EMBRACING HARM REDUCTION COULD REVITALIZE QUEER POLITICS

Activism / Pipe Dreams & Real Lives

We all take drugs. And all drugs pose risks -- from medications
prescribed by your doctor to that Smirnoff Ice at last call. But if
you ask most people to describe the stereotypical drug user, it's
rare for anyone to hold up a mirror.

A middle-aged gay man who snorts the occasional line of coke at a
party may think he has little in common with a homeless woman turning
tricks and smoking crack in an alley just a block away. Still, in the
face of a conservative social and political tide, more people are
realizing that when it comes to drug use and sex work, we need to
reduce the harms associated with these activities instead of trying
to curtail them.

Whether it's the ongoing fight in Ottawa to maintain a crack-pipe
distribution program, or the constitutional challenge intended to
decriminalize the sex trade, a harm-reduction approach rejects the
idea that prohibition is a useful way to approach sexuality or drug
use. And at a time when queer politics don't have a clear rallying
point -- but rather a scatter of issues both local and national vying
for our attention -- we have much to learn from the lessons of harm reduction.

When it comes to drug use, not everyone understands harm-reduction
philosophy. After all, shouldn't addicts aim for abstinence instead?

It's a question often put to Adam Graham, a prevention worker at the
AIDS Committee Of Ottawa who works specifically with gay men.

"If someone is using drugs in a way that makes their life too chaotic
and consequently decides that they are in a position to reduce their
harm enough to self-initiate recovery? Good on them," says Graham.
"It would be extremely irresponsible -- and dangerous -- for public
health officials to offer only one solution to people in our
community. Harm reduction works for some of us, treatment works for others."

Graham's perspective acknowledges that things aren't always so
simple. Not everyone wants or needs to quit using drugs. But for
those who do, defeating an addiction can involve years of effort and
many setbacks -- even if you have access to recovery professionals, a
network of supportive non-using friends, and a safe, secure and
comfortable place to live. But many addicts -- especially those with
mental-health challenges, or who are poor or homeless -- lack all of
these comforts.

And supporting someone to use in a safer way can keep them healthy
until they are better equipped to stop using successfully.

"You can't get off drugs if you're dead," states Anne Livingston of
the Vancouver Area Network Of Drug Users (VANDU), in the poignant
documentary Fix: Story Of An Addicted City. The film chronicles the
political battle that birthed InSite, a safer-injection facility in
the poverty-sticken Downtown Eastside neighbourhood of Vancouver.

At InSite, drug users can inject in a clean and well-lit environment
under the watchful eye of medical staff -- instead of picking up used
needles off the ground and using dirty water from the gutter to
prepare their fix. The site garnered international acclaim and
scientific studies proved its benefit to the health of users and the
community -- but despite all the evidence, the Harper government has
yet to confirm that the centre can remain open beyond Dec 31 of this
year. Meanwhile, the City Of Ottawa has turned its back on crack
smokers, in a decision that could have deadly impact if allowed to stand.

Ottawa On Crack

Smoking crack in the nation's capital achieved a countrywide high
profile after a weekend Globe And Mail expose back in April warned
that Ottawa had experienced an "explosion" in the drug's popularity.
Recently elected conservative mayor Larry O'Brien told the Globe it
wasn't too late to take action to address the problem. And indeed,
before too long he and suburban city council colleagues took aim at
downtown crack users.

On Jul 11, Ottawa city council voted 15-7 to terminate its
safer-inhalation program, which used some city funds to create safer
crack-use kits. Along with condoms, lube, lip balm and health
information, each kit included the makings of a glass pipe with a
protective rubber mouthpiece.

Many crack smokers employ dangerous handmade pipes -- often fashioned
from discarded pop cans, asthma inhalers or broken ginseng bottles --
cutting and burning their mouths and hands in the process. As a
result, users are at higher risk for acquiring or transmitting HIV or
hepatitis C either from sharing the pipes or when performing oral sex.

A 2007 study by Montreal's public health department indicated that
over 60 percent of injection drug users have hep C -- and other
research has shown that more than 80 percent of injectors also smoke crack.

HIV and hepatitis C (HVC) can be a dangerous combination. Having HIV
can cause HVC to multiply eight times faster than normal -- and
anti-HIV medications can negatively affect the liver, worsening the
impact of hepatitis.

For a cost to the city of $7,500 a year, Ottawa's chief medical
officer of health Dr David Salisbury estimated the crack-pipe
initiative could save millions in future health-care costs because of
disease prevention.

The epidemic of HCV infection among drug users is a public-health
crisis -- and safer inhalation programs are a key part of the
solution. Dr Lynne Leonard, a social epidemiologist with the
University of Ottawa, carried out research demonstrating the success
of the program in reducing pipe sharing -- as well as converting drug
users from injection to a less-risky alternative: smoking it. Similar
health initiatives are in place across Canada in cities including
Halifax, Whitehorse, Winnipeg, Guelph, Vancouver, Montreal and Toronto.

Quitting handing out pipes will not stop anyone from using crack,
especially since homemade pipes are so easy to make -- but it will
prevent users from protecting one another by doing so more safely.
And support agencies say it will drive the marginalized practice
further underground, severing a vital link between crack smokers and
health workers.

Nicholas Little is an outreach professional with the AIDS Committee Of Ottawa.

"I hand out crack kits ever single day," says Little, who argues that
ending the program will have a catastrophic impact. "Users won't come
see us anymore. That means I can't help them find housing, or get
jobs, or access a shelter, or get into treatment if they want to get
off drugs or reduce their use."

Little says politicians are toying with people's lives and he feels
there is a strong role for queer activists to play.

"The queer community needs to advocate that safer inhalation be
mandated at a provincial level -- so municipal governments can't
dismantle health programs based on ideology," says Little.

Little and Adam Graham tend to tag-team on these issues, especially
when it comes to advocating for the program. Graham echoes Little's
anger at council's decision.

"Ottawa city council hasn't got a single leg to stand on with the
baseless conviction they used to yank funding from the crack pipe
program, yet those of us who use crack and those of us who work in
public health have both our own experience and now science on our side."

Little is sympathetic about the level of drug use in the queer community.

"The prime motivator to use drugs is just to cope with all the
fucking bullshit that we live with everyday." Queer youth are
vulnerable in particular, he says.

"Queer youth face hostility and violence at high levels, in the
school system and at home. Many are chased out of their homes and
live on the street," Little points out. His anger at the situation is
palpable. "I don't think anyone could really say that if they found
themselves in that situation, they might not also turn to substance
use to cope with the pain."

Harm Is Relative

Few would deny that crack addiction can have harmful consequences.
According to the Safer Crack Use Coalition (SCUC), a Toronto-based
advocacy group, the health impact of chronic crack smoking can
include heart and blood-pressure irregularities, serious respiratory
infections and "doing the chicken" -- blacking out while experiencing
uncontrollable body twitches -- which can sometimes result in sudden death.

But the drug generates pleasure as well -- a rare respite for users
whose lives are already marked by poverty or mental illness. For
many, crack use is the least of their worries.

Chris Gibson, a program director at the Toronto men's hostel Seaton
House, explained it this way, speaking before a federal government
special committee on non-medical drug use: "Drugs create feelings of
well-being. Stopping drug use is going to allow them to wake up every
day and be clearly aware of that fact that they have no education,
they have nowhere to live, and they have limited prospects -- which
seem like really good reasons to use drugs."

Law-enforcement officials will tell you drugs like crack are illegal
because they're harmful to users and society. But the reverse is even
more true -- some drug use is harmful specifically because of the
fact that it's against the law.

For instance, needle use can lead to many more health problems than
inhaling a substance -- such as abcesses, endocarditis (a potentially
fatal heart infection) and a greater risk of overdose and death. But
if you can be arrested for getting high, many people will choose the
route least likely to be detected -- and shooting up generates no
telltale smoke or odours.

One of the biggest harms of all associated with addictive drugs is
their economic cost. It's easy to link illicit drug use and criminal
acts such as theft -- after all, both are considered morally suspect
in the public imagination. But most addicts wouldn't steal if illegal
drugs -- produced and distributed via underground economies fraught
with risk -- were not so unfairly expensive. In this way, drug laws
set up a cycle of incarceration that wouldn't otherwise exist.

Connor McCullum is the hepatitis C coordinator for Prisoners'
HIV/AIDS Support Action Network (PASAN). He works men and transwomen
in federal prisons -- where condom availability is poor, and needle
and crack-pipe distribution is prohibited. Drug-related harm is an
even more serious issue behind bars.

"A homemade syringe will pass through the hands of literally hundreds
of people," he points out.

"People do everything in prison that they do outside -- they have
sex, they get high, they get tattoos -- but they are forced to do it
much less safely." McCullum says medical staff in jails support harm
reduction but their efforts are thwarted by prison authorities. This
tension between health experts and law enforcement is mirrored on the
streets as well. According to Dr Leonard's report, about 25 percent
of Ottawa crack users had their pipes taken away from them by police
officers -- who in some cases smashed them on the ground to destroy them.

Queers And Harm Reduction

"The gay community understands harm reduction -- but only when it
comes to sex, or club drugs," says Walter Cavalieri, director of the
Canadian Harm Reduction Network.

"But AIDS -- which first united the gay community -- is about more
than just sex. It's also about injecting drugs and using crack. Many
AIDS organizations deliberately marginalize drug users, and it makes me angry."

Cavalieri is a gay man and a harm-reduction pioneer. He spearheaded
one of Canada's first needle-exchange programs at Toronto's Parkdale
Community Health Centre.

"Street people won't join organizations perceived as gay because they
face enough stigma already." He adds, "I understand why gay
organizations avoid drug users -- they are perceived as difficult.
But we all need to try harder."

PASAN's McCullum agrees.

"Drug users are 'queer enough' when we're having sex with them -- but
not when they're getting arrested for using drugs or when they have
to sleep in a park," he says.

Harm reduction is relevant to queer politics because some of us are
homeless, sell sex or use drugs. But it goes beyond that, too.

The vast majority of same-sex loving people around the globe are
unable to be open about being queer. The very act of coming out is
one of the most basic forms of harm reduction. Mere decades ago,
queers in Canada faced some of the same forms of widespread stigma
experienced by drug users today -- we were considered morally
deficient and targeted in medical and social discourse as diseased.

At the outset of the AIDS epidemic, we knew that abstinence wouldn't
work -- so we fought to keep bathhouses open and pioneered
community-based safer-sex education instead.

Safer-sex efforts prevent the spread of HIV. So, we use harm
reduction in the gay community to promote safer sex.

But sexual harm reduction doesn't end with defending HIV-negative
folks. People with HIV deserve reduced harm too. This means access to
treatment and efforts to defend against other infections. Protection
from harm for people with HIV also includes the right to determine if
and when to disclose their status to others, including sexual partners.

The gay-liberation slogan "we are everywhere" is as true of the crack
house and the street corner as it is of the corporate boardroom. And
the philosophy of harm reduction forms a logical middle ground
between the mainstream and anti-assimilationist conceptions of queer
politics -- because it advocates looking at people's lives as they
really are, rather than wishing either that we could be just like
everybody else or that we overthrow the system.

In the meantime, Walter Cavalieri has some advice for Ottawa's Mayor
O'Brien -- that he spend a couple nights with the people distributing
safer crack pipes on city streets. "Be humble. And listen."

Good advice for us all.

[Sidebar]

By The Numbers

What the University Of Ottawa study showed:
[]

Figures from Dr Leonard's findings. City Of Ottawa Public Health
Safer Crack Use Initiative. Released Oct 2006.
http://www.medecine.uottawa.ca/epid/pdf/Crack%20Report.pdf.