By Cheryl Bauer
Harm reduction is a concept gaining attention in recent times, but that has existed for all of human history. The key principle of harm reduction is acknowledgment that certain behaviors that carry inherent risks or danger are a constant in society, and those at greatest risk for harm should be given resources to make better choices that will reduce the risk of harm or death when it is not possible to abstain from these behaviors. One nearly universal example in the US are seatbelt laws. In order to reduce the risk of death, seat-belts are required for use in personal automobiles. Air bags, proximity sensors, rear cameras, and anti-lock brakes are all examples of measures that have been implemented to make driving a safer experience despite the risk of injury or death in an accident.
In the 1980s, the notion of harm reduction emerged as a strategy to mitigate the spread of the HIV virus among intravenous (IV) drug users and sex workers. These perceived vices were among risk factors for contracting the virus, yet admonition and insistence that people simply abstain proved ineffective in reducing the spread of HIV in these populations.
In response, a new tactic was employed: acknowledge the futility of expecting behavior to cease, and empower at-risk populations to make safer choices when they did participate in IV drug use or sex work. IV drug users were encouraged to not share needles, and needle exchange drives were sponsored to provide clean equipment and resources for medical care and addiction treatment to those who were ready to seek it. For sex workers, condoms were distributed by community volunteers, and facilities for sexually transmitted infection (STI) testing and treatment were founded. These efforts continue today, and some communities have gone further. Some counties in Nevada have legalized sex work and provide safe spaces for workers to engage with clients, contraceptives, physical security, and STI monitoring. Other localities have explored providing safe injection sites for IV drug users to use in a controlled environment, with monitoring and medical attention available in case of an overdose.
Today we see overdose awareness campaigns and Naloxone (Narcan TM) becoming available at little or no cost to help stop an overdose. (It is important to note that the effects of Naloxone do wear off after a short while, and emergency medical attention is still required to prevent a second overdose event.) Pharmacies and community advocacy groups like Prevention Point Pittsburgh, even the Allegheny County Health Department, periodically offer Naloxone kits and training to interested individuals and organizations. Anyone who uses, or loves someone who uses opioids in any capacity – including prescription – should have Naloxone on hand! You also never know, especially in communities with high opioid use, when you might come across someone experiencing an overdose.
Information about Naloxone training and needle exchange services can be found online at Prevention Point Pittsburgh’s website, pppgh.org, or by phone: 412-247-3404. Call your local pharmacy ahead of time to learn what they provide, though you may need to use your health insurance to cover the cost. Narcan is sold at most pharmacies in Pennsylvania without a prescription. Prevention Point Pittsburgh also offers free Narcan supplies and training to individuals.
Efforts to address violence against sex workers, without penalty of criminal charges for the workers themselves, are gaining popularity in some major cities, while legislation like Stop Enabling Sex Traffickers Act and Allow States and Victims to Fight Online Sex Trafficking Act (SESTA and FOSTA, respectively) have actually made sex workers more vulnerable by forcing many back on to the streets and rendered unable to thoroughly screen potential clients before agreeing to engage with them, by restricting the online resources they had come to rely on.
The controversy over the merits of abstinence vs. safe indulgence in human vices is often morally polarizing. What we are seeing, though, is that when people are empowered, supported, and have the basic necessities and resources we all need for life, the need to fill the emptiness within with a temporary euphoria subsides and often disappears.
Sex work will always be a part of our world, whether we acknowledge it or not, and it serves a purpose regardless of our collective approval. Sex workers are no less deserving of safety, dignity, and protection from violence than any other person who needs to earn a living.
IV drug users are no less deserving of a chance to heal than any other person fighting a disease, mental or physical.
Allowing people to reclaim dignity where there has for so long been shame, ridicule, and cruel expectations helps everyone to see others as whole humans living out a chapter of life. I hope that rather than judge these chapters, we can walk each other through them to safety and comfort. The concept of harm reduction can be applied to so many other facets of life, as individuals and as a collective, and we should never stop seeking to provide these supports.
Cheryl Bauer is a member of the Merton Canter and the NewPeople editorial collective.
NewPeople Newspaper VOL. 50 No. 2. March, 2020. All rights reserved.