I have been an HIV Prevention provider for over 25 years. I consider myself a Harm Reduction Provider/Harm Reductionist—a title I am very proud to claim—though it wasn’t always this way. I first heard about Harm Reduction in the mid-1990s through a program doing needle exchange in the low-income, community of color where I worked and lived. As I saw White men coming into a Black neighborhood handing out needles, I had many concerns. I thought their message was: “Go ahead, destroy your lives and your community, just don’t get the rest of us infected!” I also couldn’t understand why our cries for more treatment were being met with more needles. Since then, I have learned just how wrong I was about the intentions of needle exchange programs and the underlying philosophy of Harm Reduction.After practicing Harm Reduction for over 18 years with various groups and individuals at high risk for HIV and associated health issues, these are my top five reasons for using a Harm Reduction approach:
- A core principle of Harm Reduction is that there is inherent dignity in everyone, and everyone deserves to be treated with care and respect, regardless of their circumstances.
One of the most prominent qualities found in Harm Reduction-based programs is a clear and demonstrated effort to show care and respect for people served. Treating people well is a basic tenet that most of us have come to expect when interacting with service providers. Instead, many people served by our programs experience shame, disrespect, and humiliation when engaging with providers and have come to expect this response. When Harm Reduction programs counter this with respect and hospitality, they stand out. In fact, the more marginalized the population, the more effective Harm Reduction approaches tend to be. When I hear from folks that a program is great because “they treat you really well,” “they really care about you,” or “they’re real with you,” I know this is likely an effective Harm Reduction program.
- Program model, staff, policy, and space all reinforce the idea of non-judgmental service provision.
Creating a space where people can ask questions and have frank conversations without fear of being judged builds rapport and trusting relationships; it also facilitates disclosure. The more honest and open a person can be while doing behavior change work, the better the outcomes. A strong program recognizes the need to clearly communicate a nonjudgmental approach.
- Harm Reduction prioritizes appropriate relationship building.
Harm Reduction recognizes that a trusting relationship between the provider and person accessing services is the linchpin of all services. The stronger the trust and relationship, the more likely a person will be invested in their behavior change goals, the more likely they are to disclose challenges and obstacles that could impede their progress, and the more likely they are to follow up with referrals for support services.
- Harm Reduction Works!!!!
Harm Reduction works to safeguard the health of individuals at high risk and the overall health of the communities in which they live. In 2015, when Scott County, Indiana was suddenly struck with an acute outbreak of HIV and Hepatitis-C (numbers jumped from 4 to 5 annually to more than 170 in 7 months) among people who use intravenous drugs, the county leadership and the Governor called the Center for Disease Control (CDC) to find out what to do. The CDC’s immediate response was to open a needle exchange program in the area. This was an enormous departure from a few years prior when the CDC wouldn’t use the term “Harm Reduction.” The mounds of data supporting the efficacy of Harm Reduction finally won out, and this was the official response to the Scott County Outbreak. As a result, Scott County has seen a plateau in infections, and federal agencies have lifted their ban on supporting needle exchange programs.
- Harm reduction is our greatest hope for keeping people safe and healthy until they are ready to seek help.
After doing behavior change work for many years, I have learned that you cannot force, scare, manipulate, reason, or coerce people into changing their behavior. Behavior change only comes from one place—within. The best we can do is support, educate, encourage, and troubleshoot other people’s processes for behavior change. Harm Reduction recognizes that most people are going to do what they feel they want or need to do, and the best we can do is keep them safe, healthy, and alive so they can enjoy the best lives possible. If their path includes eventual treatment for addiction or substance use disorder, they will know where to get help, and we can link them to appropriate services. And should they eventually get clean or sober, they can do so free of HIV, viral hepatitis, and other associated harms.
Learn more about Harm Reduction in an online t3 course starting February 3, 2016: