A clear pill bottle filled halfway with pills. A small flowering plant grows in the top half of the bottom.

Harm Reduction

Harm reduction refers to a set of principles and strategies to address the health, social, political, legal, spiritual, and relational impacts of behaviors that are criminalized—substance use, sex, sex work/sex trade, and engaging in the street economy. While popular definitions focus on minimizing the harm associated with these behaviors and survival strategies, harm reduction has been practiced by our communities to focus on our survival and recovery from trauma and violence. It emerged in the late 1980s/early 1990s in direct response to the War on Drugs and the HIV/AIDS epidemic at a time when the dominant ideology was to blame, abandon, and punish those most impacted by these conditions.

Syringe exchanges, safe injection sites, medication-assisted treatment (such as methadone and buprenorphine), and safer-sex strategies are popular examples of harm reduction. As a philosophy, harm reduction challenges us to prioritize self-determination, liberation, and radical acceptance of the ways criminalized survivors navigate structural violence and intergenerational trauma. Harm reduction recognizes and honors the myriad of ways survivors cope, recover, and heal. It requires us to confront our discomfort and judgment of behaviors such as substance use, sex that is considered socially taboo, and other behaviors considered self-injurious.

Harm reduction forces us to consider the context and conditions survivors must navigate and directly implicates the harms associated with criminalization, stigmatization, the exile we put upon survivors, and ways survivors are forced to adopt a trajectory of healing that reinforces ableism, capitalism, white supremacy, misogyny, and queerphobia and transphobia. As a part of the root system of healing justice, harm reduction calls us to broaden how we think about healing by centering those in our communities who are considered most disposable, perceived as needing to be cured or fixed. Through harm reduction we understand the importance of centering the experience, leadership, and expertise of criminalized survivors in our work while fighting to disrupt the systems and practices that harm them.

Healing Justice Lineages : Dreaming at the Crossroads of Liberation, Collective Care, and Safety

Harm reduction, like many radical philosophies, was co-opted by institutions of public health, social work, and the medical industrial complex. Activists fighting for the rights and safety of drug users; people in the sex trade, street economy, and involved in sex work; and people with chronic illness and disabilities sought to make the philosophy of harm reduction a part of the United States’ public health strategy in order to stem the spread of HIV/AIDS in the late 1980s. As a result of the successful work of these revolutionary organizers, some of you may have heard about syringe exchanges, the most popularized example of harm reduction.

What you may not know is that while the risk-reduction strategies embedded in harm reduction (condom distribution programs, syringe exchanges, etc.) did eventually become part of public health’s standardized approach to HIV prevention in most states, much of what actually makes up the daily practice of saving our own lives—the core values of the philosophy of harm reduction—was stripped away inside these institutional settings. The truth is that harm reduction was designed and created by drug users, sex workers, feminists, trans activists, people with chronic illness and disabilities, those of us working to end violence without the police, and those of us working to end prisons and the violent state. It is a practice steeped in joy, in living into the beauty of our lives no matter how messy they may (appear to) be.

Healing Justice Lineages : Dreaming at the Crossroads of Liberation, Collective Care, and Safety

In order to understand the philosophy of harm reduction, we have to interrogate our understanding of the idea of “risky behaviors” and reimagine our trauma-centered practice. The strategies survivors use to fight back, heal, cope, and yes, seek pleasure, are highly stigmatized and criminalized. Minimally, drug use and involvement in the street economy, the sex trade and sex work, self-injury, or not using prescribed (psychiatric or other) medication are often criminalized.

Survivors whose survival strategies have been deemed morally wrong or criminal are made even more vulnerable by healers and health care providers who lack a complex trauma analysis. We have become targets of a system that cannot make sense of us and seeks only to control us. Sometimes I think these systems have little help to offer, and other times I think these systems hoard resources from our communities intentionally and force us to fight each other for what little access we have. Depending on a person’s age, race, or gender presentation, the judgments of institutional representatives can and often do have carceral implications.

So we are forced to lie to our health care providers about our drug use, sex work, housing, medication adherence, and more to cover our tracks as much as we can. Even if we want to stop using drugs and seek out rehab or other forms of assistance, we are subject to humiliation and monitoring of our bodies that is designed to reduce caseloads and keep costs down.

Healing Justice Lineages : Dreaming at the Crossroads of Liberation, Collective Care, and Safety

What Is Liberatory Harm Reduction?

This is the definition collectively created in the book Saving Our Own Lives: A Liberatory Practice of Harm Reduction:

Liberatory Harm Reduction is a philosophy and set of empowerment-based practices that teach us how to accompany each other as we transform the root causes of harm in our lives.

We put our values into action using real-life strategies to reduce the negative health, legal, and social consequences that result from criminalized and stigmatized life experiences such as drug use, sex, the sex trade/sex work, surviving intimate partner violence, self-injury, eating disorders, and any other survival strategies deemed morally or socially unacceptable.

Liberatory Harm Reductionists support each other and our communities without judgment, stigma, or coercion, and we do not force others to change. We envision a world without racism, capitalism, patriarchy, misogyny, ableism, transphobia, policing, surveillance, and other systems of violence.

Liberatory Harm Reduction is true self-determination and total body autonomy.

Harm reduction disconnects the ideas of sobriety and healing. We center all of our lived experience and don’t create false hierarchies with sobriety at the top. We honor decisions to be off medications, herbs, engage in the street economy though the sex trade or selling drugs. We hold each other close and fall in love with each other’s survival and survival strategies.

The idea of keeping our community safe from harm through the practices of abundance, love, joy, and welcoming each other as whole people is deeply rooted in the cultural practices of many Black, Indigenous, Latinx, and other people of color who find ways to survive in the United States. The impact of harm we are reducing results from the long-term impact of white supremacy, cisheteropatriarchy, ableism, and structural violence.

Healing Justice Lineages : Dreaming at the Crossroads of Liberation, Collective Care, and Safety

Where Does Liberatory Harm Reduction Come From?

Liberatory Harm Reduction focuses on transforming the root causes of oppression that cause the actual risk for illness, death, and incarceration.

In the United States, the story of the evolution of harm reduction predates the AIDS crisis. Parts of Liberatory Harm Reduction came through Marsha P. Johnson, Sylvia Rivera, and activists like Miss Major Griffin-Gracy, Trans Women of Color who were sex workers and street based and who created shared housing, syringe exchanges, and sex work safety information. Liberatory Harm Reduction came through the Black Panthers creating free breakfast programs to feed and nourish a revolution, and from the Young Lords taking over Lincoln Hospital in the Bronx to demand—and ultimately create—community-accessible drug-treatment programs. It comes from underground abortion providers, Indigenous resistance fighters, and AIDS activists.

Liberatory Harm Reduction came to be because people in the sex trade, people of color, queer people, and transgender, gender-nonconforming, and two spirit people, people with disabilities, those who were houseless, and fat people saved our own lives. It is a collective story of Bad Date sheets passed between sex workers to warn each other of dangerous customers. It is the story of clean syringes, “liberated” from empathetic doctors’ offices and then passed between punks in squats in the East Village by women like Isabel Dawson and Kelly McGowan—early AIDS activists—who made sure that everyone had syringes and knew how to use them in 1983.

Healing Justice Lineages : Dreaming at the Crossroads of Liberation, Collective Care, and Safety

Healthism stands in contrast to both healing justice and Liberatory Harm Reduction, which are grounded not only in ideas of collective care but also in the thinking that physical and mental health cannot be “achieved” and does not have a singular destination or representation. Healthism is inherently ableist, not survivor led, nor does it try to understand how generational, individual/collective trauma impacts our collective bodies and lives. Harm reduction and healing justice counter healthism because they embrace what Glenn Marla, radical activist and art therapist, says perfectly: “There is no wrong way to have a body.”

Healing Justice Lineages : Dreaming at the Crossroads of Liberation, Collective Care, and Safety

Further reading,