new york harm reduction educators (nyhre)
Interview with Paul Gregoire
New York Harm Reduction Educators (NYHRE) seeks to redress the disparities faced by the communities who use drugs and sex workers, especially communities of colour. What are the disparities that they face and how do you seek to redress these?
We are based in East Harlem and the Bronx. These neighborhoods are some of the poorest in New York, and NYHRE participants are facing barriers in housing, employment, health care, and treatment. These communities are highly policed and our participants are often victims of police harassment and arrests. We are members of the coalition, Communities United for Police Reform, which is working to bring oversight and accountability to the NYPD.
Many participants have been incarcerated and their records can prevent them from finding housing and employment. Stigma is a significant problem in these communities. NYHRE’s participant action program helps to identify societal issues participants face and works to change policies and laws that cause or exacerbate those issues. We work to bring people who engage in sex work and drug use to the bargaining table with policy makers and elected officials so that they can speak directly to their experiences. We fight stigma by showing that drug users and sex workers are human beings with inalienable rights.
We run the UPRISE (Uniting Peers for the Rights of Injectors and Sex Workers Everywhere) program, which works to develop NYHRE participants into community leaders and advocates for social change. The program accepts 10 participants twice a year. Participants go through 18 weeks of workshops about harm reduction, HIV and Hep C prevention, stigma, community organizing, policy change, LGBTQ issues, etc. After they finish their workshops they start a 6 month field practicum with NYHRE doing outreach, syringe exchange, and community organizing. They receive a stipend for their work and are able to develop skills that can lead to future employment.
What is the situation like on the ground in New York City for these communities today?
The socio-economic status of NYHRE participants is an extreme reflection of poverty in the communities we serve. East Harlem and the South Bronx are among the poorest neighborhoods in the country. NYHRE participants are among the most marginalized, stigmatized individuals in our society. They suffer from unemployment, unstable housing, high incarceration rates, a higher than average incidence of negative health issues, and are routinely and systematically excluded from the political and social processes that determine policies affecting their lives.
The Bronx and East Harlem communities suffer from high rates of poor health indicators including obesity, diabetes, asthma, cardiovascular disease, hospitalizations for drug and alcohol use (3-4 times higher than NYC), death rate due to drugs (3 times higher than NYC), infant deaths and low birth weight babies, and some of the highest rates of injection drug use in NYC. 59 per cent of those who are HIV positive in the Bronx are injecting drug users and 24 per cent are homeless.
Residents in the South Bronx have particularly high rates of poor health indicators. Residents experience significantly higher rates of mental illness hospitalization than the overall rate in NYC (excluding alcohol- or drug-related illness) which has increased 11 per cent (1,051/100,000) in the last decade. Nearly 37 per cent of residents said they lacked money to buy food at some point in the past 12 months which is more than any other Congressional District and twice the national average, 18.5 per cent. The South Bronx also has some of NYC’s highest documented rates of chronic hepatitis C (HCV) (419/100,000 persons). Even though the number of newly reported HIV cases has dropped by 80 per cent since the mid-1990's, primarily due to the successful implementation of programs like NYHRE’s, the South Bronx and East Harlem continue to rank in the top 1 per cent in New York City and New York State in all HIV/AIDS epidemiological indicators.
According to U.S. Census data from 2005-2009, 24 per cent of adults under 65, 22 per cent of adults over 65, and 39 per cent of all children live below the poverty level in Bronx County as a whole. 25 per cent of all families and 40 per cent of families with a single female head of household live below the poverty level. Based on NYHRE's intake data, 100 per cent of NYHRE's participants live below the federal poverty level, which is an exceedingly low measure by New York City cost of living standards.
Institutional racism is a profound obstacle for low-income people of color as policy and practice often dictate disparate treatment toward low-income communities of color. For those who use drugs, hyper-surveillance and over-policing in these communities means more arrests for petty drug offenses. Once in court, the drug user without financial resources must rely on public defenders who are overburdened with enormous caseloads, whereas the wealthy defendant can afford an attorney that will provide the individual attention required. These disparities have been well documented.
In 1980, the incarceration rate for young Black males without high school diplomas was 10 per cent; by 2008 it had increased to 35 per cent. This increase mainly speaks to the interplay of institutional racism and drug policies that favor incarceration over treatment. In fact, in the South Bronx and East Harlem young Black men are more likely to be imprisoned than employed.
Of the over 5000 participants that received services in the last year from NYHRE, a significant number were living in temporary or unstable housing with 1,121 living in a homeless shelter, 334 living on the streets, 290 living in a transitional housing and 387 doubled up with family and friends.
You advocate for social justice for these communities. How do you go about undertaking this process and do you have specific campaigns that you run?
We work with our participants to identify issues that are directly impacting the community. We also work with other organizations on policy efforts to facilitate social change. We are involved in campaigns to prevent overdoses, reform the NYPD, and to end the criminalization of individuals who use drugs or engage in sex work. We are particularly involved in campaigns to ensure that officers no longer arrest people for syringes, condoms or marijuana as these are all ways that our participants have routinely been harassed and arrested. Syringes have been decriminalized in New York whether they are used or new, but NYHRE participants report they are frequently arrested or have their syringes confiscated. Personal possession of marijuana has been decriminalized in NY since 1977, but it is a misdemeanour to have marijuana burning or in public view. The NYPD illegally search people through the Stop-and-Frisk program and when marijuana is found in an individual’s pocket they are charged as having marijuana in public view.
The issue of condoms arrests is particularly insidious. Condoms are not illegal, but the NYPD will use the condoms as evidence of sex work, confiscate their condoms, arrest people, and charge them with ‘prostitution’ related offenses. NYC might be the only city in the world that has its own brand of condoms. The Health Department teamed up with Lifestyles brand condoms to make the “NYC Condom” which is given out at health centers, harm reduction programs, bars, restaurants, schools, practically everywhere. NYC has accepted that it is sensible public health practice for New Yorkers to be carrying condoms. Regardless, the NYPD has been confiscating condoms and arresting people, particularly sex workers and transgender youth of color. Last year a PROS Network (Providers and Resources Offering Services to sex workers) report showed that almost half the people surveyed have not carried condoms at some point for fear of police repercussions. This is a problem not only in NYC but in many other cities in the U.S., as can been seen in a Human Rights Watch Report, and internationally as can be seen in an Open Society Foundations Report. We are working in coalition with other sex worker and anti-trafficking organizations to change this policy in New York.
Overdose is currently the number one cause of accidental death in the US, surpassing even car accidents. Since 2006, New York State law has supported community program such as NYHRE to distribute Naloxone to individuals who are likely to witness an opioid overdose. Naloxone is a safe and effective medication that can block the body’s opioid receptors and bring someone back from an overdose. There is no risk of abuse and the medication will have no effect on a person who has no opioids in their system. Unfortunately, Naloxone is a prescription medication. There are a very limited number of prescribers who have agreed to work with community-based organizations to distribute Naloxone. We are working with organizations such as VOCAL-NY to pass legislation that would allow for non-patient specific or ‘standing order’ prescribing. This would allow programs to distribute more Naloxone kits and train more participants in how to recognize and reverse an overdose.
What practical measures do you take to help these communities in regards to resources, tools and support that you provide to them?
NYHRE helps participants make direct connections to other service providers so that they can access services for health care, mental health, housing, food, or anything else they may need to improve their overall well being. The practical measures we take not only include creating those connections, but it also includes advocating on the phone, through letters, or in person to ensure that participants are given the best possible service.
In addition to providing connections to outside services, NYHRE also provides many essential services in our drop-in center and at our street-based syringe exchange sites. We have Harm Reduction Counsellors who provide case management for participants to help identify what they need and help connect them to services. The Harm Reduction Counsellors help participants fill out applications and forms. We have Social Workers that provide free mental health services and conduct the mental health assessments required to get into programs such as supportive housing.
We also provide very tangible resources and services such as acupuncture, therapeutic and educational groups, syringes and other safer injections supplies, safe sex kits, education on safer drug use and safer sex, “know your rights” trainings, HIV/HCV testing, overdose response and prevention training, as well as a place where participants can come to get off the street, feel safe, and know they will not be judged by the staff. Our staff will work with participants to ensure they can access any services or tools they want or need. We try to ensure our participants know that someone from NYHRE is always willing to fight for their rights, advocate for their needs, and listen to their stories.
What are some instances where you have seen some positive results from your work?
Many NYHRE participants have made positive changes in their lives. The successes of harm reduction interventions are sometimes not recognized as much as clinical services or abstinence-based approaches to drug use and sex work. If a participant has started to use clean needles for every injection, that is a positive result. If a participant finds a permanent place to live, that is a positive result. If a participant begins to adhere to their HIV medication regimen and finds their health improves, that is a positive result. Anytime a participant improves their health, safety, or wellness it is a positive result, so we see positive results every day.
The UPRISE program has successfully educated many Peer Educators, some of whom have gone on to work as a part of the permanent NYHRE staff, and some who have obtained employment at other agencies. Our Participant Action Program has been successful at changing important laws. We were a part of passing an expanded profiling bill to protect New Yorkers from profiling by the NYPD. We were a part of passing legislation to appoint an Inspector General to oversee the NYPD. We helped pass a bill to mandate that medical providers in NY offer a Hepatitis C (HCV) test to anyone born between the years of 1945 and 1965. We have reversed over a hundred of overdoses and saved dozens of lives. NYHRE sees the positive results from our work both in the individuals we serve and in the policies impacting the communities we serve.
Your website quotes from an anonymous source the following, “When you judge someone you don’t define them, you define yourself.” Can you expand on this?
This quote is meant to show one of the foundational tenants of harm reduction, that NYHRE’s programs and services must be delivered in an accepting, non-judgmental, non-stigmatizing manner. The laws, policies, and culture of our society are highly stigmatizing of people who use drugs and people who engage in sex work. NYHRE hopes to fight against stigma and for human rights and social justice. The communities we work with have experienced stigmatizing labels, such as being called a crack head or a whore, but we say that these labels do not define us.
A person may choose to use crack, but they are also a person who loves their friends and enjoys baseball. The website quote is attempting to explain that we cannot let others define us and we cannot let society stigmatize us.
How did your grass-roots organisation come into being? What’s the history behind New York Harm Reduction Educators?
NYHRE began as a part of ACT UP (Aids Coalition to Unleash Power). In 1988 there was a small syringe exchange program put together by the Health Department, but in 1990 Mayor Dinkins ended the program. ACT UP activists recognized the importance of syringe exchange to prevent the spread of HIV/AIDS and began organizing underground syringe exchanges throughout the city. There were syringe exchange sites set up in the Lower East Side, Bushwick, Williamsburg, and the West Bronx. They were run by volunteers and funded mostly through ACT UP.
In 1992, the NY State Health Commissioner signed emergency regulations that allowed for legal syringe exchange. The underground exchanges were able to become independent non-profit organizations and the Bronx/East Harlem Syringe Exchanges became New York Harm Reduction Educators (NYHRE).
Other services were added on, over time, in response to requests from participants who wanted access to drug treatment, support groups, case management, mental health services, holistic health treatments and referrals to a host of agencies and services.
Today we operate the largest syringe exchange program in New York and the East Coast with 10 street-based sites and a strong network of current and former drug users and sex workers who provide services to their peers. We have a drop-in center in East Harlem where participants can meet with Harm Reduction Counsellors and Social Workers. We provide HIV and HCV testing, run groups, host the UPRISE training program, provide acupuncture, and are involved in social and political change. All of our services are free, and require no Medicaid or health insurance. All of our street-based services are anonymous to allow participants to feel safe exchanging syringes and disclosing their status without fear of being labelled or stigmatized.
What is New York Harm Reduction Educators take on the prohibitionist system?
Prohibition has been proven time and time again to be a failure. Many of the harms associated with drug use and sex work are not inherent to using drugs or exchanging sex, they are either caused by or made more severe by the criminalization of drug users and sex workers. The risks for injection drug users such as HIV/AIDS, overdose, abscesses, HCV, etc. could all be either eliminated or vastly reduced if we were to change our policies. Clean syringes, cookers, waters, and all the other supplies we distribute do a great job at reducing these harms. If we were able to provide a safe place to use drugs, such as a drug consumption room or a safe injection facility, we would be able to reduce these harms even further. The work of Insite Vancouver has shown this to be true.
When we criminalize and stigmatize people who use drugs or engage in sex work we are putting more barriers between them and personal change. People are unable to ask for help with their use or their lives when the policies are so harsh. Having a criminal record creates barriers for housing, employment, education, and government benefits. Asking for help is hard to do when you feel that you will be judged for your behaviour or arrested if you fail to succeed at making a change.
When discussing sex work, criminalization creates even more obvious harms. Sex workers are unable to access basic work place protections because their workplace is illegal. If they are assaulted, raped, or robbed there is no way to call law enforcement for support. The laws and policies conflate trafficking with all sex work so that it is possible to be charged as a trafficker for giving a friend who happens to be a sex worker a ride home. Trafficking is a real problem, but trafficking and sex work are not the same thing. Our current policies are working in a way that would be analogous to calling all domestic workers trafficking victims. There are certainly domestic workers who are trafficked, but there are also domestic workers who are making a choice to provide a service for money so that they can survive. All trafficking victims need support and interventions, but not all individuals involved in the sex trades are victims. All workers deserve rights and protections and sex workers are no different.
Do you advocate for an alternative system to that of prohibition?
NYHRE Staff members, peer educators, and participants are all working to change the system every day. Our agency comes from a history of underground activism to ensure our communities have what they need to stay safe. We are no longer operating outside of the law, but we are still carrying that same activist spirit 20 years later. We advocate for an end to policies that criminalize sex workers and drug users. We fight stigma through speaking out and through education. We provide services that put the needs and desires of the participant first. We work to help participants navigate the system to get what they need, and to change the system when the policies create barriers for participants.
Recently, Marijuana has become legalised in the US states of Colorado and Washington. What do you think of this move?
Marijuana legalization is good for almost everyone. Marijuana legalization can bring in a significant taxable income for the government which can be used to provide funding for harm reduction services. With legalization comes quality control and oversight.
NYC is currently the marijuana arrest capital of the world. The NYPD arrests more people for marijuana possession than anywhere else. Most of those arrested are young men of color. If marijuana were to be legalized in NYC we would see these arrests stop. It has been conservatively estimated that tax payers are spending $75 million annually on marijuana arrests. Not only would marijuana legalization be fiscally responsible because of tax revenues, it would save significant amounts of money as well.
How has the situation for the communities who use drugs and sex workers changed in recent history in New York and what do your foresee for the future?
The policies in New York have been consistently improving for people who use drugs or exchange sex thanks to the hard work of activists and advocates across the state. In 2009, there was a significant reform of the Rockefeller Drug Laws. These reforms eliminated mandatory minimum sentencing for most drug cases, expanded drug treatment and other alternatives to incarceration, and allowed for the resentencing of some people who are currently incarcerated under the old laws. There is certainly more progress that is needed on this issue, but these reforms were a major step forward. In 2010, the NY Penal Code was changed to ensure that syringe possession was not a crime whether those syringes were new or used. The Health Code had allowed for syringe possession, but the penal code did not. In 2011, the 911 Good Samaritan Law passed which is meant to protect people from prosecution for possession when they call 911 (emergency personnel/ambulance) if experiencing or witnessing an overdose. The Good Samaritan law is a big step in the right direction for protecting the lives of people who use drugs, their friends, and their families. However, the law does not protect against all possible consequences of possession. For example, if you call 911 to report an overdose you may not be charged with drug possession, but the Administration of Children’s Services may still open a case on you if you have children.
The recent progress we have seen are all wonderful steps in the right direction, but there are still critical areas that need to be addressed. The campaigns we are working on to improve policing and overdose response are just some examples of how there is room for improvement with existing policies. There is still a lack of affordable housing, an overdose epidemic, and the ever-present issues of stigmatization and criminalization of people who use drugs or engage in sex work. We are hopeful that we will continue to make progress on all of the issues impacting NYHRE participants on a daily basis and ensure policy changes that reduce harm and recognize the human rights of people who use drugs or engage in sex work. As even the most conservative of elected officials are beginning to realize, it is not cost effective to lock up such large numbers of people in prisons and shelters. Treatment, permanent housing, and harm reduction interventions are more cost effective and more socially just.
As much as the situation in New York City has been improving dramatically, there is a significant and dire need throughout much of the rest of the state. In the city there are 14 syringe exchange programs and dozens of methadone programs, treatment programs, shelters, etc. Upstate there are areas where there is no access to services of any kind for over 100 miles. In these places there needs to be a significant response or the situation will continue to get worse. Overdose death rates are even higher in the rest of the state than they are in the city. We need to see more programs and services and more organizing throughout New York State to ensure that people who use drugs or engage in sex work are able to get essential services and supplies to improve their health, safety, and wellness.
check the new york harm reduction educators site
Mike Selick has been the Policy and Participant Action Associate at New York Harm Reduction Educators (NYHRE) for the past two years. Mike came to NYHRE with a background in community organizing for human rights and social justice as well as a degree in Social Work and public policy. NYHRE began in the late 1980’s as an underground needle exchange program run by ACT UP, and in 1992 they became one of the first legal syringe exchange programs in New York. Today they remain connected to their history as a grassroots nonprofit organization dedicated to social justice and human rights principles they continue to operate the largest syringe exchange program in the state. NYHRE is dedicated to promoting the health, safety, dignity and well-being of marginalized, often homeless, low-income persons who use drugs or engage in sex work, their loved ones, and their communities. You can contact Mike and NYHRE at mselick@nyhre.org or follow them on twitter @NYHarmReduction.