In 1985, doctors at a methadone clinic in the South Bronx made the harrowing discovery: 50 percent of their patients had HIV. Three years later, in the same neighborhood, a pair of epidemiologists estimated that as many as one in five young men were positive for the disease. Those numbers made the South Bronx one of most critical hotspots for HIV in the country.

Joyce Rivera was born and raised in the South Bronx. She watched as heroin flooded into her neighborhood followed by HIV. When Rivera’s brother died in 1987, she decided to do something. Working with a heroin dealer and a local priest, she defied the law and set up an illegal needle exchange in an attempt to prevent the transmission of HIV among injection drug users. And she largely succeeded. But what if this country had treated drug addiction like a public health issue instead of a criminal problem?

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