1. Harm Reduction and
HIV Prevention:
Working with sex workers,
substance users, and other
criminalized communities
Amna Shaikh, Lindsay Roth, and Kahn Miller of

2. Objectives
 Introductions
 Continuum of acceptability
 Frameworks and definitions
 Applications in practice
 Discussion

3. This is a safe space
 Confidentiality: What’s shared here stays here,
what’s learned here leaves here
 One Mic
 Make Room, Make Noise
 Ouch/Oops
 If you don’t know - ask!
 Speak from the “I”
 Avoid assumptions
 Please do not record this presentation (the slide
show with bibliography and notes will be made
available)

4. Who We Are,
What We Do
All volunteer, grassroots direct-service and advocacy organization
for and by women in Philadelphia’s sex trade, with a focus on
women surviving in the street economy in Kensington.
Barriers to care are material, social, and structural. Services
include:
•late night street outreach •bad date sheet
•home deliveries •case management •health & safety
tips
•overdose response training •rape and assault referrals

5. What is Harm
Reduction?

6. What is Harm
Reduction?
 A public health theory addressing
behaviors that carry risk.
 We all do things we know are bad for
us, and only the individual can decide
what measures to take to mitigate harm
 Those who engage in these behaviors
should have a leading voice in any
organization or program they utilize

7. Continuum of Acceptability
Not OK for anyone ever (in the history of
ever)
OK for some (over there, far away)
Fine but not a preferred practice
Good for others, not good for me
Good for others, good for me
Consider these as you move through the continuum

8. Debrief
 What was the first thing you thought of?
 Have you always felt this way?
 How would your position change if this
were a continuum of risk?
 What other factors influenced your
position?

9. Criminalization
 Oppression via state control of body (legal
gender, incarceration, condoms as
evidence, drugs & paraphernalia) and
mind (access to education/information,
mental health care, definition of disease)
 Can be explicit in law or how laws are
enacted/enforced, and replicated through
other institutions/centers of power
(education, medicine, media and pop
culture)
 Not a vacuum but a wave

10. Frameworks (everybody has one)
 Sex work as work
 Substance use vs.
Drug Abuse
 Theory of
Intersectionality
These frameworks
acknowledge the material,
social, cultural, and
spiritual impacts of
criminalization

11. Sex Work as Work
 Sex Work, Sex Trade, Survival Sex
Work – it doesn’t need currency to be
commerce
 Focus on the sex worker
 Honors Autonomy (Choice/Agential
Choice)
 Free of stigma, implies alliance
 Provides for a more comprehensive
understanding of what exploitative forces
may be at work (interpersonal,

12. Substance Use vs.
Drug Abuse
 Language creates our reality
 Our reality, as providers, should be free of bias
 Create a space for individuals to self-identify and/or
qualified professionals to properly diagnose
 Consistent with evidence based practices and
contemporary research
Substance Dependent
Chaotic Use
Supporting
Addict
Rock-Bottom
Enabling

13. There is a rainbow of options
between chaos and abstinence!

14. Intersectionality
Criminalization is experienced disproportionately under multiple
forms or systems of oppression, domination, or discrimination.
These frameworks must be considered within the theory of
intersectionality.

15. Application in Practice
Harm Reduction approaches to serving
historically vulnerable, marginalized and
oppressed populations mitigate the impact of
criminalization –
especially in HIV treatment and care.
…So how do we do this?

16. Our Suggestions
 Know your own boundaries
 Affirming and appropriate language and
visual presentation
 Check your knowledge base
 Seek ongoing education
 Know the laws and policies that impact your
clients and yourself
 “Nothing about us without us” from the
waiting room to the board room
 Meet people where they are at – literally!
 Use strengths based models

17. (not the) Final Discussion
How can we apply these frameworks in
context in which we are all survivors of
criminalization?

18. Thank You!
Please stay in touch
Amna Shaikh, Lindsay Roth & Kahn Miller
www.projectsafephilly.org
safephila@gmail.com
Stop by our table!