In harm’s way

It’s not just about exchanging clean syringes for used needles, but the service providers at Harm Reduction Services may start with such a swap. Or they’ll start with just about any need a client has.

“We’re trying to meet people where they are on whatever issue they’re dealing with,” said Raven Hoopes, a case manager with the small Oak Park-based agency. “If someone comes in and says, ‘I need a sandwich,’ we start with finding them a sandwich.”

The goal in the harm-reduction model of treating health issues—usually issues involving drug use or other high-risk behaviors for exposure to hepatitis C, HIV or sexually transmitted infections—is to help clients reduce the possibility of negative consequences. For example, dirty syringes can lead to infections or disease transmission, and if discarded improperly, become a public health risk. At Harm Reduction Services, clients can exchange their used needles for clean ones, reducing the risk of harm to both themselves and the public.

One of the most obvious harm reductions, as we mark the 20th World AIDS Day this week, is the reduction in transmission of HIV, the virus that causes AIDS.

If that first step of responsibly disposing of used needles provides a useful improvement in the client’s life, he or she may decide to make other changes. Or not.

“We’re interested in the client’s idea of what’s important to them,” said Peter Simpson, the executive director. Simpson, Hoopes, outreach specialist and HIV counselor Dan Wilson, and client Lisa Cook spoke to SN&R last week in the agency’s small but comfortable main waiting area. The walls were inscribed with messages from clients about the services received. Rather than feeling like graffiti, the effect was more along the lines of love notes.

Harm Reduction Services makes its home in a building in Sacramento’s Oak Park, but you’re just as likely to run into the care and education providers anywhere in town. The organization offers outreach wherever the need exists: downtown, Midtown, homeless encampments, party spots. With a van and an RV, they can take their HIV- and hep C-testing, syringe-exchanging, safer sex-educating show on the road. And they do.

Two things separate the services offered from those available at other agencies. The first is the open-door policy. Many agencies require a commitment to abstinence for services. Not Harm Reduction Services.

“We’re not anti-sobriety,” Simpson said. “We’re just not pushing clients to do anything they don’t want to do.”

“We accept any amount of change in behavior as a big success,” Hoopes added. “Every little step they make is a celebration for us.”

The second difference is in what Simpson refers to as “do-overs.”

“In a lot of programs, if you screw up, you’ll be lucky to get one do-over,” he said. “We don’t pitch people for screwing up. Every time you show up here, it’s a fresh start.”

That open-door policy was just what Lisa Cook needed. Cook came to Harm Reduction Services to exchange syringes and receive testing. “I came in spun to the hubs,” said the slight, raspy-voiced brunette. “There was nothing in my life that made me want to be clean.”

But she started to make changes for better health, beginning with using clean needles. She’s now been clean for several months and is no longer homeless, and she says that the no-strings-attached attitude at Harm Reduction Services helped her make those changes on her own timetable.

“Coming to Harm Reduction Services is like talking to your neighbor,” Cook said. “I wasn’t made to feel like I was less than. I was somebody that they gave a damn about and they were gonna do whatever it took to get me through today.”

Simpson points out that much of the focus on providing care for substance abusers is on abstinence and recovery, with attention going mostly to those who are—or are trying to become—clean and sober. “But only 10 percent of all drug users are clean and sober at any given time, while 90 percent are using,” Simpson said. “We serve that 90 percent. We want them to stay safe, be better parents, stay out of jail and have a place to live. Even if they’re not clean, they should be as safe as we can help them be.”

And according to Wilson, the key isn’t just the needle exchange, “it’s everything that goes with it.” He elaborated by noting that, often, the syringe exchange “is the first interface with services.”

“That’s when we can start them thinking about bringing the needles back for exchange and taking part in keeping other people safe,” Wilson said. “That’s when we can let them know that we’re there to help with other things, too.”

Or, as Hoopes put it, “That clean syringe holds unlimited possibilities for change.”