Harm Reduction and

HIV Prevention:Working with sex workers, substance users, and other criminalized communities

Amna Shaikh, Lindsay Roth, and Kahn Miller of

Objectives

Introductions Continuum of acceptability Frameworks and definitions Applications in practice Discussion

This is a safe space Confidentiality: What’s shared here stays

here, what’s learned here leaves here One Mic Make Room, Make Noise Ouch/Oops If you don’t know - ask! Speak from the “I” Avoid assumptions Please do not record this presentation (the

slide show with bibliography and notes will be made available)

Who We Are, What We Do

All volunteer, grassroots direct-service and advocacy organization for and by women in Philadelphia’s sex trade, with a focus on women surviving in the street economy in Kensington.

Barriers to care are material, social, and structural. Services include: •late night street outreach •bad date sheet

•home deliveries •case management •health & safety tips

•overdose response training •rape and assault referrals

•ladies night drop-in

What is Harm Reduction?

What is Harm Reduction?

A public health theory addressing behaviors that carry risk.

We all do things we know are bad for us, and only the individual can decide what measures to take to mitigate harm

Those who engage in these behaviors should have a leading voice in any organization or program they utilize

Continuum of Acceptability

Not OK for anyone ever (in the history of ever)OK for some (over there, far away)Fine but not a preferred practiceGood for others, not good for meGood for others, good for me

Consider these as you move through the continuum

Debrief

What was the first thing you thought of?

Have you always felt this way? How would your position change if

this were a continuum of risk? What other factors influenced your

position?

Criminalization Oppression via state control of body

(legal gender, incarceration, condoms as evidence, drugs & paraphernalia) and mind (access to education/information, mental health care, definition of disease)

Can be explicit in law or how laws are enacted/enforced, and replicated through other institutions/centers of power (education, medicine, media and pop culture)

Not a vacuum but a wave

Frameworks (everybody has one)

Sex work as work Substance use vs.

Drug Abuse Theory of

Intersectionality

These frameworks acknowledge the material, social,

cultural, and spiritual impacts of

criminalization

Sex Work as Work

Sex Work, Sex Trade, Survival Sex Work – it doesn’t need currency to be commerce

Focus on the sex worker Honors Autonomy (Choice/Agential

Choice) Free of stigma, implies alliance Provides for a more comprehensive

understanding of what exploitative forces may be at work (interpersonal, institutional, or otherwise)

Substance Use vs. Drug Abuse

Language creates our reality Our reality, as providers, should be free of bias Create a space for individuals to self-identify

and/or qualified professionals to properly diagnose

Consistent with evidence based practices and contemporary research

Substance Dependent

Chaotic Use

Supporting

Addict

Rock-Bottom

Enabling

There is a rainbow of options between chaos and

abstinence!

Intersectionality

Criminalization is experienced disproportionately under multiple forms or systems of oppression, domination, or discrimination. These frameworks must be considered

within the theory of intersectionality.

Application in Practice

Harm Reduction approaches to serving historically vulnerable, marginalized and

oppressed populations mitigate the impact of criminalization –

especially in HIV treatment and care.

…So how do we do this?

Our Suggestions Know your own boundaries Affirming and appropriate language and

visual presentation Check your knowledge base Seek ongoing education Know the laws and policies that impact

your clients and yourself “Nothing about us without us” from the

waiting room to the board room Meet people where they are at –

literally! Use strengths based models

(not the) Final Discussion

How can we apply these frameworks in context in which we are all survivors of criminalization?

Thank You!Please stay in touch

Amna Shaikh, Lindsay Roth & Kahn Millerwww.projectsafephilly.org

safephila@gmail.comStop by our table!