Harm Reduction Zine

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HARM

REDUCTION
IS
NOT
A
METAPHOR
Living in the 21st Century with
Drugs, Intimacy, and Activism

A zine by What Would an HIV Doula Do? and Visual AIDS,


at the invitation of MoMA PS1 for Homeroom on the occasion of
Niki de Saint Phalle: Structures for Life and Gregg Bordowitz: I Wanna Be Well.

@momaps1 @visualaids @wwhivdd


Table of Contents

03 Indigenous Harm Reduction


Canadian Aboriginal AIDS Network and the
Interagency Coalition on AIDS and Development
04 Foreword: Harm Reduction Through Art and Activism
Visual AIDS

08 Introduction
Abdul-Aliy A. Muhammad

14 Harm Reduction = Life


AIDS ACTION NOW!

16 Needle Exchange + Junkie Union + Jon Stuen-Parker


What Would an HIV Doula Do?

22 Communities of Drug Use


Tamara Oyola-Santiago

26 Desenredando la Maraña (Untangling the Weave)


Bronx Móvil + El Punto en la Montaña and community activists

30 How To Get Narcan


Jodi Bosin

32 Collectivities in Kensington
David Oscar Harvey

37 Opioid Crisis is Still Not Just a ‘White’ Problem


Abdul-Aliy A. Muhammad

40 Decriminalization vs. Legalization: What You Need to Know


VOCAL-NY

43 BOOF IT!
Sessi Kuwabara Blanchard

44 As a Woman With HIV, I Make My Sex Partners Sign


a Disclosure Contract: Here’s Why
Tiffany Marrero

47 Safer Sex + Play Fair + How To Have...


What Would an HIV Doula Do?

51 Don’t Yuck My COVID Yum!


Molly M. Pearson

57 Sustainable Safety:
I Don’t Need You. I Want You. A Year of Feeling the Difference
Nick Melloan-Ruiz

60 Is Holding Space a Harm Reduction Practice?


What Would an HIV Doula Do?

65 Housing and Support + STAR House


What Would an HIV Doula Do?

68 Abolition as Harm Reduction


charles ryan long

72 Need Help With...


Project SAFE

74 Harm Reduction Stickers


Jade Forrest Marks and ripley soprano

76 EVERY TIME YOU SAY VOTING IS HARM REDUCTION another


faggot moves to hell’s kitchen...*
ripley soprano and Jade Forrest Marks

80 Voting is Not Harm Reduction


Indigenous Action

82 Where Will HIV Be in 10 years?


Alexander McClelland

88 Harm Reduction and the Archive


Salonee Bhaman

90 Credits
Indigenous Harm Reduction
Canadian Aboriginal AIDS Network and the
CANADIAN ABORIGINAL AIDS NETWORK

Interagency Coalition on AIDS and Development

“Mainstream harm reduction practices such as needle


exchange programs, naloxone distribution and opioid
substitution therapies have been established as a main
approach in the prevention of HIV, hepatitis C,
and overdoses. While these approaches are lifesaving,
they are not enough to make a meaningful difference
within Indigenous communities. Mainstream harm
reduction models focus too narrowly on substance using
behaviours, neglecting the broader social and system-wide
issues that contribute to and intersect with substance use
for Indigenous peoples in the first place. For Indigenous
03

communities, harm reduction = reducing the harms of


colonization. It is inclusive of, but much broader than,
INTERAGENCY COALITION ON AIDS AND DEVELOPMENT

a focus on using substances or safer sex. Indigenous harm


reduction is a way of life, rooted in Indigenous Knowledges
and worldviews, combined with the best of what the Western
world can offer, and focused on mitigating the living
legacy of colonization. Among Indigenous communities
however, harm reduction can be contentious and contested.
If Indigenous approaches to harm reduction are to be
successful, communities and community leaders must find
ways to engage in conversations informed by evidence and
understanding to facilitate inclusion of all Indigenous people
in ceremony, programs and community life.”

From the introduction of the 2019 report, Indigenous Harm Reduction.


BLAKE PASKAL & KYLE CROFT

Foreword:
Harm Reduction
04

Through Art and


Activism
Blake Paskal and Kyle Croft
for Visual AIDS
FOREWORD

@visual_aids
“The world has been experiencing a whole pattern of auto-destruction,

whether in environmental disasters like Chernobyl or health disasters

like AIDS... Young people need to become involved. AIDS is a complex


BLAKE PASKAL & KYLE CROFT

situation that’s sure to bring out the best and the worst in people.

And it’s just beginning.”

— Niki de Saint Phalle, 1988

These words from a 1988 People magazine interview


with Niki de Saint Phalle were published at a time
when information about HIV transmission and AIDS
prevention was clouded with inaccuracies and stigma,
if it was available at all. Saint Phalle’s words have an
uncanny resonance with Gregg Bordowitz’s reminder,
a decade and a half later in 2002, that “the AIDS crisis
is still beginning”—words that ring true today, as life
saving medication and healthcare remain inaccessible
05

to many within the US and social inequities compound


the impacts of the epidemic along racial, economic, and
geographic lines.

Bordowitz and Saint Phalle made their first AIDS-related


work in the 1980s, when government and health officials
offered little guidance about transmission routes and
prevention practices. Safer sex techniques and other
harm reduction practices like bleaching needles were
FOREWORD

developed and disseminated by activists responding to


a lack of information and services from the government.
Bordowitz, Saint Phalle, and many others in the arts
realized that they could communicate this life-saving
information most effectively through community-specific
messaging. Saint Phalle’s playful and colorful drawings
cut through concerns about taboo subjects with simple
and direct statements that could be easily understood
by children and adults alike. Bordowitz’s safer sex
BLAKE PASKAL & KYLE CROFT

shorts, made with Jean Carlomusto for Gay Men’s Health


Crisis, illustrated that safer sex could still be sexy with
pornographic shorts that were distributed to bathhouses
and gay bars.

Today, condoms and other safer sex practices are still


effective forms of harm reduction, but the landscape of
AIDS has changed. Information about safer sex and HIV
transmission is now widely available (though many states
still teach abstinence-only sex education), and antiretro-
viral treatment, U=U (undetectable = untransmittable),
and PrEP have created new methods of HIV prevention.
However, this new paradigm has also reinstated an
06

emphasis on personal responsibility and “good choices,”


illustrated through public health campaigns that put the
onus of the epidemic on people with HIV (“HIV Stops With
Me”) rather than the structural inequities at the heart of
the AIDS and COVID pandemics.

Though it’s been over 30 years since Saint Phalle stated


that “the world has been experiencing a whole pattern
FOREWORD

of auto-destruction,” her words feel just as relevant


today as we consider pandemics like AIDS and COVID-
19 in relation to the threat of global warming and the
escalation of white supremacist and state violence. The
continued relevance of her words urges us to examine
our collective commitment to dissolving inequity,
particularly at a time when activism is often reduced to a
social aesthetic or metaphors separated from the lives of
those most in need. It prompts the question: What does it
BLAKE PASKAL & KYLE CROFT

mean to be in a continual and constant practice of activism?

As an arts-based organization that uses art to fight AIDS,


Visual AIDS understands how art often coincides with
activism, and vice versa, and the role that both play in
educating about harm reduction practices. Our Play
Smart safer sex kits and broasides like “You Care About
HIV Criminalization, You Just Don’t Know It Yet” provide
educational information about HIV prevention and treat-
ment while also drawing attention to issues like criminal-
ization, stigma, housing justice, mental health, and the
structural inequties that exacerbate the epidemic.
07

On the occasion of Gregg Bordowitz and Niki de Saint


Phalle’s exhibitions at PS1, we at Visual AIDS want to
consider the work of these artists in relation to ongoing
practices of harm reduction today. We asked our friends
at What Would an HIV Doula Do? to share their insights
about harm reduction as a strategy for navigating and
surviving in the present day. Understanding that every-
one navigates a pandemic differently, the zine assembles
FOREWORD

writing and artwork that grapples with the complexity of


living through the simultaneous AIDS, COVID, and opioid
epidemics from a range of perspectives and position-
alities. We hope these materials provide helpful tools,
create connections, and prompt meaningful conversa-
tions that extend beyond the museum’s walls.

ABDUL-ALIY A. MUHAMMAD

Introduction:
Harm Reduction is
08

Not a Metaphor
Abdul-Aliy A. Muhammad
INTRODUCTION

(They/Them) 37 yrs old

@mxabdulaliy
I was born to two Black Muslim parents on October 26,
1983, in Philadelphia. This was at the beginning of the
crack epidemic in the US.
ABDUL-ALIY A. MUHAMMAD

My father Gregory Trice, Sr., who was from Germantown


and used his islamic name Sulahuddin Shakur, was
jailed due to the trafficking of narcotics in 1974. He was
set to do a considerable amount of time. That changed,
however, when he petitioned for an appeal, representing
himself, arguing that he had received ineffective counsel.
The verdict was overturned on August 11, 1982 and my
father was released. But before that, in 1980, he met my
mother, a Black woman who grew up in the West Park
Apartments housing project. They met at FCI Otisville,
located in NY State, where he was incarcerated, and
she was visiting her brother Tajiddin, also jailed on drug
09

charges. Picture this: my mother’s first flirtation with


my dad was from a distance, her looking across a prison
visitation room, peeking into the eyes of a man she’d
soon come to love.

Their romance was brief. It produced me. My dad ulti-


mately found himself engaged with the criminal “justice”
system, up until his death in September 2013. My mother
INTRODUCTION

died of lung cancer in 2012, after a five year battle with


the disease. My mother’s name was Melody Ellen Beverly.
I miss her so much.

With this background, I consider my very existence


inextricably tied to the infrastructures of an anti-
Black system. From a young age, I have had a deep
understanding of how Black people are policed.
It is from the place of lived experience that I draw
my expertise.
ABDUL-ALIY A. MUHAMMAD

It is also from my everyday life. As someone who uses


drugs, and as an HIV+ person, I know how stigma places
the burden of systems, lack of access, and poverty on the
shoulders of the marginalized and criminalized.
The responsibility of meeting our material needs is tied
to the systems we live within.

It is with this in mind that I have also come to understand


harm reduction, a term that often gets co-opted by
non-profits and the mainstream media, but as you will
read throughout this zine, is rooted, not in metaphor,
but in grassroots community practice.
10

For example, in a text entitled, “Collectivities in Kens-


ington,” harm reduction therapist David Oscar Harvey
writes, “Institutions hurt us far worse than any pain we
bring on ourselves.” When I think of my parents, and my
own life, this is something that resonates profoundly
within my bones.
INTRODUCTION

So what is harm reduction, or rather, how do we reduce


harm? Well, I always like to start with systems, because
our entanglement with them starts at the colonization
of stolen indigenous land and the brutal enslavement of
kidnapped Africans, some of whom were thrown over-
board and murdered at sea during the middle passage.
This system of racialized capitalism has engulfed us
generationally and continues its oppressive control
today. This boxing in of people, categorizing each race,
found its utility in justifying the system of slavery.
ABDUL-ALIY A. MUHAMMAD

This nation under God (yeah right) has morphed into


global hegemony. This system puts undue pressure on
people, many of us seeking relief from pain and agony.
The use of medicines or substances to care for ourselves
is often what allows us to press on and live into the
future. There should be safer spaces to consume and
engage with substances that allow for access to medical
treatment and other critical social services. Otherwise we
will continue to lose people who are taking care of their
pain and discomfort just for the sake of moralism.

In my own city I see this. Fatal overdoses increased 40%


for Black Philadelphians in the first three quarters of
11

2020. This coupled with the outsized death that Black,


Brown and Indigenous communities have dealt with as
the COVID-19 pandemic has crushed communities and
families.

Harm reduction is what we do with each other, for each


other. In her contribution to the zine, public health
educator and harm reductionist Tamara Oyola-Santiago,
INTRODUCTION

points to the balm that helps communities impacted


by devastation thrive: “Mutual aid networks exist in our
communities; in fact, they are part of the fabric of BIPOC
and communities often marginalized and deemed hard
to reach.”

She goes on to discuss Bronx Móvil, a collective she is in


made up of people “impacted by the HIV crisis, who have
lost loved ones to HIV and the opioid overdose crisis,
who use drugs, who have experienced homelessness,
who are Puerto Rican, Bronx residents, Queer, migrants.”
ABDUL-ALIY A. MUHAMMAD

Together, they travel throughout the Bronx with nalox-


one, harm reduction bags, safer smoking kits, syringes,
food, water, socks, juice, PPE.”

In reading about Tamara’s work, I am reminded that we


are always the experts, and collectively we see each other
through AIDS, the War On Drugs, mass incarceration,
and now, COVID-19. It is us that hand out and educate
each other about internal and external condoms, us that
understand that a clean needle is as vital for our lives as
food and water. It is us that mask up at protests, and it
is us that build solidarity between communities of sex
workers, people who inject drugs, and activists.
12

Through out this zine, you will find essays, case studies,
images, and reprints about drugs, sex, and activism, with
many of the contributions containing resources for more
information. Please take your time, dive in, and share
with your community.

Let us hold each other, and put naloxone in our pockets,


INTRODUCTION

place clean works and needles in our backpacks, for


these tabooed offerings, like food, can mean the differ-
ence between nourishment and death. Judge not for
the rock you throw, is ultimately that belonging to the
system, and that system wants us dead.
SOURCES AND RESOURCES

BOOKS
Drug Use for Grown-Ups: Chasing liberty in the land of fear,
Dr. Karl L. Hart, Penguin Books, 2021
ABDUL-ALIY A. MUHAMMAD

Sex Workers, Psychics, and Numbers Runners: Black Women in New York
City’s Underground Economy
LaShawn Harris, University of Illinois Press, 2016

Crack: Rock Cocaine, Street Capitalism, and the Decade of Greed


David Farber, Cambridge University Press, 2019

ARTICLES
Coronavirus, like past pandemics, shows how black bodies are political,
by Abdul-Aliy Muhammad

Drug Overdose Data, Centers for Disease Control

Opiate Overdoses Spike in Black Philadelphians, But Drop in White


Residents Since COVID-19, Penn Medicine News

Progress Against the Opioid Epidemic Is Not Reaching Black Americans,


Caitlin White

Drug overdose mortality among stateside Puerto Ricans: Evidence of a


13

health disparity, Manuel Cano, Camila Gelpí-Acosta

Drug User Union, Next Distro

Resources, Next Distro

ZINES
STRIDE ZINE from St. James Infirmary

Three Harm Reduction Zines from People Who Use Drugs in Denver

BLOCKED: A sex worker’s guide to stalking and harassment, from


SWARM
INTRODUCTION

SEX WORKER ZINE PROJECT

Harm Reduction: How to prevent and respond to an opioid overdose,


from Parkdale Women’s Leadership Group

“The Young Injectables,” from Van Asher and U.A. Morrison

BIO
Abdul-Aliy is a poz troublemaker, writer and organizer who is rooted in
Philadelphia, the unceded land of the Lenni Lenape people, Lenape-
hoking. A cofounder of the Black and Brown Workers Co-op. In their
work, they often problematize medical surveillance, discuss the impor-
tance of bodily autonomy, and center Blackness. They identify as queer

and nonbinary and grew up in a working class Black family. Find them
on Twitter at @mxabdulaliy.
Harm Reduction = Life
AIDS ACTION NOW!
aidsactionnow.org
AIDS ACTION NOW!

At the 2012 International AIDS Conference in Wash-


ington DC, activists from Toronto’s AIDS ACTION NOW!
protested Canadian Minister of Health, Leona Aglukkaq,
for her AIDS related budget cuts and her track record for
denying scientific evidence when implementing policies
and recommendations.

As part of their protest, members of AIDS ACTION NOW!


interrupted her speech and led the crowd in turning their
backs on the minster as she spoke, all while 3 activists
stood in front of the stage with a huge banner that read
HARM REDUCTION = LIFE.
14
REPRINT

AIDS ACTION NOW, Harm Reduction = Life, 2012


This slogan, a remix of the 1986/87 poster,
Silence = Death, became a successful emblem for AIDS
ACTION NOW! They used it in future actions, and even
printed t-shirts that they then sold to fund more life
AIDS ACTION NOW!

saving activism.

Click here to watch a video of the protest.


15

AIDS ACTION NOW protests the Canadian Minister of Health, 2012


REPRINT

THEODORE (ted) KERR

CASE STUDY

Needle Exchange +
Junkie Union +
16

Jon Stuen-Parker
Theodore (ted) Kerr
for What Would an HIV Doula Do?
CASE STUDY
In the late 1970s, the state and societal response to
people who injected drugs in the Netherlands was
confused, to say the least. “The notion that the addict
was a patient, not a criminal, had become the foundation
THEODORE (ted) KERR

of national and local policy by the mid 1970s. However,


if we look at the actual treatment the addicts received,
many of them were left uncared for,” writes researcher
Gemma Blok.

Out of this ambivalence between the role of “patient”


and “criminal” emerged a third way, led by people who
use drugs.

In the years before HIV hit in the Netherlands, and


eventually across Europe, unions of drug users formed.
In contrast to treatment centers and the self-imposed
17

isolation that many users cultivate for safety and well-


ness, the unions were sites where people could gather
and share stories about the damaging impacts of being
seen as sick and needy in a culture that valued specific
ideals of health and independence. From there emerged
a collective understanding: individual behavior by people
who do drugs was not what needed intervention per se,
rather it was the state and socially sponsored discrimina-
CASE STUDY

tion they were exposed to that negativelyimpacted every


aspect of their lives. This included where they could live
and work, with whom they could make community,
and how and where they could consume drugs.

Their third way was treatment. Specifically, treating


people who use drugs with respect and support, rather
than focusing on cure and abstinence, which had been
at the core of the Netherland’s response. In some cases
treatment looked like improving existing services, such
as the creation of community-run night shelters that
THEODORE (ted) KERR

provided safe places where people could crash regard-


less if they were using, or peer-run methadone clinics.
In other cases, it took innovation.

In 1984, members of the Junkie Union heard that a


pharmacy, popular with members and other users,
was halting the sale of inexpensive needles and syringes.
The Union feared that an equipment shortage would
increase sharing, which could result in an outbreak of
hepatitis B.

Formed in the late 1970s, the Junkie Union had quickly


18

amassed what they needed to be of use to their commu-


nity, including a city center building that offered services
and a functioning relationship with the municipal govern-
ment. With these things in place, by the time the phar-
macy incident was about to unfold, the union brokered
a deal with the city in which they were able to offer a
sterile needle and syringe for every used pair someone
traded in. Along with the clean set, people were offered
CASE STUDY

condoms, and the exchange created opportunities for


counselling and educational outreach. The city govern-
ment provided the new needles and syringes, and took
care of the disposal of the used equipment. This was a
result of Junkie Union’s work, and the drug user commu-
nity’s trust, but also the local government’s willingness
and wisdom to listen to the community. According to one
researcher, in 1985 over 100,000 needles and syringes
were traded out by the Junkie Union.

The adoption of needle exchange in the US, of course,


THEODORE (ted) KERR

is a different story. While some local governments and


officials were amenable to needle exchange, federal
power and other local opposition got in the way. In 1995,
Noel A. Coutinho, a public health official in Amsterdam,
summed up the opposing forces around needle
exchange in the US almost a decade and a half into the
AIDS pandemic:

Some fear that the wider availability of injection equipment will lead to
an increase in the number of illicit-drug injectors. Others regard these
programs as an endorsement of illicit drug use in general and therefore
not compatible with the policy of placing strict criminal penalties on the
possession and sale of illicit drugs. Opponents demand definite proof for
19

the effectiveness of syringe exchange before such programs are imple-


mented. Supporters stress that HIV is spreading fast among injection drug
users and that intervention should start now.

In the face of opposition, people who use drugs worked


to persevere. In 1985, the National AIDS Brigade was
formed, a volunteer-based organization that did needle
exchange in Philadelphia, Boston, and New York. The
founder was Jon Stuen-Parker, a former Yale student and
CASE STUDY

heroin user, who began distributing sterile needles back


when he was in college in New Haven, CT.

In the Netherlands, needle exchange practitioners were


met with support. In the US, they were met with the law.
In less than a decade, Stuen-Parker amassed over 27
harm reduction related arrests in various states, includ-
ing a 1991 arrest with other members of ACT UP who
were brought in for exchanging needles on Manhattan’s
Lower East Side.
THEODORE (ted) KERR

While being ensnared in the criminal justice system was


not ideal, for ACT UP and people like Stuen-Parker, it was
also something of a tactic. Scholar Katherine McLean
writes: “Citing an ethics based in pragmatism and social
justice, many of the first needle exchange practitioners
actively sought to contest a politics that excluded and
abandoned drug users, publicizing their cause through
acts of civil disobedience.”

Over time, even with governmental opposition, needle


exchange started happening beyond the east coast corri-
20

dor. By the early 1990s, needle exchange was available


in Portland, Tacoma, Los Angeles, San Francisco and
elsewhere, often at great emotional and economic cost
to the people making it happen. These were intimate
outfits that McLean describes as often being “little more
than a curbside table, a cache of sterile needles, and a
bucket for the disposal of used works.”
CASE STUDY

Often when people talk about needle exchange, it is to


credit the practice as a vital tactic in the early days of
the AIDS epidemic. And for good reason—clean needles
did (and do) save lives. What this well-earned praise
may obscure, though, is that needle exchange is both
a focused service to help people consume drugs, and a
point of human contact that offers a network of support,
peers, friends, and community.

What drug user union members in the past and people


THEODORE (ted) KERR

who do drugs now understand is that while doing drugs


may pose a risk, the most intense threat to their safety
is the system. Good harm reduction practices address
both elements.

SOURCES AND RESOURCES

“The Coming of Age Of Needle Exchange: A History through 1993” by


Sandra Lane, Peter Lurie, Benjamin Bowser, Jim Kahn, Donna Chen in
HARM REDUCTION: NATIONAL AND INTERNATIONAL PERSPECTIVES
(Book Chapter)

The politics of intoxication. Dutch junkie unions fight against the ideal
of a drug-free society, 1975-1990, Gemma Blok, 2011,
21

What the needles said, by John Curtis, Yale Medicine, 2001

Below the Skin: AIDS Activism and the Art of Clean Needles Now,
Dont Rhine, X-TRA, 2013

The Biopolitics of Needle Exchange in the United States,


Katherine McLean, Crit Public Health, 2011

Annotation: Needle Exchange Programs- Do They Work?,


Noel A. Coutinho, American Journal of Public Health, November 1995

Bold Fury: The overdose crisis and ACT UP’s needle exchange legacy,
Hannah Gold, N+1, 2021
CASE STUDY

HELPFUL TERMS
Safe Consumption Sites (often called Overdose Prevention Sites)
are spaces that allow for the consumption of preordained drugs under
the supervision of professions, volunteers and/or mutual aid workers,
who are often trained to link to relevant health and social services, and
intervene in case of an overdose. Safe Consumption Sites are currently
legal and open across Canada, Europe and Australia. At present, they
are illegal across the entirety of the United States.

Syringe service programs (SSPs) distribute sterile syringes, safer drug


use supplies, and education to people who inject drugs. There are over
400 SSPs in the U.S, but many areas still don’t have access.
(source: HarmReduction.org)

TAMARA OYOLA-SANTIAGO

Communities of
22

Drug Use

Tamara Oyola-Santiago

@bronxmovil
ESSAY
“Harm Reduction on the streets? Love is love.” In front of
a shelter in upper Manhattan as we distributed food and
harm reduction supplies, a participant welcomed and
thanked us with that sentiment one night in May 2020. It
TAMARA OYOLA-SANTIAGO

was a week before George Floyd’s death, New York City


was already in crisis in the middle of the first wave of the
COVID-19 pandemic, and the fragility of the city’s social
services sector was being fully revealed more and more
everyday. This was not news to us, and neither were the
solutions.

As social bubbles and pods were being named as


innovative in mainstream media such arrangements
were already thriving in our communities pre-pandemic
and grew exponentially as the months passed. Mutual
aid networks exist in our communities; in fact, they
23

are part of the fabric of BIPOC and poverty-impacted


communities often marginalized and deemed hard to
reach. And so we—Bronx Móvil, a collective of people
impacted by the HIV crisis, who have lost loved ones to
HIV and the opioid overdose crisis, who use drugs, who
have experienced housing insecurity, who are Puerto
Rican, Bronx residents, Queer, migrants—hit the streets
with naloxone, harm reduction bags, safer smoking kits,
syringes, food, water, socks, juice, PPE. The donations via
ESSAY

churches, sewing collectives, community partners and


organizers, and other harm reduction organizations flew
in. The networks, la familia, grew. And we did our best to
share what we were being given.
Previously on March 20th, New York Governor Andrew
Cuomo ordered residents to stay home and all non-es-
sential businesses to close; harm reduction nonprofit
organizations at the forefront of services for people who
TAMARA OYOLA-SANTIAGO

are unsheltered and unhoused were grappling with an


impacted workforce and many closed as well. Limited
services meant that amid a historic pandemic, there
was no water for bathing or drinking or laundry, no
case management, no HIV or Hep C testing, and limited
ongoing medication-assisted treatment. Also, medical
appointments were cancelled and some community
kitchens became grab and gos with meal bags. Our
participants understood that the shelter system they
were being “pushed into,” which was already experi-
enced as a violent one, was also now a petri dish of the
novel coronavirus.
24

Resources, funding, and production lines transitioned


to personal protective equipment and vaccine develop-
ment. The impact was felt deeply. We assume syringe
production was also diverted, because there were simply
not enough syringes available for basic harm reduction:
a new syringe for each and every shot.

If that was not enough, in early May the subways shut


ESSAY

down overnight; this was a de facto eviction for many


New Yorkers. Our participants—almost all Spanish speak-
ers; Black, Indigenous and people of color; Puerto Rican;
migrants; people who use drugs and/or are experiencing
housing insecurity—already knew how to survive the
streets. But this was a whole new level of vulnerability.

Now, as vaccines are mobilized, and capitalism gaslights


TAMARA OYOLA-SANTIAGO

people into returning to normal, we reiterate our vision


that is radical love: In the city that never sleeps, harm
reduction must be 24/7. The war on drugs must end.
Housing is a human right. People who use drugs are
loved. Solidarity is community.

Dedicado a Cabe

SOURCES AND RESOURCES

Overdose Deaths Continued Climb in 2020


Overdose deaths continued to worsen during the COVID-19 pandemic.
In NYC, confirmed deaths during 2020 (including some deaths in the
25

4th quarter) were higher than all of 2019. Opioid overdose death is
a reflection and the result of oppression; communities with higher
rates of mortality are also where structural racism and socioeconomic
inequity reign. Click here to read more.

Unmasked: Impacts of Pandemic Policing


A report that gathers and expands on the impacts of policing and
criminalization in the context of the coronavirus pandemic.
Click here to read.

BIO
Tamara Oyola-Santiago is a public health educator and harm reduc-
tionist navigating the multiplicities of home, justice and healing. She is
co-founder of Bronx Móvil where radical love and hope humanize.
ESSAY

Desenredando la Maraña
(Untangling the Weave)

Bronx Móvil + El Punto en la Montaña and


community activists
@bronxmovil @nextdistro
BRONX MÓVIL

Desenredando la Maraña (Untangling the Weave) is a


collective of harm reductionists who in early 2021 met
and organized to address the opioid overdose crisis in
our communities across New York City (NYC). Most of us
are Bronx-based and working in the trenches of disrupt-
ing and dismantling the war on drugs.

Data published in 2019 by Cano and Gelpí-Acosta


demonstrates that the opioid overdose crisis has had a
26

disproportionate impact on certain Latinx communities,


in particular, stateside Puerto Ricans. The data shows that:
• From 2009 to 2018, the age-adjusted drug overdose
mortality rate in stateside Puerto Ricans doubled
among women and nearly tripled among men.
• In 2018, the age-adjusted drug overdose mortality rate
was significantly higher in Puerto Rican-heritage than
non-Latinx white individuals.
• The 2018 drug overdose mortality rate was highest
REPRINT

among Puerto Rican-heritage men ages 45-54.

The numbers are terrifying and we suspect that in 2020, the


year marked by COVID-19, the morbidity and mortality of
the opioid overdose crisis will be worse for Puerto Ricans.
So what is the weave the collective aims to untangle?
One thread is language and the non-specific terminology
of categories used in biomedicine and public health.
Although it strives for gender diversity, the heterogeneity
of the term Latinx hides real data about specific commu-
BRONX MÓVIL

nities. As harm reductionists on the streets, we need data


that will then help shape specific language (vocabulary)
and cultural centeredness (going beyond appropriate)
health promotion programs. Another thread is harm
reduction that empowers and transforms towards equity
and social justice. We cannot just provide public health
tools—we need to combat gentrification and NIMBY;
the war on drugs must end; and we must acknowledge
and support sovereignty for indignenous and colonized
peoples.
27

And so, Desenredando la Maraña created Narcanazo,


a play on Narcan, the brand name for naloxone,
a medication that reverses an opioid overdose. And we
are centering Puerto Ricans in The Bronx, where we live
and one of the epicenters of the crisis. Our pillars are
education and action.

Get trained and train others.


Let’s talk about drugs,
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specifically about opioids.


Learn harm reduction tools,
including the use of naloxone.
Together we heal and we work towards community
empowerment where we end the war on drugs and
center the human rights of people who use drugs.
We created posters and a social media campaign in
Spanish. We are canvassing our neighborhoods and
talking with our neighbors, local business leaders and
kinfolk members, from lovers, padres, madrinas and
primas to churches, botánicas and bodegas. Our goal is
BRONX MÓVIL

community charlas and community naloxone kits readily


available for use.

Two of the social media posts folks can use are:

Una de cada 5 muertes por sobredosis entre boricuas en


Estados Unidos sucedió en Nueva York. ¡Vamos a salvar
vidas! Aprende a usar la naloxona. (One of 5 overdose
deaths among Puerto Ricans in the United States
happened in New York. Let’s save lives! Learn how to use
naloxone.) #reduccióndedaño #lanaloxonasalvavidas
28

#boricuassalvandovidas #narcanazo

La comunidad latina está muriendo debido a la sobre-


dosis de opioides. El Narcan es un medicamento que
revierte la sobredosis y salva vidas. ¡Obténlo! Visita
@bronxmovil y @nextdistro. Te adiestramos y te damos
el Narcan. (The Latinx community is dying due to opioid
overdoses. Narcan is a medication that reverses over-
dose and saves lives. Get it! Visit @bronxmovil and
REPRINT

@nextdistro. We will train and deliver the Narcan to you.)


#reduccióndedaño #lanaloxonasalvavidas
#latinxssalvandovidas #narcanazo
BRONX MÓVIL

Bronx Móvil + El Punto en la Montaña and community activists,


Desenredando la Maraña (uno de cada cinco), 2021
29
REPRINT

Bronx Móvil + El Punto en la Montaña and community activists,


Desenredando la Maraña (Naloxona), 2021

How To Get Narcan

Infographic by Jodi Bosin


@jodi_bosin
Introduction by David Oscar Harvey
JODI BOSIN

Narcan (naloxone) is available free of cost at many social


service agencies throughout the state that are committed
to harm reduction and overdose prevention. Additionally,
thanks to a standing order prescription, residents of New
York and a majority of other states can get Narcan for little
to no cost simply by stopping in at your local pharmacy.
See the infographic for details. Carry Narcan; it’s easy!

GETTING
30

NYS PUBLIC HEALTH LAW ARTICLE 33, TITLE 1 SECTION 3309(3)(B)(II)

1. 3. NARCAN
In NYC a
pharmacist may
Medical
insurance will
FROM YOUR
LOCAL
dispense an opioid cover most or all
antagonist of the cost of
(Narcan) to an Narcan.
opioid antagonist
recipient through a
non patient
Without insurance,
nasal Narcan costs
$150, but with a
PHAR M ACY
IS EASY!
coupon from
specific (standing www.GoodRx.com
order) prescription. approximately $30

2. 4.
REPRINT

Most pharmacies Owning and


and all major carrying Narcan is
chains have a 100% legal and can
standing order to save lives.
dispense Narcan.

Pharmacies with a standing order in New York state:


https://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/docs/pharmacy_directory.pdf

Jodi Bosin, How To Get Narcan, 2021


SOURCES AND RESOURCES

HELPFUL TERMS
Fentanyl is a synthetic opioid that is about 50 times as potent as
heroin. People use fentanyl because it is cheap to manufacture and
a small amount goes a long way. Many individuals consume fentanyl
without knowledge while others use it intentionally because of its
JODI BOSIN

potency. Overdose (OD) happens when a toxic amount of a drug, or


combination of drugs overwhelms the body. People can overdose
on lots of things, including alcohol, Tylenol, opioids or a mixture of
drugs. Opioid overdoses happen when there are so many opioids or
a combination of opioids and other drugs in the body that the victim
is not responsive to stimulation and/or breathing is inadequate.
Overdose deaths are preventable. We have the tools we need to stop
people from dying from drugs. 190 people die from an overdose every
day. That equals 70,000 avoidable deaths every year. Harm Reduction
offers evidence-based strategies that reduce the risk of dying from an
overdose. We aim to support people who use drugs, and the people
who love people who use drugs, with information to mitigate the risk
of an overdose and to stop an overdose while it’s happening.
(source: HarmReduction.org)

Narcan is a prescription medicine used for the treatment of a known


or suspected opioid overdose emergency with signs of breathing
problems and severe sleepiness or not being able to respond.
31

(source: Narcan.com)

Standing Order is a mechanism by which a healthcare provider with


prescribing privileges, including a state health officer, writes a prescrip-
tion that covers a large group of people. Right now, many states in the
US have a standing order related to naloxone to help stop preventable
opioid related deaths. Find out what is going on in your state.
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DAVID OSCAR HARVEY

Collectivities in
32

Kensington

David Oscar Harvey

@DavidOscarHarvy
ESSAY
“They are us; we are them.”

—Prevention Point

Philosopher Felix Guattari wrote that people who use


DAVID OSCAR HARVEY

drugs experience life between extreme situations of


solitude and collectively. Thanks to the merciless logic of
the war on drugs, which alienates us from friends and
family, conventional social structures, and indeed each
other, we often experience solitude without remorse.
I myself have felt the vacillating pull between isolation
and collectivity both in my history as a drug user and in
my work at Prevention Point Philadelphia, Pennsylvania’s
largest harm reduction social services agency. Prevention
Point is in the Kensington section of Philadelphia, which
contains the nation’s highest concentration of houseless
opioid users as well as the most prolific open air drug
33

market on the Eastern seaboard.

It would be obscurantist to deny the agonies of isolation


dotting the Kensington landscape, but it is the moments
of collectivity that stand out. Here, community manifests
unpredictably and everywhere. It is in the ubiquity of
overdoses, against the rarity of a fatality. The Narcans
in our backpacks are like pledges to allegiance. It is in
the easy collegiality of participants waiting for wound
ESSAY

care, lounging and smoking on folding chairs outside the


mobile clinic. It is in the efforts of organized resistance
against ravenous NIMBY forces encroaching upon our
dearly held resources. A local community art studio, an
oasis of creativity and camaraderie for 4+ years, was
recently closed due to an arcane interpretation of local
zoning laws. Collectivity is the picket signs protesting its
closure and the upstart art studio now held in a parking
lot (“the love lot”) a few blocks away.
DAVID OSCAR HARVEY

The activities listed above are examples of harm reduc-


tion. Yet the harms most in need of reduction aren’t
the ones commonly cited. Let’s backtrack a bit: what
is harm reduction? Classically, it is defined as activities
that mitigate harm within “risky” behaviors. However,
this definition is insufficient. Harm reduction is nearly
always behavior that is policed and moralized; namely
“casual” sex, sex work, and drug use. Driving cars and
eating sugary foods bear the risk of injury, yet wearing
a seatbelt and brushing your teeth aren’t commonly
figured as harm reduction. Harm reduction is reserved
34

for behaviors that bear the mark of supreme social


disapproval; for activities engorged with and thus disfig-
ured by stigma. This saturation redoubles the potential
of harm exponentially.

From my work and my life, I can tell you: Before the harm
nested in the behavior itself, the subjects of harm reduc-
tion contend with the injury of existing apart, bearing
stigma, being marginal; a social liability compounded for
ESSAY

LGBTQ+ folks and BIPOC. The injury shows up in mani-


fold ways, but its existence is abstract and far less visible
than, say, the abscesses that follow the reuse of injection
materials. The community of people who use drugs and
those who care for them in Kensington must reduce the
harm of living in a large city that only has one brick and
mortar syringe exchange, of the cold, cruel refusal of
a safe drug supply, of the foreclosure of life sustaining
employment afforded to folks with a criminal history,
DAVID OSCAR HARVEY

with the mental health strain of being marginalized, with


the lack of housing options for people who use. The
examples can fill a book. Most of the hurt hammered
down upon the subjects of harm reduction is not pain
yielded by their own behavior; it is born of government
policies at best indifferent to our well-being and at worst
hostile to it; it is the fallout of the War on Drugs.

Institutions hurt us far worse than any pain we bring


on ourselves.

Imagine being a subject so stigmatized that hateful


35

activities of shunning and punishment are somehow


transmogrified into a perverse type of (“tough”) love?

We face a crisis of representation. The mainstream


imaginary would have us consider people who use drugs
as joyless, alone, without solace. Indeed, most “street
photography” of Kensington replicates this impression.
But it is propaganda, nothing but sensationalist, inhuman
drivel glibly trafficking in the optical unconscious of the
ESSAY

War on Drugs. Alienation is not the whole story, but it


is the one most often being told. We must resist this
narrative, for it bears the danger of cohering within us,
denying us from the comfort of others and indeed the
care and love of our own selves. Resist ideology that
encrypts people who use drugs in a plaster of stigma,
frozen and incapable of coming together and reaching
out. Imagine a community. Imagine care. In Kensington,
these are everywhere. Those who do not see it are stupi-
DAVID OSCAR HARVEY

fied by the stubborn logic of a prohibitionist perspective.


Don’t look at us with harm in your eyes.

Dedicated to Kevin Murphy (1983–2020)

SOURCES AND RESOURCES

Stanton Peele, “Beyond Harm Reduction: Encouraging Positive Drug


Use,” Filter Mag, January 31, 2020

Dr. Carl L. Hart, Drug Use for Grown-Ups: Chasing Liberty in a Land of Fear
(2021)

Robert P Fairbanks II, How It Works: Recovery Citizens in Post-Welfare


Philadelphia (2009)
36

Aubrey Whelan, “Philly’s Needle Exchange Prevented 10,000 Diagnoses


of HIV, but Fentanyl Means Cases are Up,” Philadelphia Inquirer,
October 29, 2019

The Stairs, directed by Hugh Gibson (2016)

BIO
David Oscar Harvey is a harm reduction therapist in Philadelphia, PA.
ESSAY

Opioid crisis is still
not just a ‘white’ problem
ABDUL-ALIY A. MUHAMMAD

Abdul-Aliy A. Muhammad for


The Philadelphia Inquirer
@mxabdulaliy
@PhillyInquirer

“Black people are using opioids too,” writes Abdul-Aliy A.


Muhammad in this op-ed for The Philadelphia Inquirer,
a reminder that part of “doula-ing the system” is ensuring
that no one gets left behind.

When I was 17, I witnessed, for the first time, another


black Philadelphian using pain medication recreationally.
A friend asked if I wanted to join her for pancakes and
syrup at 11 p.m. Greedy for breakfast food, I promised to
37

drive her to North Philly to pick it up. I waited in the car


on Diamond Street as she went to get the pancakes—
so I thought. She came back instead with a wrinkled
piece of aluminum foil containing two round pills and a
small container of cough syrup. While I didn’t partake,
I did learn that day “pancakes and syrup” could mean
barbiturates with codeine cough syrup. I would go on to
encounter other black people around my age who had
REPRINT

experience with it.

Over the last few weeks, debate has raged over Safe-
house, the nonprofit trying to open a supervised injec-
tion site in Philadelphia to prevent overdose deaths from
opioids. In late February, the group announced it would
open a site in South Philly within a week, but canceled
plans when community members pushed back.
I remember growing up amid a very different conflict
around drugs in Philly. Long before opioids hit crisis
point, and before Safehouse entered our city’s social
ABDUL-ALIY A. MUHAMMAD

and political consciousness, I lived in a Philadelphia


haunted by the crack epidemic. I got an education in
survival, pained addiction, and the poverty of families
stifled by drugs. My family and neighbors saw close up a
devastation hellbent on killing the black body, as annual
homicides in the city peaked at 605 during the epidemic’s
height, in 1990. Philadelphia officials admitted decades
later that crack use and addiction were treated as crimi-
nal problems rather than a public health problem,
the way the opioid epidemic is viewed today.

It’s in fact well-documented that the crack epidemic was


not met with the same concern and humanity as the
38

opioid crisis. Black people were criminalized for selling


and using crack cocaine, often given harsher sentences
than dealers who sold powdered cocaine. Many of us
know the rest: Federal lawmakers intensified penalties
for crime and drug use during the era, and hyper-incar-
ceration ensued. That is a stark contrast to the many
editorials, funded campaigns, and political support we
see today tackling the overdoses and devastation caused
by opioids, which have disproportionately affected white
REPRINT

Americans. Can you imagine Mayor Ed Rendell backing a


safe consumption site for crack in 1994? Absolutely not.

The truth is that in a racialized society, humanity is


granted primarily to white people. A crisis among white
people will more likely get a response from the systems
that be, while black and brown people’s suffering will be
seen as tertiary or dismissed wholesale. This disparity is
rightfully embedded in the rage communities feel toward
safe consumption sites.
ABDUL-ALIY A. MUHAMMAD

But that rage ignores what I learned at age 17: Black


people are using opioids too. They’re also dying from
them. As The Inquirer reported in 2019, as of that year,
opioid overdoses were killing more black Philadelphians
than homicides.

Within the communities I grew up in, I know people who


will disavow anything other than completely eradicating
drug use. But the reality of saving lives, for any race,
is more complicated.

Our city should respond to all black death, not just wring
39

its hands over politically expedient topics like violence


without actually reducing homicides. Just as decrying gun
violence in the black community without truly protecting
communities isn’t working, exclaiming “no” to Safehouse
does nothing to stem the thousands of overdose deaths.
Safe consumption sites are a pathway to save lives.
More must be done, including exploring safe consump-
tion for other drugs, such as stimulants—like crystal
meth—whose use has recently spiked in Philly and is a
REPRINT

particular risk for LGBTQ users.

We must work to bring communities, users and nonusers


alike, together to build a path forward.

Visit The Philadelphia Inquirer for more writing from Abdul-Aliy A. Muhammad.
Decriminalization vs. Legalization:
What You Need to Know
Voices Of Community Activists & Leaders (VOCAL–NY)
vocal-ny.org
VOCAL-NY

VOCAL–NY (Voices Of Community Activists & Leaders) is a


statewide grassroots membership organization that builds
power among low-income people affected by HIV/AIDS,
hepatitis C, the drug war, homelessness, and mass incarcer-
ation in order to create healthy and just communities.

VOCAL–NY believes that people who use drugs should be


treated with dignity and respect. And that if a person is expe-
riencing problematic drug use, then they should have access
to care and support, not stigmatization and criminalization.
40

VOCAL–NY’s drug policy work is carried out by their Users


Union, which unites low-income people directly affected by
the war on drugs. Below, VOCAL outlines important informa-
tion about decriminalization. Learn more about VOCAL and
their accomplishments.

Decriminalization does not equate to legalization.


• The goal of shifting away from criminalization to a
health-based approach for drug possession is to
REPRINT

reduce the harms of criminalization, and offer care


and safety to communities.
• Drug decriminalization would remove the threat of
arrest for drug use and possession of small quantities,
and increase services and access to care for people
struggling with drug use.
• Most forms of decriminalization change criminal
penalties for possession of small quantities of drugs to
a non-criminal violation (a ticket), making drug users
pay a fine and/or connect with treatment and social
services -- not force them into jail.
VOCAL-NY

Decriminalization will not trigger drug use to skyrocket,


rather, it can reduce overdose deaths and increase the
amount of people accessing treatment.
• Decriminalization has several public health and racial
justice benefits. In places where drugs have been
decriminalized, there’s been an associated decrease in
the number of people arrested and incarcerated.
• Portugal, which decriminalized all drugs in 2001,
has seen drug use “declined overall among the 15- to
24-year-old population” and the rate of HIV/AIDS infec-
41

tion also plummeted. The Health Ministry estimated


only about 25,000 Portuguese use heroin—down from
100,000 when the policy began, according to a New
York Times analysis.
• Meanwhile, incarceration increases the risk of
overdose death, and it is the leading cause of death
for people with a substance use disorder who are
released from jail or prison.
• The CDC just released preliminary data for 2020
REPRINT

showing that overdose deaths are at record levels,


and last year’s spike in deaths are higher than any
year for the last two decades.
Decriminalization would address the disproportionate
penalization of Black and Brown people and their
interaction with the criminal-legal system.
• According to the Drug Policy Alliance, Black people
make up 29% of those arrested for drug law violations
and roughly 35% of those incarcerated in state prison
VOCAL-NY

for drug possession only, despite making up just just


13% of the U.S. population.
• In 2019, more than 45% of people arrested or cited
for drug offenses in NYC were Black, despite Black
New Yorkers making up under 25% of the city’s total
population.
• In 2018, there were more than 1.6 million drug arrests
in the United States. More than 86% of these arrests
are for possession only, and many more are for minor
selling and distribution violations.
42
REPRINT

BOOF IT!
Infographic by Sessi Kuwabara Blanchard
Introduction by David Oscar Harvey
SESSI KUWABARA BLANCHARD

@SessiBlanchard

Boofing, or booty bumping, is a method of consuming drugs


through the anus. People boof, rather than inject, as injection
can lead to painful skin and vein damage. Through boofing, the
drug user is far less at risk to skin conditions like abscesses, which
can lead to debilitating and even lethal infections. Boofing also
circumvents the nasal irritation from snorting and the potential
lung damage of smoking.

Compared to other administration routes, boofing has a high


bioavailability. That means a higher concentration of the drug
finds its way into the system, leading to a more concentrated
experience of its effects. Boofing still retains risks, like anal tearing
and susceptibility to infections. For safest boofing practices,
please consult the marvelous infographic below!
43
REPRINT

Sessi Kuwabara Blanchard, BOOF IT! Getting High Down Under, 2021

Click here to see more work by Sessi Kuwabara Blanchard


As a Woman With HIV, I Make My Sex
Partners Sign a Disclosure Contract:
Here’s Why
Tiffany Marrero for TheBody
TIFFANY MARRERO

@theeblackteebrand
@TheBodyDotCom

Often the source of harm comes from the state. Read an


excerpt from activist Tiffany Marrero’s article about a
contract she asks people to sign before they become physi-
cally intimate to protect her from HIV criminalization.
This article was originally published on TheBody, which
delivers vital information, news, support, and personal
perspectives on HIV and related issues. We have republished
it with their permission.
44

It all seems so sexy in movies: A submissive signs her


name on an erotic dotted line consenting to sexual acts—
from anal to water sports, soft and hard boundaries, safe
words and lace—all so fun and all so easy. Right?

Nope. Not for my life.

My contracts, though they pave the way to sex and fun,


REPRINT

were created not out of my own preferences but birthed


from ignorant prejudice, old-school rhetoric, and criminal
laws that I’ve needed to navigate while living with HIV.

Body autonomy? What is that?


Anyways, back to the contract: It’s a blunt and tactful way
to keep my vagina safe. Though each person needs to
be sure a contract would be legally valid where they live,
and we all know that there’s sometimes no guarantee of
equal justice under the law, I hope that mine shows other
TIFFANY MARRERO

women that we still have some sort of control of our


pussies. Although the laws are starting to change,
we know that change is slow --and in the meantime,
this is at least something.

And it is something that says:We are worthy of nice hot


nights of bliss, despite laws that put women at harm.
This contract is, in essence, an act of rebellion against
the law, the ignorant, the hate-parade folks who think
it’s acceptable to police my body under the notion of
keeping the public safe.
45

This contract, from top to bottom, contains formal code


words for the following:
• My partner consents to eating my box and fiddling my
violin with the understanding that I am, and have been
for the past 25 years, living with HIV.
• My partner signs their name acknowledging they were
not heavily medicated or coerced in any manner by
me or anyone else to swap spit and maybe blood with
REPRINT

me. (Did I mention I love kink?)


• My partner signs on the dotted line with understand-
ing that I, let’s repeat it one more time for the nonbe-
lievers, have a positive punnany.
• For another rebellious act, I note that I am
undetectable.
This “contract”—written at 2 a.m. after reading up on
another HIV criminalization case—should not lead you to
believe that I am indeed afraid of my sexuality or that my
other positive sisters need fear their orgasms. Nah.
TIFFANY MARRERO

Let it be known that many, many people, be they men,


women, cis, trans, non-binary, black, Latinx and/or
others, have in fact tasted the juices squirted out of my
body, well-aware of my sexy positive status. YES!

This contract is a permanent staple of my distaste for


laws that reject and destroy my right to disclose or to
sexual fulfillment. This contract also goes to show you
the injustice I may have to face. Will my contracts have
my blood-stained fingerprints on them? Will they carry
the salt-laced aftermath of my tears? What if all poz folks
46

created their own contracts and we made a contract quilt?

I, my friends, will NOT stop enjoying condomless sex or


sex with condoms, whichever I want, simply based on
“laws” that were created without thinking of Tiffany...
a baby named Tiffany, who happened to be born with HIV,
who is now 26 and has the potential to face a felony charge
in her state if there is even a whisper that she had sex.
REPRINT

Read the rest of Tiffany’s essay at TheBody.



THEODORE (ted) KERR

CASE STUDY

Safer Sex +
Play Fair +
47

How To Have...

Theodore (ted) Kerr for


CASE STUDY

What Would an HIV Doula Do?


In the early 1980s, as word of a “gay cancer” was increas-
ing, two pamphlets started to circulate among costal
communities of gay men, queer nuns, and their respec-
tive communities about the role that mutual affection
and specific precautions could play to ensure a healthy
THEODORE (ted) KERR

sex life. While both publications are often remembered as


advocating for gay men to use condoms to reduce their
chances of getting STIs, these historic documents are
arguably more noteworthy in their assertion that mental
health and community care are harm reduction methods.

In 1982, in San Francisco, the Sisters of Perpetual


Indulgence released PLAY FAIR, a fold out pamphlet that
used culturally specific language, such as “rimming” and
“poppers,” to provide tips on how to avoid STDs and
infections. Included in their prevention run down are acts
48

of care such as exchanging names and contact info with


sex partners. PLAY FAIR also contains STD definitions for
everything from Hepatitis and Herpes, to guilt.
CASE STUDY

The Sisters of Perpetual Indulgence, excerpt from PLAY FAIR, 1982

While the term HIV/AIDS is never used, the Sisters do


acknowledge that “mysterious forms of cancer and pneu-
monia are now lurking among us” and defined Kaposi’s
sarcoma and pneumocystis pneumonia, which we now
understand as AIDS related opportunistic infections.

Less than a year later, in 1983, across the country in New


York, Richard Berkowitz and Michael Callen, under the
THEODORE (ted) KERR

direction of Joseph Sonnabend, release their pamphlet


How to Have Sex in an Epidemic: One Approach. Over the
course of 40 pages, they run through the risks of various
sex acts under headings such as Sucking, Getting Sucked,
Fucking, Getting Fucked, as well as No Risk Sex that
includes the sub headings: Creative Masturbation and
Creative Penetration.
49
CASE STUDY

Richard Berkowitz and Michael Callen,


under the direction of Joseph Sonnabend, excerpt from
How to Have Sex in an Epidemic: One Approach, 1983

Unlike PLAY FAIR, How to Have Sex in an Epidemic does


use the term AIDS, although it troubles the accepted
definition, outlining theories that understand AIDS: 1) as
a result of a virus, (what the authors call “the new agent
theory”), or 2) as a result of numerous STI exposures over
time resulting in a build up of cytomegalovirus (CMV) in
a person’s body (they call this “the multifactorial theory.”)
This was a moment in history when HIV had only recently
been identified, and much remained unknown or
unclear, like how to test for the virus.
THEODORE (ted) KERR

How to Have Sex in an Epidemic has none of the camp


tone of PLAY FAIR. Instead it is earnest, grappling with
the meaning of gay liberation as the authors attempt
to prevent a health crisis. In a section called “Love,”
Berkowitz and Callen write, “Maybe affection is our best
protection. Hard questions for hard times. But whatever
happened to our great gay imaginations?”

These documents capture not only a turning point in gay


liberation, forever moving forward to be connected to
50

HIV, they also illustrate in no uncertain terms the role


that community plays in sexual health. As Jennifer Brier
makes clear in chapter one of her book, “Infection Ideas,”
works like PLAY FAIR and How to Have Sex in an Epidemic
are the precursors to what would come to be called
“safer sex,” and are vital documents in the ongoing story
of sex and harm reduction.
CASE STUDY

SOURCES AND RESOURCES

Richard Berkowitz and Michael Callen, under the direction of Joseph


Sonnabend, How to Have Sex in an Epidemic: One Approach, 1983

The Sisters of Perpetual Indulgence, Play Fair, 1982

Jennifer Brier, “Affection Is Our Best Protection: Early AIDS Activism


and the Legacy of Gay Liberation,” from Infectious Ideas: U.S. Political
Responses to the AIDS Crisis (2009)

MOLLY M. PEARSON

Don’t Yuck
51

My COVID Yum!

Molly M. Pearson

@mollympearson
ESSAY
I am lucky to be in community with all sorts of people
who genuinely want the world to be a better place.
Within these leftist, activist, and liberationist circles,
the phrase “harm reduction” has become ubiquitous,
MOLLY M. PEARSON

to the point where the meaning of it can get lost.


It’s often presented via meme, and sometimes with
a vague, cool distance that is divorced from practice.
Sometimes the phrase is used as a shorthand signifier
for salacious assumptions of sex work and drug use,
almost with an air of saviorism, as if to say THOSE people
over THERE, doing those WILD THINGS, need our compas-
sion! Maybe THEY can’t help themselves, but WE can! Some-
times it is co-opted by well-meaning liberals, who use
“harm reduction” as a figure of speech to describe the act
of voting when presented with less than ideal candidates.
Flattened interpretations of harm reduction like these
52

make it that much more urgent that we name harm


reduction as a practice. It is active. It is real. In an era
of multiple pandemics—HIV/AIDS, COVID-19, systemic
racism, settler colonialism, and climate change—we are
all faced with the task of assessing risk and mitigating
harm in pursuit of pleasure, and we all benefit from the
radical compassion that is inherent to a harm reduction-
ist way of being in relationship with others.
ESSAY

Some of us have long understood harm reduction as a


tangible practice. We may have come to this understand-
ing through things we have chosen to do and from things
that have happened to us. I can only speak for myself.
I am a former sex worker, and I kept a hammer next to
my bed and kept my roommate updated on my client
schedule. I am someone who for a time loved cocaine
to the point where I wanted to use it less, so I asked for
accountability check-ins from my friends, which they
MOLLY M. PEARSON

gladly gave. I am someone whose biological parents both


died of AIDS by the time I was seven, and I was raised in
the love and kinship that emerges from HIV and illness.

Today, I am someone who is a caretaker. I care for Paul,


the man who raised me after my parents died. He is
72 years old, and he came out as gay nearly fifty years
ago. While he manages multiple chronic illnesses, he is
HIV negative. He is living proof that we did not “lose an
entire generation” to AIDS, and he is living proof that
harm reduction saves lives and makes life bearable.
Sometimes, when I travel to my hometown to care and
53

be with him, we shed our masks and share meals from


across the room together—and yes, we did this before
either of us were vaccinated. I relish it every time. I would
hope that others would be glad for Paul and me and the
COVID routine we have mutually agreed upon. His death
is imminent with or without COVID in the picture, and
these maskless meals are worth it to us.

The radical compassion that I need, and that we all so


ESSAY

badly need, has been hard to come by, or it’s at least


been unpopular. A rigid, hardline stance on COVID
exposure has proliferated for more than a year by now,
sometimes from people within our circles we would least
expect. It’s a baffling thing to witness someone whom
you thought you knew and understood share informa-
tion about their local mutual aid network and then in
a flash engage in public shaming for “bad behavior.”
Folks who have long relied on harm reduction to make
MOLLY M. PEARSON

life worth living have been gaslit on a massive scale


throughout the COVID-19 pandemic. The online shouting
has been deafening, perhaps louder than usual because
the internet has become our de facto crowded bar,
nightclub, coffeeshop, and gossip session. I’m referring
to well-intentioned, but aggressive posts like these:

Zoom Thanksgiving > ICU Christmas. STAY HOME!


Stay home. Make better choices.
Please stop posting the reasoning behind your
murderously irresponsible holiday travel.
I am very sadly, and bitterly, going to view many
54

of my fellow citizens as murderers…

And so on. Similar posts and memes have been blasted


across multiple platforms, liked and retweeted and
reshared to a point beyond mere virtue signalling, and
into a space of pernicious vitriol thinly veiled as citi-
zen-led public service announcements.

Of course, no cultural response to a major event is


ESSAY

monolithic, especially on the internet. Several writers


have highlighted the benefits of using principles and
skills commonly found in pleasure-based sexuality educa-
tion to help guide COVID conversations with our social
pods, lovers, and families. It’s true that we have much to
learn from sex educators about negotiation, boundaries,
consent, and what feels good to each of us as individuals.
While this approach is ideal for interpersonal exchanges,
it falls short when we try to apply it to a community level.
MOLLY M. PEARSON

We may figure out our own boundaries through personal


negotiation, but it’s still too easy to hold blanket disdain
for other people’s choices; it’s still too easy to yuck others’
COVID-era yum. Enter harm reduction, which expands
liberationist possibilities in our thinking. It allows us to
honor and trust that folks in our communities are assess-
ing risk, mitigating harm, and pursuing pleasure in ways
that we need, want, and deserve.

We all benefit from the radical compassion that is inher-


ent in a harm reductionist practice. It should not only
apply to people who are so marginalized that they were
55

already negotiating, prior to our COVID reality, how to


survive and make life worth living at the same time. Nor
should it only apply to people who have transactional
sex and use drugs. To be alive is to negotiate risk, and
COVID has made that plain. Harm reduction is relevant
to anyone living in a body, even when living in a body is
sometimes mundane and has nothing to do with sex and
drugs. No one is above the need for harm reduction.
No one is undeserving of care and compassion.
ESSAY

I want sex workers to be honored as the healers they


are. I want people who use drugs to be celebrated as
pleasure activists.
And I want every person on a ventilator everywhere to be
loved and cared for regardless of how they got there.

A virus is a virus is a virus, and its containment is only


MOLLY M. PEARSON

as strong as the socio-political actions taken to protect


those most vulnerable to contracting it. Individuals
among us don’t deserve to bear the brunt of misplaced
collective rage. The practice of harm reduction has the
power to help us focus our rage where it must go: the
systemic failings that make pleasure elusive and death
too easy.

SOURCES AND RESOURCES

M. J. Murphy, “Confessions of a COVID-19 Super-spreader: My Memo-


rial Day at a Gay Campground,” May 28, 2020

Marty Fink, Forget Burial: HIV Kinship, Disability, and Queer/Trans Narra-
tives of Care, 2020
56

Mia Mingus, “Access Intimacy: The Missing Link,” Leaving Evidence,


May 5, 2011

Melissa Meinzer, “Saint of the Streets: Dr. Punch Saves St. Louis,” Out
in STL, September 18, 2020

BIO:
Molly M. Pearson loves to write, talk, share, and learn about sex,
identity, illness, and community. She can be found in St. Louis, proba-
bly listening to disco while doing the dishes.
ESSAY

NICK MELLOAN-RUIZ

Sustainable Safety:
I Don’t Need You.
I Want You.
57

A Year of Feeling
the Difference
Nick Melloan-Ruiz

@25centstoplay
ESSAY
I got a dog because I did not want to lay in bed looking at
the wall alone.

I miss the pandemic moment when old hookups whose


NICK MELLOAN-RUIZ

numbers you had deleted would text you just to check in,
even if the last time they saw you your face was smashed
against a pillow at dusk and you never knew their name
to begin with.

I prefer that over your #1 hookup dom daddy unceremo-


niously ending a years long standing-appointment-
sexual-relationship by simply saying, “I have no interest
in seeing you again.” When it happens like that the level
of importance gets muddled and you spend far too much
time lamenting it.
58

When I invited you into my bubble in September I felt safe.


I felt like a real person, part of something, going through
all the steps amid vast global shifts. I now wonder what’s
next as I confront that my salad days are over. I wasn’t
expecting to meet the person who would let me be my
most self while still giving me chances to grow. My survi-
vor’s guilt rages on as I bask in your love, calmly reading.
I worry if it is sustainable, if you will grow tired, if I will
come back from a shower and you won’t be here, if my
ESSAY

answer to a question will be unsatisfying and, viola, out


the door you go. I am always uncertain: what more can
happen? Your arrival gave me a reason, structure, and the
space to ask: why can I allow myself to feel settled and
relaxed once I have achieved my goal of safety?

My normal is to always be suspicious and defensive.


I have the tools but don’t know how to use them.
I’m sorry you are the person I’m putting years of trauma
on, shifting through memories while you sit calmly
reading. Right when I’m sinking I look over and I know
that I’m firmly in the present even if it’s tragic, exhaust-
NICK MELLOAN-RUIZ

ing, rage inducing, and reducing us to the verge of tears


at a moment’s notice. At least we are together. At least
we can access deeply ingrained moments of trauma,
followed by a hearty ass eating session, share a full day
of headphones up, followed by me blowing you as the
bok choy simmers on the stove. This home engineer
hopes you’ll stay.

One year ago I was at a sleepover. I kept wanting to


leave. I was tired of trying to insert myself into their
narrative, sitting in an unfamiliar living room, texting
friends near and far telling them to take me home,
59

asking myself if this candle or pair of pajamas or Sheena


Easton album will make me feel safe. The answer almost
certainly being no, but I will try again and again.

I’m so glad you suggested we watch Cruel Intentions in


June and then all the other 90s women-in-peril movies
starring Ashley Judd that I forgot about, or had no inter-
est in to begin with.
ESSAY

SOURCES AND RESOURCES

Hit Parade podcast, Turn Around Bright Eyes part 1

Donna Summer, “Romeo”

Carly Simon, “Take Me as I Am”

Cruel Intentions final scene

Nadiya Hussain’s Chicken, Brie, Cranberry and Pink Pepper Pithivier

BIO

Nick Melloan-Ruiz is a Chicano writer living in Bloomington Indiana


focusing on HIV, Pop Culture and their dog.
IS HOLDING SPACE A HARM
REDUCTION PRACTICE?

What Would an HIV Doula Do?


@wwhivdd
WWHIVDD?

Harm reduction is not a metaphor. It is a series of practices


developed and shared over time informed by and for people
who use drugs, sex workers, people living with HIV and other
communities impacted by neglect, bias, and state violence,
in order to survive and thrive. Harm reduction is central to
the ongoing HIV response, and as members of WWHIVDD,
we see it as vital to collective care and liberation.

As we often state, we think a doula is someone who holds


space in times of transition, with an understanding that HIV
60

is a series of transitions that begin long before diagnosis,


continue through treatment, and may last long after death.
We have come to learn that doulas often employ harm
reduction strategies, and harm reduction can be a form of
transition.

With that in mind, we have a question: is holding space a


harm reduction practice?
REPRINT

The term “holding space” came to us at the event that led


to the creation of WWHIVDD. Lodz Joseph used the term to
talk about her work as a midwife and doula. In a transcript
excerpt from that first conversation shared below,
she expands on the term after being prompted to say more
by curator Alex Fialho. Later in the conversation Chaplain
Michael Crumpler builds upon Lodz’s comments, with exam-
ples from his work in hospitals.

Reading Lodz and Michael together, one sees how “holding


WWHIVDD?

space” is a doula task that requires addressing


a patient’s needs, while navigating the people and spaces of
an institution. Holding space in these situations can be seen
as cultivating a place between harm and an individual,
and seeing how the harm can be eradicated, or defused.

Additionally, we see how Michael further understands a


doula as someone who helps people remember themselves
in the face of trauma, something akin to producing a mirror
for someone after a storm has passed but the winds and the
work ahead remain. The harm reduction here is an act of
61

witnessing, and against forgetting.

Read below, and tell us, is holding space a form of


harm reduction?

ALEX FIALHO: When you say “Hold space,” how does


that happen?

LODZ JOSEPH: I remember when I first heard my


REPRINT

mentor say it. I was like, “this hippy.” I grew up in NYC


and I was crazy Type A and now I am not. For me the
phrase is really just about observing what is going on
and sometimes I make a decision to touch a certain
way because I know what you may need but you may
not necessarily know how to articulate it. Sometimes
it is hugging, massage, leaving the room so you and
your partner can have time alone. Sometimes it is
asking your partner to leave the room. I will say to the
partner, “I need you to go on a walk right now, can you
WWHIVDD?

go get me water?” or “Can you just leave cause you are


messing up the energy?”

And sometimes it is about me just getting out of the


mom’s way. There are times when I am not in sync
with the client, when I am the problem and I am in the
way. And that is tough. It is crushing to the ego but
also tough when you get your ass handed to you. Talk
about being humble - when you are not in sync for the
client, and you were holding space the wrong way.
Not every client has referred me or ran a referral for
62

me. That also happens. I think holding space is also


taking care of myself. When I take care of myself I
don’t look at the emails, and the referrals come.
When you are taking care of yourself it is just easier,
boom, everything is easy. When you are not, you feel
tired and that you can’t be there. But I can’t call sick or
go home. That does not exist in our world.

MICHAEL CRUMPLER: We can build off what Lodz was


REPRINT

saying about what a doula is and how it relates to


chaplaincy. Chaplains function in health care facilities
as that third space, I knew exactly what she was
talking about when she said holding space. But we
hold space in a much more traditional, orthodox way.
Usually chaplains are encouraged by a particularity.
There are Jewish chaplains, Catholic chaplains,
Protestant chaplains, Muslim chaplains and even
beyond those faith identities. They come to advocate
for the patient, at times. Yes, they are part of the
organizational structure of the hospital. So that would
WWHIVDD?

be a little different, correct me if I am wrong Lodz, but


it sounds like you are hired by the patient to be there.
Whereas the chaplain is part of the healthcare system,
accountable to that system, but also accountable to
keeping that power structure accountable, you know?

A chaplain goes into a system and holds space for


the humanity of the patient. So whether it is a mass
casualty event like a car accident, a shooting or if life
sustaining support is going to be removed, the chap-
lain holds emotion and spiritual experience.
63

You are going to be out of the way of the nurses, but


at the same time you are going to function as a certain
ethical and moral authority. Example: if I am praying
with a patient and a nurse or doctor, who think their
role is more urgent than prayer, it is my job to say,
“Can that wait? Can you get that blood pressure in 10
minutes when I am done with this conversation?”
Or sometimes it is, “She is cold, and she has asked
you three times for a blanket”. Or it could be standing
REPRINT

in for the doctor when the patient is critical of the


system. Sometimes I have to be like, ”Really, do you
really think the nurses don’t like you and they like
everyone else?”
Later…

MICHAEL: What I think about a lot is unconscious


competence, I think we all have knowledge we don’t
realize we have. I think what happens with trauma is it
WWHIVDD?

causes you to forget what you know...By the time


I became HIV+ I had gone to college, I had a degree,
I had already done pastoral care, I had already served
four years in active duty in the military, I had already
traveled internationally, but trauma made me forget
what I knew, I lost my internal compass. What would
have been nice is for someone to have reminded me
that I wasn’t insane, that becoming positive does not
make you stupid. You know what to do. It’s like if there
is a fire all of a sudden you forget how to call 911.
I think what a lot of people do is forget what they
64

know. I think a doula reminds you of what you know.

Click here to read the full conversation.


REPRINT

THEODORE (ted) KERR

CASE STUDY

Housing
and Support +
65

STAR House

Theodore (ted) Kerr for


What Would an HIV Doula Do?
CASE STUDY
The history of the US is thick with examples of commu-
nities pushed to the margins, doing what they can to
survive and thrive, including the work of the Street Trans-
vestite Action Revolutionaries (STAR), founded by Sylvia
THEODORE (ted) KERR

Rivera and Marsha Johnson in 1970. As Leslie Feinberg


wrote in 2006:

Rivera and Johnson saw the need to organize homeless trans street youth.
Both Rivera and Johnson were themselves homeless and had to hustle on
the streets for sustenance and shelter. “Marsha and I just decided it was
time to help each other and help our other kids,” Rivera stated.

Among STAR’s first actions was the creation of STAR


HOUSE, a building in NYC’s Lower East Side where they
fixed up the electricity, plumbing and the boiler.
As Rivera shared with Feinberg:
66

“We fed people and clothed people. We kept the building going.
We went out and hustled the streets. We paid the rent. We didn’t want
the kids out in the streets hustling. They would go out and rip off food.
There was always food in the house and everyone had fun. Later we had a
chapter in New York, one in Chicago, one in California and England.
It lasted for two or three years.”

Rivera and Johnson’s efforts stand alongside The Black


Panthers’s Free Breakfast program and The Young Lords
CASE STUDY

community health clinic. In the face of homelessness,


malnutrition, and lack of healthcare, community leaders
stepped in, intervening against biased and neglectful
systems and states, with the aim being the ongoing
survival of people within communities marked for
premature death.
Last year, activist and long time Harm Reduction practi-
tionerZoë Dodd defined harm reduction as “an ideology
rooted in Liberation.” It is safe to say that when Rivera
and Johnson opened STAR HOUSE, they were fighting
THEODORE (ted) KERR

for the survival and liberation of their people, working


to literally reduce the harm being inflicted upon them as
survivors within a biased, and too often cruel system.

Soon after starting STAR, Riviera and Johnson joined


The Young Lords in their work, and in 1971, Rivera
remembers Black Panther Party leader Huey Newton
including STAR as part of the revolution. Today, long
after their deaths, Rivera and Johnson are remembered
as leaders who were there at Stonewall and led unapol-
ogetic lives against the tyranny of gender norms and
binaries. Increasingly, because of artists and activists
67

who continue to share Riviera and Johnson’s legacies,


and the ongoing work of STAR, more people are learning
about STAR HOUSE, and the numerous ways Riviera and
Johnson were early Harm Reductionists!

SOURCES AND RESOURCES

Leslie Feinberg, “Street Transvestite Action Revolutionaries,” Workers


World, September 24, 2006
CASE STUDY

Frederick Douglass Opie, “Feeding the Revolution in the 1970s: The


Young Lords in the Bronx”, 2014

The Young Lords: A Radical History, by Johanna Fernández, 2019

Black Food Matters: Racial Justice in the Wake of Food Justice, edited by
Hanna Garth and Ashanté M. Reese, 2020

“Housing First and harm reduction: a rapid review and document


analysis of the US and Canadian open-access literature,” by Dennis P.
Watson, Valery Shuman, James Kowalsky, Elizabeth Golembiewski &
Molly Brown in the Harm Reduction, 2017

Abolition as Harm Reduction
charles ryan long
@discojihad
CHARLES RYAN LONG

Hindsight being 2020 I now realize that many of my


works since 2014 (and previously for that matter) have
strived to make space for my own personal, unseen
(to some) realities and survival mechanisms. Making
these explorations public now, in 2021, shows me how
there is a world-making possibility in our efforts to
reduce harm to ourselves and our communities. For me,
all and any of the ways we mediate harm to our commu-
nities is harm reduction, expanding from safe injection
sites/traditions and on to less complex acts like publicly
signifying danger and complicating harmful public meta-
68

narratives. Like the road towards the ablition of prisons


and police, our efforts to vanquish harm from our lives
must be bold and unapologetic, and we must use all the
tools we have at hand and all the tools yet to be invited
into our what’s possible? to get the job done. One of
my contributions is to make artworks that harness the
combined elements of love and rage into machines of
transformation and becoming. We must publicly and
declaratively call for the dismantling of whyte patriarchal
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systems and (him)haviors and also address the ways


in which (he) lives within us. This moment in time has
shown us what many of us already knew too well: they
aren’t coming to save us and if they do show up, it is
more than likely to exploit us and further traumatize
our livelihoods. Let us walk away from this moment
firmer in our convictions that we got us and that through
our efforts of mutual aid and the continued building of
alternatives to the systems that cause us the greatest
harm, we make what we want, need, and deserve possi-
CHARLES RYAN LONG

ble again. It is my hope to return to my artworks over


time and begin to look back and view the messages and
proclamations they make as no longer necessary...won’t
you join me?
69
REPRINT

Dirty & Proud, 2014


iron on patch (designed for Visual AIDS’ Play Smart)
CHARLES RYAN LONG

charles ryan long, CLEAN, 2014


70
REPRINT

charles ryan long and Christopher Paul Jordan, I am HIVx, 2018


CHARLES RYAN LONG
71

charles ryan long, for Visual AIDS, 2019


REPRINT

charles ryan long, WDWD, 2020



Need Help With...
Project SAFE
@safephila
PROJECT SAFE
72

Project SAFE, graphic, 2020

Project SAFE is a grassroots direct-service and peer-based


organization of: women, non-binary, gender non-conform-
ing, and trans people, providing women and femme-
centered harm reduction services to people involved in the
street economies in Kensington. Read more about their work
REPRINT

in the age of COVID-19:

“[Project SAFE] Board member Jeanette Bowles worries


that overdose rates will rise because of fluctuations in
the drug market, economic contraction, and self-
isolation. “Your ability to maintain economic stability
affects overdose risk,” she said. “And we’ve been telling
people for years that they should never use alone—that’s
one of the biggest risk factors for overdose—but now
we’re telling them to stay home.”
PROJECT SAFE

The national “Never Use Alone” hotline offers an opera-


tor who will stay on the line while you use, calling 911 if
you become unresponsive. But people are wary about
disclosing their drug use and address to a stranger, and
many of Project SAFE’s participants don’t have stable
access to a phone. It’s hard to hang onto one when
you’re homeless.

What’s more, many of Project SAFE’s participants are


sex workers—and sex work is another economic area
affected by the recent contraction. “Business is really
73

slow,” said Lulu Duffy-Tumasz, delivery services coordi-


nator for Project SAFE. “People are hustling even harder,
but not making enough money for drugs. We’ve gotten
more requests for pepper spray, and we’ve been prepar-
ing for people who are having to work in situations they
normally wouldn’t, because of scarcity.”

Full article: “The Challenge of Treating 2 Epidemics at Once: As overdose


deaths climb advocates and activists fear the opioid crisis will run head-
REPRINT

long into the Covid-19 crisis”, by Sophie Pinkhan, for The Nation.

Harm Reduction Stickers
Jade Forrest Marks and ripley soprano
@69herbs @suck_dick_carry_narcan
JADE FORREST MARKS

69herbs is a New York-based apothecary and design


project by jade forrest marks, that aestheticizes a dream
of collective healing by blending fantasy, faggotry, and folk
herbalism, by blending focus on trans and queer health,
accessibility, and harm reduction. As part of their offerings,
they work with fellow harm reductionist and artist ripley
soprano on various projects, like the stickers below.
Each work is a powerful statement on its own, when seen
together harm reduction as punk, as queer, as loving,
as community, as healing, and as a way of life emerges.
See more at 69herbs.com.
74

Jade Forrest Marks, sticker, 2020


REPRINT

Jade Forrest Marks, sticker, 2020


JADE FORREST MARKS

Jade Forrest Marks, sticker, 2020


75

Jade Forrest Marks, sticker, 2020


REPRINT

Jade Forrest Marks and ripley soprano, sticker, 2019


EVERY TIME YOU SAY
VOTING IS HARM REDUCTION
RIPLEY SOPRANO & JADE FORREST MARKS

another faggot moves


to hell’s kitchen...*

*A joke about assimilation, homonormativity, and real estate


ripley soprano + Jade Forrest Marks
76

David Wojnarowicz’s jacket at ACT UP’s FDA Action,


October 11, 1988. Photo by Bill Dobbs
REPRINT

HARM REDUCTION IS a framework rooted in the legacy of


grassroots community organizing + street based care.

Harm redux is historically led by hookers, faggots, drug


users, HIV+ people, sick, crazy, and disabled people,
people who live on the streets, and others who have
been historically excluded from institutional resources
and medical systems.
Harm redux is clean needles and pipes, fentanyl test
RIPLEY SOPRANO & JADE FORREST MARKS

strips, Narcan, safer injection sites, PrEP, abortion and


birth control access, suboxone and methadone,
free condoms.

Harm redux is the people’s medicine, it is an antidote to


shame and stigma. It’s main principle is as radical as it is
simple: no one deserves to die from lack of access
to resources.

The demands of harm reduction are not reformist.


The demands of harm reduction are free housing and
healthcare for all, people’s run health services, nothing
less than a new world order. The term “harm reduction”
is rooted in a specific history and vision.
77

VOTING IS NOT HARM REDUCTION

(As we know...) the United States is a colonial empire


built on genocide and slavery; an inherently anti-Black,
whorephobic, homophobic, transphobic state that has
always killed and neglected those who harm redux is for
and by.
REPRINT

Voting is (just stating facts) a participation in the electoral


politics of the State; in the two party system that we have
collectively inherited and did not choose into.

We know from our history that there are countless


reasons why marginalized people can’t vote, or would
choose to opt out of voting.
The brilliance and beauty of harm reduction is that it
RIPLEY SOPRANO & JADE FORREST MARKS

upholds a commitment to ending shame and stigma.


An actual harm reduction approach to voting is to truly
refuse to stigmatize and shame people for not voting.

Whether or not one believe’s that voting for a Democratic


ticket is, in fact, “reducing harm,” using the language of
harm reduction is a misappropriation. The language we
use matters. Attempts to bring voting into the frame of
harm reduction with this language are assimilating,
white washing, and liberalizing the radical legacy of
this framework.

Pls pls pls step back with the non-voter shaming ~


especially of Black & latinx & indigenous & criminal
78

non-voters. Pls remember that voting currently +


LEGALLY excludes incarcerated people, people with
felony records, undocumented people, and residents of
US colonized territories (ie all of Puerto Rico). The system
was built this way. If you’re into voting and increasing
voter access, cool- but let’s call it for what it is. + let’s chill
with calling it harm reduction
REPRINT
RIPLEY SOPRANO & JADE FORREST MARKS

Clean Needles Now, Vehicle in MacArthur Park area, 1995


79
REPRINT

Keith Mayerson & ACT UP,


Instructions for sterilizing used syringes with bleach, 1992

Voting is Not Harm Reduction
Indigenous Action
@media_action
INDIGENOUS ACTION

Indigenous Action (originally Indigenous Action Media) is a


radical volunteer crew of anti-colonial and anti-capitalist
Indigenous media makers, designers, artists, writers, and
agitators that work together on a project-by-project basis for
liberation for Mother Earth and all her beings. Indigenous
Action was founded on August 25th, 2001 to provide stra-
tegic communications and direct action support for Indige-
nous community’s sacred lands defense. Over the years they
have organized hundreds of actions, marches, banner drops,
workshops, conferences, benefits, and much more. Vital to
their practice is the creation of media, including the making
and distribution of zines. In February 2020, in anticipation
80

of the upcoming US general election, Indigenous Action


released Voting is Not Harm Reduction—An Indigenous
Perspective. Here is the cover and opening paragraph.

Click here to see the full zine.

When proclamations are made that “voting is harm


reduction,” it’s never clear how less harm is actually
calculated. Do we compare how many millions of
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undocumented Indigenous Peoples have been deported?


Do we add up what political party conducted more
drone strikes? Or who had the highest military budget?
Do we factor in pipelines, mines, dams, sacred site
desecrations? Do we balance incarceration rates? Do we
compare sexual violence statistics? Is it in the massive
budgets of politicians who spend hundreds of millions of
dollars competing for votes?
↝ REPRINT 81 INDIGENOUS ACTION

Indigenous Action, 2020


ALEXANDER McCLELLAND

Where Will HIV


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Be in 10 years?

Alexander McClelland

@alexmcclelland
ESSAY
I was asked to share my utopian vision for 2031 at
a recent HIV research conference in Canada. What I
describe is an imaginary vision for 10 years from now.
I’m tired of being in a reactive position – reacting to bad
ALEXANDER McCLELLAND

policy, oppressive laws, and harmful research practices.


My thoughts are an effort to open imaginations and see
beyond where we are now.

By 2031, settlers will have conceded all control of the


land to Indigenous communities. Turtle Island will
be governed through traditional ways of knowing.
Interdependence will be privileged over marketability.
Connection to the land, to each other, and to resources,
as well as preservation of the land and resources, will be
understood as vital to community health and well-being.
Individual forms of leadership and competition will be
83

dismantled. Collectivity and collaboration will be the


way we live.

All biomedical knowledge, past, current, and cutting-edge


medical technologies, and expertise, will be common
goods, owned by the people. Development
of new knowledge on health and well-being will be part
of the commons, and will be rewarded, not through
individual capital gains, but through the betterment
ESSAY

of society. The patent system will be undone, and sole


proprietorship over medicines, chemicals,
and compounds, will be abolished.

Top-down systems of surveillance—such as public health


and epidemiological research—will be inverted.
Data about our lives will not be extracted, held only by a
few, and then used to study us as objects.

Data about our lives will be held in community data


ALEXANDER McCLELLAND

trusts, which will be owned and governed by local


communities. Data will be mobilized in the service of
community needs to support health and well-being.
A data trust is a data stewardship platform, where data
is managed and overseen—not by governments or
private industry—but by a governance collective of
community leaders and experts. Many different types
of data trusts will exist, based on geography (so data
about people in your neighbourhood can be used to
help improve how you all live), as well as populations
(so various different populations could benefit from the
collective data of others).
84

Data from communities will be collected through opt-in


systems, with dynamic, transparent, and ongoing
consent, and where autonomy and data protection are
key. If you are living with HIV, you could opt-in to have
data about your life be part of a data trust run by and for
people living with HIV. One will exist for people who use
drugs, Black people, Indigenous people, and so on.
ESSAY

Those who are most impacted will be at the center of


it all. Different communities will set their own research
directions for how the data trusts can be mobilized, with
researchers primarily being from those communities.
If someone outside a community wants to apply to have
access to the data from a trust to conduct research, they
will need to demonstrate their ethical responsibilities to
that community, and must outline how outcomes of their
research, are aligned with community research priorities
and will benefit the community.
ALEXANDER McCLELLAND

It will no longer be possible for data to be weaponized,


and to be used externally to pathologize, classify,
label, or diagnose, and to then intervene in people’s
lives from outside. It will no longer be possible to build
forms of capital off collecting people’s biomaterial, and
information on people’s lives, patterns, and behaviours.
Algorithms will be regulated and used only for collective
benefit, as determined by communities themselves.

The inner dialogue you have telling you that what I’m
saying is unrealistic, not possible, far-fetched, that inno-
vation won’t happen this way, that communities can’t
85

be trusted to know and define what they need, and that


you—or other sorts of experts—know better, that inner
dialogue, will also be gone from your mind in 2031…
we will live with a new trust of others, a trust to know
what is best for their own lives.

People will not be viewed as objects of study, but rather


as active subjects with autonomy and control over
information about our lives. There will be no such thing
ESSAY

as “hard-to-reach” people or “at-risk” communities,


as an interventionist and surveillance logic of public
health, social workers, and external researchers will be
undone. Instead, communities will be provided with an
abundance of resources to support themselves.
As a result of settlers conceding control of the land
to Indigenous communities, we will no longer be in a
constant reactive position of fighting against forms of
structural oppression, harmful laws, and the resulting
ALEXANDER McCLELLAND

social stigma and discrimination. The settler colonial


legal system will be abolished, meaning the oppressive
criminal justice system, laws, prisons, and policing
infrastructure will be dismantled. We will live governed
by a collective understanding of “do no harm” with a
deep respect for the other. In the rare instance where
anyone enacts harm to another person, local communi-
ties will employ restorative justice models of community
accountability.

We will see beyond drug decriminalization and legal-


ization. We will have realized total and complete drug
86

liberation. Drug use will be understood not as a medical


issue, or a risk, or a problem. Neoliberal individualism,
which views any form of dependence as a failing or
problem, will be no more. The small number of people
who depend on drugs regularly for survival, will not
be seen as having a disorder, or an individual failing,
as human dependence on substances, things, and on
each other, will be understood as part of the natural
interdependence all of us have to each other, to land,
ESSAY

and to resources.

Outside of pain relief, drug use will now only be viewed


through the lens of pleasure. We won’t need harm
reduction, it will be reconceptualized as pleasure maxi-
mization. Drug supplies will be regulated, and drugs will
be available to whomever needs them. We will support
each other to feel the best they can, to have cognitive
autonomy, and to feel as much pleasure as possible.
People who had been incarcerated for drug penalties,
sex work, HIV criminalization, and other so-called crimes,
ALEXANDER McCLELLAND

will be released, and there will be no such thing as crim-


inal records preventing people from realizing economic
security and well-being.

HIV will be understood as a common human experience,


not an individual moral failing, that is sensationalized,
pathologized, and stigmatized. There will be no need to
talk of eradicating or ending HIV, and the logic of risk will
be no more.

Poverty will be eradicated, billionaires will be abolished,


we will all have a realistic guaranteed income. Resources
87

will be equitably redistributed to enable communities


to support their own needs. All communities will have
access to housing, to clean drinking water, to sustainable
food sources. Scarcity and austerity will be a thing of the
past, we will all live in abundance. We will flourish.

SOURCES AND RESOURCES

Alexander McClelland & Zoë Dodd, ”Thoughts on an Anarchist


ESSAY

Response to Hepatitis C & HIV,” (2015)

Data 4 Back Lives

Edwin J. Bernard, Alexander McClelland, Barb Cardell, Cecilia Chung,


Marco Castro-Bojorquez, Martin French, Devin Hursey, Naina Khanna,
Mx Brian Minalga, Andrew Spieldenner & Sean Strub, “We Are People,
Not Clusters!,” The American Journal of Bioethics, 20:10 (2020)

BIO
Alexander McClelland has been living with HIV for over 20 years. He is
an Assistant Professor at Carleton University’s Institute of Criminology

and Criminal Justice, in Ottawa, Canada.


Harm Reduction and The Archive
Salonee Bhaman for the
Asian American Feminist Collective
@saloneee
@aafcollective
SALONEE BHAMAN

A harm reduction approach to history understands that


the archive is your aunt’s closet, the last stall in your local
dive bar, your phone—wherever stories can be shared.
When we give up the idea that only institutions hold the past,
we remember that “we make histories,” as historian Salonee
Bhaman states in her text “The Archive” for the Asian
American Feminist Collective zine, Solidarity, Politicizing,
Talking Back.

There’s something powerful about the promise of


88

an archival repository: they hold within them stories,


secrets, and clues about the past that all seem to be
waiting to be put together and made recognizable.
Inside each dusty box or slide of microfilm is a snippet
that someone, somewhere, felt that the future must
know about. Someone made a choice to preserve these
objects, and to tell these stories. Rifling through these
carefully preserved artifacts of the past can create a
sense of urgency for a historian: what are we supposed
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to learn from these documents? Why did someone save


them? This can be the trap of the archive as well: who
decides what documents are saved? Which characters
get to play the starring role in history? Who counts?
Too often, archives are resigned to the hallowed
repositories of universities and municipalities. Those who
can access them must read between the lines, interpret-
ing within gaps and silences and implications, in order to
find the working people who make a city run, the women
and caregivers who nurtured movements and people,
SALONEE BHAMAN

and the stories of diaspora, migration, and displacement


that lack tangible form. Luckily, these stories can be
found. Often, these stories are in our homes, tucked
away in a photo album, or in the minds of someone
we love or respect or know, waiting to be coaxed out
and committed to paper and tapestories waiting to be
treated with the reverence of History. Oral histories,
familial objects, and community learning are at the core
of feminist historical practice.

We make histories.
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Read the full zine here.


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CREDITS

Harm Reduction is Not a Metaphor was created by What Would an HIV


Doula Do? and Visual AIDS at the invitation of PS1.

WWHIVDD would like to thank Benni from L’Association Québécoise


pour la promotion de la santé des personnes utilisatrices de drogues
(AQPSUD) for the generous invitation to consider harm reduction this
spring. Your work was deeply influential to the making of this zine.
WWHIVDD?

Editors
Theodore (ted) Kerr for WWHIVDD; Kyle Croft and Blake Paskal
for Visual AIDS, and the Harm Reduction Zine working committee
for WWHIVDD (Abdul-Aliy A Muhammad, Molly Pearson,
David Oscar Harvey, Tamara Oyola Santigo, and Jennifer Brier)

Copy Editors
Alexandra Juhasz, Molly Pearson, John Freeman, Kyle Croft,
Blake Paskal, Cea (Constantine Jones)

Zine Design
Aaron Fowler

Poster Design
Jade Forrest Marks

What Would an HIV Doula Do? is a community of people joined in


90

response to the ongoing AIDS Crisis.


hivdoula.work | @wwhivdd

Visual AIDS utilizes art to fight AIDS by provoking dialogue, supporting


HIV positive artists, and preserving a legacy, because AIDS is not over.
visualaids.org | @visual_aids

This document was collected and edited by people living on


Lenape land, with contributions from people across Turtle Island.
CREDITS

HARM
REDUCTION
IS
NOT
A
METAPHOR

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