The Center for Ethics Education’s Advancing Health and Social Justice Web Series, jointly sponsored by the HIV and Drug Abuse Prevention Research Ethics Training Institute, presented “Harm Reduction in the Era of COVID,” on February 22nd, the second panel in the webinar series. The panel included guest speakers Andrea Haddox, MSW, Executive Director, and Hailey Ferguson, Director of Social Media, Stop Harm on Tulsa Streets (SHOTS), Tamara Oyola-Santiago, Program Leader, Bronx Móvil, Clayton Ruley, MSS, MLSP, Director of Community Engagement and Volunteer Services, Prevention Point Philadelphia, and Susan Staats-Combs, M.ED., LPC, NCC, MAC, Director, Shelby County Treatment Center. The panel was moderation by Lloyd Goldsamt, PhD, Senior Research Scientist at New York University.
The panelists are all members of public service organizations aimed at harm reduction that provide services to high-risk communities. Ruley defined harm reduction as a “set of practical public health strategies designed to reduce the negative consequences of drug use and promote healthy individuals and communities without necessarily reducing drug use.” Examples of harm reduction include clean syringe distribution, overdose prevention education, sexual education tools, and STD testing opportunities. During the panel discussion, the speakers discussed how the Covid-19 pandemic has affected their organizations, as well as the impact of the pandemic on the communities they serve including disparities they face both in terms of healthcare and resources.
Susan Staats-Combs, MEd, LPC, NCC, MAC
Susan Staats-Combs, MEd, LPC, NCC, MAC, Co-Owner and Executive Director of the Shelby County Treatment Center began her presentation with an overview of the opioid crisis in Alabama. From 2012 to 2019, Alabama wrote the most opioid prescriptions per capita. The Shelby County Treatment Center provides medication assisted treatment (MAT) for substance use disorders, especially opioid use disorders, and is also a medical office that employs many health care professionals including doctors, nurses, counselors, and pharmacists to help those with opioid addiction. Methadone treatment centers are one of the most regulated types of facilities in the United States, according to the National Institutes of Health (NIH), and they are highly regulated in the state of Alabama and must be federally accredited. Despite being one of the most researched medications in the U.S., there is a lot of stigma around methadone treatment despite being associated with lower risk in overdose mortality, reduced risk in HIV transmission, reduced criminal justice involvement, and greater likelihood of employment according to the National Institute on Drug Abuse (NIDA).
The Shelby County Treatment Center is a medical facility that is extremely clean, welcoming, and healthy, unlike the stigma people associate with methadone clinics. In addition to substance use treatments, patients of the clinic receive annual physicals, HIV and STD testing, counseling, and education. The longer the clinic’s patients remain in treatment, the less likely they will contract diseases such as HIV or hepatitis.
During the Covid-19 pandemic, the state of Alabama has provided MAT clinics with tests for Covid-19. However, the clinics have experienced challenges as a result of the pandemic including standard services such as physicals being less thorough as a result of shorter appointments which has created concern that symptoms of HIV or other diseases may be missed. Some organizations have adapted to using virtual communication through Zoom, but there are ethical issues with clients using telehealth including access and confidentiality. Another ethical issue is that many people are not complying with the Alabama mask mandate making it difficult to return to in-person services fully. Additionally, AIDS Alabama has not been providing testing since the start of the pandemic. Overall, there has been a reduction in quality health care and the utilization of healthcare services. The lack of healthcare and prevention education services for patients as a result of the Covid-19 pandemic has increased and stigma continues to impact HIV and treatment of addiction. Susan Staats-Combs continues to be an advocate for needle exchange programs to be legalized in the state of Alabama.
Tamara Oyola-Santiago, Co-Founder of Bronx Móvil and Director & Mentor at the Institute for Transformative Mentoring (ITM), discussed harm reduction in New York City, specifically the Bronx. In 2017, the Bronx had the highest rate of overdose fatalities across all five boroughs of New York. Additionally, the Bronx has extreme housing insecurity, in addition to systems of oppression via racism, classism, homophobia, and transphobia.
Bronx Móvil is a bilingual (Spanish and English) harm reduction collective that provides resources and direct services to communities by driving vehicles through the streets of the Bronx 24 hours a day, and specifically on evenings and weekends when other clinics or providers are closed. The program was designed as bilingual because language is critical for culturally-centered harm reduction and with the philosophy that community leaders should “meet people where they’re at” in real time, geographically, and emotionally. Oyola-Santiago emphasized that in addition to providing harm reduction services like naloxone, syringes, condoms, wound care and other safety kits, as well as resources like water and food, harm reduction must also address systematic policies and procedures. She also shared that the goal of the program is not be abstinence, and that participants should decide their aims and lead the process. In other words, harm reduction should be a goal that that is maintained and motivated to better the community, and promote social justice.
The Bronx Móvil aims to help reduce the experiences of oppression by the community, provide healthcare and resources, and reduce harm. For Oyola-Santiago, three important policy issues for harm reduction in New York City include federal support for syringe services, safer consumption facilities, drug policy reform.
Clayton Ruley, MSS, MLSP
Clayton Ruley, MSS, MLSP, is the Community Engagement & Volunteer Service Director at Prevention Point Philadelphia (PPP). PPP is a non-profit, public health organization committed to promoting health, empowerment, and safety for communities affected by drug use and poverty. They are one of the two only legal syringe services programs in Pennsylvania. However, some areas of Pennsylvania do have “underground” syringe exchange programs that are considered illegal. Since 2016, there has been a 115% increase in new HIV infections attributed to unsafe injection drug use in Philadelphia. Stigma still plagues the state, and it is one of the two states on the eastern shore that doesn’t have legal syringe exchange throughout the state.
PPP’s values include having a non-judgmental stance, respect, trust, responsibility, advocacy, flexibility, and transparency when it comes to the community they serve. The agency focuses on harm reduction and the recognition of poverty and social injustice. Some of the agency’s goals include reducing or stabilizing HIV seroconversion rates, Hepatitis B and C, and other cases of sexually transmitted diseases, to educate the population about HIV, Hepatitis B and C, and risk reduction and how to reduce drug-related harm, to provide access to healthcare regardless of insurance status, and to provide a bridge to housing services.
The needs of the Philadelphia population have not changed since the start of the Covid-19 pandemic, but they have been intensified. PPP’s current services include sterile syringe access/pipe access, safer injections/smoking, wound care, safer sex education/supplies, medical supports, legal supports, and social service supports such as a full-service post office for those without permanent home addresses. Some barriers facing PPP include funding, people power, allocation of resources, outside stigma, time, and building capacity. Ruley shared that the services of PPP help the community and prevent further harm, and that PPP contributes to advancing both social and economic justice.
Andrea Haddox, MSW
Andrea Haddox, MSW, Co-Founder and Executive Director, and Hailey Ferguson, Director of Development of Stop Harm on Tulsa Streets (SHOTS) discussed the program and current challenges they are facing. SHOTS is a harm reduction, non-profit organization in Tulsa, Oklahoma that provides services and educations for people dealing with substance use disorder. SHOTS provides delivery services, HIV testing and education, naloxone distribution and overdose education, and syringe services. This year, Haddox and Ferguson are advocating for the legalization of harm reduction services in the state of Oklahoma.
When moderator Lloyd Goldsamt, asked about the challenges facing the organizations during the Covid-19 pandemic, Ferguson of SHOTS stated that one of the major challenges the organization is still trying to address is not being able to see their participants face-to-face. A barrier to virtual services the organization is offering as a result of the pandemic is participants’ lack of access to technology. Ferguson shared that this barrier has affected the participants’ overall mental health as they rely on SHOTS for motivation and support. Another challenge that SHOTS has encountered is the rate of online volunteers which has slowed down due to the suspension of in-person mentoring.
Oyola-Santiago of Bronx Movil stated that one of the major challenges that they are experiencing, which has worsened since the start of the pandemic, is housing insecurity. She also explained how the social service sector of the program and other organizations that have assisted the community with housing and reducing homelessness have also experienced challenges since the beginning of the pandemic. Oyola-Santiago stressed that the Covid-19 pandemic did not create the majority of issues facing the community, including housing, social services, and financial insecurities, but has amplified them.
For PPP, Ruley stated that the social services that his program offers has experienced the same struggles that the other programs have faced. Participants have not been able to be seen as regularly as they’re used to which has stunted personal progression. Although Covid-19 has presented these challenges, Ruley explained that they have been able to maintain 80% of their core services such as overdose prevention, safer sex, meal services, as well as Covid-19 testing. Ruley highlighted their meal service serves between 500 to 700 people daily throughout the week which has helped the community significantly.
Finally, Staats-Combs explained that in Alabama, Covid-19 has amplified major insecurities and issues for the community the Shelby County Treatment Center serves. Staats-Combs stated that patients abiding by the mask mandate has been an issue for them, as well as regulating PPE. Patients of the Center have been neglectful in utilizing their masks and Staats-Combs explained that they continue to provide masks to patients they have already supplied. She also shared that Alabama is struggling to reducing the STI/STD rate. Additionally, virtual services have created barriers with patients and how they access certain services such as testing. As a result, there has been a reduction in both testing patients for HIV and the provision of prevention services. A major crisis that Staats-Combs also discussed during the panel is the overall lack of accessibility to healthcare services for people in the state and the prolonged opioid crisis that Alabama has been battling with for years.
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