The 20-something woman approached the van looking jittery and conflicted.
Seeing that the back of the delivery-style truck was open, she meandered there.

PENDLETON — The 20-something woman approached the van looking jittery and conflicted.

Seeing that the back of the delivery-style truck was open, she meandered there. The boxy truck, with Umatilla-Morrow Alternatives Health Van written on the side, was parked at Pendleton's Stillman Park.

"Is this where you exchange needles?" she asked, hesitantly.

When volunteer Darrell Alston replied yes, she dug in her purse and came up empty. She punched a number into her cell phone and asked someone on the other end to "bring my dirties."

She disappeared and 10 minutes later, a man drove up in a shiny SUV. He handed a Ziploc bag full of dirty needles to Alston, who swapped him for an equal number of clean ones. The SUV roared off.

The contaminated needles lay at the bottom of a sharps container inside the van.

Alston and Frank Roa, Umatilla-Morrow Alternative volunteers who man the van, watched him go. Their mission, they said, is to reduce the spread of HIV, hepatitis C and other blood-borne diseases by removing dirty needles from circulation. The pair travels to sites in Pendleton, Hermiston, Umatilla and McNary where they exchanged over a thousand needles since May. The two also hand out portable sharps containers and condoms.

Alston and Roa have no illusions that everyone agrees with their methods. Some critics, they know, equate the practice of giving drug addicts needles with handing out matches to pyromaniacs or gin to alcoholics. They shake their heads at that kind of thinking. A few large studies, including one by the National Academy of Sciences, suggest that offering clean needles to intravenous drug users reduces the spread of AIDS without increasing drug use.

"It's not a moral issue — it's a public health issue," Alston said. "We're not advocating the use of drugs."

Sharon Waldern, Umatilla Public Health clinical nursing supervisor, agreed with Alston and Roa on the effectiveness of needle exchange.

"Studies show that when you have a needle exchange program in your area, it really does reduce the transmission of HIV and hepatitis C," Waldern said.

While the methodology may seem counterintuitive, Alston said, it keeps people from sharing needles and blood-borne diseases. Contaminated needles, he added, can also affect non-drug users and even children who might come across needles or syringes along the river or other places where they play.

The AIDS virus has personally touched Alston and Roa, who share a domestic partnership. The men are both HIV-positive. Roa, 34, received his diagnosis in 1999 and Alston, 54, learned of his status last year.

Alston rubbed his gloved hands together and shuffled his feet as a chilly breeze invaded the van. The Chicago native, a graduate of Northwestern University, said he once taught elementary school before getting wanderlust.

These days, Alston uses his college degree in a different way, waiting for teachable moments in the needle exchange van. Those moments don't come every time. Some people come and go quickly with little eye contact or conversation. Other times, they talk. Some express the desire to get off drugs or worry about the possibility of having hepatitis or HIV.

"This is more than just a needle exchange," Alston said. "It opens the avenue to discuss things related to drug use."

The van offers two types of HIV testing. One is a finger-prick blood test that takes 10 minutes. The other, requiring cheek swabbing, takes 20 minutes.

"Both tests are 99 percent accurate," Roa said.

Before the two-hour stint at Stillman Park ended, a ruddy, bearded man wearing a red bandana hesitantly inquired about hepatitis C and HIV testing.

The Federal Drug Administration is working on 20-minute hepatitis C mouth swab test, they told him, but it isn't available yet. They invited him into the van for an HIV test.

The man perched on a bench seat and Roa pulled a test kit out of a small refrigerator. Donning exam gloves, Roa partially unwrapped a plastic swab and invited the man to remove the swab, rub his gums and place it in an enzyme solution. Roa started the timer. Twenty minutes later, the man went on his way, buoyed by the news that no HIV antibodies lurked inside his body.

The tests are anonymous. If results come back positive, Roa and Alston refer the person to the Umatilla County Health Department for confirmation. Waldern said a nurse will draw blood or do an oral swab and send the sample to the Oregon State Public Health Laboratory.

"We treat them all as if they are positive," Waldern said. "There are very few false positives with the rapid tests."

Since May, Roa has had to break bad news five times out of 200 tests given.

"All of the positives were in Tri-Cities," Roa said. "Four out of five were female."

Roa, who grew up in Irrigon, remembers receiving his own test results. After he tried to give blood, one of the volunteers took him into a private office and broke the horrible news.

"I was numb," Roa said.

He and Alston are working to esure that others won't feel that way. They have pledged to continue swapping clean needles for dirty, handing out condoms and offering HIV testing. They promise to make it easy.

"We're not going to lecture you," Alston said. "You can walk up and say, 'I have needles to exchange' — end of story."