Syringe service programs (SSP) in the United States began as acts of civil disobedience by drug users in the early days of the HIV crisis. Acts of love, for their friends and families and partners dying all around them. At the time, the “point” really was the point (to paraphrase the legendary Dave Purchase)—HIV prevention was a matter of life and death.
In the ’90s, harm reductionists like Dan Bigg liberated lifesaving naloxone from the medical establishment and put critical tools in drug users’ hands. Research later proved what we long knew: that supplying naloxone at the community level is an effective overdose intervention. It was one we would desperately need even more as fentanyl began spreading through the drug supply in the mid-2010s.
Peer-led, community SSP remain the cornerstone of harm reduction. Yet as the number of authorized SSP has grown, the funding has not kept pace.
Nearly two decades ago, the National AIDS Fund—what today is AIDS United—began the Syringe Access Fund to support SSP by bringing together a collaborative of large donors and dispersing the money across the community.
Over the years, harm reduction has become more and more professionalized. This has brought some benefits, but has also seen the movement quietly appropriated by people without lived experience of drug use or HIV, who tend to have more public-facing jobs and personas that invite people outside the movement to look to them as the experts because they find them more approachable.
We’ve seen our terminology taken up by legislators and pundits, but not always our philosophy.
Harm reduction today is gaining a tenuous hold on broad public support while battling unprecedented crises. We’re at the intersection of intense stigma and repression contrasted against federal recognition and funding. We’ve seen too many organizations in adjacent fields posture as harm reductionists without hiring people who use drugs, let alone advancing them to leadership positions. We’ve seen our terminology taken up by legislators and pundits, but not always our philosophy.
The Syringe Access Fund has now been rebranded as the Harm Reduction Futures Fund. Nothing about the focus or goals has changed, but the change in name reflects the real-world impact of perceptions of our language.
The word “syringe” continues to bear a stigma that makes potential partners in restrictive environments hesitant to work with us. We sought a new name because, candidly, in order to sufficiently support peer-led SSP we needed to be able to court more donors—being an “intermediary fund” means that it only grants as much money as it can raise. We also sought the new name because, over time, “syringe access” has become somewhat of a misnomer for what we do.
Syringes are only a portion of what the Fund supports. The new name better reflects the breadth of what we have evolved to do and what we could resource with increased funding. Harm reduction is about access to much more than just syringes—smoking pipes, blood-borne disease testing, condoms, naloxone.
I’ve been in this movement for 15 years and still struggle to find the right words to convey the power and scope of harm reduction. But I know that it includes not just surviving one day at a time, but building ourselves a future.
A future without preventable HIV, viral hepatitis and mass overdose, a future grounded in compassion, dignity and respect. That prioritizes services rooted in radical love and demands ongoing and righteous civil disobedience.
Photograph courtesy of Kastalia Medrano