BISMARCK - Staff members at North Dakota's first syringe exchange program say they're slowly building trust with people they hope to serve.

Custer Health in Mandan has enrolled four people during the first month of the Good Neighbor Project, which aims to reduce rates of HIV and Hepatitis C by providing access to sterile syringes and education.

About 10 people have stopped by the program but left after spending a few minutes in the waiting room, said Jodie Fetsch, director of nursing for Custer Health.

"I think we're going to have to build trust," Fetsch said. "It's just going to take a while for them to get used to us treating them anonymously and not calling the police. They worry about the police coming."

People who enroll in the syringe exchange program are tracked by an identification number, not their names, and given an identification card to present each time they visit.

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Participants are required to get Hepatitis C and HIV testing every six months and provide their names for the testing. But Custer Health maintains two separate charts on each individual, one with the person's name for the disease testing information, and a second for the syringe exchange program that has only the identification number.

"There's no way I can track this person that does syringe exchange to associate them with a name," said Rebecca Nielsen, a registered nurse with the program.

Custer Health staff does not call parole and probation about participating in the syringe exchange, a question nurses receive often, Fetsch said.

Staff would call police only if an individual fails to comply with program rules, which prohibit drug use on the premises, drug dealing and violent or threatening behavior.

Individuals 18 and older are eligible for as many as 20 free syringes each week. They are required to return dirty syringes in a biohazard bucket before receiving new ones. Participants also can receive one cooking kit each week, which contains sterile items to prevent the spread of disease.

The nurses provide harm reduction information at each exchange, such as safe injection practices and how to prevent an overdose. Participants also are offered Naloxone, a medication that can reverse an opioid overdose.

"We just make sure that they're using the safest practices," Nielsen said.

North Dakota saw a 36 percent increase in Hepatitis C from 2013 to 2017, with 1,112 cases reported in 2017, according to preliminary figures from the North Dakota Department of Health.

Among cases involving people 35 and younger, 85 percent reported injection drug use, the health department said.

"Hepatitis C is definitely on the rise," said Lindsey VanderBusch, a program manager with the Department of Health.

Custer Health is the first North Dakota program to offer syringe exchange since state lawmakers made the programs legal during the 2017 legislative session. It began operating on Jan. 16. Fargo city leaders recently approved a similar program.

A major goal of the program is to connect people with substance abuse treatment. Nurses do a risk assessment and make referrals to services in the community.

"Most times, when they're coming for syringe exchange, they're ready for a change, they're ready to be healthier," Fetsch said.

Mandan Police Lt. Pat Haug said he hadn't heard of any problems during the program's first month.

"To the best of my knowledge, we haven't had any issues," Haug said.

Fetsch said she hopes the Mandan Good Neighbor Project will have 25 clients by the end of 2018, and 100 by 2021. Syringe exchange services will be provided to anyone, regardless of residence.

The program is available from 1 to 4 p.m. Tuesdays and Thursdays at Custer Health, 403 Burlington St. S.E., Mandan. For more information, call 701-667-3370 or visit