Harm Reduction: More Than Just How to Use a Condom

Kate D’Adamo

In the last few weeks, the federal bills SESTA and FOSTA have spurred a dialogue about harm reduction for sex workers online. Conversations about screening and safety information and their inherent liability when something is criminalized weighed heavily in the minds of service organizations (though, less so in the minds of politicians). It was wonderful to see organizations talking about how access to information about safety and health were direly important for people who trade sex. It also gave a strong reminder that the first rule of harm reduction is asking *what* harm people are addressing, instead of making assumptions.

The harm reduction conversation has become more prevalent, especially as different health crisis have emerged around opioid use and access to syringes and safer use supplies. Street outreach for sex workers distributing condoms and other safety supplies have become a corner stone of many organizations’ work. This primary focus on medical needs, though, can often narrow the conversation and make us forget that what organizations can offer must align with what folks actually want and need.

Many of the journalists and advocates asked if there was a way to narrow the language of the final bill to preserve sites offering purely harm reduction services and information. While I played with the idea of this in my head, I always came back to the same foundation: that when the bill’s target is facilitation of prostitution, and targets those websites, people can’t stay online. The form of harm reduction that matters is the ability to work in a safer space. Trying to preserve screening tips while letting online advertising sites go is like asking for a rubella vaccine while being executed.

And in the fall-out since the bill’s signing, it has not just been advertising sites which have been lost. On Reddit in particular, threads where sex workers talked and found community were also deleted. Harm reduction is also based on the ability to connect to others, to build trust, and to know that something else is possible. One of the harms of abstinence-only based conversations around drugs or sex is that they pretend like there aren’t options to stay safe — and when sex workers are constantly reminded of their own mortality, and groups like the National Center on Sexual Exploitation’s excitement for it, it may seem like violence and death are the only experiences to have.

This is not to say there is anything inherently violent about sex work in other venues, including on the street. The things that make sex work dangerous — its policing, its isolation, its visibility and targeted creation of a population easily victimized — are all amplified in street-based locations. Online work simply mitigates many of those existing issues. Online advertising also carries its own risks around a digital footprint which can be targeted or the longer timeline from need to money that might be too high for folks, making street-based solicitation the preferable option. Either way, we are talking about the harms of criminalization and stigmatization, not the harms of exchanging sex.

Harm reduction in sex work is not just about how to properly use a condom. It’s also about having someone to talk to after you’ve had what feels like an assault, but it was with a client and you feel crazy for having complicated responses. It’s also asking for advice when you have to find a new place to live and can’t figure out how a cash economy can get you a lease. It’s making the friend who will watch you kid when you need to work who doesn’t side-eye you when it’s 11:00 at night for two hours. It’s being able to say “does anyone know a medical provider I can go to where I can talk about this stuff?” Harm reduction doesn’t just begin in harm, it begins in the knowledge and trust that can only be built in people who know. And this, at its core, is what SESTA erodes.