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Can harm reduction, the philosophy that stems HIV transmission and heroin overdoses, help curb a Thanksgiving COVID-19 meltdown?

By John Keilman, Chicago Tribune on

Published in News & Features

CHICAGO — Millions of Americans appear set to defy government guidance to stay home this Thanksgiving, disregarding the growing peril of COVID-19 to gather with distant loved ones. To Erica Ernst, it is a familiar scenario.

She is president of the Chicago Recovery Alliance, a group that tries to minimize the odds of HIV transmission and drug overdose through harm reduction, which aims to minimize the danger of risky behavior rather than try to stop it altogether.

Ernst said this phase of the pandemic reminds her of the early days of the HIV crisis, when people lapsed into denial, fatalism or exhaustion instead of taking simple steps to protect themselves.

"A lot of people died," she said. "Older folks in harm reduction or older gay men can tell you they lost their whole social group. We forget these things. We push them aside. But the messaging just needs to keep going out and keep getting pushed."

The messaging, in the case of the pandemic, should be about minimizing risk, Ernst and other harm reduction experts said. Some people will gather no matter what, they said, so government officials should talk more about how to do it in the safest possible manner.

Daniel Weinstock, a law professor at McGill University in Montreal who has written about harm reduction and COVID-19, said experience has amply demonstrated the ineffectiveness of trying to eradicate risky behavior through shame or government mandates.


"As we know from abstinence campaigns in the area of sex or drugs, it just doesn't work," he said.

He said harm reduction is an alternative to prohibition, especially when prohibition is impossible to achieve. Insisting on perfect adherence can lead to "unregulated noncompliance," he said, which can produce the worst outcomes.

Harm reduction attempts to stem that by presenting alternatives. For HIV prevention, those include condom use and less risky sexual practices. For reducing overdoses, advocates distribute the overdose-reversing medication naloxone and encourage people not to use drugs alone.

Weinstock said the key to success in any harm reduction plan is to make people feel like they have a role to play.


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