SWAN Study Shows ​“Harm Reduction” Keeping People Safe On The Street

A few years ago, hospital workers tried to confiscate the purple-gray backpack that Christine carries with her everywhere, she said. At the time, the bag was her only possession; it doubled as a pillow when she slept on the streets.

Rather than sacrifice the bag, Christine refused health care. She has avoided medical centers ever since.

Now, as a volunteer with the Sex Workers and Allies Network (SWAN) who obtained housing, Christine uses that same backpack to carry a form of medical care that hospitals often fail to provide: ​“harm reduction” supplies like clean needles and condoms, which can mean the difference between life and death for those who use them.

Christine, who asked to be identified only by her first name, joined other members of SWAN on Friday morning to hear the results of a Quinnipiac medical student’s research on the benefits of a harm reduction organization like SWAN.

The group gathered in the Fair Haven headquarters of the women’s homeless services organization New Reach as med student Allison Cammisa shared her findings.

Cammisa interviewed 12 SWAN members over the age of 18 to learn how the organization built trust and community with its members.

She learned that the lived experience that SWAN leaders had as sex workers was critical in building strong relationships with members; that the organization’s founder, Beatrice Codianni, has had a strong impact on members through her tireless advocacy; that harm reduction supplies, such as Narcan for overdose treatment, have helped members take better care of their health; and that the network of connections that SWAN establishes has also helped people stay safe.

SWAN, which was founded in 2016, runs structured support groups and hosts yoga, meditation, sexually-transmitted disease educational sessions, and self-defense classes. The organization also builds community informally, with activism, street outreach, and efforts to spread the word about ​“bad dates” to avoid, for instance. 

“What people most talked about was relationships,” said Camissa’s advisor, Quinnipiac social work professor Amber Kelly. ​“When people are talking about harm reduction, people talk about stuff. They don’t usually talk about community.”

From her interviews with SWAN members, Camissa said, ​“I realized how to approach patients better”: by looking people in the eye, for instance, and using respectful and open body language.

Camissa, who started the study in 2018 and is now in her fourth year of medical school, said she never learned about harm reduction in her classes. ​“We don’t really touch upon it.” 

Codianni has been advocating for hospitals to treat patients with substance use disorder from a harm reduction approach. Without resources like clean needles, substance users can contract illnesses from dirty needles. ​“You’re killing them,” she said.

“We’re not trying to ​‘save’ people,” said Codianni. ​“We’re trying to meet people where they are.”

SWAN recently joined the Connecticut Harm Reduction Alliance and is growing its programming now that the pandemic has become less acute. Codianni dreams of opening a ​“SWAN house” that can provide housing for sex workers, along with a drop-in center near Ferry Street that would accommodate women who have survived harassment and gender-based violence.

Many sex workers have had traumatic experiences seeking medical care, as Friday’s conversation demonstrated. Christine recalled that as the hospital attempted to confiscate her bag, someone told her to take off her clothes so that doctors could assess abscess infections, which made her more uncomfortable. She said that one health care worker told her, ​“Do you want to go to Yale [hospital] or jail?” The interaction still distresses her, she said; she has avoided medical care whenever possible since, especially if no one else is there to make sure she’s safe.

Attendees on Friday contrasted those experiences with the community-based care offered by Cornell Scott Hill Health nurse practitioner Phil Costello.

“So many of us would be dead without Phil Costello,” said Christine. She said that Costello checks in on her regularly, takes her to appointments at other institutions, and always asks if she is comfortable with every step of the medical process. The fact that Costello provides medical care directly on the street, right where patients are, makes the experience far more accessible, she said. 

Christine provides street harm reduction outreach herself. Christine’s backpack now contains hand warmers, toiletries, gloves, alcohol pads, condoms, needles of different sizes, socks, wipes, and other supplies. She gives out these tools to anyone on the street who needs them. Perhaps the most important tool, she said, is the ​“cooker kit” — a tool that can be used to prepare heroin. Many heroin users have forms of hepatitis C, Christine said, and the cooker kit helps prevent people from sharing tools and potentially endangering their health.

“I’ll carry this till the day I die,” Christine said.