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What Harm Reduction Means To Me
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What Harm Reduction Means To Me - International Harm Reduction Association This section sets out to find out exactly what ‘harm reduction’ means to the experts from around the world who have been actively involved in the field over the years. As we approach the Barcelona conference in May 2008, new testimonials will be added to this section in addition to the existing ones from the 2007 event in Warsaw, Poland.
| Professor Adeeba Kamarulzaman (Malaysia)
| The International Network of Harm Reduction Nurses
| Beatrice Stambul (France)
| Sam Friedman (USA)
| Bijan Nassirimanesh (Iran)
| Marcus Day (Caribbean)
| Dr Ingrid van Beek (Australia)
| Jörg Gölz (Germany)
| Prof Adeeba Kamarulzaman is a member of the IHRA Executive Committee and President of the Malaysian AIDS Council and UMMC.
“Harm reduction to me means applying what is known to work for the last twenty odd years to effectively deal with the twin HIV and drug use epidemic. It means putting aside differences based on misguided ideologies and moralities to save lives. It means having to convince those who are not in favour of it through evidence and dialogue. It means giving voice and hope to those who might otherwise not have a second chance. It means working in an area of medicine that is probably the one most fraught with challenges but ultimately one of the most satisfying. It has also introduced me to a whole new world that has constantly surprised and humbled me!”
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| Beatrice Stambul is a Psychiatrist at the Medecins du Monde Association (France) and the Française de Réduction des Risques.
“As a French Medical Doctor, my primary involvement was with Humanitarian Action and Medecins du Monde: go where others do not go, give care to those stigmatised, excluded, persecuted for political, religious, ethnical, medical, or gender reasons, or any other difference or vulnerability. And this is how I got involved in harm reduction, because it seemed to me that drug users belonged to our target population and responded to our medical and human rights ethics.
I started a program in my home city of Marseille, then I began another one in Russia, and today I am working in Myanmar. Providing we adapt it to local culture and specific patterns of use, harm reduction is universal, and it is fascinating to see professionals everywhere engage in specific actions with enthusiasm, competence and success.
I regard harm reduction as a subversive way of performing medicine: doing outreach work, sharing knowledge with users, empowering them, care and cure in a more human, respectful and humble way, inventing a model which not only concerns drug use, but also transforms my whole practice”.
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| The International Network of Harm Reduction Nurses (INHRN) is a coalition of nurses working in a variety of community, prison, and acute care hospital settings. Here, Raj Boyjoonauth (UK), Irene Goldstone (Canada), Rod Thomson (UK), Meaghan Thumath (Canada), Dana Murphy-Parker (USA) and Stephane Ibanez De Benito (Spain/UK) tell us what harm reduction means to them as nurses.
“Much has been written about harm reduction and risk reduction, yet very little in relation to the roles played by the nursing and midwifery professions with drug users in health and social care settings. Nurses, midwives and health visitors are key players in the promotion of harm reduction and risk reduction approaches.
As public health care workers, the roles of nurses, midwives and health visitors in using harm reduction and risk reduction interventions to eliminate bacterial and/or viral infections as well as mitigate the harmful use of drugs in countries such as India, Pakistan, Africa and South America with individuals and their environment are well recognised and acknowledged. Nurses and their colleagues have been very successful as agents of change in effecting healthy behaviour lifestyle changes to the individuals and their environment both within hospital and community settings. Likewise, in the UK, Australia, Canada, and other western countries, they continue to play a vital role in curbing the spread of HIV/AIDS and other BBVs amongst drug users and mitigating the harmful use of drugs.
With over 12 million nurses, health visitors and midwives around the world, their roles as public health care workers in using harm reduction and risk reduction approaches must be further enhanced to make a difference to the care and treatment of substance users. The general philosophy of nursing itself is aligned to the concept of harm reduction. As public health care professionals, they are uniquely placed in the health care systems of countries to adopt and implement harm reduction strategies in their day-to-day work directly or indirectly with substance users in specialist services or in the community through health visiting, district nursing, and midwifery settings as well as at Accident & Emergency Hospital Units.
IHRA, working together with nurses, midwives and health visitors specializing or interested in substance misuse, can make the difference to effect the culture change in the nursing professions. To us, nursing is harm reduction!”
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| Sam Friedman, works for the National Development and Research Institute in the USA. This is what harm reduction means to him:
“The magnificent work people who injected drugs in New York in the late 1970s and early 1980s did to figure out that they were under attack by an insidious disease - long before science figured it out.
Their success, in spite of continual assaults on their dignity and autonomy by media, politicians and police, in figuring out how to reduce their risk of acquiring or passing on this new disease - long before public health or others did much of anything.
The creativity of users (and their saying “We Are Human”) as they organised activist groups to pressure service providers and governments to help them when they need it and to respect their dignity and autonomy at all times.
The instigation and success of programmes - sometimes by users, sometimes by their civic allies, and sometimes by public health systems - to reduce the spread of HIV and other infectious diseases.
The great reduction in HIV infections and deaths due to syringe exchanges. The end to the funerals as thousand of New York users were lost to AIDS and related diseases”.
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| Bijan Nassirimanesh works for the Asian Harm Reduction Network in Iran.
“To me, harm reduction means love, passion and care to all human beings who live with us - without discriminating against any person or any group simply because they are white or black, Muslim or Jewish, using drugs or not, young or old. I have graduated from university twice - once from a medical university in Shiraz (my home town) and once from the street university with all the people who use drugs and live with drugs. To me, the most efficient and noble experience was having the chance to be with people on the streets – to live with them and learn from them. Now they are my best friends and my best teachers whenever I need. I feel for the first time in my life that now I have a meaningful dream to live with”.
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| Marcus Day is the Director of the Caribbean Harm Reduction Coalition and the Caribbean Drug Abuse Research Institute. He is a Saint Lucian and resides in Castries, Saint Lucia with his 3 children and their cat Bubble.
“I had to smile when I was asked to write this short piece of what harm reduction means to me. Harm reduction for me has become more than something I do at work. It is a philosophy that I have adopted to guide how I deal with many sides of my life and I practice it not only professionally but maybe more importantly in my home. I am a single parent with three teenage children - two girls (11 and 15 years old) and a son of 13. I realised a while back that as they were “coming up” (a West Indian expression for getting older). I needed to do something, to have some strategy to raise them in a rational way and prepare them to make the tough life-affecting decisions that would confront them daily. In my work on the street with homeless crack users, the philosophies of harm reduction, respectful interventions and including the client in the consultations and decision making process as a partner worked well and both my clients and I embraced it’s application.
Harm reduction in has worked well at helping people to help themselves reduce the harms caused by drug use. My clients are the most vulnerable - they have been rejected and abused by society and its laws - and I soon came to realise that the philosophy I embraced for my street interventions was also appropriate to apply at home.
I have created a non-judgmental environment in my home where my children are comfortable sharing with me what is going on in their lives. HIV and drugs have been a regular topic of discussion in my kitchen for years! Condoms have always been around our house and are not seen as something weird or external - my children know what they are for. I have educated them to be peer educators in terms of drugs, sexual health, and HIV - so that when they hear misinformation from their friends they are able to provide the correct information. They know that I would rather that they did not use any substances, but we have also discussed each substance (including tobacco, ganja, crack and alcohol) and they know the harms associated with each. Instead of preaching sexual abstinence with my children, I have discussed with them the physical and mental health benefits of postponing intercourse to a later age and we have discussed other strategies for satisfying a partner through ‘outer-course’ (politically correct word for ‘mutual masturbation’ or ‘heavy petting’ - as it was called when I was 14!). If they chose penetrative sex, then they know that any boy who refuses to use a condom is not worth having sex with.
The age of sexual consent is 16 in Saint Lucia. As they turn 16, I will let them use the guest apartment under the house for their conjugal visits rather than have them go out to a car or beach where rape is a possibility.”
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| Dr Ingrid van Beek is the Medical Director for the Sydney Medically Supervised Injecting Centre in Australia, and also the Director of the Kirketon Road Centre.
“I have been involved in the provision of a range of harm reduction-focused health services for ‘at risk’ young people, injecting drug users and sex workers in Kings Cross, Sydney for the past 20 years. As a medical practitioner, I see the harm reduction approach as being in keeping with the ethical framework that guides all medical practice - agreeing that harm reduction encompasses abstinence as a desirable goal, but recognises that when abstinence is not possible, it is not ethical to ignore the other available means of reducing human suffering.
I see harm reduction as being at one end of a continuum of approaches to drug-related harm - with abstinence at the other - rather than being in opposition or in conflict. However, abstinence-based approaches are often pitted against harm reduction approaches by advocates of zero tolerance - and this is where we need to focus our efforts as it is almost impossible for harm reduction services to operate effectively in situations where the zero tolerance approach prevails, with public health the victim.
However, as an atheist committed to science-based approaches, I am sometimes uncomfortable when harm reduction is referred to as a “movement” - concerned that this implies an evangelism like that afflicting many of its greatest critics. We need to maintain our critical objectivity at all times, embrace vigorous debate where appropriate and be willing to subject all harm reduction efforts to ongoing rigorous scientific scrutiny.
However, I feel a lot more uncomfortable when among those who do not appreciate that drug use, when it results in social marginalisation, discrimination and stigmatisation is a significant social justice issue - particularly when it affects drug users’ access to quality health care and other basic human rights.
I feel immensely proud and privileged to work in this field and value the lasting friendships I have formed with colleagues from many parts of the world who share this passion for promoting health among marginalised populations.”
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| Jörg Gölz is the Head of the German Society for Addiction Medicine.
“For most drug users, harm reduction – not abstinence – is the only chance to survive. Harm reduction relieves them from the humiliating consequences of prohibition (at least those who have not been deterred). Harm reduction enables them to save their lives and live them free of contempt and humiliation. Harm reduction means to lead a constant fight against people’s need to reassure themselves of their superiority by stigmatising those who deviate from normality. Harm reduction forms a lively counterbalance to the exaggerated sense of duty and hostility to pleasure originating from puritan ideology. Harm reduction supports people who do not want to suffocate in a puritan corset but who strive for a life with intense experiences, even if their attempts often ended in failure. Harm reduction keeps up the best tradition of modern medicine (apart from treating individual somatic and psychiatric diseases) - keeping an eye on the social origins of these diseases and interfering with public discourse about social problems – with the full weight of medical authority behind it.
By fighting for harm reduction, social workers, nurses and doctors lend their voice to those who otherwise do not have anything to say. The quality of a democracy can be judged by the treatment of its weakest members. Harm reduction cares for the weakest. Therefore, the keeping up of the principles of harm reduction is a touchstone for the implementation of freedom, equality and fraternity in a society. It shows clearly if the foundations of modern civilisation are still solid or if we are on shaky ground.”
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