CHARACTERISTICS OF
HARM REDUCTION SERVICES:
(plus examples & a drawing)
Speaking to young activists from across the country on harm reduction drug education
At a national conference held by Students for Sensible Drug Policy
November 20, 2004, University of Maryland, College Park.
- Any program designed at reducing the harms caused by a human behavior. In other words, this could include anything since every activity comes with risks.
- Status of Problem vs. Attempted Solutions. This means that the scope of the issue and specific problems currently taking place is compared with ideas, proposals, and strategies that have already been used to try to solve the problem(s). Instead of continuing to do the same things and failing, harm reduction is about recognizing which solutions actually work and sticking to those.
- Practicality & Necessity vs. Morality & Legality. Many behaviors where harm reduction can be applied are illegal, and immoral to many people too. Whether you or anyone else feels the behavior is wrong is irrelevant to your work as a harm reductionist. The point is that people are still engaging in the behavior, the risks are still there, and certain services and information that show people what they can do are more effective than laws and opinions that tell people what they should do.
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Don’t aim directly at wiping out problem completely. Harm reduction is not the same as harm elimination. We do not try to resolve the whole situation overnight. Instead, we realize that the behavior and risks stemming from it will always exist. Our strategy is to break the whole issue down, look at each individual risk/problem, and then address each of them step by step. You can’t get rid of the entire problem by making people abstain from their behavior, but you can get rid of part of the problem by making them engage more safely in the behavior.
- Do not be judgmental, critical, or hostile. Again, set your morals and propaganda aside and focus on the problem at hand. Simply offer your information and services and let them choose their own path without harassment or ridicule. Do not say, “If you do this, you’re gonna die! That’s what you'll get for it, ha ha ha!” Instead, say, “If you do this, there is a high risk of harm. Here’s a way to minimize that risk if you want to take that into consideration.”
- At-risk individuals participate in resolution. Harm reduction is not about going into someone else’s community, identifying the problem for them, forcing the solution on them, and threatening them with whatever if they don’t comply. It’s about letting the community in on the process of deciding what’s really going wrong and what can be done about it. The people engaging in the behavior have a right to teach and learn about the behavior and formulate ways of reducing the risks that are causing the problems. Peer education and popular education are direct methods of letting the people you’re helping have a say in the solutions.
- Examples
- Needle exchange
The first issue here is that individuals are addicted to particular drugs such as methamphetamine, cocaine, and heroine, which can be consumed by being injected into the body. The other issue is that sharing needles to inject the drugs, which many users have done, increases the spread of HIV by the additional exchange of body fluids. While the users may be aware of the risks they’re putting themselves in, their addiction prevents them from stopping, regardless of possible arrest and imprisonment. By offering clean needles for these users, at least the risk of HIV infection is reduced. Although it does not completely solve the problem of addiction and illegal drug use, it reduces the problem far more quickly than arrest, imprisonment, or efforts to cut off the availability of the drugs.
- Seat belts
Auto accidents can occur at any time or any place. We have many different methods of preventing them from happening - technological advancement in vehicle safety standards; improved roadways, signs, and street lighting; citing those who violate traffic laws; etc. But we must accept the fact that auto accidents can happen no matter how hard we try to prevent them and take additional measures to reduce harm in the event that an accident happens. As such, seat belts have not reduced the number of auto accidents in the world. But they have saved countless lives that would have been lost had the individual not been wearing the seat belt at the time of the accident.
- Abortion
Anti-abortion activists argue that abortion is murder and a disregard for human life. Pro-choice activists argue that it is a woman’s right to choose whether or not she should bear a baby. A harm reductionist does not necessarily have to choose sides. Rather, one must recognize the risks at hand without the availability of legally regulated abortion clinics. First off, women and teenage girls may continue to have unprotected sex despite the possibility of unwanted pregnancy. If some of these impregnated women want to abort their baby badly enough, the lack of legal abortion clinics may push them to seek abortion at illicit clinics where, without government regulation, medical procedures can be unsanitary and unsafe.
- Illegal street racing
Some cities have adopted an interesting way of dealing with local youths who race their cars on public streets and pose threats of serious accidents with their fast speeds and occasional stunts. They have organized legal events every now and then where these youths can come out to race at public tracks under the supervision of police as well as the spectatorship of fellow racers.
This way, instead of threatening or criminalizing the local race scene, authorities gave racers the opportunity to engage in their activities in a more regulated setting where potential harms to themselves and others were far less likely to happen. Furthermore, auto accidents are likely to increase if police deal with the situation by locating the races and chasing everyone down. In Oakland, California, for example, injuries and at least one fatality did not occur until after crackdowns proliferated and caused drivers to flee at high speeds.
- Condoms
Many high schools still do not distribute condoms and instructions on their use to students, because they fear that doing so will encourage high school students to have sex. Having intercourse carries a risk of disease and pregnancy (at least with heterosexual sex), and these risks can be completely avoided by abstaining from sex. Nonetheless, many teenagers today still do choose to have sex. From a harm reduction standpoint, it would be better to give teenagers information about sex, pregnancy, and STDs, and provide condoms to reduce the risk of STDs for those who choose to have sex. In this way, we are reducing the potential harms associated with sex.
The condom example is similar to pill-testing in that many people don't like distributing condoms for the same reason they don't like pill-testing: they don't like the relevant behavior (drug use, sex) so therefore they don't like anything that might make it easier to engage in that behavior.
However, that's completely missing the point of harm reduction. You don't have to like the behavior, you are simply recognizing that it occurs whether you like it or not, and doing what you can to reduce the harmful effects that can result from that behavior.
- Earplugs
Sustained exposure to loud noise (like the kind you find at rock concerts and raves) can produce hearing loss. The best way to avoid this is to completely avoid exposure to loud noise. Nonetheless, many people like to go to events where there is loud noise. Rather than banning loud music entirely, one can reduce the harms associated with listening to loud music by educating people about the risks associated with exposure to loud noise and providing earplugs to help reduce that risk.
- Prostitution
The street business of selling one's body for sex is as preventable as drug use and teen sex. None of these activities are preventable with any amount of legislation, law enforcement, or social stigma. And like drugs and sex, prostitution is more dangerous when only made illegal. While not necessarily approving of a harlots' lifestyles, countries in Europe have adopted an open-arms policy where contraceptives, safety info, and HIV testing are all available at health centers set up in areas of high prostitution rates.
In addition, police supervision of the neighborhoods reduces crime. Instead of arrresting buyers and sellers of sex, officers simply monitor the area for more serious crimes, such as theft or violence. This prevents rapes, beatings, and robberies that hookers (and sometimes their customers) are often subjected to. In fact, a majority of victims of serial murder cases are female prostitutes. Because of their vagrancy, inclination to ride off with strangers, and business in sexual pleasure, prostitutes make very easy and appropriate targets for serial sex killers.
- Condoms in prison
To reduce health risks caused by both rape and consensual sex in prisons, condoms and other health services should be available. The problem is assuming that inmates are not having sex simply because they shouldn't be having it. Again, harm reduction must replace this unrealistic notion. Most men engage in sex with other males during prison time not because of homosexuality, but because of the unavailability of women or other outlets for the release of sexual pleasure. Sometimes, the partner will consent to it. When the partner doesn't, force may be used, in which case the rapist will seldom bother using protection. And not offering condoms will make protection impossible even when they are willing to use it. Testing and treatment should also be available since a significant number of prison deaths are from HIV and other infections.
- WW I and WW II
During the beginning of the 20th century, conservative Victorians were trying to preserve high morals against the teachings or expression of sexual behavior. Part of their agenda leaked into the education given to World War I soldiers about sex. Only abstinence was taught, and scare tactics about venereal disease were used to raise hysteria. Of course, none of this worked. Tens of thousands of soldiers slept with prostitutes while away and came back with various diseases, some of them fatal. By World War II, our government knew better and offered sex education, factual info on VD, and condoms to the servicemen. In fact, the pin-up girl was specifically invented to help alleviate the sexual urges of men who were off in combat.
- Dumping babies
The idea of young mothers throwing their unwanted babies into trash cans is horrible. But instead of threatening to catch and arrest any woman who did so, a more effective way of saving newborn lives would be to provide amnesty for the desperate mothers. To make a law or sentencing standard for such an act would not prevent someone in the situation from committing it. In fact, as with prostitution or drugs, they'd be forced to do it in even more clandestine places and more dangerous places. So hospitals in various parts of this country allow women with unwanted babies to drop them off in emergency rooms. The mother may remain anonymous, will not be charged for anything, and is free to go. Despite how horrible it is to abandon a newborn, if a mother with no other options will do it anyway, wouldn't you rather the baby be dumped in a hospital than a trash can?
- Drug emergency victims
Another form of amnesty many hospitals practice applies to victims of overdose or other drug emergencies and the friends who bring the victims in. Many users of illegal drugs fear going to police or the ambulance to report a problem because they don't want to get in trouble with the law after recovering. As a result, most EMTs, doctors, and officers on the scene will not arrest or charge the victims and friends who helped the victim to the hospital unless other more serious crimes (such as violence or major dealing) were committed while under the influence of the drug. The first objective is to save the person's life, and it cannot be done if everyone's afraid of calling 911.
- Drunk driving
Instead of banning driving altogether, banning drinking altogether, or both, media campaigns, bar policies, and road laws attempt to prevent drunk individuals from getting behind the wheel at whatever level. From an enforcement perspective, at-risk individuals are threatened with fines and jail time. Other alternatives offered include taking public transportation, having a designated driver, or simply not drinking to the point of intoxication. Some states require bars to give designated drivers unlimited amounts of free non-alcoholic drinks. In drunk driving cases, police often investigate whether the driver had come from a bar. If so, the bar could be held accountable in court for allowing a driving customer to leave intoxicated.
© 2004
Feel free to email me at lesliu@gmail.com for questions or feedback.
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