This is the third part of an ongoing series.

Organizations tackling the District’s HIV epidemic are struggling to fund prevention and treatment programs as demand for services increases, threatening their long-term success in the fight against a disease whose D.C. infection rates were once higher than those in parts of West Africa.

For one of the three local nonprofits that run needle exchanges—a program that’s almost singlehandedly responsible for reducing new HIV transmissions via drug injections by 87 percent between 2007 and 2013—time is running out.

Cyndee Clay, executive director of the nonprofit HIPS, says her agency has surpassed the D.C. HIV/AIDS, Hepatitis, STD, and TB Administration’s annual needle exchange goals nearly four months early. Consequently, the organization has spent $22,000 of its own general operating funds since February to pay for the supplies to run its syringe exchange program—equal to roughly 90 percent of its total annual needle exchange budget.

That $22,000 bought HIPS 170,000 needles along with related items—like tourniquets, cottons, cookers, sterile water, vitamins, hand sanitizer—as well as gloves and bio-hazard bags.

“It’s not sustainable,” says HIPS program director Elizabeth MacIntosh. “The issue is we are pretty much at the highest level of funding from foundations, so that leaves us to plead with the health department [for additional funds].”

Demand for clean needles continues to multiply: HIPS alone has seen a 25- to 50-percent increase in the number of needles it has exchanged in the last year. In May 2015, for example, HIPS dispensed about 18,700 needles to clients. In May of this year, it distributed more than 38,000.

But despite the program’s overwhelming success and regular requests for additional city funding, HIPS has received level funding—$180,000—for three years.

Its D.C. funding will renew Oct. 1 at the same rate. But if the organization’s resources don’t expand, it will “have to cap the number of people we serve, [and] cap the amount of supplies we exchange,” MacIntosh says. “We won’t meet the demand for this service, which could have life-threatening consequences.”