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With a new mobile testing and outreach van, GLIDE joins the OPT-IN effort to connect the most vulnerable to services

On a remote stretch of road just west on the Third Street artery that runs through San Francisco’s Bayview neighborhood, a young man is about to receive life-saving treatment.

The setting is anything but residential and yet full of makeshift housing—weathered campers, trailers and other vehicles, tents and lean-tos, all situated in an abandoned industrial landscape decorated over in graffiti and sectioned by torn chainlink fencing topped with razor-wire.

GLIDE’s Harm Reduction Community Outreach van makes a bright addition to these surroundings, the iconic orange heart on the front acting as a beacon of support to the neighborhood.

Frank Castro, GLIDE case manager and the van’s driver, has just pulled up in front of a slightly run-down mobile home with covered windows. Alix Strough, a nurse with the Department of Public Health’s Street Medicine unit, hops out of the GLIDE van and looks around. A moment later, the San Francisco AIDS Foundation (SFAF) outreach team pulls up, too, just in front of GLIDE. Roy and Damon step out of SFAF’s white cargo van, which sports a random assortment of stickers promoting harm reduction and decrying the war on drugs.

Greetings exchanged, the crew scans the area. The mid-September day is cloudless and unusually hot, already into the low 90s, and at first no one seems to be around. “Normally there would be more foot traffic,” says Frank, “lots more.”

On site in the Bayview, September 2019 (photo by Robert Avila)

This is the team’s usual Friday stop. For the past several months, they have been spending several hours here each week, and been well received for the services and support they offer the homeless people living in the area. GLIDE and SFAF typically divide up the services to maximize their time here, with SFAF offering syringe access, Narcan training and distribution, and other harm reduction services while GLIDE’s specially equipped van allows the GLIDE team to concentrate on testing and linkages to care.

Frank, in cargo shorts and a black GLIDE tee, opens the van’s sliding door. He has decided to keep the engine on today in order to keep the air-conditioning running. Inside the van, GLIDE Health Systems Navigator Khaiya Croom is arranging equipment by the phlebotomy chair, preparing the space for testing.

The van is equipped to test for HIV, Hepatitis C and Sexually Transmitted Infections (STIs). HIV and Hep C test results can be had on-site in a matter of minutes. With Alix onboard, the van can also offer rapid testing for syphilis, which alarmingly has been on the rise among women of childbearing years. As a nurse, Alix can treat STIs on-site as well.

Today, Frank has test results for someone he has been engaging with in this area. “When we see this person, I’ll let him know. At that point I’ll ask him if he wants to be in the OPT-IN program,” he explains, referring to the collaborative street outreach effort managed by the City’s Department of Public Health. “At that point, I’m his case manager.”

Alix decides to venture around the area and let people know there are harm reduction and testing services available. She and Damon load up a backpack with bottles of water and head down the nearby railroad track, respectfully pausing by the tents and camps scattered along either side to offer water (gratefully accepted on this scorching day) and let people know the vans have arrived with services for those who want them.

Across the street from the GLIDE van, beside a camper with a boat on a trailer, two men and a woman express their appreciation for the outreach, not only for the material support but for the judgment-free way in which it is offered.

“It’s amazing how looked down upon you are just because you live on the street,” the young woman tells Roy. “You guys all talk to us just like we’re anyone else.”

Back at the van, meanwhile, Frank is speaking with a young man with a neatly cropped beard who has ridden over on a bicycle. Alix has returned from the railroad track and joins the interaction. Afterward, she takes her laptop into a patch of shade as Frank relates the successful result: The young man has learned his status, and has agreed to sign up for treatment for Hep C.

Alix registers him with the Department of Public Health and will ultimately be able to administer his medication here on-site. Frank, as his case manager, will coordinate regular contact, offer emotional support, help with related challenges, and generally work to mitigate factors that could impede successful treatment.

In a matter of months, the young man can expect to receive treatment and eradicate the virus, all without ever having to enter a clinic or hospital.

“This is what our hope was,” says Frank, referring to the days of outreach before OPT-IN, “but this is the piece we needed. We needed a nurse.”

 

Project OPT-IN

OPT-IN arose to meet the challenge of reaching the most marginalized populations with successful health interventions and services for addressing the HIV and Hep C epidemics and other harms among the city’s homeless residents.

Funded by a five-year grant to the city’s Department of Public Health (DPH) from the Centers for Disease Control and Prevention, the program joins DPH’s Street Medicine unit with two social service agencies with extensive experience working with the populations concerned: San Francisco AIDS Foundation and GLIDE.

It was GLIDE’s Director of Harm Reduction Services, Paul Harkin, who offered the name, which stands for “outreach, prevention, treatment and integration.” But the name also points to a fundamental approach, grounded in the harm reduction principle that health interventions must be invited and not coerced.

“We see our approach as meeting trauma-informed criteria with cultural competency and humility,” says Paul.

“Our staff genuinely get what’s going on in these populations and are respected by them for the way that they treat everyone. Any approach to the most vulnerable populations has to come with that perspective. The notion of using coercion or threats is a failing approach. It’s totally counterproductive. It scares people away from care. It adds to their trauma and it actually makes them more vulnerable and more at risk.”

For Paul, OPT-IN is the logical extension of the outreach GLIDE has long done in the Tenderloin and South of Market, and more recently in monthly visits to encampments across the city. Now, with the van, that citywide relationship-building runs five days a week in places like the Bayview, the Western Addition, and Haight Ashbury. This consistency, showing up regularly and reliably to build trust, is crucial.

“One of GLIDE’s strengths is our presence on the streets,” he explains. “That’s how you build up cred. You get to know people. We’ve only added to that with OPT-IN, by adding more outreaches, and increasing that engagement.”

OPT-IN Outreach Worker Daniela Wotke and Health Systems Navigator Khaiya Croom. (photo by Alain McLaughlin)

Going where the need is

On the way back to GLIDE, Frank confers with Khaiya and Alix about an idea he has for maximizing floor space in the van to further improve the care they provide. Alix, in turn, updates Frank on the status of a pregnant young woman they know who had been living in a small RV. She’s at San Francisco General now, says Alix, and doing well.

The day invariably includes many such conversations, as well as the sharing of information with the public, distribution of harm reduction supplies, and other social interactions that increase trust, knowledge, solidarity and options between the outreach team and the people they serve. The hard stats for the afternoon: two people were tested, one person learned their health status, and one person was connected to treatment.

Treatment is a process, however. Increasing access for people on the margins to the range of available services, from clinics to pharmacies, is also a daily effort.

“That’s the other part of this job,” says Frank, “going to service providers, talking to the staff, letting them know the feedback I’ve gotten and seeing how receptive they are to a conversation about how we can make this situation better for our clients—how we can widen the margins for getting services.”

“We have a lot of resources in this city,” he says. “Our job here is being the grout between the tiles.”

Monday the van will be at another populated area in the Bayview, but each weekday the team makes a different regular stop across the city. These stops change only as populations move around. As that happens, the OPT-IN team adjusts its schedule accordingly.

That’s the mission, as Frank explains. “Paul told me: Go wherever our people are.”

 

GLIDE Harm Reduction Services director Paul Harkin demystifies fentanyl and shares the known solutions to the opioid crisis

Friday, August 30, is Overdose Awareness Day, dedicated to remembering lives lost and lives saved in the opioid crisis, as well as to informing the public about humane and evidence-based ways to mitigate the risks and fatalities associated with drug use. Here in the TL, we’ll be gathering from 1:00 to 3:00 pm at the Tenderloin National Forest (511 Ellis Street) to honor the lives lost, as well as to celebrate the power of community—by sharing information, Narcan trainings, our stories, and good food and music. This day and everyday, it’s important to remember that there are things we can all do to reduce risks and harms in our community. The first step is educating ourselves on the facts about drugs and drug use, including the known health interventions out there. Current media attention on fentanyl, a powerful synthetic opioid helping to fuel overdoses in the Bay Area and across the country, is too often inclined to focus on the sensational or to even trade in misinformation. We know that sensationalistic stories only make matters worse. So to learn more about fentanyl and the proven health interventions that can reduce the risks it presents, we spoke with Paul Harkin, director of GLIDE’s HIV/Hep C and Harm Reduction Services. The following conversation has been shortened and lightly edited for clarity.

Can you give us some context for the current focus on fentanyl?

Paul Harkin: I came to San Francisco in 2000 to work at the Tenderloin AIDS Resource Center. My first week at work I saw people who were using fentanyl. Even back then, there were people for whom that was their drug of choice, because it’s fast-acting and it doesn’t last as long. There was not the same hysteria around it then. I just saw it as another opioid among the many opioids that are available to people, whether it’s a pharmaceutical or street drug.

About three years ago, we saw a real uptick in fentanyl in the drug supply in San Francisco. One of the first things we saw was Xanax pills that were counterfeit and had fentanyl. So, you’ve got people that are taking a pill that they thought was a benzodiazepine and it’s full of fentanyl, and they died, or they overdosed.

It was very perplexing. You’re wondering, who would do that? We don’t know if some of this is cross-contamination. There’s been fentanyl traces in a lot of different substances.

And we’re still seeing a lot of opioid users dying from fentanyl overdosing because it’s very strong and the onset is so quick. If I were doing heroin, an overdose is probably about 30 minutes from the shot to the point where I have respiratory failure. There’s quite a decent window there to save me, if there’s anybody around. With fentanyl, that respiratory failure can happen within five minutes.

What’s the approach you and GLIDE take to this situation?

[Fentanyl] has been here for a long time. It’s given to pregnant mothers in maternity wards during childbirth. Any approach that’s hysterical is counterproductive. We just need to look at it rationally: It’s an opioid. It’s a strong opioid. It’s a fast-acting opioid. People have used it for years and not come to harm. Other people have used it once and died. Like with a lot of drugs. We can’t be shaming, stigmatizing, sensationalizing. We just have to educate people that overdoses are reversible. No matter how much somebody takes or how quickly they go into an overdose, if somebody there has Narcan they’re going to be able to reverse that overdose. That means we need to have Narcan distribution.

But we also have to create a climate where people are not using alone, because then nobody can reverse your overdose. It’s like having a designated driver, having somebody with you when you get high. For some folks that’s a challenge because they don’t want to be outed—they might be using drugs secretly. That’s an ongoing community intervention, trying to de-stigmatize use so that people can feel safe to have somebody with them.

Can you elaborate on the life-threatening consequences associated with stigma?

When we look at stigma, whether it’s drug use or sexual behaviors, it’s always been counterproductive. It makes people want to keep secrets; it pushes people further away. By de-stigmatizing substances and substance use you make it easier for someone to talk about it. You can check in with them. “Hey, I’ve noticed you’re getting high a lot more lately. What’s going on? Is everything OK?” You can have that conversation. That’s what we have to get to.

It’s just like with gay men and HIV. We saw that stigma helped promote the infection, because people were feeling unable to discuss their status or getting tested—there was shame, there was stigma, there was criminalization. All of these things are counterproductive. We need to move away from that model. People need the facts, told in a calm and composed way. And then we work with them, based on the facts, on how to reduce the harms.

What are the known health interventions that can reduce or eliminate the threat of overdose deaths?

When we talk about the shocking uptick in opioid overdoses, we should also be talking about the known solutions.

Number one is having overdose prevention available to you through Narcan. If everyone who used had somebody sitting there with Narcan there would be no more overdoses.

Another intervention would be having safe consumption sites where people are medically supervised, or they’re supervised by community members trained in overdose prevention. We have these all over the world. There’s never been a single overdose death in any of them.

Another intervention that we use at GLIDE is giving people fentanyl test strips. It’s not sufficiently adequate because it’s just saying, yes, there is fentanyl in this drug. It’s not telling you the degree of contamination, the percentage of the drug that is fentanyl. However, if you bought ecstasy and it tested positive for fentanyl then that’s a big deal. Now, if you’re buying heroin and it tested positive for fentanyl, that’s also a big deal but it’s still in the same class of drug. So maybe you take less of it. You do a test shot, or you smoke a bit. There are different tried and tested methods that reduce the possibility of overdose.

With those test strips, another good thing about them is that they help us generate conversations about overdose and make sure that people are very aware of how strong fentanyl is and the uptick in the incidences of overdoses, including fatal overdoses.

But, to me, we’re not going to get beyond the opioid deaths until we get to safe consumption sites. There’s really no downside, except for people who see it as a moral failing and they’re morally outraged. It’s coming from an ill-informed position. Let’s talk to drug users, and let’s talk to people who work with drug users and have expertise. You’ll see that the evidence shows that this is a highly efficacious intervention.

It’s like people who say our thoughts and prayers are with you after mass shootings, but they don’t want to touch gun legislation—saying you’re outraged at the opioid crisis and all these deaths, but you won’t implement evidence-based solutions. It’s really time for the people who work with this population, the medical experts, to say we need to do these interventions. The time has come.

Paul Harkin (above, second from left) is the director of GLIDE’s HIV/Hep C and Harm Reduction Services.

We are thrilled to relate that Antwan Matthews, a Phlebotomist and HIV Navigator on the GLIDE Harm Reduction Team, was recently awarded a prestigious fellowship from Rise Up, an Oakland-based organization advocating a better future for youth, women and girls globally. This year, Rise Up selected 22 winners out of 550 applicants who are using technology, innovation and advocacy to improve sexual and reproductive health, and advance rights and justice for women and girls in East Africa, South Asia, and the United States.

Antwan Matthews is a Phlebotomist and HIV Navigator at GLIDE.

In the United States, the committee only accepts applications from Mississippi and Louisiana. While Antwan lives and works in San Francisco, he grew up and attended university in Mississippi. Antwan had applied to Rise Up in 2017, and while he made the top 30, he was not selected as an awardee. This year, the organization called him and requested that he re-apply.

“I was thrilled that they were still interested in me, that they remembered my application and that I could still be funded even if I’m not living in Mississippi at the moment,” Antwan recalls.

“I want to help inform individuals about their bodies holistically.”
— Antwan Matthews

Antwan has the opportunity to receive up to $12,000 to help him conduct a year-long project.

“I’m planning on coordinating with some of the students at my alma mater in Mississippi, Tougaloo College, to create a curriculum that will be developed into a class about sexual and reproductive health that is taught every other semester,” says Antwan.

Antwan anticipates that his project will take significantly longer than one year, so he is already looking into additional funding.

“Developing a curriculum that can address sexual and reproductive health in the state of Mississippi is relevant because the HIV epidemic and other STIs are spiraling out of control, along with individuals not really knowing much about sexual and reproductive health,” Antwan explains, underscoring that the subject is relevant for everyone regardless of gender. “Most of the time when we think about reproductive health, we think about women. But men also have issues related to reproductive health. If they want to produce children, they don’t know what type of nutrition they need, how much water to drink, et cetera. I want to help inform individuals about their bodies holistically.”

When Antwan was an undergraduate, he started a public health organization at Tougaloo in which he and other participants worked with the goal of redefining the philosophy of health, a goal, he says, that is still reflected in his work at GLIDE.

“The program that I started as a student was always about training undergrads in certain skill sets to go into the professional world. We used to advocate to have HIV/Hep C testing, STI testing… Basically, what I’m doing on the fifth floor at GLIDE, I was trying to make it possible for students to do in Mississippi,” Antwan says.

According to Antwan, it is difficult to explore a career in public health with a focus on sexual and reproductive health in Mississippi because of the conservative-leaning culture and political class.

“It’s very Bible Belt—people think, my child isn’t having sex, your child isn’t having sex. The citizens are also very skeptical about introducing such a curriculum in middle and high schools because they just don’t believe their child is having sex! Actually, your child probably is. Not being informed about STIs [sexually transmitted infections] or PrEP [pre-exposure prophylaxis] or not knowing about condom usage, or, if it’s a guy who likes guys, that you need lube—the system is not in place in Mississippi to effectively address social determinants related to STIs.”

Antwan plans to work with undergraduate students to develop the curriculum, who will then be able to teach it not only at Tougaloo College but also in public schools in Jackson. Ideally, he wants to bring the curriculum to the Mississippi State Education Board and have it approved to be taught in public schools throughout Mississippi.

“The Bay doesn’t currently have an exchange with southern institutions to address such issues, and that is something I want to focus on.”
— Antwan Matthews

“Overall, my project’s aim is to help people be more aware of sexual and reproductive health, to protect themselves at an early age,” says Antwan. “There is no way you can have a healthy pregnancy if you don’t have access to information about how to have a healthy pregnancy.”

Antwan calls his project “The South-West Exchange,” referring to the flow of public health research and resources from Western states, and how they are implemented in the South.

“The Bay doesn’t currently have an exchange with southern institutions to address such issues, and that is something I want to focus on,” he says.

Left to right: Rio Amor, Sarah Thomas, Mayor London Breed, Khaiya Croom and Antwan Matthews providing outreach services and testing at a Juneteenth event in the Filmore.

Beyond this much-needed project, Antwan sees a larger future in health and advocacy, one that draws directly on the knowledge and expertise he has gained while working at GLIDE. He plans to eventually apply for a dual-degree program in medicine and law at Stanford.

“GLIDE has helped me grow by sending me to phlebotomy school and getting me trained to be a Hep C and HIV tester,” he says. “Working directly with the homeless population, individuals who are using substances, HIV-positive people, rape victims, sex workers, trans individuals—everything that I would see in the clinic or a hospital, I see that directly here.”

“As a young African American living with HIV, [Antwan] brings energy and lived experience to the team and he has demonstrated maturity beyond his years.”
— Paul Harkin

As a navigator and phlebotomist at GLIDE, Antwan, who is HIV-positive himself, helps people navigate and alleviate obstacles they may be facing while living with HIV, providing them linkages to care, facilitating focus groups, assisting them with securing housing, and much more. As a licensed phlebotomist, he conducts rapid HIV/Hep C blood testing at community events and sends reactive tests to the Department of Public Health. If someone is found to be positive for either disease, they are referred back to Antwan and GLIDE Harm Reduction navigation services to ensure they get the support they need.

Meanwhile, Antwan also guest lectures at City College, conducting seminars with undergraduate students about HIV and Harm Reduction practices.

“We are delighted to have Antwan on the Harm Reduction Team,” says Paul Harkin, Director of GLIDE’s Harm Reduction Program. “As a young African American living with HIV, he brings energy and lived experience to the team and he has demonstrated maturity beyond his years. Alongside this, he has a history of providing leadership on the issue of HIV in the African American community. Antwan has set his goal to become an MD/JD, and this is a great venue for him to learn what it is like working with marginalized populations. I have no doubt he will fulfill his professional goals.”

“When I do become a physician and JD, I will know who to advocate for, and how to do it effectively,” affirms Antwan. “Honestly, I can’t see myself anywhere else for my first job.”

In keeping with our values of radical inclusivity and acceptance, GLIDE has a long-standing policy of welcoming all people, as well as their animals, through our doors. On any given day at GLIDE, you will see dogs in backpacks, strollers, baby slings, tote bags and on leashes. In celebration of the unconditional love that animals and humans provide one another, here is a look at some of the dogs and their humans that have made an impact on us over the years.

Richard and Kane.

“All the GLIDE staff are wonderful to me and Kane. Now I have a real apartment. I save $300 a month to pay my rent. This has given me back my dignity. GLIDE allows me to be an individual and Kane is recognized as an individual, not just a dog.”

Bailey and Marley.

The sweeps are what originally caught my eye about GLIDE Harm Reduction, the fact that you can go out and collect all the needles in the street. I live about three blocks away, I take my dog on walks around here and it’s dirty! I have to make sure my dog’s not stepping on dirty needles! It’s a really awesome program and as soon as I started helping with the sweeps I wanted to do more.

Marley was five weeks old when I got him. It was the night of a blood moon and I was sleeping in the woods in Oregon at the time. When I brought him to my camp, we stayed up together and howled at the blood moon.

For a long time I was very nomadic. This is the first time I’ve lived indoors in the last six years. Before that I was sleeping outside under the stars. But sleeping in the city, in doorways, is really scary, and he’s always protected me. I’ve been in the weirdest situations while hitchhiking by myself, and he’s got my back.

Bill, GLIDE Harm Reduction Syringe Access Outreach Coordinator, and Rosie.

As far as the people we serve, people experiencing homelessness or struggling with chaotic substance use, a dog can take them to a grounding, centering place. I think also give them a sense of meaning, purpose and connection, especially if they’re lacking a healthy social support network with humans. Dogs will at least give them some love in their life, and we know that everyone does better with a little love in their life!

Rosie helps me to be grounded and centered, more so than I would be without her. If I get frustrated or angry, I look at her and everything melts away. How can I be pissed off when I’m looking at that little face? She contributes to this whole office area being a better place!

John and Odin

I used to not be homeless and I lived on the East Coast and hiked the Appalachian Trail a lot. One fateful night six years ago, me and a buddy are out camping and we stopped for the night. We hear whining and small barking! I’m like, whatever, somebody camped near us. We’re chilling, we’re hanging out, we’re talking, and it gets closer! We ignore it for a good 10, 20 minutes. Finally it drives me nuts to the point where I open up the tent and I look out and about five feet away he’s sitting there staring me in the eye going, “Dude!”

We look around, there’s no campfire, there’s no lights, I hollered for people to see if anybody had lost their dog. I pulled him into the tent, he had no collar or tags, no nothing. As soon as he got into the tent, he ducked into my sleeping bag, curled up, and passed out! Done! I thought, all right, well I guess you’re sleepin’ here tonight!

I can’t sleep without him now. He keeps me calm, he keeps me going. Eventually my girl and I are going to end up getting some land in Arizona and starting a farm. The whole premise behind it is Odin and our other dog.


Amber or Syringe Access Services and Daydream.

Daydream has been my dog for a little over seven years. She’s 11. She was my partner’s and when he passed away, I got her. She has absolutely saved my life. Without her, I don’t think I would be on this plane anymore. That was one of the hardest times of my life.

We pretty quickly ended up on the streets and she helped to keep me sane. She would keep me warm at night, and safe from all sorts of external issues like sexual assault, robbery… I didn’t start having seizures until after I got her. She’d been my partner’s seizure alert dog. I had no idea what was going on the first time, and she knew exactly what to do and took care of me. After that, she became able to let me know before I would get them, and I got on medication. Thankfully I don’t get them very often anymore, but I’m able to recognize what that feels like when they’re coming on. Without her, I don’t know how far along I’d be on that.

It’s no secret that at GLIDE, we believe in love. We believe in radical, unstoppable, unconditional love. We also know that love manifests in as many ways as there are people in our community—people like Elena and Zach, two GLIDE interns who are helping to link hard-to-reach members of the community to harm reduction and HIV/Hep C services.

Zach and Elena are much loved members of the Tenderloin’s harm reduction community.


GLIDE Harm Reduction Peer Program: An entryway to connection, education and community

Recently, GLIDE’s Harm Reduction team initiated its first-ever Peer Program, managed by Outreach Coordinator Bill Buehlman. The purpose of the fledgling program is to provide internship opportunities to people who have struggled with substance use themselves, so that they can not only learn about harm reduction and direct service but, in turn, reach out to others in the community who are otherwise not receiving services—either because they get overlooked by other programs or they tend to distrust traditional service providers.

“We’re trying to engage people with lived experiences,” explains Bill, “active participants who want to do any level of service work.”

Bill serves as both a trainer and a mentor to participants in the Peer Program, who are usually people who currently use or have formerly used GLIDE’s harm reduction services.

“The people who are difficult to reach are the people we most want—especially with regard to Hep C testing, education and treatment. Seven out of 10 injection drug users in this city will test positive for Hep C antibodies. We are good at outreach, but that doesn’t mean we can reach everybody. That is part of what this program is about—using people within the community to navigate in there and help link folks to services.”

Another member of the Peer Program, Bill Buehlman, Elena and Zach pose together after a Friday afternoon harm reduction outreach.

 

Elena and Zach arrived in San Francisco last year after many years of travel, and were immediately drawn to GLIDE’s Harm Reduction Program.

“With Zach and Elena,” reflects Bill, “they really want to be in this world of harm reduction.”

Harm reduction principles are founded on respect for individuals’ choices, and a deep understanding of the often winding and difficult road to recovery. The Peer Program reflects these values by operating with a compassionate and judgment-free approach.

“As long as they can show up and do the work, that is all that should matter. And that is what Zach and Elena have done, consistently, and it’s been unbelievable.”

Elena and Zach

Elena and Zach met in a park on a hot day in Oregon, while they were both travelling independently around the country. Elena is from a small town in northeastern Ohio, while Zach is from Texas.

“We feel very strongly that people deserve clean equipment and good health care. To be in a position where we can advocate for that is really amazing because no one was ever there to advocate for us.” — Zach

“It was really special. We were both backpacking separately across the country,” recounts Elena. “I saw him and he had a Grateful Dead tapestry, which is one of my favorite bands. I had just been in Washington mining for quartz and crystal, so I had a really big case of nice shiny rocks and gemstones. I showed them to him. It’s a really odd thing to be interested in. Not many people share a love of minerals! But he did too, and so we’ve been together ever since. That was three years ago.”

Through their shared interests in music and minerals, Elena and Zach formed a strong bond. Together they grew an extensive collection of gems.

“After we met, we made that our focus, and we went on mining expeditions while we were moving around the country. You can go in any national forest or Bureau of Land Management land and you’re legally allowed to remove seven to 20 pounds of minerals every day,” Elena explains. “We have the gift of gab, so we took our cases of rocks out on the sidewalk in any city we were at and sold them on the street.”

Elena walks through the Tenderloin on a Friday afternoon outreach.

 

But when they arrived in San Francisco, Zach and Elena committed fully to volunteering at GLIDE. Today, they help run our Syringe Access Services, lead community outreach and needle sweeps, and were sponsored by GLIDE to become certified as Hep C/HIV test counselors.

“We were the first peers that Paul [Harkin, Director of GLIDE Harm Reduction Services] sent to become certified,” says Elena with justifiable pride.

“We’ve both had our fair share of experiences in places where there was no harm reduction,” adds Zach. “We feel very strongly that people deserve clean equipment and good health care. To be in a position where we can advocate for that is really amazing because no one was ever there to advocate for us. We’ve definitely needed these services, and we definitely used them all when we first got to San Francisco.

“We’ve since straightened our lives out in a different way, so we’re not using every day, but there was a point when we were using three, four, five times a day, coming here for supplies and hitting GLIDE up when they were on outreach.”

“The people around us are extremely supportive of what we’re going through, and that’s amazing. I couldn’t do it without them, and especially not without Zach.” — Elena

“Now, we’re actually providing the services that we used to come here to get ourselves. That really adds to our passion for it,” says Zach. “If it wasn’t for these guys, we wouldn’t have gotten the things we needed.”

Elena and Zach speak candidly but thoughtfully about their relationship with drugs over the years. Elena struggled with opioids for six years, and other substances before that.

“There were times when I was off and on, but there wasn’t any time when I was off that I wasn’t thinking about being on,” she says. “I’m dealing with 15 years of depression right now, in this time of transformation. The people around us are extremely supportive of what we’re going through, and that’s amazing. I couldn’t do it without them, and especially not without Zach.”

As for Zach, he has been injecting drugs for over three years, but says that he has been doing opiates since he was in his early teens.

“I remember a specific point in my youth when I decided to steal a bottle of Jack Daniel’s out of my dad’s closet. I was on opiates soon after that,” he explains. “I got addicted to drugs because I have problems that I’m trying to cope with.”

Now, Elena and Zach are studying for their Community Health Worker Certificate at the Community College of San Francisco (CCSF), and both intend to pursue BA degrees afterwards.

“I was concerned about going to school while homeless, but it’s been good. The teachers are supportive,” says Zach. “We are slowly moving forward in our lives.”

Elena plans to develop a strong application for UC Berkeley through her extensive harm reduction experience and CCSF coursework. Her goal is to have a profession in clinical research for an organization that focuses on the mental health benefits of controlled use of psychedelic medicines, such as psilocybin and MDMA.

“I’m interested in studies looking at these substances being used to treat depression and PTSD, and LSD being used for alcoholism and other disorders. The FDA is approving things that we never thought would be approved. That’s the field where I would like to see myself in eight to 10 years,” Elena says.

Zach wants to continue his education and work in harm reduction as well.

“I look forward to getting into a position where I can help troubled kids find their path and stay out of trouble because that is where I was when I was a kid. No one could relate to me, no one tried to relate to me. I really want to be that somebody that kids can relate to and help them find a good productive path,” he says.

Zach carries harm reduction supplies for distribution in the Tenderloin.


Radical love

As with any recovery journey, Zach and Elena’s love story is far from a fairytale. They have faced relapse. They are technically unhoused, currently living in a navigation center and unsure of where they will find a roof at the end of the month. And, while they thankfully have free tuition at CCSF, they still need to find affordable ways to access readings for their courses, purchase food and navigate complicated government systems to ensure they stay housed, healthy and safe.

Through all of this—years of substance use, mental health issues and financial insecurity—they have maintained their love for each other and for the community they serve. Their ongoing story is a testament to the power of unconditional love to not only transform individuals but whole communities and society at large. It is no small coincidence that harm reduction approaches are simultaneously the most effective and the most compassionate ways to address substance use disorders.

“GLIDE has helped me in ways that no one else ever has,” Zach said.

Elena agrees.

“I don’t think I’d be where I am at without these people at GLIDE,” she says. “Working here is the most amazing thing that’s ever happened to me in my entire life. They took me as I was—and look at the work I’ve been able to do.”

Paul Harkin on what you need to know

This month, Barbara Garcia, director of San Francisco’s Department of Public Health, announced that the city was looking to pilot two Safe Injection Sites (SIS) for intravenous drug users as early as July 1. This announcement comes amid a spiraling opioid crisis that has encouraged many city leaders across the U.S. to consider adopting some of the evidence-based approaches already working in other countries. Locally, Director Garcia’s announcement comes less than a year after the Board of Supervisors created a task force to investigate the feasibility of operating such sites in San Francisco. The task force’s findings strongly supported the idea.


With Director Garcia’s announcement, San Francisco is now poised to be the first city in the country to open a SIS. This development has great significance for the people and communities GLIDE has long served. In their outreach work throughout the Tenderloin, GLIDE’s Harm Reduction team is literally on the front lines of the opioid epidemic. Given the recent developments, we are reposting excerpts from an earlier interview with Paul Harkin, manager of GLIDE’s Harm Reduction Services, who speaks to the scope of the problem and to the arguments in favor of Safe Injection Sites (also known as Supervised Consumption Services) as a viable, compassionate and rational approach.
Continue reading “Safe Injection Sites Are Coming to San Francisco”

In July 2017, GLIDE joined a coalition of 15 agencies across San Francisco to launch the Law Enforcement Assisted Diversion (LEAD) program, which coordinates with San Francisco’s law enforcement agencies and its criminal justice system to re-route willing nonviolent offenders from jail to services. With support from a major grant from the Department of Public Health (DPH), GLIDE will be hiring new staff to support LEAD, including outreach workers and case managers. Paul Harkin, who oversees GLIDE’s HIV/Hep C Prevention and Harm Reduction Services, will manage GLIDE’s participation in the pilot program, with help from Harm Reduction’s Janet Ector, who will act as Program Coordinator.
Continue reading “The Way Forward: GLIDE and LEAD SF”

Due to concern about HIV, Hep C and overdose deaths, there has recently been a surge in discussion both locally and nationally about creating Safe Consumption Services (or Safe Injection Facilities) where people who use drugs can take them under medically supervised conditions. These facilities would mitigate the risk of harm to folks who are already using drugs in very unsafe surroundings, such as in the streets or in bathrooms of businesses.
After months of meetings, research and rallies, the city now awaits a decision from a designated Safe Injection Services Task Force on whether Safe Injection Services will be made legal in San Francisco. GLIDE spoke with Paul Harkin, HIV/Hep C & Harm Reduction Programs Manager, to learn more about the need for legalized Safe Injection Services and how these facilities exemplify compassionate harm reduction-based policy.
Continue reading “"A transformative way of dealing with drug use": Paul Harkin on Safe Consumption Sites”

As members of GLIDE’s HIV & Hep C Harm Reduction Programs, the Hepatitis C navigators and I get the pleasure of being part of the City of San Francisco’s End Hep C SF initiative. End Hep C SF is a multi-sector collective-impact initiative that includes various service providers and community members working towards the elimination of hepatitis C in San Francisco. As a collective, we meet regularly in different work groups to find creative ways to increase testing and linkage to hepatitis C care, improve research and surveillance on hepatitis C prevalence, increase prevention and education efforts in the community, and increase hepatitis C treatment access to all hepatitis C–positive people in San Francisco.
Continue reading “"Tales from the Cured": Ending Hepatitis C in San Francisco”

Welcome to another installment of Eye on the Ball. There’s so much happening these days that it can be hard to keep focused. So, we’d like to spotlight a few things going on this week of special relevance to our communities.
As we all know too well, something is rotten in Denmark—(no offence, Denmark, we mean Washington, D.C.) From resisting racist immigration policy to defending the Affordable Care Act, we all have important work to do in defending one another and advancing the values of a decent society.
Continue reading “Eye on the Ball: Where the Action Is”