Browsing Category: Harm Reduction

World AIDS Day with Team Cleveland

Team Cleveland in front of Care Alliance's testing Van at World AIDS Day

Team Cleveland in front of Care Alliance’s testing Van at World AIDS Day

This year for World AIDS Day,  team Cleveland partnered with the AIDS Funding Collaborative and Care Alliance Health Center to do outreach and testing at Tower City. In preparation for World AIDS Day our team created harm reduction business cards to be handed out alongside support ribbons. Throughout the day team members canvased public square and RTA bus/train stations handing out harm reduction cards, ribbons, and condoms. Care Alliance brought their outreach van where members did testing and HIV education.

At the end of the day all ten thousand of our harm reduction cards had been passed out, 58 HIV tests had been performed, and hundreds of condoms had been distributed! What an amazing number of people reached, and all in less than ten hours!

As an AmeriCorps member it is sometimes hard to see the impact we are making in our communities, at our placements, or with the individuals we work with. Often the work we do tends to have more long term effects rather than immediate results. Knowing the number of people reached or tests performed is satisfying because we can quantify our efforts into something tangible. However, the impacts made by outreach efforts such as World AIDS Day go far beyond these numbers.

Each condom, harm reduction card, and support ribbon is a seed planted within the mind of the receiver. The people we reached out to displayed a variety of reactions when offered free condoms and information about HIV. Some were delighted and intrigued while others were confused or disapproving. Regardless of their reaction, the important part is that for a split second we were able to get them to think about HIV and the importance of condom use.

Seeds don’t always germinate right away, and sometimes it takes multiple planting before a seed takes root. However, each outreach effort, condom, and harm reduction card is one more seed planted. One more step closer to the end of HIV.

Why Overdose Prevention Matters for People Living with HIV/AIDS

by Leilani Attilio, MPH, RN
Overdose Prevention Coordinator
North Carolina Harm Reduction Coalition

Prescription drug overdoses (OD) have reached epidemic proportions1, 2 and is the fastest growing drug problem in the United States1.  OD deaths are the second leading cause of unintentional injury3.  Among rural states, North Carolina, has one of the highest percentage increases of unintentional OD deaths from opiate drugs2.  In the most recent issue of the New England Journal of Medicine, a research study found that abuse-deterrent formulations of OxyContin, an opiate, has generated unintended negative outcomes4.  Although there has been a significant decrease in OxyContin use, heroin use nearly doubled simultaneously4.  Heroin use poses dangerous consequences to include contracting the Hepatitis C Virus and HIV due to high-risk drug behaviors such as needle sharing5.  As a result, harm reduction organizations, drug treatment centers, and AIDS groups understand the importance of a comprehensive program planning in HIV/AIDS treatment, which includes OD prevention for people living with HIV/AIDS.

OD prevention encompasses rescue breathing and the distribution of naloxone, which is a highly effective antidote to an opioid OD.  Naloxone is not a controlled substance, nor can a person become high and thus, has no potential for abuse.  It can be safely administered to clients as a rescue medication in the event of a respiratory arrest6.  Outlined are several reasons OD prevention is an important topic among people living with HIV/AIDS.

1.) OD prevention services act as a bridge between people who use drugs and HIV prevention, drug treatment, and primary healthcare8.  Globally these programs draw new clients into their HIV prevention services and thereby, enabling HIV prevention to expand beyond traditional services in order to mitigate the HIV epidemic.

2.) Nonfatal overdose outcomes (e.g., pneumonia, acute renal failure) can be worse in people living with HIV8.  Hospitalizations can interrupt the HIV treatment regimen and may induce HIV-related diseases such as tuberculosis and bacterial pneumonia.

3.) HIV drug regimens may block the breakdown of opioids in the system and ultimately, putting the client at risk for an overdose8.  Opioid medications are routinely administered for their analgesic effects to people living with HIV/tuberculosis co-infection.   Many of these people also have a substance use disorder and would benefit from overdose prevention education.

4.) There is a disproportionate number of overdoses among HIV positive injection drug users8.  Since injection drug use is a the third leading cause of HIV in North Carolina7, HIV services should prioritize overdose prevention support to their clients who are using drugs.

5.) Overdose prevention empowers people that use drugs who are at-risk for acquiring HIV8.  Research suggests that people who use drugs are as skilled as medical providers in correctly recognizing overdose and determining appropriate use of naloxone9.

6.) Policies that increase HIV infection risk among people who inject drugs also increase the risk of overdose8.  For example, the release from prison greatly increases the risk of overdose for people who inject drugs10.  Health and social programs who serve inmates inside or exiting from these settings are in an opportune position to support those at greatest risk for overdoses.

7.) People living with HIV and use drugs are concerned about overdose8.  In a study among people who inject drugs in the United States, almost all (87%) were strongly in favor of participating in overdose prevention education and training in resuscitation techniques11.

OD deaths are a major public health issue.  By bridging people who use drugs to necessary social services and empowering the most vulnerable, OD prevention not only is effective and feasible, but most importantly humane piece in HIV/AIDS programming.

The North Carolina Harm Reduction Coalition is a grantee of AIDS United

References:

1. Paulozzi L, Baldwin G, Franklin G, et al. CDC Grand Rounds: Prescription Drug Overdoses-A U.S. Epidemic. Atlanta: Centers for Disease Control and Prevention; January 13 2012.

2. Sanford K. An Unrelenting Epidemic of Deaths from Prescription Drugs in North Carolina. 2008; http://www.ncmedboard.org/articles/detail/an_unrelenting_epidemic_of_deaths_from_prescription_drugs_in_north_carolina/. Accessed July 16, 2012.

3. Paulozzi L, Annest J. Unintentional Posoning Deaths-United States 1999-2004. Atlanta: Centers for Disease Control and Prevention; March 28 2007.

4. Cicero TJ, Ellis MS, Surratt HL. Effect of abuse-deterrent formulation of OxyContin. N Engl J Med. Jul 12 2012;367(2):187-189.

5. CDC. Hepatitis C Information for Health Professionals. 2011; http://www.cdc.gov/hepatitis/HCV/index.htm. Accessed July 16, 2012.

6. Tobin KE, Sherman SG, Beilenson P, Welsh C, Latkin CA. Evaluation of the Staying Alive programme: training injection drug users to properly administer naloxone and save lives. Int J Drug Policy. Mar 2009;20(2):131-136.

7. Foust E, Clymore J. Epidemiologic Profile for HIV/STD Prevention & Care Planning. Raleigh: State of North Carolina Department of Health & Human Services;2011.

8. Curtis M, Dasgupta N. Why Overdose Matters for HIV. 2010; http://www.soros.org/publications/why-overdose-matters-hiv. Accessed July 16, 2012.

9. Green TC, Heimer R, Grau LE. Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States. Addiction. Jun 2008;103(6):979-989.

10. Binswanger IA, Stern MF, Deyo RA, et al. Release from prison–a high risk of death for former inmates. N Engl J Med. Jan 11 2007;356(2):157-165.

11. Seal KH, Downing M, Kral AH, et al. Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area. J Urban Health. Jun 2003;80(2):291-301.

“This Is the New War on Drugs!”

By Shannon Wyss, AIDS United Grants Manager

What are the intersections between harm reduction and sex work?  Should the harm reduction community get involved in the struggle for or against sex trafficking?    These were a few of many questions addressed by one of the panels during the 2012 Harm Reduction Conference in Portland, OR.

“Trafficking Wars,” held on the conference’s second day, addressed many of the issues raised by the fight against sex trafficking and examined how this fight affects sex workers, men of color, and youth. Two of the four panelists declared the anti-sex trafficking movement “the new war on drugs,” and the arguments presented by the four panelists and the moderator stemmed from independent research, work with clients in non-profit organizations, and studies into the potential impact of the newly-passed anti-trafficking Proposition 35 in California, as well as similar, already-implemented laws in Illinois and Washington, DC.

Why anyone would be “for” sex trafficking was not, of course, the crux of the discussion. No one on the panel argued that individuals who are forced into sex work against their will should be left unaided. The first panelist, however, did offer a detailed analysis of how and why many estimates of persons trafficked are wildly overblown.

Rather than supporting trafficking, the panel’s focus came from a critical feminist analysis of anti-trafficking work – work that, they acknowledged, has involved many other feminists who come from a very different perspective. Using a specifically anti-racist, anti-ageist framework, the panel’s conclusion was clear:  harm reduction work is under attack through the fight against sex trafficking.

The panelists pointed out that, while feminists have spent decades fighting for women’s reproductive rights and the right of teenagers to access abortion services without parental consent, anti-trafficking statutes take direct aim at these hard-fought victories. By denying youth the capacity to consent to selling sex under any circumstances, young people are disempowered and infantilized.

Furthermore, teens who are caught up in anti-trafficking sex stings are often placed under the surveillance of family courts until the age of twenty-one and may be forced back into the unsafe family or foster care situations from which they had originally escaped.

Organizations that take a harm reduction approach to working with youth on the streets are also directly impacted. For example, anyone caught working with a young person who is engaging in sex work can be charged as a trafficker.  This includes harm reduction workers who give their clients meals, rides home, bus tokens, or clothing. It also includes youth who assist other youth on the streets, whether by merely hanging out together or by helping each other find clients. And yet one of the first harm reduction methods taught to young sex workers is to work in pairs. So any caseworker who helps a teenage sex worker – or any young person who aids another – can potentially be arrested, charged, and imprisoned as a sex trafficker.

Anti-sex trafficking laws also feed directly into the racist prison industrial complex, according to the panelists.  Not only do police departments receive increased funding for anti-sex trafficking work, but these statutes empower police to increase their surveillance and targeting of men of color for arrest; similar actions have not been concentrated in white communities.  Furthermore, many of these laws have increased the severity of related crimes:  what used to be misdemeanors are now felonies.  So men of color are being targeted by police, arrested more frequently, and convicted of more severe charges with more required time behind bars, thereby exacerbating a system that is already stacked against non-white men.

And, of course, from a harm reduction perspective, prison is not a safe place for anyone. Being stuck in a system where inmates face increased risk for HIV, hepatitis, harassment, and rape is hardly an environment in which an individual can easily reduce her/his risks and stay healthy.

All the panelists agreed that the harm reduction community has not been fully engaged in the fight to end anti-sex trafficking statutes and the deleterious impact that they have on so many individuals.

By extension, the HIV community stands to benefit from the end of anti-sex trafficking laws:  the amazing organizations that do such critical HIV outreach and prevention work will be able to continue fully engaging youth and others involved in sex work; men of color, already at astronomically increased risk for HIV, will be less likely to end up in prison; and we can continue to make inroads in stopping the spread of AIDS and keeping those who already are infected healthy and in care.

To get involved, contact your local sex workers’ rights organization or an agency that provides supportive, non-judgmental, harm reduction-based services to individuals involved in commercial sex work.

Atlanta Adds Southern Flavor to Harm Reduction

By Tessie Castillo, NC Harm Reduction Coalition

You know you’re in for a good time when a conference kicks off with an electric guitar performance. Last week Atlanta hosted the 2nd Annual Southern Harm Reduction conference, launched with a spirited song about jack shacks and brothels and sung by a former sex worker from Georgia…and it only got better from there. Throughout the three day conference, active and former sex workers and drugs users gathered with law enforcement, veterans, academics and community service providers to discuss hot button issues such as overdose prevention, safer crack use, mass incarceration, human trafficking, and drug policy. The event aimed to add southern flavor to harm reduction, a concept usually synonymous with government-funded syringe exchange programs in northern states. But while New York and Massachusetts might have a strong harm reduction presence, small nonprofits and activists from all over the south are quietly addressing issues such as syringe access, appalling rates of HIV and hepatitis, mass incarceration of minorities, violence against sex workers, and drug user stigma.

Take Atlanta for example. Syringe exchange is illegal in the state of Georgia, but Atlanta Harm Reduction Coalition (AHRC), who was one of the conference hosts hosted, has been providing life saving syringes to drug users and taking dirty needles off the streets for years. Rain, snow, sleet or hail, you’ll see Mona Bennett and her famous button hat offering HIV testing, referral to drug treatment, or a helping hand to people who use drugs.

Further up the coast, the North Carolina Harm Reduction Coalition provides harm reduction based direct services and advocacy, as well as trains law enforcement officers on how to avoid accidental needle-sticks and works with them to advocate for saner drugs laws.  In addition, organizations like Project Lazarus have saved hundreds of lives through educating medical providers and the community about overdose prevention.

To the west, Streetworks in Nashville is educating drug users on how blood borne pathogens spread through crack and injection drug use and works to improve the lives of people who use drugs.

Dip down to New Orleans where Women with a Vision provides women and sex workers with empowerment tools for how to lead healthier lives and to serve as their own advocates. These organization are just a few of the many harm reduction programs working to save lives, reduce stigma, and make safer communities below the Mason-Dixon line.

There is a lot of harm reduction in the South, it’s just not as visible as elsewhere. Southern programs grapple with different challenges than northern states, such as greater stigma, fewer resources, and complex legal situations. Southern harm reduction isn’t big and flashy, but small groups of dedicated people are making a difference in every state. The conference in Atlanta was a chance to come together and to learn about what works from people who are doing it. It was a chance to realize, “hey, we’re not alone.” It was a chance to say, we don’t have to bring harm reduction to the south, because we’re already here.

What People Said About the Southern Harm Reduction Conference in Atlanta:

“This conference is a chance to grow harm reduction in the south. I love it because I feel like my neighbors are getting closer.”

– Mona Bennett, Atlanta Harm Reduction, Atlanta, GA

“The incredible attendance for the conference speaks to the commitment in the south to be part of a harm reduction movement and to highlight the issues we face here, because they are unique.”

– Deon Haywood, Women with a Vision, New Orleans, LA

“As a law enforcement officer, I feel encouraged that people from various disciplines are willing to put their differences aside and come together to discuss greater safety and better communities for everyone.”

– Ronald Martin, North Carolina Harm Reduction Coalition, Raleigh, NC

“Using drugs doesn’t make anyone less of a person. We’re here to learn how to protect drug users’ rights and to reduce the harm caused by active drug use.”

– Ron Crowder, Streetworks, Nashville, TN

“I’m stoked at the number of people who have poured out to support southern harm reduction. It’s been a long time coming. I’ve always said that if we could bring support and experts to the south and begin to educate our folks about harm reduction, we could really start to see changes here.”

– Jeff McDowell, Atlanta Harm Reduction, Atlanta, GA

“I’m here to learn and to support my fellow peers in the trenches…I believe we can learn from each other. We get a lot of edicts from the CDC about prevention measures, but what works in New York might not work in the rural south. At this conference I can meet someone from Kentucky who is doing great work and I can bring it back to my state and emulate it.”

– Art Jackson, Independent, Fayetteville, NC

“It’s wonderful see participation from sex workers and people who use drugs. Living in Washington DC it’s easy to get away from that, so it’s important for me to listen and participate and to get involved with people on the ground.”

– Whitney Englander, Harm Reduction Coalition, Washington DC

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*To see conference photos go to the “Southern Harm Reduction and Drug Policy Network” Facebook page

*To check out the podcast on the conference go to the following link: http://harmreduction.org/publication-type/podcast/seventy-nine/

Finding Common Ground With Lawmakers, Law Enforcement, Substance Users and the Community

by Tessie Castillo, NC Harm Reduction Coalition

It’s not every day that law enforcement and active drug users agree on something, or that Democratic and Republican politicians find common ground. But on Tuesday, June 12th, the Summit on Law Enforcement Safety and Drug Policy forged unlikely collaborations on issues of law enforcement safety in North Carolina. During the event, law enforcement, civil servants, academics, public health workers and concerned community members discussed various topics affecting law enforcement, including the importance of preventing needle-stick injuries to officers and the community, the need to include law enforcement to address the epidemic of prescription drug overdose, and reducing recidivism among prison populations.

Preventing Needle-Sticks to Law Enforcement

The Summit was held at the legislative auditorium in downtown Raleigh. During the first panel of the morning, former officer Jen Earls spoke articulately about her first needle-stick as a rookie cop in Chicago. “Getting stuck by a needle was one of the scariest moments of my career,” said Earls. “I pulled over a woman driving a posh Lexus in a rough neighborhood. She told me her driver’s license was in her purse and when I put my hand in, I got stuck on a needle. I didn’t know what to do and didn’t want to make a big deal out of it because no rookie wants that kind of attention. So I put a band-aid on it and went on with work.”

Conference participants, including Republican Representative Glen Bradley, Democratic Representative Dianne Parfitt, Jon Sanders of the Jon Locke Foundation (a conservative think-tank), and several members of law enforcement, articulated the need for syringe decriminalization laws in North Carolina. Syringe decriminalization would allow residents, whether the state’s 680,000 diabetics or 25,000 urban injection drug users, to carry clean syringes without fear of arrest. Current N.C. laws, which categorize syringe possession as a Class A misdemeanor, discourage people from declaring syringes to an officer during a search and result in 1 in 3 officers receiving a needle-stick during their careers, with 28% receiving multiple sticks. Syringe decriminalization has been shown to reduce the incidence of needle-sticks to officers by 66%, as well as to reduce HIV and hepatitis transmission in communities where it has been enacted.

“Representative Bradley and I are usually on opposite ends of the political spectrum,” said Representative Parfitt during the Summit, “But we are in 100% agreement on this issue [of syringe decriminalization]. I think the will is there and we will look at a way to make this happen.”

“I believe a combination of harm reduction programs and syringe decriminalization will make a vast difference in the lives of law enforcement officers,” explained former officer Earls. “I think officers need to know how to safely handle paraphernalia and needles. They need to know when to wear gloves and when to take extra precautions.”

“There are many costs associated with needle-sticks, such as the lifetime costs of HIV and hepatitis infections that are born by taxpayers for people without insurance,” said Jon Sanders of the John Locke Foundation. “Even diabetics who live in a bad neighborhood are afraid to carry their own needles and they put their own health and the health of law enforcement at risk. Syringe decriminalization is a low cost measure that will lower health costs and raise public health, and for those reasons I support it.”

Reducing Recidivism

Following the needle-stick panel, Republican Representatives Leo Daughtry and John Faircloth, as well as Democratic Senator Ed Jones, led a discussion on the need to reduce recidivism rates in North Carolina, which have climbed to nearly 40% for adults in recent years. The legislators championed the Justice Reinvestment Act, passed by the NC General Assembly in spring 2012, which aims to reduce recidivism by allowing parole officers to intervene more quickly to discipline parole violators instead of waiting months while the case lags in the courts and the negative activity continues. “The Justice Reinvestment Act is about taking money that goes into prisons and putting it into rehabilitating people,” explained Representative Daughtry.

“Communities will be safer, law enforcement will be safer, if there are more efforts directed towards opportunities to find housing and jobs [for ex-offenders],” said retired officer Ronald Martin.

“When I started [in law enforcement] 35 years ago I had the idea that we should lock up everybody and throw away the key,” said Senator Jones. “I know now that we can’t do business that way…we have to think about people as being a part of society and not remove them from society…I would ask you to make every effort to see that these [ex-offenders] have a decent starting life when they get out.”

The Representatives spoke alongside Dennis Gaddy, Executive Director of the Community Success Initiative, Bill Rowe, General Counsel and Director of Advocacy at the NC Justice Center, and Jon Sanders of the John Locke Foundation.

Utilizing Law Enforcement to Decrease Overdose Deaths

The final Summit panel addressed law enforcement’s roll in reducing the epidemic of drug overdose deaths. Overdose death from prescription painkillers has recently passed motor vehicle fatalities as the number one cause of accidental death in the United States. North Carolina suffered over 1000 overdose deaths last year alone, mostly from opiate painkillers. Research shows that most people overdose in the presence of another person. However, current laws discourage witnesses to an overdose from calling 911 for fear of drug possession charges. Consequently, many witnesses wait too long to call emergency services, or don’t call at all, often resulting in the death of the person who has overdosed.

Some police departments around the country have begun requiring their officers to carry Narcan, a drug that reverses fatal overdoses. As police are often first to arrive at emergency scenes, especially in rural areas where ambulance arrivals are delayed, law enforcement officers have a unique opportunity to save lives with Narcan.

Lieutenant Detective Pat Glynn, champion of a Narcan program at the Quincy police department in Massachusetts, joined the Summit to discuss the success of the Quincy program.

“A couple years ago we had 47 overdose deaths in Quincy over an 18 month period,” said Lt Det. Glynn. “After we started the Narcan program, from October 2010 to June 2012 overdose deaths dropped to 16, and our officers conducted 90 successful overdose reversals with Narcan…We had a family member feel so comfortable [with police using Narcan] that they pulled up to the parking lot of the police station, knocked on the door and the police were able to come out with Narcan and save the individual’s life. It’s refreshing to see people coming to us and looking at [law enforcement] in a different light.”

In addition to Narcan programs, legislators participating in the Summit discussed 911 Good Samaritan laws, which would grant amnesty to witnesses to an overdose who call emergency services to save a person’s life.

Representative Parfitt offered a personal perspective on overdose. “At one point my 85 year old aunt was admitted to Duke with a drug overdose from Valium…we have to overcome the idea that [drug overdoses happen to] other people, not us…a lot of people are affected because someone inappropriately uses drugs…there are some simple solutions and one thing we can do here is look at the 911 Good Samaritan bill.”

“There is a larger problem with prescription drugs in America than there is with illegal drugs,” said Representative Bradley. “We have here potential programs to help reduce the rate of overdose and death… and one is immunity for emergency 911 calls, the medical amnesty program, and another is the Narcan program to keep Narcan in vehicles so we can respond right away.”

“The Good Samaritan laws and Narcan programs honor life…this is an issue that unites people across the political spectrum and I find that personally refreshing,” said Jon Sanders of the John Locke Foundation.

Comments on the Summit from Participants

“I thought [the Summit] was fantastic. [We] had a great cross section of people from different professional groups, which was really important. The only thing [we] needed was some people who were really not believers so we can hear them and ask what their problems are… I need to find out what is standing in the way, what those road blocks are.”

– Representative Dianne Parfitt, (D)

“[Last year] I said we needed to reach out more to law enforcement [on syringe decriminalization], and that has been done. The foundation is now really solid to walk up to groups who can really make [syringe decriminalization] happen in the legislature, the Sheriffs Association for example, or the Police Benevolence Association… if you get these groups on board not only will you get legislation passed, but you will get it passed overwhelmingly.”

– Representative Glen Bradley, (R)

“I thought it was a remarkable event and a tribute to NCHRC that [they] were able to pull this off. I wish every state would do this. It’s good to raise awareness with legislators and let them know what is going on.”

– Leigh Maddox, retired Captain of Maryland State Police

“If I had had a chance to work with the guys like [Lt Det Glynn], I might have stuck around [the force] longer…nobody is talking about [these law enforcement issues]. It almost has to come from the top down. A lieutenant needs to bring it up and say, here is what we are going to do.”

– Jen Earls, retired Chicago police officer

“There is really no down side to [adopting these measures].”

– Ronald Martin, retired law enforcement detective from the New York police department

“I really enjoyed the forum today, and I learned a lot. [The Summit] will help build agency collaboration on issues we have been fighting for over the last 3-4 yrs at the legislature.”

– Dennis Gaddy, Executive Director of Community Success Initiative