The U.S. South continues to be disproportionately impacted by the intersecting opioid and HIV epidemics. These epidemics are exacerbated by the stigmatization of drug use through abstinence-based and exclusively treatment-focused approaches. Harm reduction (HR) is an evidence-based approach that aims to reduce negative consequences associated with drug use at the individual, community and systemic levels. HR approaches are effective in reducing drug use-related HIV and Hepatitis transmission, and prompting entry into substance misuse treatment and other social services. HR integrates analysis of systemic oppression in its service approach, which is central to anti-oppressive service provision. Despite this, little is known about the extent to which HIV service organizations in the U.S. South implement HR. Understanding the landscape of HR in the South is essential to developing system-wide and organizational change interventions to increase the uptake of HR in this region. The aims of this study are to understand 1) the extent to which HIV service organizations in the U.S. South practice HR and 2) barriers to utilizing this approach.
Survey data were collected via SurveyGizmo (n=207 organizations representing AL, FL, GA, LA, MS, NC, SC, TN, TX) to identify HIV healthcare service needs including substance use and HR services. Participants were identified using the National Prevention Information Network (NPIN) and Substance Abuse and Mental Health Services Association (SAMHSA) service provider databases. Analysis consisted of frequency distributions of survey questions related to substance use and HR services.
Participating organizations were diverse in staff size, number of clients served and number of years providing HIV services. The majority of organizations surveyed provided substance use screenings and service referrals (74% and 86% respectively). 50% provided substance misuse services. 75% of organizations did not think available substance misuse services met their community’s needs. 50% reported that their policies reflected a HR orientation. 61% reported that their organizational documentation reflects a HR orientation. 26% provide specific HR services. 17% reported that their organization does not take a HR approach, and of those, 75% would like to. However, these percentages may reflect a misinterpretation of HR principles. Only 45% of organizations had ever completed an organization-wide HR training (84% were interested in receiving such training). Additionally, many open-ended responses providing examples of “other harm reduction approaches'' included things such as “individual substance abuse counseling,” which may or may not align with a HR approach. Reported barriers to implementing HR included funding (74%), expertise/knowledge (50%), capacity/staffing (49%), and political climate (29%).
To our knowledge, this study is the largest survey of HIV service organizations in the U.S. South that includes HR data. Our study finds significant gaps in the implementation of HR in Southern HIV service organizations. Systemic barriers, such as lack of funding and training, impede the uptake of this social justice centered, evidence-based approach. Authors have used this research to inform HR training and capacity building infrastructure development in the South and will share the impact of this work during the presentation.