Harm Reduction

Rachel Schreiber: Naomi, you have been a sex workers' rights activist for a long time, and for many years you were the executive director of the St. James Infirmary. I'd like to begin by to asking you about the term harm reduction and how it came to be a guiding methodology of care for sex workers.Naomi Akers: I first heard about harm reduction at Promise, in the mid-nineties. I had always been interested in drug policy as well, and I've always felt that drugs should be legalized and that criminalization is bullshit.During the 1990s, I was an undergraduate student at San Francisco State University. The executive director of Casa de las Madres, a shelter for women experiencing domestic violence, spoke to our class. I connected very strongly with their mission. I began to volunteer there, and I learned about two significant issues. One, drug users were not allowed in the house—they had to first get sober before they would be allowed physical safety from their partner. Two, if women were in sex work, and their abusive partner was a pimp, they would not be allowed in the house because they would not be considered to be experiencing domestic violence. This also demonstrates the ways that for me, harm reduction in response to drug use, sex work, and violence against women are all inextricably linked.Feeling that sex workers needed more advocacy, and considering my previous experience as a sex worker, I began to seek out organizations that were serving sex workers. This was 1995. Two of the staff from La Casa were on the advisory board for an organization called Promise, which ran a drop-in shelter for women in the sex industry. Promise was started by a woman who had worked at WHISPER in Minneapolis (Women Hurt in Systems of Prostitution Engaged in Revolt, another domestic violence shelter). The foundational viewpoint of WHISPER is one of antiprostitution, claiming that all sex work is violence. Promise was not as rigid in these views and was practicing low-threshold harm reduction. I began to volunteer and would eventually help the San Francisco Domestic Violence Consortium to develop best practices for domestic violence shelters, eventually leading to a harm reduction mandate for all the shelters.RS: And this in turn led you to develop harm reduction principles for sex workers. What is harm reduction, specifically in relation to sex work?NA: To understand harm reduction, we should begin by deconstructing the harms. Who is defining harm? Are they socially created harms, or are they inherent to the behavior? The language around sex work says that it's inherently harmful. Harm reduction allows us to see that the behavior itself if not harmful; it's the policies, laws, responses to the behavior that cause harm. Criminalization is what is causing harm; not sex work itself.RS: This sounds like a great framework for understanding the goals of harm reduction, and the approach. Can you speak to some very specific ways that you have seen harm reduction be put into action around sex work?NA: One example is the condoms initiative that you helped us with, Rachel. The police had been using possession of a condom as evidence of solicitation. Of course, this only served to discourage sex workers (and clients) from carrying condoms, which was obviously a problem. St. James led the effort, which was eventually successful, to get the police department to stop this practice. We distributed condoms that said "This condom is legal," and lobbied for these changes.Legal brothels can be a form of harm reduction if they create safety. My experience of working in the Nevada brothels is that they have disadvantages, but also advantages. There is safety there—not just for the workers but for the clients as well, because they often get robbed or shaken down in other settings. And most clients prefer to know that the sex worker herself has rights and is being treated ethically. Brothels offer the ability to be mentored, to have better experiences and encounters, to negotiate money, and even to pursue work that is emotionally satisfying. If you believe that sexuality is part of our lives and necessary, then the exchange can be spiritual—it can involve empathy and compassion. In a brothel you can learn this, largely by processing with your colleagues—after good experiences as well as bad ones. Also, screening new clients is challenging in an illegal economy. A safe, clean place—such as a brothel—can help with that. I want to say, "I don't agree to anal sex. I will agree to vaginal sex, but a condom is required." In a brothel, I can choose to only work with clients I have screened.Beyond brothels, fortunately in California we have a 2020 amnesty law, which acknowledges inherently that what is truly horrific is rape, murder, and physical violence. Under this law, a victim can report a crime, and when it is violent and dangerous, they will receive amnesty from their own behavior, such as drug use. The law acknowledges that violence trumps something like drug use, so that is also a form of harm reduction.Basically, anything that brings dignity and agency to sex workers can be understood as harm reduction. Language is powerful. Even the term sex work can be thought of as harm reduction, because it is a way to humanize.RS: The core idea that you have said here, that resonates for me, is that harm reduction is about allowing people to make their own decisions and choices, and not judging them. Spending time at St. James, volunteering and just getting to know the community, I think the thing that was so incredibly powerful to me was the notion of being radically nonjudgmental.NA: Yes. I love the work we were doing there. Radical nonjudgment is pretty amazing.I want to conclude with two things. First, it's really important to listen to what people's concerns are, to make accommodations wherever they are needed, and to understand that a lot of where people are coming from is an emotional place.Second, to a certain extent, I can't make you feel safe no matter what I do. People need to understand where their own fear is coming from, and they need to do that work themselves. Otherwise, they externalize that fear and look at homeless people, drug users, or sex workers and just have so much angst about what they are experiencing, that they feel the need to "fix" what they perceive to be the problem. And then it's impossible to get to the root causes that are creating the situation in the first place. Harm reduction says, educate people so they can make their own choices, and don't stigmatize them or judge them in the process. It's a very powerful way of thinking, and it definitely can extend well beyond sex work.Naomi Akers, a sex workers' rights activist in the Bay Area since 1995, has worked in multiple sex work venues, both legal and illegal, including Nevada brothels, escorting, stripping, massage parlor work, taxi dancing, and street hustling in San Francisco and Los Angeles. Her passions center around harm reduction, social justice, and health care as a human right, particularly for sex workers, substance users, and prisoners. She is currently an artist at East Bay Made.