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August included Overdose Awareness Day and GLIDE’s Center for Social Justice and Harm Reduction Services marked the observance with an inspiring panel discussion that clarified what harm reduction is and is not and focused on policies that help or continue to harm. Harm Reduction As Justice was moderated by Director of Harm Reduction Services Juliana DePietro, and included panel members CSJ Policy Manager Wesley Saver, Harm Reduction Services Program Manager John Negrete, and Code Tenderloin Founder and unofficial Mayor of the Tenderloin Del Seymour. 

GLIDE’s Women’s Center, in conjunction with community partners The Healing Well, La Cocina, YWAM San Francisco, and Simply the Basics, hosted a Womxn’s Wellness Fair on Friday, May 7–the start of Mother’s Day Weekend. The free, day-long event was meant to celebrate and serve all unhoused, and housed women-identified residents in the Tenderloin and took place in the Tenderloin Community Resource Hub at Ellis Street and Taylor in front of GLIDE.

Womxn’s Wellness Fair activities included fellowship, fun, food, art, resources, music, carnival games, bingo, and even free yoga, tai chi, and acupuncture. Women could access resources like hygiene products, mental health support services, harm reduction kits, free snack bags, and $5 vouchers for the newly opened La Cocina Marketplace. The fair is part of ongoing outreach efforts by GLIDE’s Women’s Center to support women who are living on the street, in an unstable housing situation, or need social support.

“Our event was a tremendous success!” said Shannon Wise, manager of GLIDE’s Women’s Center. “Thank you to our 24 participating agencies and all the women in the community who came out. We served about 300 people that day. It was great for agencies to network with each other on-site, and in-person providing up-to-date information and community resources.”

“I am so happy that they have a Woman’s Fair, said attendee Hoamy “Linda” Ung. “I have been waiting and praying for it.”

“I really believe in women empowering women and women having a platform just to better themselves, just to be happy to be who they are, said participant and organizer Juthaporn Chaloeicheep. “We should praise women for the good jobs they do.”

When women get together, we’ve been able to do amazing things.” “I just wanted to come out because I’ve been locked up so much,” said Marquita Stroud, who lives in a nearby hotel. “My favorite part has been playing all the carnival games.”

Wise is hopeful that the Wellness Fair will make more women aware of the services available through the Center. “We’re here and we can help,” she said. “We just want people in the community to know that we are a resource for them.”

GLIDE’s Women’s Center provides a safe haven for women on the road to recovery from trauma, violence, and isolation. Through its essential support services, the Center helps women, and their families stabilize their lives and thrive. To find out more about the Women’s Center, please visit glide.org/program/womens-center.

In December, GLIDE welcomed its new director of Harm Reduction Services, Juliana DePietro. A native of Davis, California, Juliana comes to GLIDE with years of frontline experience working in harm reduction services and outreach in Portland and elsewhere, and fresh from completing a master’s degree in public health at Harvard University. Last spring and summer, at the outset of the pandemic and while completing her master’s degree online, Juliana returned to the West Coast to operate an emergency social distancing shelter in Portland. She joined this effort, “to be of service to my community” while “approaching that space from as much of a harm reduction lens as I possibly could.” She recalls being driven in that work by an “understanding of all of the overlapping spaces of harm that folks can encounter in emergency shelter systems—as well as in interactions with uprisings against systemic racism and police brutality which occurred over the summer across the country including in Portland.” Juliana recently took a few minutes to let us know how she was settling into her new role. 

Juliana, welcome to GLIDE and the Tenderloin! Can you tell us a little bit about what brings you to GLIDE? 

Thank you! I come from many years of direct service alongside people experiencing homelessness as well as working directly with people who use and inject and smoke drugs. I began my career also working directly with people with mental health concerns. Working with folks at all of those intersections unfortunately also involves a lot of interaction with law enforcement, with systemic racism, and with other systems of oppression that have significant impacts and traumas on these populations, particularly for folks of color and LGBTQ+ folks. I have done most of my harm reduction work in Portland, Oregon. I worked for a dual diagnosis harm reduction program there and also helped launch the Multnomah County LEAD [Law Enforcement Assisted Diversion] pilot program. I know GLIDE held its own LEAD team for a while. I worked in a few other spots in Portland and then transitioned into graduate school. 

I saw the opportunity at GLIDE when I was job hunting this fall, I’d heard about GLIDE from family and friends in the Bay Area as a space of moral grounding in San Francisco, an organization that acts upon deeply rooted values and has a legacy of activism. That, and the chance to be involved in strategic thinking for harm reduction services, really drew me to apply and to join what I’m really getting to know as a citywide and coalition-based set of harm reduction programs. I’m so honored and grateful to be a part of this work.

Can you tell us a little about the graduate school, what drew you there and what you bring back? 

I attended the Harvard T.H. Chan School of Public Health—I actually just finished this past week, so I’m feeling very relieved about that! 

Making the leap to graduate school was a really difficult decision because my heart is in direct service, in outreach, and in the nontraditional public health programming that GLIDE Harm Reduction Services provides. I found that while I had strengths in the compassionate, person-centric care that undergirds harm reduction services, the strengths that I wanted to tap into were more systems-level and more programmatic and operational. While there was a lot of cognitive dissonances while I was attending graduate school, I had the opportunity to solidify my values and push back on problematic things that I saw in academia and at Harvard in particular, while also trying to bring some of my experience as a provider to folks who were often pushed out of public health systems. Bringing those stories and experiences to that space and interacting with a lot of traditional public health providers, I tried to stretch perspectives on what public health looks like now and needs to look like going forward.  

I bring back the results of those conversations, thinking about public health as it is right now and as it could be—a wider, more inclusive social safety net that is well-resourced and well-connected in sustainable ways. I’ve seen the foundations of this public health future in the work that harm reduction teams like the one at GLIDE and other essential nontraditional social service providers have stepped up and just provided that social safety net during this pandemic, regardless of the infrastructure in place. I’m recognizing that we often provide the core and the basics for folks who need it most. How do we build out those systems and make them more sustainable?  

How do you see the pandemic impacting both the people GLIDE serves and the work that you’ve been focused on in your career? 

On a systems level, and on a public awareness level, it’s really bringing to light how our country lacks a safety net. How people can “fall through the cracks”. In my opinion there shouldn’t be any cracks to begin with, but this pandemic is really exposing the cracks that exist. In my work in emergency shelterings over the summer, I met countless people who had never been homeless before, who were not used to living in shelter life, who lost their jobs and lost their housing very rapidly because of the pandemic.  

Behavioral health is also gaining a lot of attention because more and more folks are finding they need help with the stresses of the pandemic. Not always, but often, people use drugs to cope with trauma and stressors, and we’re going through a collective trauma right now. Hopefully, a wider spectrum of people are gaining empathy for their neighbors and community members use drugs and who have serious and persistent mental health issues.  

In terms of the people GLIDE serves, so much of our traditional health infrastructure is closed or the barriers to accessing it are higher. That has real and immediate impacts on the people we serve. It makes me extremely grateful for our frontline healthcare workers and our frontline harm reduction specialists, experts who are every single day showing up and providing services as safely as they can. It doesn’t surprise me, but it terrifies me the extent of the impact on the populations that we work with, how much has shut down and how many opportunities have closed because of the lack of preparedness and the lack of response to this pandemic.

I know also that people who use drugs and people who live outside and people who engage in sex work, and all other folks that we serve in harm reduction, are incredibly resilient and survivors and will continue to figure out ways to get their needs met even if our systems take some time to catch up. I’m just grateful to be a part of the bridge to getting those needs met for folks and to bolster the systems that are in place to have that happen. 

GLIDE Community members receive support from Daily Free Meals program

What will your role entail, now that you’re at GLIDE? 

I have big dreams for harm reduction in general. I’m really excited to learn about and from the work that is already being done in San Francisco. There are a bunch of really talented, creative, hard-working folks who make up the harm reduction community. So, though I have my own big dreams, my goal for GLIDE’s harm reduction program is to integrate within the sector of harm reduction services with our partners and figure out the best ways to collaborate with one another and continue to build the strongest coalition we can to spread harm reduction as far and wide as we’re able. There’s a lot of learning from and building relationship with our community partners.  

I also really recognize how hard my team has been working and how much trauma we’ve experienced in terms of being on the frontlines of this pandemic as harm reduction providers. One of my priorities is making sure that our team has everything that we need to continue the work in a safe, healthy, sustainable, and joyous manner. Because I know how much my team cares about GLIDE’s work in our community and I want to make sure that we’re able to continue that.  

And then I think about where we want to go. What that looks like for me is getting an understanding from our team about both the gaps that we see that need to be filled and then also the work that we’re already doing or end up doing that isn’t sufficiently resourced and trying to figure out the best ways to formalize that. I’m focused on striking a balance between being a harm reduction innovator and a collaborator and a nurturing support system. 

Harm Reduction team members Felanie Castro and Ali Lazarus hand out supplies to the community

Speaking of collaborations, SB 57, as a piece of proposed state legislation, recently returned the issue of safe consumption services to the political agenda. Can you speak about the significance of this legislation? What’s the opportunity you see here? 

SB 57 is the latest attempt to legalize safe spaces for overdose prevention resources via the safe consumption of substances that are currently illicit, making sure those spaces are hygienic and safe and monitored to reduce the negative impacts that substance use cans have, including overdose. In our context, this can feel very progressive but safe consumption sites exist all over the world, in Europe and in Canada. It’s a very exciting opportunity that has been raised by bringing this bill into the legislature. I know a similar bill was brought a couple of years back [but was vetoed by then-Governor Jerry Brown]. I know that dealt a huge blow to the harm reduction community. At this point, within the pandemic context in San Francisco and all over California, we’ve seen a really tragic rise in overdose deaths. A space like this, while not curing the problems that lead to overdose, would absolutely provide a safer venue for folks to be able to use inside, and without the threat of incarceration, without the threat of criminal legal system intervention. That’s a huge part. I know San Francisco is already pursuing and acting on calls from the community to decouple the police and law enforcement intervention from other spaces of a behavioral health crisis. This just feels like an extension of that, and one that is particularly important when we think about the larger context of the racist war on drugs in our country—how people using drugs who are Black, who are Latinx, who are indigenous – are over-policed and over-criminalized for their substance use. It fuels the prison-industrial complex.  

With the passage of SB 57 and the opening of multiple different modalities of safe consumption sites, we could start to respond to the impact of the racist war on drugs. This bill is an incredible opportunity for our harm reduction community of providers and advocates to work together to figure out what different safe consumption sites could look like.

Really, for me, it’s also about acknowledging that people use drugs—something which is harder to deny the longer we go without safe consumption sites, without affordable housing, without robust healthcare systems. [SB 57] is just an extension of that recognition, acknowledging the humanity of those folks, that they deserve to continue to live their lives as they are able to with the respect and support of our community and without the surveillance of law enforcement.  

Harm Reduction outreach in San Francisco

A lifeline in a landscape stalked by poverty and the coronavirus

As most of San Francisco remains at a relative standstill to slow the spread of the coronavirus, GLIDE Harm Reduction Case Manager Felanie Castro is behind the wheel, crisscrossing the city seven hours a day.

Piloting GLIDE’s community outreach van, and accompanied by a rotating roster of GLIDE health systems navigators and other Harm Reduction staff (Rita Bagnulo, Ali Lazarus, Jason Norelli, Amy Rodriguez, Amber Sheldon, Mike Thompson), Felanie makes between 20 and 35 stops a day, supporting unhoused San Franciscans for whom social isolation and resource scarcity have only deepened in the context of the current public health emergency.

“Everybody I’m seeing is getting a meal and water, and if they have any SAS [Syringe Access Services] needs, they’re getting that,” explains Felanie during a recent phone conversation.

“I’m also screening people—asking them if they’re having a new cough, experiencing a fever, having shortness of breath. I have a non-contact thermometer that DPH [San Francisco Department of Public Health] gave me. And I’m passing out tents. I think I’ve passed out over 400 tents since the 25th of March. I’m passing out hand sanitizer and hygiene kits. Masks when I get them.”

In practice, mobile outreach is nothing new to Felanie and her Harm Reduction colleagues. GLIDE introduced its customized community outreach van—complete with a phlebotomy chair and other equipment for on-site testing—last year as part of a new program called OPT-IN.

OPT-IN, part of a five-year grant operated in partnership with DPH, is designed to further the reach of GLIDE’s Harm Reduction program in serving the most marginalized populations across San Francisco with successful health interventions for addressing the HIV and Hep C epidemics and other harms among the city’s unhoused residents.

But in the context of a global pandemic—and the necessary scaling back or shuttering of restaurants and most other businesses, all in-person cultural events and many city services—priorities have shifted. More than ever, Felanie and crew act as a literal lifeline to people living an increasingly precarious existence in makeshift encampments and enclaves that fan out from the city center—from SoMa and the Mission to Excelsior, Potrero Hill, Bayshore, Bayview Hunters Point, all the way to the far side of Candlestick Park and beyond to the water’s edge.

“I’ve seen over 2,400 people since the end of March. Distributed over 2,000 meals,” recounts Felanie.

“There are 10 to 15 locations a day that I visit all the time. I’ve been to certain places where they’re saying, ‘Thank you, because you’re the only person coming out here. You’re the only person to ever come out here. And you’re repeatedly coming out here.’”

“The distribution of water and hygiene kits is a critical intervention to prevent disease transmission among persons with no access to running water, such as in the Warehouse district,” adds Harm Reduction Program Manager Daniela Wotke.

In addition to basic necessities and harm reduction services, information has been another valuable offering to help guard the health of people living unhoused.

“I’ve been passing out some literature, too. Little half-page booklets. Dispelling some of the myths that they have,” says Felanie of the people living outside.

“It’s still abstract for a lot of people who are already kind of remote. I’m also giving them the information about MSC South. There are a lot of people who tested positive at MSC South. There are probably people who are positive who were at MSC South and who are out in the community. So physical distancing and having a mask are really things to pay attention to.

“I’m really good with boundaries,” continues Felanie. “I’m wearing my mask; I ask people to keep their distance. So, I lead by example in that respect. Different pockets have different levels of anxiety and stress over this—all coupled with their stress about, ‘Hey, how am I going to get food and water, and basic things to clean myself with, if you don’t come out?’”

To date, no one Felanie has screened for symptoms presented signs that would necessitate further evaluation at SF General. “I haven’t had anybody yet,” notes Felanie, “and I’ve screened maybe 350 people.”

GLIDE Harm Reduction team members Felanie, Amy and Jason with the OPT-IN van on February 6, 2020. (photo: Rob Avila)

Fortunately, regular services like the ones offered from the OPT-IN van, including the basics of food and water and modest shelter, mean many unhoused city residents have the ability to shelter where they are without having to risk venturing into the more congested centers of town.

And, as Felanie makes clear, the outreach is a community effort:

In addition to logistical support from DPH, and the regular SAS outreach conducted by San Francisco AIDS Foundation (another member of the OPT-IN program), GLIDE’s OPT-IN team relies on a network of allies for sourcing such critical supplies as tents (Coalition on Homelessness), hand sanitizer (via homeless rights activist Christin Evans), meals (GLIDE’s Daily Free Meals team, with donations from Gate Gourmet and others), hygiene kits (The Sisters of Perpetual Indulgence), and masks (some homemade ones, some from a local drive instigated by District 6 Supervisor Matt Haney, to which many generous individuals contributed).

For now, the OPT-IN mobile outreach remains a vital and, for many, a unique line of support as unhoused people across the city weather a season of increased deprivation, uncertainty and risk.

“When you talk about Market Street all the way to the water on the East side, I can’t think of a street that I have not been on,” says Felanie. “There was one or two days when I was between Bayshore and the water all day. I put 50 miles on the van, just in that area. That’s going every single block.”

https://youtu.be/WdwjJV8Gwuw

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

Given the recent news about the dramatic rise in fentanyl-related deaths in San Francisco last year, we’re reposting this interview with Paul Harkin from August. 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. Interview by Robert Avila, Director of Communications, August 2019.

The following thoughts from GLIDE’s Director of Harm Reduction Services Paul Harkin come in response to a frequent assertion by people addressing the crisis of drug use on our streets: that offering support to those who use drugs only encourages them to keep on using, thereby only adding to the problem, and that only abstinence-based, tough love measures and punitive approaches are sufficient to move people in the direction of recovery and health. While the evidence points in the opposite direction, the myth persists. Below, Paul offers a perspective from his years of work in the field of harm reduction.

As a long-term harm reduction service provider, I am committed to meeting people where they are at, and not leaving them there. There are multiple ways to help individuals deal with the manner in which they are using substances. Harm Reduction uses evidence-based, respectful, dignified and supportive responses to help individuals.

It is all too common for me to hear people who have experienced recent success in their struggle with substance use, get up on a podium and demand that everyone just does what they did and “cures” their problematic drug use. Everyone else is wrong, harm reduction is a failure, because it “makes it easy for people to use drugs.” This person has all the answers, if only we would follow his or her lead.

While it’s great that such a person is choosing at least for now not to use drugs, the indignation and borderline loathing towards harm reduction principles and practices that can accompany this position—an attitude well-known to providers of harm reduction programs—is not helpful in the effort to mitigate harms in general.

When someone puts him or herself forward as a born again “drug free” human being, we certainly wish them health and happiness in their life. My concern comes when he or she thinks their experience must be both relevant and the model for everyone; we must all pay attention to and heed their particular conclusions: “Look at me, I used to be a degenerate drug user and now I am an awesome drug-free person—you, too, can do like I did and be like me.”

The problem is, of course, that such an individual has no idea what another person is actually experiencing or why they are choosing to use drugs. He or she does not know if a person has had horrible adverse childhood experiences, for example, or if another person has a history of trauma, or another person has reasons for seeking refuge of sorts, self-medication, in substance use to mask other horrors that they are struggling to cope with.

Yet despite having no insight into other people’s lives, he or she is encouraged and lauded for telling us what every person needs. I do not believe that a born-again, “tough love” approach is actually geared to other human beings in any meaningful, compassionate or just way. If you don’t really bother to see and understand where a given individual is coming from, you’re not really seeing them at all, and certainly not caring about them. Only when you truly do not see a person are you capable of saying things like, “we make it too easy to use drugs.” What does that mean? Behind the accusing finger is nothing but the moralizing paternalism of Prohibition or the War on Drugs, each of them a scourge and failure of historic proportions.

Another thing we see a lot of are the ill effects on the evangelical non-user who decides to use again: then all the shame, guilt and stigma and self-loathing that they have learned gets directed inward towards themselves. This is not only common, it’s tragically unnecessary and counterproductive.

There will always be those who respond to their own substance use disorder by prescribing for others their particular treatment, based as is it on their own unique experience. They do this at the expense of denying others their own uniqueness.

We hear a wide variety of such proclamations. One person says, “It took jail to get me off drugs,” another says, “I needed my family to kidnap me and lock me in a room for weeks,” while still another says, “I almost died of an overdose and then I knew I had to change.” The reality is that, however extreme, these random successes are just that, purely random.

As healthcare providers, we need evidence-based solutions for treating substance use disorders. We need to be asking better questions. Not moralizing. We should ask a person who has come out of a serious substance use disorder while living on the streets: Did they get HIV or Hep C while out there using? If yes, did they get connected to treatment? Did they overdose and get saved by another user with Naloxone? Where they offered and connected to Medically Assisted Treatment? These are crucial evidence-based services that most people with substance use disorders may require.

Harm Reduction programs say, “support, don’t punish” drug users. Decades of dehumanizing and racist drug war propaganda has entrenched so many myths and false ideas that perpetuate stigma and oppression. The popular idea that people have to “bottom out” to “kick” drugs is proven to be false.

In the end, it does not matter if one person finds a lasting solution to his disorder or if he chooses to use again. As providers, we are here for him and everyone else. If someone tries abstinence and then chooses to use again (there is a  90-95% failure rate for 12-step programs), harm reduction programs will be right there, supporting them without judgement, ensuring that we offer them protection from HIV and Hep C and give them the tools to prevent/survive overdosing on opioids.

That is what harm reduction is: a non-judgmental, evidence-based response to support drug users. We oppose punitive responses to drug use because we know they only cause further harm to the user. We demand scientific, supportive, compassionate solutions to help individuals deal with substance use disorders in ways that work for them.

Paul Harkin has over 20 years of experience as a harm reduction professional and is the director of GLIDE’s Harm Reduction Services. The above opinions were shared in conversation with Robert Avila, Director of Communications, in December 2019.

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.”

This story, by Robert Avila, Director of Communications, originally appeared in the Fall 2019 print edition of GLIDE’s Real Talk newsletter.

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.”