Current News

/

ArcaMax

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.

"Everything we do that allows one fewer unprotected contact to occur, that's a measurable contribution to the task of limiting the number of transmissions," he said.

"Emphasizing that we can all be agents in the fight against the virus rather than being subjected to the harsh hand of the state — that conforms pretty well with what I've always understood to be at the heart of harm reduction."

Dr. Eric Kutscher, an internist at NYU Langone Health in New York who has written about "safer socializing" during the pandemic, said the strict lockdowns of the spring reminded him of efforts to close bathhouses in the 1980s to prevent the spread of HIV.

 

In both cases, he said, risky behavior was just transferred to private spaces.

"What we're seeing (with COVID-19) is that the peaks of transmission are happening in small gatherings," he said. "Part of that is we don't have venues created where people can follow social distancing at a wide scale. So instead, people are creating their own environments that don't actually have any regulations in place and are probably more risky."

Aside from government directives that are often ignored, the pandemic has featured plenty of shaming aimed at people who don't wear masks or who party in close quarters. Jacob Watson, a Chicago artist and educator, wrote an essay over the summer saying that approach was futile, only to get pushback from his friends and family.

"They said, 'Don't you think it's good to shame people doing something harmful?'" he recalled.

His response, he said, was that authorities need to appeal to people's moral side.

"These mandates are not especially enforceable," he said. "People will follow them if they want to. I think it's really important to create conditions that incentivize and encourage that."

Julia Marcus, an infectious disease epidemiologist at Harvard Medical School and the author of several essays about using harm reduction techniques against COVID-19, said there is no doubt the pandemic is more dangerous now than it has ever been, and people contemplating travel should understand that the safest course is to stay home.

"But a harm reduction approach will also acknowledge not just what we hope people can do, but what people will do," she said. "It's clear that many people are going to gather with others outside their household, and that many people are going to travel. It's already happening. So just telling people to cancel their Thanksgiving is missing an opportunity to give them risk mitigation strategies for when they do gather or travel."

Suggesting anything but total fidelity to stay-at-home advisories is a touchy matter; Marcus pointed to a Friday column by New York Times journalist Farhad Manjoo that unleashed a torrent of social media scorn after he wrote that he planned to visit his parents for a socially distanced, backyard Thanksgiving meal.

But for those who insist on traveling, Marcus said, creative approaches can reduce risk, such as eschewing dinner in favor of an activity in which everyone can stay masked.

Ernst said indoor festivities could be made safer with open windows, or with family members eating in separate rooms. An outdoor pastime, such as flying a kite, could be another alternative.

"Something that's not a contact sport," she said. "I know folks like to go out and play some football. Maybe not that."

(c)2020 Chicago Tribune Distributed by Tribune Content Agency, LLC