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Advocacy for harm reduction scale-up
In this video, Daniel Wolfe from OSF speaks about advocacy with a focus on funding and convincing people; from neighbours to decision makers
Simply put harm reduction advocacy is about
That can be at local, national or international levels, but the advocacy generally shares a common impulse which is to offer people support without first requiring that they stop drugs to get help
Harm reduction scale up generally requires government, and that can be complicated, since governments are frequently divided in their attitudes towards drugs and people who use them. In countries as varied as the US, Malaysia, Vietnam or Ukraine, you can find ministries of health supportive of Harm Reduction, but other parts of the government, particularly ministries of interior or police, distinctly less convinced. And even when countries say that they will treat drugs as a health rather than a criminal issue, health systems often retain a policing impulse and treat drug users kind of like drugs themselves as something to be controlled or contained. For example, posters like this one used to hang in AIDS clinics across the former Soviet Union. It says
And while that may sound reasonable, in a time when HIV medicines were scarce, the reality is that this was a region where the overwhelming majority of all people with HIV used opiates daily. So what did that the poster really say? “Don’t come back – This clinic isn’t for you.” People who use drugs face similar system barriers all over the world. Governments may support treatment, but feel uncomfortable supporting clean needles. Treatment programs may welcome women partners of drug users or former drugs users, but not those still actively using drugs. People in need then are forced to hide their drug use, and then the system—which has actually caused this—says “You see those drug users? You can’t trust them, they’re not honest.”
What has worked much better is for governments to give money to community organizations that have trust and credibility with people who use drugs and that can provide the needed services including often medical services.
Harm Reduction International analysed global financing for Harm Reduction, and they found a huge gap. About $188 million US was being spent on harm reduction which was far short of the $1.5 billion UNAIDS estimated was necessary. A much greater amount of money though about 100 billion US was being spent on drug enforcement. Politicians routinely fund zero tolerance approaches to drugs without requiring that they show any evidence of efficacy. Harm reduction by contrast is often asked to show which we have done in study after study that we effectively reduce risk and improve health outcomes.
Our reliance on health evidence can also be a challenge and a trap. Harm Reduction programs tend to define harm reduction according to the World Health Organisation norms and standards, mostly focused on HIV and hepatitis risk reduction and prevention. This can lead projects to orient themselves toward the demands of the donors, and the normative agencies rather than the people they are trying to help for example, not buying naloxone, since their funding is for HIV. A people-centered view of harm Reduction recognizes that things not on the W-H-O list of interventions, like housing, or access to a lawyer, may be as critical to health as a sterile syringe or an anti-retroviral medication.
For example, my organization supports a group working in Mare, an informal settlement in Brazil, which used photo shoots and video interviews to literally picture drug users as a part of the community rather than as a threat. They also worked with people who use drugs to reclaim public land and build a bathroom that anyone can use, and that has clean running water. The W-H-O and many harm reduction donors might not recognise the bathroom as a Harm Reduction intervention, but it prioritized people’s health and safety and it reduced stigma.
I sometimes picture the challenge of fundraising like opening a bunch of different locks. Different donors require organisations to bend themselves into a particular shape to unlock a funding stream. For example, in the case of my organisation, Open Society Foundations, human rights of people who use drugs has been the focus while for the US government or the Global Fund, HIV prevention has been the focus. Knowing the priorities and cycles of local budget makers, and analyzing how those monies are spent, can also be key to unlocking funds. In Ukraine for example we supported a group who analyzed the budget to show that the local government was spending more on sheltering dogs than on homeless drug users.
That group got more money the next time the budget came around. This kind of ‘Budget Advocacy is increasingly important as governments all over the world shift health and social service funding to provincial and city level, and as international donors, especially in the age of Covid, reduce the amount of support they have to offer.
Advocates and harm reduction experts often have address books full of international donors and researchers’ names, but have little contact with neighborhood groups, politicians or local faith leaders. This can be unwise, since we know that many donors suffer from what I would call DADD - Donor Attention Deficit Disorder. Even when they are supporting life-saving services, they may abruptly change focus or withdraw without a transition plan. Work with local community groups and with public officials is critical both to pushback when donors withdraw too fast, and to rally local funding and support.
This first video of the week introduces some common challenges and opportunities in regards to harm reduction scale-up. Harm reduction implementation often depends on a range of stakeholders, all with different interests and (sometimes contradicting) objectives. This ranges from the local community in the neighbourhood, the national government and up to international stakeholders such as international donor agencies. This video will expand on some ways to work with all these complexities.
Including people who use drugs in local initiatives to the benefit of the larger community can reduce stigma and foster support for harm reduction.
Harm reduction covers a broad range of health and social issues. In most contexts, multiple ministries are involved and it can be helpful to find allies in supporting government departments to advocate for the scaling-up of harm reduction.
International donors all have their own area of interest and harm reduction programs can ensure their eligibility for such varied (and changing) grants by emphasising different components of their overall package of interventions.
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