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Aug 8, 2008

Speech "The New Frontiers Of Harm Reduction" AIDS Mexico 2008

Nothing about us without us, The New Frontiers of Harm Reduction

Stijn Goossens, Belgium

Click here for the session slides

Full Video - The New Frontiers of Harm Reduction
(Stijn's presentation starts at the 41st minute of the video)

  • HR2 - Harm reduction and human rights, Rick Lines, United Kingdom

  • Young people taking the lead, Caitlin Padgett, Canada

  • HIV and drug use (including alcohol) in Africa, Olanrewaju Onigbogi, Nigeria

  • Nothing about us without us, The New Frontiers of Harm Reduction, Stijn Goossens, Belgium

  • HIV and non-injecting drug use in Latin America, Graciela Touze, Argentina

Good day to all of you.

It’s wonderful that the organizers of this year World AIDS Conference have included so many harm reduction and DU related events in the program.

It is also wonderful that a DU is invited to speak at the New Frontiers of HR session.

Unfortunately - it’s already not that wonderful that I / the DUA have to speak again on “Nothing About Us Without Us”. Since the IHRA’s IHRC’2006 held in Vancouver, where VANDU (the local DUO) presented first this small- but very true - booklet, it seems that wherever there is a HR event a DUA is invited to speak on “Nothing About Us Without Us”.

Nevertheless, if we look what happens in practice we’ll see that nothing has changed that much since Vancouver. DU – insist to be included; the professionals – acknowledge that our partnership is crucially needed, but apart from some very local or very isolated examples – no real cooperation have ever been achieved.

Therefore, this time I’ll not repeat again WHY DU Should be involved in everything About Us. Apparently – either for real or for show off – everyone agree here. Our main concern and I mean my peers and my own main concern is can we Ever Achieve a Real Cooperation?

I say this because the general way DUA are addressed and treated drives them away from DUA.

With all my respect and admiration to everybody in this room and everybody world-wide who is striving for real harm reduction, I’ll try to present truly my – DU point of view – on how I feel about DU Activism, WHY the best of our peers lose their flame, and HOW to keep them involved. I mean no insult to anyone. Just “Nothing about Us without Us” can never be if there are no DUA with experience and expertise left around.

To be able to make it more clear that We Really Do Lose Our Best DUA and also – to make it more clear Why They Go Away – I start from the very bottom-line, or – from the most basic and fundamental position, which in our case - I believe - is the differences in the understanding of :


Let’s before speaking about cooperation agree upon who we (the DUA) will cooperate with? About what? And mainly – Where Harm Reduction Ends And Turns Into Something That No Real DUA Will Cooperate For.

I’ll repeat once again- I mean no insult to anyone. It’s not me. It’s the brutal reality my peers and me are forced to accept daily. And please – trust me that I have plenty of reasons to make all these statements you read behind me.

Still, being a DU - or not that trustworthy by default - I’ll also give prove, so everyone could have a better trust in me and in my position.

If we just open the official web page of one well-known Harm Reduction organization on the most central place, under the title What Is Harm Reduction we read:

The major consequences of drug use are:

  • Transmission of blood borne diseases such as HIV/AIDS and Hepatitis B and C

  • Overdose

  • Various medical and psychological conditions, etc., etc. and there are some more of these.

So as I’ve appointed DUA find these consequences and all of the other consequences included in the quoted web page to be consequences of Prohibition, not consequences of Drug Use. It’s even not mentioned – consequences of Illegal Drug Use.

From another hand – the three UN Drugs convections, including the last one – about the Drug Free World achieved by Prohibition – obviously are the harm reduction measures of our society when DU opinion is not taken into consideration. That’s why we insist ‘Nothing About Us Without Us”.

That’s why also we lose our best DUA. The difference between Harm reduction and Prohibition is so small that we (DUA) after some time get confused what we work for, who we work with and from this moment on it’s very difficult for us to remain involved as activists.

To make it more clear again I’ll go back to the quoted web-site of the same partner-organization.

At the very same page there are 5 principle of HR appointed. The 1st is that wrong that I have to make a training to explain it. Without going too deep in the concept of Harm reduction I may say that in any case my (DU) basic need is not achieving abstinence in some future moment. This is neither the first principle of HR, nor - an appropriate perception to approach and cooperate with DUA. Even more- such starting position will never result in effective, user-friendly, client-centered harm reduction services.

Principle 2 is just partially wrong. It says: A hierarchy of risks must be established to avoid HIV infection from drug use.

I say that it’s partially wrong, because nowhere in the whole web-site there is no indication that harm reduction may refer to something else apart from preventing HIV and other blood transmitted infections. Actually Harm Reduction is much more. Harm reduction is not limited to one of the consequences of Prohibition. It covers all consequences and does not exclude any of the available options – even drug free is good enough when drug free comes as a result of personal voluntarily decision.

Anything that complies with human rights and is acknowledged by the local DU community as helpful, as useful, as working is harm reduction. And by local DU Community I mean – the community where the measures or the harm reduction programs are implemented.

Harm Reduction is not for sale! What works in Belgium does not necessarily work in Russia or elsewhere. Each community has its own problems that cause harms to both – the local DU and the local public.

Therefore, if we want to implement real harm reduction programs, the very first step should be – go deep down in the DU Community and check what is needed. That’s why we insist ‘Nothing About Us Without Us”.

And because no one actually listens to us – the people who use drugs- currently what we see in practice is:

In Belgium Harm Reduction is studied by criminologist. So far about Belgium and about the Harm reduction services in Belgium.

The best argument the professionals world-wide have pro harm reduction is : Cost Effective.

I really do not know how we -the DUA should feel about cost effective. Our peers – the previous generation DUA started what we nowadays call harm reduction with the sole goal – to save lives. Back then harm reduction belonged to DU Community and its cost-effectiveness came along implicitly.

Nowadays when harm reduction is monopolized by harm reduction professionals, when millions are spent on harm reduction projects, some of which – with questionable results, others – named Drug Free. And everything is so institutionalized that DU have to remind constantly that the main harm here is caused inside our community and by our community. I do not know how to feel about the cost-effectiveness of harm reduction.

I also do not know how to feel about harm reduction itself, if the people who do harm reduction today define it as – I quote: “a concept with alternative approaches that aim to keep drug users alive, healthy and productive until drug treatment works or until they grow out of drug use”. In any case - if our productiveness is calculated in the cost-effectiveness – we don’t like the cost-effectiveness that much anymore.

All around the world DU are stigmatized, discriminated, marginalized, and criminalized. We are also sick, isolated, homeless, detained in concentration camps! And .... WE have to be productive!

Under these conditions we do not want to be productive!!! And when addressed like this – we do not want to be cooperative!!!

That’s why today I changed the approach. Instead of explaining one more time WHY “Nothing About Us Without Us” I put the focus on HOW.

And if I quote all the time one and the same organization it is not to point finger. If you allow me I’ll even not name it. As I said – I do not want to insult anyone. I just want to make it more clear: what we – DUA - encounter daily. If I go to other web-sites of other acknowledged DU partners I’ll encounter for sure the same attitude. The reason to quote one and the same organization is to leave no room for misinterpretations of what I say.

I want to be absolutely clear that I do not make a compilation of the worst experiences my peers and I have ever had. For us – what you hear now is a routine. So at the current stage of cooperation we and our service providers have achieved, there are just few other things I want to add before I finish.

The most important is:

Do not do it without us. The practice show that it does not work. And all mistakes cost human lives. And if you want to do it in the right way, please, do not forget to approach in the right way, which means respect us as equal partners. My experience shows that the way we are approached is the main reason that makes the cooperation with DUA so difficult.

To clarify respect and equal partnership I have included three more pointers:

Don’t take DUA involvement for granted, or obligatory for us. We also have our bills. Pay us. I think here everything should be clear. We are far above the age of enthusiastic teen-agers. We might believe in what we do, but we have to survive. Most of us have families to support.

Our job is too exhausting to do it as a side hobby and meanwhile – to make our living as full time employees elsewhere. It just doesn’t work like this. There is no such hobby - activism. Being a DUA totally drains us. So having an airplane ticket and a hotel room for free from time to time is not good enough. Not that we are greedy. As I said – we have to survive to be available – like it goes with drug free: First - keep us alive.

Also - Do not think that we are the beneficiaries. Society wins. Motivate us. Don’t confuse payment with motivation. Being a DUA is neither easy, nor - pleasant, nor – a well paid job. Sooner or later even the most devoted of us start asking themselves why they have to take all that comes along with the job, if nothing seems to make a difference. Please, reconsider what motivation we have to do what we are expected and why should we undertake anything. Try for a moment to look from our point of view.

And once again - revise your approach and the offered motivation. Take into consideration our personality and individuality. WE ARE AVTIVISTS! Here we come again to the main issue we have: respect. If there was respect in our relations, everything else I said about payment, motivation would be unnecessary details.

If our professionals really respected us they would never address us in the way they do it now. Happily, although exceptions, we have real partners. I just would wish that our real partners become the majority.

What else I can say. If this is a session about the new frontiers of harm reduction and I’m suppose to speak on Nothing About Us Without Us, probably I have to make a comment on our – DU view on the new frontiers. But before appointing the new frontiers, let see where we stand now:


International level - promote the best practices worldwide

Local level – advocate for more harm reduction programs that address the needs of the local DU Community. Free, affordable and equal access to these programs

Cocaine and all other stimulants of amphetamine type: Start from the very beginning – RESERCH! And again: Implement HR programs based on the needs. This means Needs ASSESSMENT, not – political decisions, based on judgmental moralism or moralistic judgments. We do not need moralism – a little bit pragmatism will do better.

And, of course, under the conditions of Prohibition there will always be a black market of illegal substances that are potentially harmful.

Harm Reduction is not a constant, it’s a dynamic variable. The need for new harm reduction services does not end with concrete substances. There'll always be new drugs, new research will always be needed and new DUA who can tell you best about the new drugs.

So, if you – our professionals – prioritize what I just summarized up to now, Harm Reduction will be brought back to the right perspective from the times of its starting point. This would be one good new frontier.

For us – DUA – we will keep on insisting for more and better HR services, but we already put our new frontiers a little bit ahead. Through the approach of harm reduction we can address only the violation of our fundamental human right to health and proper medical services.

Unfortunately – the zero tolerance approach towards the DUs had unforeseeable in scale and unimaginable in cruelty practical results.

There are places where nowadays the concentration camps are called treatment facilities. And unfortunately we have our reasons to think that the future policies will allow increased options for health approach coming along with increased possibilities for repressions.

So – we’ll never turn our back on harm reduction but our new frontiers will be the approach of human rights in general. We have 30 fundamental human rights. In one way or another all of them are violated by the interpretations and the practical implementation of the UN Drug Conventions. We’ll use all possible legal means to stop the massive abuse of DU human rights world-wide.

Stijn Goossens

Drug User Activist


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