What do North Carolina law enforcement, migrant workers, Army veterans, injection drug users (IDUs), diabetics, transgender people, sex workers, and pharmacists have in common?
Well, Robert Childs, for one thing.
As Executive Director of the North Carolina Harm Reduction Coalition since 2009, Childs has brought his unique bridge-building ability to bear on the disconnect between federal funding for syringe exchange programs (SEPs) and a state law that makes the possession or distribution of drug paraphernalia a class A misdemeanor—keeping SEPs from operating openly and making used syringes a danger to public safety.
SEPs have been endorsed by groups including the American Medical Association, the CDC, National Association of State Alcohol and Drug Abuse Directors, the NAACP, National Black Police Association and the American Bar Association as a cost-effective means of decreasing HIV and Hepatitis C incidence, reducing needle stick injuries to police by as much as two-thirds, providing a gateway to treatment for injection drug users, and removing hazardous biomedical waste from public areas. Since their introduction in the 1980s, SEPs have been credited with an 80% reduction in the rate of new HIV infections among injection drug users, and research has proven that they do not increase drug use or crime.
With such prominent supporters and so many public health benefits, why are SEPs still prevented from operating in North Carolina? It’s a problem of perception, according to Childs. “Everybody thinks syringe exchange encourages drug use,” he sighs. A harm reduction approach focused on mitigating the health consequences of injection drug use fails to move conservative legislators—despite mounting evidence that certain drug paraphernalia statutes actually harm public health by making needle sharing, needle sticks, and improper disposal of used needles more likely.
Childs is undeterred by the legislature’s apparent indifference towards injection drug users and their increased vulnerability to HIV and hepatitis C. By maintaining an open door policy towards potential partners, he and NCHRC have assembled a diverse and persuasive coalition that advocates for decriminalization of syringes and the legalization of syringe exchange.
They have teamed up with local law enforcement across the state to provide grassroots training and education to police and other first-responders about the dangers of needle sticks (1 in 3 members of NC’s law enforcement get a needlestick in their career) and the benefits of syringe decriminalization and SEPs, which led to a ringing endorsement by a former Macon County sheriff. They have also reached out to North Carolina’s sizable migrant farm laborer population, among whom up to 23% engage in needle sharing for medical purposes, which constitutes a significant risk of infection by blood-borne pathogens. They have partnered with active and former armed services members, who report significant levels of injection drug use among returning troops to cope with mental and physical trauma, and who must resort to underground syringe exchange in the absence of legal means of procuring sterile syringes. (In North Carolina, syringes are available only with a prescription or by “pharmacist discretion.”) And they have targeted interventions towards transgender individuals, who may require syringes to inject hormones, many of whom are at increased risk for drug use or sex work due to deep social stigma in their communities.
Childs believes that these robust relationships will be the key to legislative victory around syringe decriminalization. Eventually he hopes to be able to change public perception of vulnerable populations and risk behavior such that harm reduction is the norm, not a novelty.
“I tell people it’s like driving a car to barbeque at your mother’s house in the country,” he says about reaching out to new partners. “You cannot be abstinent from the hazardous health behavior of driving in North Carolina, which causes widespread death and injury, because mama is going to be upset if you don’t show and you can not disappoint mama. Thus we choose to engage in a dangerous health behavior of driving. But we can make take a harm reduction approach to this problem and make it safer. We can do this by driving the speed limit, wearing seat belts, driving a Volvo or having airbags in your car. This makes it safer, not 100% safe, but safer.
“We can take the same approach to injection drug use; we can institute a program such as syringe exchange that makes the behavior safer. Speeding is illegal, like drug use, but people do it anyway. Harm reduction addresses this problem by enabling people to live their lives more safely when they engage in behaviors that put peoples’ lives at risk. It is good for the individual and the community when they take a harm reduction approach to such behavior, which raises the overall community health index.”
For more information, check out NCHRC’s homepage, amfAR’s fact sheet on syringe exchange , and the Human Rights Watch on HIV and human rights in the American South.