is committed to keeping our surrounding communities safe by collecting used syringes and making syringe disposal accessible for residents. Our SSP has three primary venues through which individuals can dispose of syringes: the RDC located in downtown Minneapolis, on site at Little Earth, and at community pop-up events.
· Public Health Clinic: Clients bring their used syringes into the clinic in safe disposal containers (either those we provide or a makeshift container such as laundry detergent or another thick plastic bottle). We also provide biohazard stickers for clients to take with them, should they decide to use a makeshift container for their syringe disposal. The biohazard stickers can provide an extra level of security to discourage the containers from being opened by anyone who may find it (either law enforcement personnel or other unintended recipients). Clients place these disposal containers into a red biohazard bin located inside of the SSP exam room to increase privacy and discretion. Clients self-report the number of the syringes that they bring in, which is recorded in our data collection for each encounter.
· Little Earth: We also have a disposal program operating with Little Earth, where we distribute and collect sharps containers on site. We have a long-standing relationship with Little Earth to provide HIV testing, naloxone distribution, Narcan/naloxone trainings, syringe disposal containers/pick-up, and linkage to services. We safely disposed of 1,500 used syringes for the Little Earth community in 2022.
· Community Outreach Events: When doing outreach or attending a pop-up event, our staff routinely bring syringe disposal containers, grabbers, and gloves.
Other partnerships include:
· Healthcare for the Homeless: Our outreach team works in coordination with Healthcare for the Homeless. This valuable collaboration helps us coordinate care for individuals experiencing homelessness that have extenuating circumstances and barriers to traditional medical care. We rely on the long-standing rapport and expertise of staff that have been embedded in the community for years and allows us to reach clients with harm reduction supplies, education, and overdose prevention kits.
· Twin Cities Recovery Project: We have an informal relationship with Twin Cities Recovery Project, a local non-profit that focuses on sober programming and events to enhance the recovery community. They come to our program to receive naloxone, which they distribute throughout the community in creative ways, such as training and distributing naloxone to gas station workers. Their Minneapolis Lake Street location is ideally placed amid high activity areas for drug use, overdoses, and homelessness.
· Minneapolis homeless shelters: Our SSP staff continue to strengthen partnerships with shelters and organizations that use a variety of models to serve the homeless population, such as AVIVO (harm reduction based tiny village program), First Covenant Church (shelter for couples), MN Indian Women's Resource Center (drop-in shelter for Native American women), and Sanctuary Supply Depot (outreach organization providing tent and supplies directly to homeless encampments). SSP staff provide virtual and in-person harm reduction and overdose prevention training, as well as Narcan kits, for frontline shelter staff and outreach workers.
· Miscellaneous Partners: Our organization provides PrEP, PEP, and naloxone distribution. We collaborate with the SSP Network and attend some of the local pop-ups hosted by community-based organizations, such as Southside Harm Reduction. We provide education internally to ICWA. Additional referrals are made via our long-term relationships with other state and community-based organizations, including the Native American Community Clinic, Southside Harm Reduction, St. Stephen's, Rainbow Health, and the Aliveness Project.