Using a Harm Reduction Approach and Mobile Outreach to Promote Health Among Those Engaged in Street-Based Sex Work and Drug Use

Community-Based Organization: HIPS | Washington, D.C.

Contact: Sasanka Jinadasa, Capacity Building and Community Resource Manager |hips.org

We recognize that there are many stages of change, and we can support people at any stage where they are at.

– Catherine Paquette, former HIPS Mobile Services Manager

Harm reduction is an evidence-based, public health approach that uses practical strategies to reduce the harmful consequences associated with certain high-risk behaviors[1]. For example, a harm reduction approach to drug use could involve counseling someone about the risks involved or giving them sterile syringes. With the aim of “meeting people where they’re at”, HIPS, a nonprofit organization based in Washington, D.C., uses a comprehensive mobile outreach program and harm reduction approach. Their services reach street-based sex workers, injection drug users, those experiencing homelessness, and other marginalized communities.

Founded in 1993, HIPS provides a wide array of harm reduction services and support including community and peer education, client advocacy, and mobile outreach. HIPS designed its outreach around the reality and context of those served by the organization. They found that individuals engaging in street-based sex work, using drugs, or living on the streets did not want to, or were unable to, go to an office to receive services. HIPS was able to better engage clients by conducting outreach at night, providing condoms and other safe sex materials to sex workers while they are working, and being an available and visible resource on the streets.

Every Thursday to Saturday, from 11pm – 5am, HIPS outreach team drives the mobile outreach van and visits pre-determined areas where sex workers and those living on the streets are usually based. The outreach teams ask clients what supplies or needs they have for that evening, and provide them with condoms and other safe sex materials, HIV testing and counseling, or a drink and snacks. HIPS also provides referrals and linkages to health and social services, case management, and counseling. All services offered are free. Additionally, HIPS supports sex workers by compiling and distributing a “Bad Date Sheet”, which keeps track of self-reported violent encounters and lists identifying traits of the perpetrators. The “Bad Date Sheet” was created because HIPS found that their clients were often reluctant to go to the police after violent encounters, due to fear and a history of being dismissed.

HIPS outreach program is made up of a large group of over 100 volunteers who work on a rotating schedule. For the weekend, night-based outreach shifts, the team consists of four people, including three volunteers and a team leader, who is usually a HIPS staff member or a seasoned volunteer. The team leader drives the van, and the volunteer who sits in the front passenger seat is responsible for approaching and engaging people. When conducting outreach, the team remains inside the van, and provides services from the front passenger seat side. For HIV testing and counseling, the trained team member will sit with the client in the van, and the rest of the team will wait inside a designated safe space, such as a hotel.

In addition to the mobile outreach services offered during the weekend, HIPS also conducts daytime outreach, which is staffed by HIPS staff and small group of volunteers and interns. The daytime outreach is focused on providing services to those who use drugs, with disabilities, have unstable housing, or have no access to a mobile phone. The outreach team goes out from Mondays to Thursdays and targets specific areas in D.C. They drive slowly through a neighborhood where there is drug use, and deliver supplies such as condoms, syringes, and other needed materials. On Tuesdays, HIPS usually sets up at designated place, such as on a corner, where people know to find them. Thursday is considered a pick-up day, where HIPS conducts site-based needle exchange by going to certain areas to collect used syringes.

HIPS continually strives to provide low-barrier services to populations that often face many challenges and barriers to accessing resources and services. In 2014, HIPS made 7,000 contacts with clients during weekend outreach, distributed over 500,000 condoms and safe sex supplies, enrolled 980 individuals in drug treatment or medical services, and distributed and collected 250,000 syringes from injection drug users. HIPS and its outreach programs are funded through a combination of private and public grants. In addition, the organization is supported by a cohort of volunteers who help implement the outreach services. As an organization, HIPS is continuing to grow, and is working to expand and go beyond their outreach services by establishing a “Center for Health and Achievement”, which will offer medical and other health services on-site.

HOP Tip: Although traditionally focused on drug use, the harm reduction approach can be useful for health workers who want to address other types of high-risk behaviors of their patients, such as smoking or unhealthy eating. Outreach workers can use harm reduction approaches and strategies to support patients and community members in reaching their health goals in a way that meets an individual’s needs and at their own pace.