Sheilah Galer spent the day before Thanksgiving the same way plenty of other civic-minded people did: handing out free stuff to people in need. The only difference was that in addition to bags of groceries, Galer was distributing drug paraphernalia.

As soon as Galer pulls her white van into a trailer park near Chimayo, two heavy, dimpled women come outside, waving. One of them has just graduated from a drug treatment program; Galer congratulates her in a warm, raspy voice while waiting for dirty needles from a man with a shaved head.

Every week, Galer, who is the coordinator for Santa Fe Mountain Center's Harm Reduction Program, collects injection drug users' dirty syringes, replaces them with sterile ones and hands out "party pack" supplies: elastic arm ties ("better than a belt," she explains), little metal cookers, cotton balls, antibiotic ointment, food and water. Everyone knows her; locals call her "Blondie," even though her hair is the color of caramel. Her next stop is a hodgepodge of small houses along a dirt road, where "Guero," a birdlike man with a deeply lined face, waves her down. Galer gets out, jewelry clinking under her bright purple blazer, and gives him a hug. Even though he's 57, Guero asks Galer to come back later so his mother won't see that he's still using.

"It's fucked up—excuse the language," he says, smoothing his long white hair into a low ponytail. "I'm fucking old, and I'm still on it. And youngsters, 14, 15-year-olds getting into that shit, they don't know what they're getting into. They're gonna ruin their lives. They're losing the world."

Galer says Guero has tried to clean up, but Suboxone—a prescription drug used to treat opioid addiction—was too expensive and, as Galer puts it, "If you can't afford it or you have to commit a crime to get it—then nothing's changed." There are only two detox programs in the entire state, she adds, which makes treatment even more inaccessible—and the population of drug users even more unreachable.

"People want to clean up here, but it's really difficult," she says. "We're talking to people that most people don't want to interact with. When they want to clean up, [having] someone to talk to really helps them."

The lack of services for and interactions with injection drug users poses another risk: disease. The world is beating AIDS—according to the World Health Organization, new infections are down 17 percent worldwide—but AIDS cases in New Mexico have remained steady. More worrisome yet is that in New Mexico, 60 percent of people diagnosed with HIV also have AIDS—which means they aren't getting tested (and aren't aware of their infection) until the disease is already advanced. In light of the WHO's call for earlier diagnosis and treatment of HIV, announced Nov. 30 (the day before World AIDS Day), that figure is particularly glaring.

"It's not just that people in the general population aren't getting tested because they don't think they're at risk," Trevor Hawkins, the medical director of Southwest CARE Center in Santa Fe, says. "Providers tend to have an idea of the HIV patient—you know, it's a gay man who's not well or an injection drug user—but the fact of the matter is, anybody can get infected with HIV. It doesn't discriminate at all."

The concept of immunity may exist because, until now, New Mexico's HIV epidemic has been what Hawkins calls "old-fashioned": 60 percent of HIV/AIDS cases derive from what the Centers for Disease Control and Prevention terms "MSM," or men having sex with men. (Ten percent of New Mexico's AIDS patients got the disease through injection drug use, and 11 percent through a combination of drug use and MSM.) But Hawkins says that's changing; HIV/AIDS is shifting toward women, people over 50 and the monolingual Spanish-speaking population. Those trends, he says, show that one of New Mexico's key needs is testing that's as indiscriminate as HIV itself.

"Education isn't doing a great job," Hawkins says. "Another way to approach the HIV epidemic is to identify people who are infected and who don't know they're infected, [who] account for over 50 percent of all new infections," he says. "Once people know they're HIV positive, the rate of risky sexual behavior is reduced by about 65 percent."

But widespread testing will take outside initiative; many New Mexicans who are infected don't have health insurance—which Hawkins says is part of the reason they aren't diagnosed until the infection gets really serious. As far as HIV/AIDS is concerned, though, Galer's program is one of the state's main bright spots.

"Probably due to the early adoption of a needle exchange program, the rate of HIV amongst our drug users is very low," Hawkins says. "It's been extremely effective." He puts the number of HIV/AIDS cases among injection drug users in northern New Mexico at 2 percent, whereas rates of hepatitis C—an older epidemic—are 80 to 85 percent.

"We've had a few people here with HIV, and the only reason I know that is they'd tape their syringes with duct tape, put them in a plastic bag, tape that and put it in another plastic bag," Galer says. HIV carries with it more fear—and a much bigger cultural stigma—than hepatitis C, she adds. "I don't think they think about HIV because they don't know anybody who has it," Galer says. "Everybody has hep C." That's exactly the danger Hawkins cautions against—and why he wants everyone tested.

To that end, Southwest CARE Center has started offering free, 10-minute AIDS testing in conjunction with needle exchange: On Dec. 3, the two vans will literally park across from each other in Española. Galer says conjoining the two programs has so far been successful—but in the meantime, she has more immediate concerns.

By 4:30 pm, she's reached her final stop: two small trailers in a gravel yard outside Española. Galer pulls into the yard and honks, and a kid who looks approximately 15 slouches out to meet her, holding his baggy pants up with one hand. He grins and turns his hat sideways.

"Hey!" Galer says, grinning back. "Where's your brother?"

The kid shrugs and asks for needles. Galer starts putting together a paper bag of supplies. The boy's mother waves from one of the trailers as the kid disappears behind it. Just as Galer is pulling out of the drive, a rusty Ford Explorer squeals into the yard.

"Hey!" yell the kids inside. "Don't go!" They pile out—three teenage boys and a pretty girl in tight jeans and a puffy, fur-lined jacket, clutching a fake Chanel bag.

"Can we sign up?" she asks in a small voice.

"Of course!" Galer says. She writes down names, explains their legal rights (like calling 911 for an overdose, even if they have drugs on them) and gives them each a card with her phone number and a sign-up package of 30 needles.

"Cool! Thank you!" the girl says brightly. She pauses, then pulls back one sleeve to show Galer her forearm. Galer winces, but quickly launches into instructions for cleaning an abscessed needle wound.

"I didn't know how to…" The girl's voice trails off. "It's embarrassing to be doing this," she says. "I need to stop."

"You will clean up someday," Galer says firmly, handing her the bag of needles and ties. "Everyone who says that cleans up eventually."