Pride in Safe Supply: The Forgotten LGBTQ+ History of Harm Reduction

by Jay Hogan

It would be difficult to trace the harm reduction movement back to one specific cause, as it has roots in so many different activist groups. The movement goes as far back as The Black Panther Party’s survival programs in the late 1960s and the women’s health movement and fight for reproductive health in the 1970s, so when HIV/AIDS was tearing through the queer community in the 1980s and harm reduction became an essential piece of advocacy throughout the pandemic, it wasn’t necessarily the beginning of the movement.

Despite this, the emergence of HIV/AIDS and the way in which the queer community chose to care for one another popularized many of the harm reduction models still used today. When HIV/AIDS first emerged, the illness was largely ignored by the US government due to its prominence among gay and bisexual men. It’s common knowledge that the public dubbed it a “gay disease”, and attitudes toward queer people at the time made it much harder for the gay men and women fighting for not only treatments and a cure, but also information regarding its spread and how to slow it.

So when it was first discovered that it was a blood-born illness as well as an STI, activists knew they had to get started working on lessening the spread, with or without the help of the government and public officials.

Perhaps the largest and most well-known US based advocacy group fighting for HIV/AIDS treatment and prevention at the time was the AIDS Coalition to Unleash Power, better known as ACT UP!, a grassroots political group that aims to stop the spread of HIV/AIDS. ACT UP! was founded in 1987 in New York City and is now a worldwide organization, still active today.

Many of the causes that members of ACT UP! fought for in the 1980s are still an active part of queer culture today, from handing out free condoms at pride parades to the practice of harm reduction via community education, ACT UP! laid the groundwork for much of the activism still continued in the community to this day.

In many cities in 2022, all it takes is a quick google search to find a needle exchange that offers resources and clean needles to drug users from all walks of life, but in 1987, with harm reduction still being in its very early days, needle exchanges were all but unheard of. This, however, did not stop the members of ACT UP! from advocating for one. With no city officials to back them, ACT UP! Philadelphia took it upon themselves to provide safe supply to their community, beginning with syringe service operations in North Philadelphia in 1988.

This illegal underground volunteer-based organization was dubbed Prevention Point, but it would eventually become the San Francisco AIDS Foundation Syringe Access Services Program. This was not only San Francisco’s first needle exchange, but is widely acknowledged to have been the first in all of North America, and it remains active to this day.

When the volunteers of Prevention Point began their underground needle exchange in 1988, even the possession of syringes was illegal, making it difficult for the organization to distribute syringes in order to slow the spread of HIV/AIDS.

This, effectively, made harm reduction illegal, and created an even bigger barrier to getting public funding and government supports. While, for the most part, police at the time were willing to turn a blind eye to those distributing clean needles (due to a deal that was made between the mayor, the head of the San Francisco Department of Public Health, and chief of police, Frank Jordan), they had to respond if a public complaint was made.

When this would happen and police would have to respond to a complaint about the work of the members of Prevention Point, they would confiscate the clean needles that were already so hard to come by due to the laws at the time. If this didn’t hurt the movement enough, police involvement often also led to volunteers getting ticketed, likely deterring some folks from volunteering.

For five long years, the members of Prevention Point operated this way, struggling to get supplies from the few volunteers who could get supplies from their day jobs in healthcare, as well as the kindness and generosity of their community.

Suffice to say it came as a relief when five years later in 1993, despite concerns of interference by the state or federal government, Prevention Point became San Francisco’s first legally operated needle exchange, starting operations with the then-brand new HIV Prevention Project (HPP). Though they may have started with only three employees and three sites, by 1997 they would have eleven different sites across the city, all with the funding they had spent so long fighting for.

The queer activists that fought for what is now the San Francisco AIDS Foundation Syringe Access Services Program did so alone and with no government assistance. Prevention Point was a volunteer-led, street-based operation, founded by a group of people whose goal was to stop the spread of HIV among intravenous drug users.

The volunteers of Prevention Point not only offered community members safe injection supplies such as sterile syringes and alcohol wipes, but they also offered free condoms and assistance with other community resources such as referrals to drug treatment programs or social services. Prevention Point was entirely funded by the community, beginning with fundraising among members at ACT UP! meetings.

It was the definition of grassroots organizing, and when it proved effective and became a legal needle exchange in 1993, word spread fast. Due to its one-of-a-kind practices, it quickly became the largest and most well-known needle exchange in the US at the time and was the inspiration for other needle exchanges and harm reduction programs across the country.

The legalization of the needle exchange in San Francisco, however, was only the beginning. With public and government funding beginning to come in, Prevention Point was able to expand its operations, and in doing so, its model of harm reduction.

With new and better resources, they were able to do things such as open spaces for indoor medical care, install syringe drop box disposals in high-risk neighbourhoods, and eventually even distribute Narcan for overdose prevention.

Despite the work of Prevention Point and the many harm reduction activists that have emerged since their opening in 1988, US federal law still prohibits the use of federal funds to support needle exchanges to this day. However, due to the success of Prevention Point, harm reduction activists now have a model for how to fight back against these unjust federal laws, and while we still have a long way to go, there are currently needle exchanges operating in 38 states. 

As of 2022, it’s been 34 years since ACT UP! and Prevention Point began their underground distribution of a safe supply during the peak of the HIV/AIDS pandemic, and their work is still being continued and expanded on in the queer community today. While not everyone in the community is aware of the queer history of the harm reduction movement, the lasting impact of HIV/AIDS in our community remains one of the many reasons why harm reduction is such an important practice in our community.

In many urban communities today, it’s easy to come by peer-led Narcan training, syringe drop box disposals, and even indoor harm reduction sites offering safe supplies and resources- all things that were revolutionized by the activists of Prevention Point. Harm reduction practices seem to be strongly encouraged in almost all queer spaces, whether it’s as simple as the offering of free condoms or as complex as an LGBTQ+ Narcotics Anonymous group, the community does its best to show up for one another.

The western world has better treatments for HIV/AIDS than ever, from PrEP, the HIV/AIDS prevention medication, to highly active antiretroviral therapy, or HAART, the medication cocktail that has been incredibly effective at slowing the spread of the virus, we are in a better place than we have been since the virus’s emergence. Despite this, harm reduction remains important in the community, and while HIV/AIDS still remains a silent threat in our community and the harm reduction methods born from that are still practiced, in recent years the movement has shifted focus to include more overdose prevention as well.

In 2018, the US-based National Institute on Drug Abuse reported that the year’s National Survey on Drug Use and Health supported the idea that drug use among queer adults was much higher than that of their heterosexual peers. The amount of LGBTQ+ people who reported use of opioids or heroin was almost three times that of the general population, with 9% of LGBTQ+ adults reporting use compared to 3.8% among the overall population.

While this is only one survey, these numbers indicate a greater need for harm reduction resources in the LGBTQ+ community. While some cities offer specific drug treatment programs and groups for LGBTQ+ people specifically, it is volunteers and grassroots organizing that continues to bring the community together to fight for better care for drug users, in the LGBTQ+ community and beyond.

It is easy to point to your local LGBTQ+ Narcotics Anonymous and call it community care, and you wouldn’t be wrong, but those groups only scratch the surface of the ways in which our community manages to show up for one another.

Whether it’s online fundraisers to pay for a community member’s rehab stay or providing a safe space to stay for a friend in active addiction, the queer community continues to show up for one another. Perhaps it’s because of our history with the HIV/AIDS pandemic- a history of being pushed aside and ignored while members of our community suffered and died, leaving a lasting impression that we are all we have.

Perhaps it’s because we lost an entire generation of queer people to the virus, and we’re determined to change the narrative- tired of our stories being ones of death and sorrow. Or maybe it’s just love- for our community, our elders, our queer found families, and hopefully, eventually, love for ourselves.

Jay Hogan is a twenty-something queer and trans writer living on the east coast of Canada. He can usually be found with a book under his nose, a cat in his lap, or an iced coffee in his hands. Tweets @jayhoganwrites

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