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The U.S. South is disproportionately impacted by the intersecting HIV and overdose epidemics (CDC, 2019; Stanton et al., 2022). Harm reduction (HR) is an evidence-based, social justice-oriented approach effective at reducing the negative consequences of harmful health behaviors. Southern HIV Service Organizations (SHSOs) are promising sites for the adoption and implementation of HR, as they often already apply a HR philosophy to safer sex and HIV health promotion. However, more research is needed to understand exactly how HR is operationalized within and among SHSOs. This study examines 1) how and to what extent SHSOs implement HR, and 2) the perceived local context within which SHSOs integrate HR.
Methods
This study uses a convergent mixed methods design to conduct a secondary analysis of two existing datasets. The first consisted of quantitative data from n=39 SHSOs that participated in HR-oriented capacity building between 2019-2022. SHSOs completed a 91-question organizational assessment of their HR implementation across five domains (i.e., General, Outreach, Principles, Services, Advocacy). Authors conducted frequency distributions and descriptive statistics. The second dataset consisted of in-depth, semi-structured interview data with n=25 SHSO staff. The protocol focused on participants’ perceptions of HR implementation. Interviews were conducted virtually and analyzed using inductive thematic analysis.
Results
Most SHSOs were led by people of color (n=27, 69%), located in urban areas (n=21, 54%), and relatively small (less than 10 staff; n=22, 56%). SHSOs most commonly indicated operationalizing HR within the following domains: Advocacy (74.4%; M=21.6 (of 29), SD=6.3), Outreach (74.2%; M=4.5 (of 6), SD=1.9), and Principles (72.7%; M=10.9 (of 15), SD=2.9). Conversely, SHSOs less frequently indicated operationalizing HR within Services (60.4%; M=18.7 (of 31), SD=6.0) and General/Organization domains (46.9%; M=4.7 (of 10), SD=3.0). Most interview participants held a leadership role in their organization (n=17, 64%) and worked an average of 14 years in the HIV field. Three broad themes emerged from qualitative analysis: 1) SHSOs lack knowledge and understanding of HR, 2) HR services are limited in the South, and 3) SHSOs work within a challenging socio-political context.
Conclusions and Implications
Results suggest SHSOs are strongest in HR advocacy, which simultaneously demonstrates the continued need for policy advocacy and the resilience of HR advocates amid a particularly difficult socio-political context. Results also suggest SHSOs are weaker in their provision of HR services, which is unsurprising given the resistance to and lack of support for (and thus, underfunding of) HR since its emergence in the U.S. Additionally, results reveal SHSOs are weakest in terms of their integration of HR into their organizational infrastructure, suggesting a need for robust capacity building assistance. Study findings call for 1) concerted funding to facilitate the adoption of HR, 2) comprehensive capacity building efforts that encompass in-depth training and coaching on HR implementation, and 3) policy change that promotes evidence-based care.