Inside the Big, Bold, Practical Movement to Reduce the Harms of Drug Use

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http://www.alternet.org/drugs/inside-big-bold-practical-movement-reduce-harms-drug-use



Arriving in Baltimore the night before the 10th National Harm Reduction Conference last week, I walked out of the hotel to get my bearings and buy a sandwich. Downtown was a desert, with banks and other businesses closed for the night. Turning a corner, I suddenly came upon a brightly lit cluster of exotic dance clubs and sex shops, guarded by intimidating bouncers, with people milling around with their hoods up, some intoxicated, the young women tottering on heels. There was a Subway open.

I learned at a panel the next morning that this incongruous patch is known in Baltimore as “The Block.” And since 2008 it’s benefited from an outreach program, thanks to activists, volunteers and the city health department. A van parks up regularly to hand out syringes and other supplies to cut the risk of HIV and hepatitis C infections for people who use drugs. “On The Block are some of the riskiest dance clubs,” said Susan G. Sherman of Johns Hopkins Bloomberg School of Public Health. “Some are like unsanctioned brothels.” A study she’s engaged in found that 42% of the women working in these clubs exchange sex, and that 55% currently use heroin, or crack or powder cocaine. The concentrated nature of The Block and its high turnover of dancers and clients means that intervening here has great potential to impact HIV and at-risk populations across Baltimore.

A woman who has worked on The Block stood up to share her knowledge: “Girls are absolutely doing things without condoms. The higher the drug use in the club, the more that is happening. The bartenders prefer it when the girls are on drugs because the girls are motivated [to make more money].”

Recently, a second van joined the needle exchange vehicle. Staffed by a doctor and an assistant, this one offers on-board pregnancy testing, STI testing and contraception. “We learned that combining needle exchange and reproductive health is feasible and affordable,” said Mishka Terplan, an OB/GYN who volunteers on the van. The team had to learn to work fast: “Most of the women have a very brief period of time, basically a cigarette break, to do the paperwork, receive the services and get back to work before they get in trouble.” But they now have over 500 clients. “This marriage of needle exchange and reproductive health is exciting,” said Terplan. “Preventing unplanned pregnancies is harm reduction.”