We’ve taken a break from blogging the past month to work on our annual conference, Harm Reduction in the House. The conference focuses on how harm reduction can be applied to improve the delivery of housing and other social services. There are a number of nuanced issues that come up for participants in programs using the Housing First Model. This year, conference attendees were able to hone in on areas to use harm reduction including safer substance use practices, sexual health promotion with tools like PrEP, and engagement strategies that promote positive changes like the SODAS Method. The conference hosted several hundred presenters and attendees from around the Midwest including Illinois, Indiana, Wisconsin, Michigan, and Ohio. In this post, we look at some of the reaction and takeaways from the conference.
The theme of this year’s conference was “Growing from Our Roots.” Harm reduction is getting into the mainstream. In recent years, a broader range of programs and providers around the world have embraced harm reduction. Growing from Our Roots is a reminder that harm reduction work began with drug users and people actually engaged in risky behaviors. Their community, respect, and self-determination drive the principles of the harm reduction philosophy in service delivery. They are experts in their own lives and must be included in the work and accompanying advocacy efforts. Daniel Raymond, policy director at the Harm Reduction Coalition, attended the conference and offers additional thoughts on this topic and more in “Holding space for the unredeemed: harm reduction and justice.”
One of the popular sessions at the conference was the “Irreverent: Harm Reduction Youth Work and Radical Ministry” workshop. Rabbi Menachem Cohen and Pastor Alli Baker led a group discussion including youth who are LGBTQ and have experienced homelessness. The conversation explored the experience of homelessness from a young person’s perspective and what providers can do to create safe, welcoming environments. When workers listen nonjudgmentally and remain flexible, they have the power to support youth in getting off the streets and remaining housed. Rev. Kathryn Ray is a member of Clergy for a New Drug Policy and offered her thoughts on this workshop after attending the conference in “Rule Breaking and Radical Love.” She discusses the way that harm reduction can open doors for people and says, “Harm reduction work is gospel work.”
We have to acknowledge that we could not put on this conference without the help of our amazing volunteers. Thanks to everyone who pitched in! Among other duties, we had volunteers live-tweeting the conference. Below are some of the highlights from the day. For a full list of tweets, check out #HousingisHR on Twitter.
Photo credit PrEP4Love.com
The fight against HIV/AIDS advanced tremendously over the last 30 years. Treatments can decrease viral loads to undetectable levels, improving the health of people living with HIV and lowering the chances of transmitting HIV to others. But, with over 40,000 new HIV infections annually in the United States there is more to be done. Additionally, people of color, trans women, and men who are gay or bisexual continue to be disproportionately affected by HIV. In response, the National HIV/AIDS Strategy increasingly promotes HIV prevention efforts.
PrEP (pre-exposure prophylaxis) is a new approach to HIV prevention. PrEP treatment means that someone who is HIV-negative can take a daily pill to reduce their risk of becoming infected with HIV. PrEP does not protect against other sexually transmitted infections or pregnancy. It is intended to be used in combination with other safer sex measures, including condoms. Truvada is the medication currently approved for PrEP treatment by the FDA. The medication must be taken for at least seven days to reach sufficient levels for protection against HIV. PrEP is recommended for anybody at high risk of HIV infection. Primarily, this includes men or transgender women who have sex with men, people who are HIV-negative but have a partner who is HIV-positive, and people who inject drugs.
Research shows people who use PrEP experience a reduction in their risk of HIV infection. Transmission of HIV has been demonstrated to drop by over 90% among people who take PrEP consistently. As explained on the website PrepFacts.org, “If you don’t take PrEP consistently it can’t protect you from HIV, but if you do take it regularly it can offer strong protection.” PrEP is sometimes confused with PEP. PEP stands for post-exposure prophylaxis and can reduce someone’s risk of becoming infected with HIV after they’ve come into contact with it. To be effective, PEP treatment must begin within 72 hours of exposure to HIV and last for a month.
It’s important for housing first providers to be informed about PrEP and PEP and to share information about these treatments with their participants. Housing first providers work with people in marginalized communities who are at a heightened risk of HIV exposure. In addition to the groups previously mentioned, HIV is more prevalent among people who are homeless. Although PrEP is highly effective, one in three health care providers haven’t heard about it. So, it’s up to service providers and other helpers in the community to spread the word about this option.
Even if a health care provider is aware of PrEP, they might be too rushed to fully understand what’s going on with their patient or stigmatize their risky choices. The Housing First Model gives service providers the time needed to get to know someone and find out about potential risks they face. If housing first providers are using a harm reduction approach, they are more likely to get honest information about a participant engaging in unprotected sex or injection drug use. That means that they might be aware of a person’s heightened risk for getting HIV and can bring PrEP to someone’s attention, who may not hear about it otherwise.
Sex feels good. It helps satisfy our need for intimacy and connection. People do it despite the risks of unwanted pregnancy or sexually transmitted infections. As with all harm reduction work, staff's goal is to help people strategize how to get the benefits from a behavior without experiencing the consequences. Creativity is a necessity when service providers are collaboratively building a menu of options to reduce harm in their participants’ lives. But, that creativity can be stifled when staff try to talk about sex and participants respond by saying that they will never use condoms or that they are HIV-positive and sexually active. Don’t be deterred! Just because a person isn’t willing to do something in the safest way possible, doesn’t mean that they won’t consider other strategies that may help. Instead of using fear to motivate decision making, the focus should be on education, options, and empowerment. These values are reflected in many of the public health campaigns promoting PrEP which are more focused on being sexy than scary. Getting comfortable talking about risky sexual behaviors and the pleasure people get from their sex lives positions case managers to introduce options like PrEP to their participants in an appealing way.
Here are some additional resources for learning about PrEP. Check out this website for information on where to find PrEP in your area. PrEP is covered by most insurance providers and Medicaid. For more details about how to get PrEP, including links to available payment assistance programs, go to prep4love.com created by the AIDS Foundation of Chicago. Prepfacts.org was created by the San Francisco AIDS Foundation and includes a detailed list of frequently asked questions. The Well Project focuses on women’s health to address HIV/AIDS and presents a balanced overview of PrEP in the article “PrEP for Women”. On September 23rd the Midwest Harm Reduction Institute will be hosting a presentation on PrEP at the annual Harm Reduction in the House Conference in Chicago. Consider attending the conference or following the hashtag #HousingisHR to keep up with the conference.
As service providers, we can be part of improving the safety of LGBTQ communities by ensuring access to the basic human rights of housing, health care, and necessary supports.
The country is still reeling from the Pulse Nightclub shooting last weekend that left 49 people dead and many others injured. As we mourn the lives that were taken and for those families and communities that will forever be impacted, it is important to remember this tragedy is one event in a long history of violence against a specific community, and to recognize the trauma many of those who identify as Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) face on a daily basis.
People who identify as LGBTQ are disproportionately at-risk of experiencing violence—childhood abuse, sexual assault, intimate partner violence, harassment by law enforcement officers, and hate crimes. This is especially true for people who are trans-identified. In addition, members of this community are disproportionately affected by poverty and more likely to experience homelessness than others in our society.
The risk of violence and homelessness is increased for sub-groups of the LGBTQ community with intersecting vulnerabilities like youth, women, or people of color. Despite being only 5% of the total population, between 20-40% of homeless youth identify as LGBTQ. One recent study from Georgia State University found that over 28% of homeless and runaway youth in the metro-Atlanta area self-identify as LGBTQ. Among the victims of LGBTQ hate crimes resulting in homicide, people of color are disproportionately impacted. This is represented by the fact that the Pulse Nightclub shooting took place on Latin Night.
The pain of this moment highlights the need for competent services for the LGBTQ community in homeless and allied social services. We have a responsibility to create safety and security for the most vulnerable members in our communities. But, our organizations and programs are often not structured to sufficiently meet the needs of LGBTQ participants. In shelters and service programs, clients are often turned away, unable to express their identity, or not offered appropriate services. As service providers, we can be part of improving the safety of LGBTQ communities by ensuring access to the basic human rights of housing, health care, and necessary supports. Increasingly, there are discussions happening about how agencies and service providers can be more inclusive and supportive of people who identify as LGBTQ. For instance, the National Coalition for the Homeless and the National Gay and Lesbian Task Force teamed up to create Transitioning Our Shelters, a guide for making homeless shelters safe for people who are trans-identified.
This symbol can be used to indicate that your office is a safe(r) space
Improving the ability of service providers to meet the distinct needs of LGBTQ participants begins with education. Staff and participants alike should be continually trained in cultural competency around LGBTQ issues. We should recognize that our words can be harmful. To avoid that, staff can use inclusive language (e.g. partner instead of husband/wife or boyfriend/girlfriend) and differentiate between sexual orientation and gender identity. We should ask people in our programs about their gender identity and allow them to identify this for themselves. Respect is then further reflected by using people’s appropriate pronouns and chosen names. We should not ignore when LGBTQ participants experience harassment from other participants in our programs but instead encourage respect as part of being a good neighbor and community member. We can make our services more welcoming to LGBTQ participants by offering gender-neutral or single-stall bathrooms in our facilities and simply having honest conversations with these participants about what we can do to increase their sense of safety in our programs. We can also partner with LGBTQ organizations for help with questions and additional resources. This is only a sampling of some of the things we can do to make our agencies and programs more inclusive.
In addition, we should hire people in our organizations who identify as LGBTQ. I am a homeless service provider and an ally of the LGBTQ community. But, without the lived experience of homelessness or identifying as LGBTQ, my ability to understand is limited. Hiring people who identify as LGBTQ and formerly homeless reflects a desire to be representative of the communities we serve and provide spaces where they can feel safer.
The LGBTQ community is vulnerable but strong. One example of the community’s resiliency is the Transgender Housing Network. This group maintains a website that is a temporary housing network connecting trans people with safe and supportive places to stay. Similarly, RAD Remedy is a new website linking people who are trans, gender non-conforming, intersex, and queer to safe and respectful healthcare services. These groups are responding to an unjust system that limits the ability of people who are trans to access adequate housing and healthcare. These are true examples of harm reduction—a community of people exposed to risk and responding in a way to make themselves safer. But the LGBTQ community should not have to do this work alone. Service providers should figure out how to join the efforts that this community is already making to gain security. As programs and agencies committed to social justice, we are all allies in the fight for LGBTQ inclusion and protection.