Whenever I hit the streets in lower Manhattan to do outreach as a peer for a syringe exchange, I always asked people I served what they needed-like truly needed. And the answer was always the same: “Money,” and “Someone nice to talk to.” Usually, they had already made clear another need in response to my offer of safer use supplies: “There better be drugs in there!”
But the harm reduction services I was tasked with providing as a peer worker were not designed to, nor were institutionally capable of, meeting participants’ self-identified needs, regardless of whether they were queer or trans. Instead, cost-cutting government agencies and elite foundations have dictated to self-interested nonprofits what may be rationed to the underclass. The mere means of survival have been laundered as healthcare.
When the harm reduction movement emerged, survival was indeed front of mind: policymakers were leaving drug users, sex workers, and queer & trans people to die from AIDS. People who used drugs and exchanged sex had no other choice but to design their own infrastructures of care, here defined as networked relations between people, material resources, and knowledge, which together make care possible. The fruits of their fight to survive ripened into the harm reduction principles and practices that structured New York City’s first syringe exchange programs, founded by grassroots social-movement champions, like ACT UP!. Nothing about us without us and Meet us where we are-such are the tenets of our movement.
