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Exploitation is to Sex Work as Overdose is to Drug Use

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Justice Rivera, Partner at RHJ

Human Trafficking Awareness Month is more than just posters and commercials — it is a month where we should take a critical look at our approaches and ask how these interventions are growing and evolving. This month, the anti-trafficking movement can learn from other movements for health and justice including the harm reduction movement. Using a harm reduction approach to drug use means trying to limit the potential negative consequences of drug use. While this can mean access to clean needles to prevent HIV and Hepatitis C transmission, it also takes seriously the social dynamics that influence drug use itself (check out the Harm Reduction Coalition at for more information on the origins and philosophy of harm reduction). Just like overdose is one potential harm of drug use, trafficking is one potential harm of labor. By considering a broad understanding of harm and broader interventions to reduce trafficking, anti-trafficking advocates can learn a lot from anti-overdose advocates.

In 2009, when opioid overdoses surpassed car crashes as the top accidental fatality in the country, drug users and people who loved and worked with drug users began changing laws to increase access to Naloxone, a drug that reverses opioid overdose. Naloxone is an overdose intervention that saves lives. It has few to no side effects. Outside of communities directly impacted by overdose, the common misconception of Naloxone and other harm reduction approaches to drug use was that it enabled people to continue using. The escalation of America’s opioid crisis and the success of Naloxone as an overdose intervention have swayed many people’s beliefs about how to approach overdose. Even treatment and criminal legal professionals now know that not all drug use leads to overdose and that when an overdose occurs, the person should be given immediate care and the option of a longer-term support strategy which can include anything from health care to treatment to housing.

This is the public health approach to overdose — where overdose is one potential negative consequence of drug use and that interventions can be put into place to prevent and reverse this harm. The harm reduction view of drug use does not stop at overdose. Harm reduction means taking these interventions one step farther to recognize that overdose is one potential negative consequence of the war on drugs. To seriously address the rise in overdose deaths, we need to consider and address ineffective policies and social conditions such as poverty and racism. These sociopolitical factors perpetuate harm and are best tackled through community-level interventions and broader social change.

Drug war tactics like policing and surveillance push drug use underground. This exacerbates the overdose crisis by reducing people’s knowledge of how or where to use safely. People are constantly put in a position where they can either use publicly and face arrest or use privately and risk fatal overdose. Community-level interventions reduce overdose by creating safe places for people to use and providing information on safety. Insite, a Safe Consumption Space in Vancouver, is an example of such a space.

Insite offers harm reduction supplies such as sterile syringes, as well as HIV/HCV testing, micro-counseling, and linkage to mental health support and housing. The facility has nurses on-site to treat bacterial infections and respond to overdoses, reversing them immediately. The top floor of the facility provides substance use treatment. After opening, city-wide overdoses were reduced. By providing people access to safe use, rather than decreasing access to safe use like the war on drugs does, Safe Consumption Sites create the best long-term health and wellness outcomes for people who use drugs. Movement is currently underway to open Safe Consumption Spaces in several US cities including Philadelphia, Seattle, Denver, and San Francisco — often referred to as Overdose Prevention Sites.

Not all sex work begins or ends with exploitation, just as not all drug use leads to overdose. Exploitation within the sex trade is a harm that can be prevented. A harm reduction approach to the sex trade means examining, preventing, and addressing all forms of possible harm that can occur in someone’s work. Since the degree of choice someone has is often determined by that person’s access to resources, applying a harm reduction lens to sex trafficking means increasing a person’s access to resources. Then, they have a higher ability to choose things that feel good to them.

The war on trafficking, like the war on drugs, takes prohibitionist measures to end the sex trade but instead results in pushing it out of sight. Inflated drug charges such as the crack vs cocaine disparity, mandatory minimum prison sentences, and discriminatory policing mean that people who use drugs exist in a violent underground market, use adulterated products, and don’t have access to safe drug use supplies. Comparably, the war on sex trafficking uses inflated charges such as pandering charges, zoning restrictions, and abusive policing that force many sex workers to work in isolation where they have a hard time accessing safety information, community, and income. These vulnerabilities are easily exploitable. One study illuminates that prohibitionist anti-trafficking measures often create less safe environments for the people existing in them without providing additional resources.

Viewing exploitation like overdose helps shift the focus from the work itself to safety. Like promoting safe drug use, promoting safe sex work means increasing access to comprehensive sex education and addressing occupational safety concerns. It means leveraging community-based interventions like bad date lists and Pros Networks. It also means promoting access to safe space. In her essay, The Paradox of Policing as Protection: A Harm Reduction Approach to Prostitution Using Safe Injection Sites as a Guide, Imani Walks discusses the benefits of applying Safe Consumption Space models to the sex trade to create Safe Sex Work Spaces. Safe Sex Work Spaces could reduce violence and exploitation by providing free, safe, and sterile places for sex workers to take dates, as well as resources and safe sex supplies.

It is these sorts of innovative interventions that should be discussed during anti-trafficking awareness month as people who are working to prevent trafficking grapple with what that means and looks like. When exploitation is treated like overdose, people’s lives and bodily autonomy are centered over public safety. Attention is shifted from the privileged public to the most marginalized in recognition that policing and prisons negatively impact people of color and people experiencing poverty the greatest. Just like drug harm reduction is a strategy for reducing overdose and racialized drug enforcement, sex work harm reduction is an anti-trafficking strategy that considers and addresses racial inequalities. It is time for it to be recognized and utilized as such.

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