Photo credit: Harm Reduction Coalition
The harm reduction approach grew out of the HIV epidemic during the 1980s, although the roots of this philosophy extend further than that. People who inject drugs became aware of the increased risk of contracting HIV by sharing needles and they spread information and resources to one another. Following their lead, providers began offering needle exchange programs to reduce the spread of HIV and other infectious diseases like Hepatitis C. The strategy was successful around the world and proved what is possible when people who use drugs are informed and empowered. The origin of harm reduction is in drug users helping other drug users. But the utility of harm reduction is not limited to needle exchanges or supervised injection facilities. We limit our impact when we don't harness the full potential of this compassionate and pragmatic approach.
The principles of harm reduction can be applied to our engagement with people around any risky behavior. Practicing harm reduction means partnering with people to identify problems and potential solutions, avoiding judgment and respecting their choices, being patient with the change process, and promoting continued engagement. The measure of success of this approach is improved quality of life. These practices are not exclusive to working with people who use alcohol and other drugs. Experiencing connection and empowerment are healing factors, no matter the ailment. Let’s take a look at how harm reduction can help with other risky behaviors.
Homelessness itself is risky and exposes people to numerous harms. The ideal solution is housing, but that option isn’t always readily available to people. The experience of homelessness disempowers. In a shelter, you are constantly living on someone else’s timetable. On the streets, you are more vulnerable to the weather or violence. While people are living in the streets and shelters, we can help them recognize what is in their control. Through these conversations, they can identify strategies to improve their safety and quality of life such as strength in numbers, avoiding people who seem dangerous, and finding meaningful activities to engage in during the day that break up the monotony while adding opportunities for structure and connection.
It can be a lot of work to eat healthy, not to mention expensive. It’s even more complicated when you’re eating whatever a shelter or pantry has to offer, have limited means to buy food, or live in a food desert. Using a harm reduction framework, we can help people develop low-threshold strategies to improve their nutrition. Gaining access to government benefits or food pantries, keeping canned or frozen vegetables in the home, and choosing inexpensive proteins like peanut butter or beans are just some of the strategies that may be within reach.
When we use a harm reduction approach, we take a sex-positive stance in frank discussions about people’s sex lives and ensure that they have access to barrier protection and STI testing. But, we don’t shut down if our participants tell us they don’t use condoms. We explore their reasons and help them seek other opportunities to reduce risks associated with sex like being selective about partners, other forms of contraception, and safer types of sexual practices.
A few years ago, the theme of our Harm Reduction in the House conference was “It’s Not Just About Drugs”. The conference looked for the risks in our participants’ lives beyond those associated with their substance use. People experiencing homelessness navigate chronic health problems, encounters with the police, and intimate partner violence to name a few. Participants in Housing First programs face all these situations and more. In every situation, there are opportunities to reduce their potential to harm. Using harm reduction to engage with participants about these risks will affect the options they recognize and the choices they make. In many ways, every year of our conference is about this theme as we continue to look for populations and situations that might benefit from a harm reduction approach. Join us for our conference this year on September 23rd in Chicago and help us expand this conversation.
In future posts, we’ll explore how harm reduction can be applied to other challenges our participants face like managing mental health.