Download this factsheet as a PDF here
Special thanks to Monique Tula and Charles Hawthorne from the Harm Reduction Coalition and Cris Sardina from the Desiree Alliance for their input and expertise
Download this factsheet as a PDF here
In the first part of our 6-part PWN-USA Policy Agenda webinar series, special guest presenters Magali Lerman of Reframe Health & Justice, Robert Suttle of the SERO Project, and Monique Tula of Harm Reduction Coalition explain how criminalization of HIV, drug use and sex work damage individuals, communities, and public health–and offer solutions grounded in justice and human rights. Watch the recording to the left!

What Is Harm Reduction?

Harm reduction refers to a set of human rights and public health-based practices and principles aimed at reducing negative outcomes associated with certain activities, some of which are criminalized—such as sex work¹ and injection drug use.

Sex work is an umbrella term which includes any type of labor where a sexual service is provided in return for a benefit. Thus, sex work can include prostitution (direct sexual services), as well as other activities like dancing, webcam work, making adult films, and phone sex. Sex work refers to a consensual transaction between adults and should not be mistaken for sex trafficking, which may involve violence, threats, deception, or other forms of coercion and exploitation.

Harm reduction efforts prioritize the safety, rights and dignity of individuals engaging in the activity, rather than focusing on ending or preventing the activity. This approach respects people’s autonomy to make their own choices, and literally focuses on reducing harm that can result from those choices. Thus, for activities that are criminalized, harm reduction practices may include reducing likelihood of contact with the criminal justice system and the harm that results from criminal justice system itself. This harm reduction philosophy is colloquially described as “meeting people where they are.”

What Does Harm Reduction Look Like in Practice?

Harm reduction strategies can vary depending on the needs of the community being served. Here are some ways they are commonly put into practice:

Organizations may provide trainings and information to promote safety and to prevent criminalization; examples include instructions on safer injection practices, bad date lists, and know your rights guides for sex workers.

Syringe access or syringe exchange programs (SAPs/SEPs) are community-based centers where people can obtain injection equipment, including syringes, and can also return used syringes for safe disposal. These programs may also provide linkages to additional healthcare and social services .

Supervised consumption sites (SCS) are legally-sanctioned locations where medical staff work onsite to ensure that people who use drugs have access to a safe and sterile place to use pre-obtained drugs. This usually includes access to sterile equipment and assistance in case of overdose or another medical event. There are currently no SCS operating in the U.S. due to ongoing concerns about interference from federal drug enforcement.

Harm reduction practices include providing intervention training for people in the community, so they can provide emergency first aid including administering overdose reversal medication (such as Naloxone or Buprenorphine).

Harm reduction strategies also include offering free or low-cost counseling, testing, and primary care health services that are non-judgmental and accessible to the community. Some harm reduction organizations also use mobile units to provide services directly to individuals on the street.

Decriminalization of sex work and decriminalizing the possession or use of drugs are also considered harm reduction policies because they aim to keep sex workers and people who use drugs safe by ensuring that they are not at risk for criminal prosecution based on the activities they engage in.

Decriminalization vs Legalization

These terms are often used together but they are not interchangeable, and their differences should be noted. Decriminalization and legalization produce different policy outcomes.

Why Decriminalize?

The criminalization of sex work and drug possession or use disproportionately impacts women, people of color, immigrants, and LGBT individuals (particularly people of transgender experience). These are communities that are already over-policed and surveilled, heavily criminalized, and vulnerable to acquiring HIV, which makes them targets of HIV criminalization laws as well.

Laws and policies that target communities disproportionately impacted by the HIV epidemic include:

25 states require mandatory HIV testing for people arrested for sex work. The confidentiality of these results is not guaranteed, and many states impose harsher penalties for people arrested for sex work if they are living with HIV.

In some cities (most notably New York, Washington, DC, Los Angeles, and San Francisco) possession of multiple condoms has been used by police as evidence of sex work, thus placing people at risk for arrest just for carrying condoms. This discourages sex workers (as well as people often profiled as sex workers) from carrying condoms, which can place them at greater risk for sexually transmitted infections, HIV, and pregnancy.

32 states consider the possession of syringes to serve as evidence of illegal drug use, which discourages people from using and carrying sterile needles, including people of transgender experience who may need to inject hormones, steroids, or silicone. Twelve states currently criminalize sharing or selling syringes.

Though the U.S. government repealed the immigration ban on people living with HIV that was put in place in 1987, U.S. visa applications still require disclosure of an applicant’s history with sex work and drug use, which can bar entry into the country.

Consequences of Criminalization

What Can Be Done?

At the Federal Level:

End the War on Drugs and its discriminatory and draconian drug policies, which for nearly half a century, have led to continued mass incarceration of Black and Latinx communities in the U.S., who are over-policed and receive especially harsh sentences for drug-related charges. Any attempt to revive a federal crackdown on drug offenses, impede the shift toward harm reduction-grounded drug policy reform, or to reduce funding for solutions grounded in harm reduction approaches should be opposed.

Repeal SESTA/FOSTA and prevent other efforts to advance policies that harm sex workers.  Though SESTA/FOSTA sought to curb sex trafficking by making website publishers liable for any content on their sites that could be considered facilitation of sex work, the broad language of the law has led websites, like Craigslist, to shut down their personal ad pages to avoid potential lawsuits. Losing websites that allowed sex workers to advertise services and screen clients safely has made them more vulnerable to violence and exploitation on the streets. Legislation like SESTA/FOSTA confuses sex work with sex trafficking which drives stigma against sex workers and threatens their lives and livelihoods.

At the State Level:

Repeal State HIV Criminalization Laws that punish the alleged non-disclosure, exposure and transmission of HIV which perpetuate HIV-related stigma and impede the goals of public health of testing, treatment and prevention. States should align HIV-related policies with current scientific understanding of HIV transmission and eliminate laws that impose sentence enhancements for sex workers diagnosed with HIV or people who use drugs living with HIV.

Adopt and Fund Harm Reduction Practices like syringe access programs (SAPs). States should also repeal laws that cap the number of syringes that can be purchased or that criminalize syringe possession and create supervised consumption services (SCS).

Adopt Good Samaritan Overdose Laws that provide immunity from arrest, charge, or prosecution for certain drug offenses, when someone calls for medical assistance for an overdose they are experiencing or witnessing. Currently, 40 states and D.C. have adopted such laws.

Decriminalize Sex Work and Related Offenses to end the over policing and incarceration of people who do sex work, both of which increase vulnerability of sex workers to violence, abuse, and exploitation. States should pass legislation decriminalizing sex work. Other policies that target sex workers and impact their safety and agency such as allowing condom possession as evidence in criminal prosecutions should also be eliminated.

Where Can I Learn More?

  • Desiree Alliance: national coalition of current and former sex workers
  • Drug Policy Alliance: advocacy network working to end drug war and criminalization of drug use/possession
  • Harm Reduction Coalition: national capacity building organization that advocates for the rights of people who use drugs and communities disproportionately impacted by the war on drugs.
  • Sex Workers Outreach Project: national network dedicated to the fundamental human rights of people involved in the sex trade and their communities, focusing on ending violence and stigma through education and advocacy
  • Survivors Against SESTA: sex worker led effort to elevate sex worker voices in the outcry against SESTA/FOSTA
  • Women with A Vision: social justice non-profit that addresses issues faced by women in the south including sex worker rights, drug policy reform, reproductive justice, and advocacy for women living with HIV.