When the harm reduction movement emerged, survival was front of mind: Policymakers were leaving drug users, sex workers and queer and 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 service 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.
But in recent years, the power of drug users and sex workers to collectively determine the institutional character of harm reduction has been eroded by an opportunistic public health establishment.
Activist-founded organizations—like my former employer, the Lower East Side Harm Reduction Center—have been absorbed by larger nonprofits that many in the movement consider to be closer to revenue-hungry businesses than people-centered groups accountable to those they serve.
The lurch away from the movement’s origins is well known to New York City peers—a class of essential harm reduction workers who use or used drugs, many of whom are currently or formerly unhoused and are survivors of the carceral state.
Our collective dismay was cemented when we learned around 2021 that a Bronx harm reduction provider—whose tax filings show its CEO’s salary leaped to nearly a half-million dollars that same fiscal year—had simply fired most of its peers. The grassroots contingent of harm reduction has faltered in making good on our movement’s radically democratic promise.
My commitment to genuinely building an infrastructure of care that actualized the ideals of the harm reduction movement is what animated the creation of the Re-Queering Harm Reduction (RQHR) Project. I had been requested by the Lighthouse Learning Collective—a queer and trans outgrowth of the National Harm Reduction Coalition and a group of which I am a member—to produce a report with recommendations on how our movement could better meet the needs of queer and trans people who use drugs and do sex work (QT-PWUD/SW).
RQHR has been guided by the principle that QT-PWUD/SW—and anyone, for that matter, struggling to survive in a country enriched by their slow death—are always already finding ways to care for themselves and each other despite insufficient support.
Some may (misleadingly, I believe) call this self-care. RQHR instead dubs it embedded care. Self-care, as a term, attempts to capture a non-professionalized quality, but in doing so it wrongly suggests that humans are capable of caring for themselves independently and individually.
Instead, care requires interdependence and collaboration. Embeddedness describes care that is provided through social relationships based on solidarity and kinship, whereas disembeddedness refers to commodified care sold on the market by the health care industry for the purpose of profit.
RQHR endeavors to illuminate the limits of the disemebedded care provided by the harm reduction industry—if they are not already apparent. The spirit of grassroots harm reduction demands a revitalization of embedded care, re-foregrounding it within the movement.
This article is an adapted excerpt from the Re-Queering Harm Reduction Project report, “Our Lives, Our Care.”
Images courtesy of Sessi Kuwabara Blanchard/Re-Queering Harm Reduction