Harm Reduction and Needle Exchange Movements, 1980s-1990s

Samuel Friedman

HARM REDUCTION AND NEEDLE EXCHANGE MOVEMENTS, 1980s-1990s. In many ways, the 1980s was a period of retreat and defeat for the left in the United States. This reality shaped responses to the HIV/AIDS epidemic that became public in 1981 (although people who used drugs in New York City had known a new disease was hitting them for several years by then.) It was not until the late 1980s that activist responses emerged. Best known is the AIDS Coalition to Unleash Power (ACT UP), which was primarily a movement of LGBTQ people, and tended to be middle class (or above) and white. The epidemic, however, was also raging among people who inject drugs (PWID), and government policy towards them—a fierce War on Drugs—made public health interventions that were standard in many other countries a matter of heated political contention. Syringe exchange programs, for example, were viewed as illegal by Federal and many state and city authorities.

Activists, some of whom were injecting drugs or had previously been people who injected drugs, and others of whom were just concerned about this new disease, set up syringe exchanges anyway. Some of these were done quietly, but many were set up publicly. When arrested, these activists used a “publicly necessity defense” that juries usually accepted. (In New Jersey, the law held that the offense was only a misdemeanor that could be adjudicated by a judge and not a jury, so some activists were convicted.)

Unlike ACT UP, syringe exchange activists were multiracial, to a large degree from the Left, and many were working class. In New York City, for example, the successful movement to set up syringe exchanges in defiance of the law was heavily composed of (previous) PWID who were involved in ACT UP or who worked in state- or federally-funded AIDS outreach programs. They were a mixture of revolutionary socialists, anarchists, left social democrats, and radicals whose views were heavily shaped by intersectional or new social movements theories.

By the beginning of the 1990s, these activists and a scattering of public health researchers and public health department employees came together in annual conventions of the North American Syringe Exchange Convention (NASEC). NASEC meetings also provided a venue for a nascent group of drug user activists to start to form their own organizations. As various syringe exchanges began to receive more stable funding from some state governments and foundations, some of them developed additional ways to serve drug using communities, such as drop in centers and the distribution of naloxone to counteract overdoses. (These programs set the stage for publicly funded naloxone programs in many localities as the national overdose epidemic got worse.) These programs set up an allied national organization, the Harm Reduction Coalition, in 1993-94.

Over the course of the late 1990s, syringe exchange and harm reduction became more accepted by politicians and police. Many programs became publicly funded, and even where they were foundation funded, less dependent on volunteer effort. Many came to have several full time staff. Some of the original activist and left members died from HIV, hepatitis C or overdose, or old age; and others retired or went on to other activities. Some became tenured professors. As has happened many times in the history of the global left, acceptance and salaries set the stage for a mellowing and de-radicalization of the movement.

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Harm Reduction and Needle Exchange Movements, 1980s-1990s

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