IN 1989, Portland nonprofit Outside In introduced a revolutionary and controversial form of community-funded medical care: a needle exchange. One of the first of its kind in the country, the idea quickly gained support as a way to cut new HIV infections among drug users. Now, 20 years later, Outside In's exchange is still combating HIV, hepatitis, and other diseases—but is also having to fight to keep its annual funding.

In the city budget officially adopted this July, the Portland Housing Bureau had to cut needle exchange's typical $63,000 in funding thanks to a citywide budget crunch. Outside In employees requested special one-time funding from the mayor's office to keep the program afloat for a year. Luckily, Mayor Sam Adams saw the program as a staple in Portland's health and safety systems and fulfilled their plea with $65,000 in one-time cash from the mayor's office.

Outside In's program allows anyone to drop off used syringes at their headquarters on SW 13th and receive sterile new syringes in return. Needle-exchange clients are also encouraged to use the site's free clinic for medical exams and treatment.

"We can use the syringe program as a bridge to treatment for those who generally don't go to other clinics," says Outside In Executive Director Kathy Oliver.

Last year, the exchange conducted roughly 150 HIV and 100 hepatitis tests on clients. They collect a whopping 500,000 syringes annually, taking those dirty needles off the streets and disposing of them properly as medical waste.

The Portland program kicked off in tandem with similar needle exchange systems in Tacoma, San Francisco, and New York City in the late '80s, igniting a national movement. Oregon is now home to nine of the nation's 211 needle exchange programs.

But the proliferation of these programs hasn't been easy. In 1988, the federal government cemented a ban on any federal funding for needle exchanges, seeing it as a contradiction of its zero-tolerance policy for drug use. While the ban was overturned under Obama in 2009, a stigma around the program for intravenous drug users remains.

"Not many funders are interested in the syringe exchange program," says Outside In Executive Director Kathy Oliver. "To them, it's enabling drug users—but that's not our point. To me, drug injectors are not expendable."

Without ample federal aid or private donations, the syringe exchange depends heavily on city and county support. Of the exchange's $191,000 annual budget, $126,000 comes from Multnomah County's public health department. "As much as we think the syringe exchange program is a necessity, we're all continually stressing when it comes to our budget," says Kim Toevs, manager of the STD and HIV program at the Multnomah County Health Department.

Dan Anderson, Mayor Adams' spokesperson, echoes Toevs' dilemma. "The mayor saw this year's funding as an important program to support, even though times are tight," he says. "But it will be up in the air again next year."