Sex, Drugs and…Harm Reduction

Drug use

Set boundaries and make a plan. Drug use doesn’t have to be impulsive. If you decide to use street or party drugs, take time to research them; learn their effects and the risks associated with them; and decide for yourself what and how you want to use. The more you know ahead of time, the safer you can make your experience.

If you’re going to use a substance, ask yourself what you want to get out of it. Knowing what you want from your use can help you choose the least dangerous substance in the least dangerous amount in order to achieve your goal. Knowing what you want can also help you identify ways to change your behavior or heal from traumas without using drugs, if you use substances to jack up or to numb out your emotions. If you have any known health conditions that could be negatively affected by specific classes of drugs (for example, heart conditions and amphetamines), be realistic about your additional risk factors. A high isn’t worth it if it could make you sick or kill you. It might be helpful to list the benefits of your use, and compare that to a list of the consequences of your use. That may help you figure out if you want to make any changes.

If you’re using socially, let others know what you’re on so you can get the best help if something goes wrong. You can use new things in the company of more experienced users, so they can help you navigate if the high is more intense or otherwise not what you were prepared to experience. People using opiates can administer naloxone (Narcan) to temporarily reverse overdoses, thereby reducing the risk of death from overdose. Chicago Recovery Alliance and many other harm reduction organizations offer trainings on proper use of naloxone—contact them for more information.

If you aren’t having fun, feel out of control, or know that your drug use is negatively impacting your relationships, health, work, or other areas of your life, get help to cut down or quit. You can work with a 12-step program; another group that doesn’t mandate abstinence or include a spiritual component (like Rational Recovery); with friends who also want to reduce or stop their use; or with an outpatient or in-patient program. Don’t know where to go for help?

DrugAddiction.com (www.drug-addiction.com), an online clearinghouse for addiction treatment information, operates a toll-free referral hotline for treatment programs throughout the United States: 1-866-SOBER12 (762-3712).

Safer use

There are as many different ways of taking drugs as there are drugs to take, and each way of getting high comes with its own risks. Smoking, snorting, gum-rubbing, and booty-bumping (removing the needle from a syringe and using the syringe to squirt a solution of dissolved drugs up your butt) are considered less risky than injecting, because of the reduced possibility of bleeding. You can weigh the risks against the kind of high you want when you’re making decisions about how to use.

To reduce the risk of acquiring or transmitting hep B, hep C, or HIV while injecting, always use your own gear (syringes, cookers, water/saline, cottons, ties, everything!). If you can’t use a fresh new syringe each time you inject, cut down the risk by cleaning used syringes this way:

1. Rinse the rig out twice with fresh water, shaking at least 2 minutes to break up dried blood and other crud in the needle or barrel

2. Rinse the rig out twice with full-strength bleach, shaking again for at least 2 minutes

3. Rinse again twice with fresh water.

Cleaning syringes properly takes time and can’t always protect you, particularly against hepatitis C (HCV). It’s much safer to stock up on supplies whenever possible, especially if you know you’re not likely to clean your works properly if you re-use them. Do the best you can with what you’ve got, and take full advantage of what your local needle exchange site offers if there’s one in your area.

Sexual behavior

Set boundaries and make a plan. As with drug use, sexual activity doesn’t have to be impulsive. You can take the time to think about what you want to do sexually (and with whom!), and lay out a plan for communicating your desires and boundaries with partners. If you’re doing things you don’t want to do, take a break for a while—figure out where your head is at, and how to make changes so you can have sex in a way that’s comfortable and empowering for you.

Likewise, if you find yourself avoiding sex when you want to be having it and you feel confident that you can do so in a way that minimizes risks to yourself and your partner/s, get some help to figure out what’s going on and how to address it. If your partner is disrespecting your boundaries, or making you do things you don’t want to do, protect yourself as best you can until you can get help or leave.

Practice safer sex. There’s lots of safer-sex information out there—this is just a short list for starters:

Very low or no risk

· Masturbation

· Hugging, massage, kissing, and dry humping

· Giving or receiving oral sex with barrier (condom for blowjobs; dental dam for cunnilingus)

· Rimming (oral-anal contact) with dental dam

Some risk

· Giving or receiving oral sex with no barrier

· Rimming with no barrier

· Vaginal or anal sex with condom

· Anal or vaginal fisting with nitrile, polyurethane, or latex gloves

Highest risk

· Vaginal or anal intercourse without condom

· Anal or vaginal fisting without gloves

Latex barriers (condoms and dental dams) really do provide sexually-active people with the best protection against sexually-transmitted infections, including HIV. Polyurethane (plastic) male and female condoms are also available, and are especially useful for those who are latex-sensitive. You need to use barriers properly, which includes putting them on or in place before any oral, genital, or anal contact with the penis, anus or vaginal area. For example, having intercourse for a little while and then putting a condom on just before ejaculation is risky—both bacterial and viral infections can be passed by skin-to-skin contact or contact with blood, vaginal secretions, or pre-seminal fluid. Pulling out before ejaculation reduces the amount of semen left in the vagina or rectum, but it’s still much safer for both partners to use a condom properly all the way through.

Be realistic about substance use and its impact on safer sex. Drugs and alcohol can mess up your head when it comes to safer sex. That’s one of the reasons some people take alcohol or drugs in the first place, to remove inhibitions or intensify a sexual experience. If you can stick to your boundaries and safer-sex goals while high or drunk, great. But if you find yourself taking sexual risks you wouldn’t take if you weren’t altered, get real with yourself. The short-term pleasure isn’t worth the long-term health risks.

Sex work, survival sex, or sex for drugs

The politics of working in the sex industries are beyond the scope of this article, but here are some harm reduction tips from people who’ve worked in them.

Keep your head on. You get to decide what you will and will not do, even if you’re getting paid or getting a place to stay in exchange for sex. Violation of those boundaries is sexual assault—tricks don’t own you, even if they paid for your services, gave you gifts, or are letting you eat and sleep for free.

Make a plan for getting what you need so you don’t have to work or trade as much, or at all. Set aside a portion of your money in a safe place, so you can save for a rent deposit or a train ticket or a car or whatever. The more autonomy you have, the easier it is for you to call the shots and keep yourself safe. Do what you need to do to survive right now, but keep an eye towards your future.

Get hooked up with a harm reduction support project for people in the industries or in the trade. Ask people you trust if they can direct you towards a support group—folks at your syringe exchange, HIV community organization, or clinic might know. There are also many online information and support forums if there’s no real-life meeting place for you. These groups can help you maintain your health and keep your head safe while working, as well as support you in making plans for your future and moving towards those goals no matter how long you continue to do sex work. If no such group exists, start one or propose it to a harm reduction-friendly agency in your area. You’re not the only one working or trading, so you’re not the only one who can benefit from this support.

Harm reduction resources

This is only a handful of quality harm reduction resources—check their websites for links to other projects and publications. Due to greater social and legal acceptance of the harm reduction philosophy, Canadian and Australian sites may be able to provide more detailed drug data and discussion than American information sources.

AIDS Community Research Initiative of America (ACRIA)—Readers seeking specific information on interactions between HAART (highly active anti-retroviral therapy for HIV), street drugs, and/or substitution therapies like methadone should pick up the Spring 2005 issue of ACRIA Update—it’s all about substance use and HIV, including an amazingly detailed article called “Drug Interactions: HIV Medications, Street Drugs and Methadone”. The issue is available online at www.acria.org/treatment/treatment_edu_springupdate2005.html, or you can contact ACRIA directly for a copy. Write ACRIA, 230 W. 38th Street, 17th Floor, New York, NY 10018. Call 212-924-3934; visit www.acria.org.

Chicago Recovery Alliance (CRA)—CRA has lots of posters, including graphics depicting safer injection techniques and vein care. Information can be downloaded free off the website, or contact them to request print materials. Excellent naloxone (Narcan) information! Write CRA, 400 E. Ohio Street, Suite 3103, Chicago IL 60611. Visit www.anypositivechange.org.

Harm Reduction Coalition & Harm Reduction Training Institute—The Harm Reduction Coalition has an extensive list of publications, posters, pamphlets, booklets, and other harm reduction materials available for download or to order in print form. The Harm Reduction Training Institute (HRTI) is the first national training center focused exclusively on drug and sex-related harm reduction. Call them to talk about organizing a harm reduction training collaboration for your organization or community. East Coast: Write HRC or HRTI at 22 West 27th Street, 5th Floor, New York, NY 10001. Call 1-212-213-6373. West Coast: Call 1-510-444-6969 (Oakland). Visit www.harmreduction.org.

Prisoners’ HIV/AIDS Support Action Network (PASAN)—PASAN develops and distributes HIV/AIDS, hep C, and harm reduction materials by and for prisoners. Their newsletter “Cell Count” can be downloaded for free, or you can have it sent to your address. The Spring 2005 issue includes information on safer jailhouse tattooing and how to repair your own syringes in prison. Write PASAN, 489 College St., #500, Toronto, ON, Canada, M6G 1A5. Call toll-free 1-866-224-9978 or phone 1-416-920-9567. Visit www.pasan.org.

St. James Infirmary—This San Francisco clinic provides safe, respectful healthcare for sex workers, and is internationally recognized as a model harm reduction project for both peers and professionals working to reduce the risks associated with sex work. Contact them to discuss ways of improving work safety standards and developing comprehensive medical and social services for sex workers in your own community. Write them at 1372 Mission Street, San Francisco, CA 94103. Call 1-415-554-8494 or visit www.stjamesinfirmary.org.

The Stonewall Project/Tweaker.org—Innovative harm reduction project focusing on gay and bisexual men and crystal methamphetamine. Tweaker.org is the website branch of The Stonewall Project, a psychological services project from University of San Francisco that provides counseling and support for gay and bisexual men who are using or addicted to crystal meth. Write them at 3180 18th Street, Suite 202, San Francisco, CA. 94110. Call 1-415-502-1999 or visit www.tweaker.org.