I chose to look at harm reduction strategies as they are applied worldwide, and take some of the learning from that and then narrow back the focus onto myself and my experiences at Our House of Portland. I’ve posted the resulting essay, “The Practicalities of Wellbeing and Being Well,” on my professional website. I have included links to much of my research materials.
The Practicalities of Wellbeing and Being Well
A long time ago, when I was in high school in the early 1990’s, I was a peer counselor. My local county health and human services administration had a program where they taught some of us high school students the very basics of active listening, warned us against giving advice, armed us with resource guides, and gave us a contact person to call in case of emergencies. We were meant to be sounding boards for our classmates, and to be information clearinghouses on anything from safer sex to the power of just saying no. The thinking was that some information and some help come best from a peer. Looking back on it now, I think it was a way for Health and Human Services to provide a bit of social inoculation for the local high school kids. When we talked to our friends, to other kids in school, we helped reduce the potential harm that we (all of us kids) were bound to do to ourselves.
Since then, I’ve become a bit more sophisticated in my understanding of any kind of intervention and of harm reduction as a tool for developing wellness. The idea behind harm reduction is pretty simple: people are sometimes going to do unhealthy things that put them at risk of injury or disease, so let’s minimize the self-damage as much as possible instead of compounding the problem. It’s an approach that can seem at odds with the punitive and judgmental nature of much of American society; addiction and illness are often seen as personal moral failings, so there’s not much reason to help people be or become better than they “deserve.” Harm reduction comes from a place of recognizing the ultimate goal (recovery and health) while also keeping in mind where individuals are in their own situation. Thus, instead of the public washing its hands of the problem and declaring that they’re getting what they deserve, needle exchanges are set up so that IV drug users lessen their risks of HIV or hepatitis infection. In short: don’t let a bad situation get worse.
Twenty years later from my high school days, I’m now embarking on a new career in healthcare, I’ve been reflecting on what it means to be healthy, and how that is not only a physical state, but an ongoing personal journey. I’m studying in order to become a nurse, and for the last few months I’ve been volunteering at Our House of Portland, a local residential healthcare center for people living with HIV/AIDS. I’d like to be the kind of person who volunteers more of his time to organizations and causes he believes in—and I’m working on that—but the practical consideration of how volunteering in a setting with direct patient interaction would help me grow in my career certainly was its own source of motivation.
When I started at Our House, I felt a little nervous. I’m old enough to remember the Eighties and the hellishness of living with HIV before protease inhibitors, and although Our House is no longer a hospice where men and women go to die with dignity, it took a couple of visits to see through the shadows of the past and see that it’s a place where people are getting help to live as well—as healthfully—as they can. Our House takes a holistic approach to their residents and clients, seeing health in a multifaceted way.
Our House residents come from all walks of life, and for some, a history of addiction and less than optimal choices can mean that being healthy—continuing on that ongoing personal journey—means that harm reduction is a real and valid tool. Now, in this context, I don’t mean needle exchange; rather, I’ve seen how the staff at Our House respects the choices of their residents—even when these are perhaps objectively less than wise. It is entirely up to a resident whether or not they give up smoking, or if they decide to party too much with their friends when they are outside of the facility. Our House respects that their residents are responsible adults with their own ability to decide for themselves, and who are in charge of their own healthcare. In doing so, they nurture each resident’s agency, and this, I believe, nurtures their health.
There’s a decided practicality about the philosophy of harm reduction that appeals to me. It’s a way of seeing people as they are and working with them to build toward their goals from there. It’s clear-eyed, and I like—respect—that very much. As a policy, it’s seen worldwide adoption as a strategy for lowering infectious disease rates and supporting communities that are at risk (such as sex workers, drug users, and the homeless). Recently, a petition signed by over 5,000 police officers from all over the world advocating for the use of harm reduction strategies with sex workers and drug users instead of traditional criminalizing tactics was published in Thailand. Law enforcement officers from beat cops to chiefs of police signed, standing behind their conviction that harm reduction lowered the rates of infection and crime, and preferring that to just creating more convicts.
Studies examining the effects and effectiveness of harm reduction strategies have been conducted all over the world, from Australian researchers looking into lowering the rates of HIV transmission among Australian youth to British insights on the home-grown approach to harm reduction amongst HIV-positive gay men, serosorting (selecting sexual partners with matching HIV statuses). All of these data help illuminate the picture of people understanding the realities of their situations and seeking out the best options, even when the decisions made might not be the ones that others would approve.
There’s a certain resilience—as well as a stubbornness—in the human spirit that is demonstrated by the embrace of harm reduction in policy and treatment. The resilience is the forward-going nature of any journey toward health and wellbeing. The stubbornness is the obstinacy of continuing to stop, or detour, or take a step back or away or sideways on that journey. The journey is a meander, not a straight line.
I am pursuing nursing as a complement to my work as an artist and writer, and I feel these pursuits operate on different but equally important scales. Both pursuits are in the service of the same goal, the same journey: my own health, physical and emotional. Over the course of these last few months, I’ve been thinking and writing a lot about my personal experience with volunteering at Our House. In addition to the greater appreciation I now have for the practicalities of harm reduction in caring for others, and the immense respect I have for the staff of Our House for their skill and dedication to their residents, and for those residents for reminding me of the dignity of agency, I feel that I have gained a surer footing on my own personal journey of wellbeing.
Research Collection (read in preparing to write this piece)
1. Police officials worldwide recognize that harm reduction strategies are more effective than traditional criminalizing approaches.
Over 5,000 Police Sign Global Statement of Support for ‘Harm Reduction’ Approaches to HIV Prevention. – Press Release. Law Enforcement And HIV Network, 20 Nov. 2013. Web. 20 Nov. 2013. <http://www.digitaljournal.com/pr/1599042>.
Law enforcement officers, who are on the front line with people who have fallen through the cracks, recognize that the traditional, hard-line approach to dealing with IV drug users and sex workers (i.e., treat them as criminals) is less useful/successful in stopping the activity and in preventing the spread of HIV. This press release comes from Thailand (which due to its large sex industry is strongly invested in minimizing the spread of HIV.
2. Researchers in Australia review programs that aim to lower HIV infection rates in IV-injecting drug user youth in Australia.
Dolan, Kate A., and Heather Niven. “A Review of HIV Prevention among Young Injecting Drug Users: A Guide for Researchers.” Harm Reduction Journal 2.5 (2005): n. pag. HRJ. 17 Mar. 2005. Web. 20 Nov. 2013. <http://www.harmreductionjournal.com/content/2/1/5>.
Australian study looking at various programs in Australia.
3. Serosorting as means of lowering risk and preventing HIV infection.
Cairns, Gus. “Serosorting, Sexual Harm Reduction and Disclosure.” HIV & AIDS Information. NAM Publications, 2013. Web. 20 Nov. 2013. <http://www.aidsmap.com/Serosorting-sexual-harm-reduction-and-disclosure/page/1061758/>.
NAM is a British NGO that arose to deal with HIV/AIDS in the UK, originally publishing the “National AIDS Manual,” a best practices guide for all topics related to its mission. It has since become even more of an information clearinghouse.
4. Harm reduction via safer smoking kits in Toronto
Hunter, Charlotte, et al. “Reducing widespread pipe sharing and risky sex among crystal methamphetamine smokers in Toronto: do safer smoking kits have a potential role to play?.” Harm Reduction Journal 9.9 (2012): 1-9.
Looking at a study piloting the use of “safer smoking” kits for crystal meth smokers to minimize or prevent the spread of infectious diseases when sharing pipes. The kits also provided safer sex supplies like condoms and lube, as there is a high incidence of risky sex among crystal meth smokers.
Over the course of writing this piece and the ones preceding it, I’ve been reflecting a lot on what I’m doing and why. Given the limitations I’ve given myself (partly arising out of HIPAA concerns with regard to the residents at Our House, and partly out of introspection), I’ve gained a better sense of how I’m going to approach integrating my work as a nurse and my work as a writer and artist. On a practical “new learning” level, I’ve learned how widespread harm reduction is in policy and treatment worldwide.