Content warning: The following text describes addiction and graphic content and can be disturbing and/or triggering for some readers. Please find resources listed at the bottom of the article.
“It was a really dark time,” recalls Jose de Marco. During the AIDS epidemic of the ‘80s and ‘90s, “many of us were losing friends, lovers, [or] community members on almost a weekly basis. It was full of stigma, full of ignorance. People's families were literally kicking them out of their homes because they were so afraid of getting HIV.”
De Marco had a partner who was HIV positive. Born in Akron, Ohio, de Marco’s partner returned to his home city as his condition worsened, accompanied by de Marco. “God knows [Akron] is not the place to be a person with AIDS,” he says. Medication was expensive, and his partner was unable to get a Medicaid card.
“I remember going into a public assistance office and literally having to raise hell and scream at the top of my lungs that ‘my partner [is] dying and he needs medication,'” de Marco says. This first direct action step marked the beginning of a life devoted to AIDS activism, of which harm reduction is an inextricable part.
Harm reduction is a public health approach that focuses on mitigating the damage caused by risky behavior rather than stopping the behavior itself. It promotes safety and evidence–based methods for preserving health, meeting people where they are, and recognizing that they may not be ready to or capable of stopping their high–risk behavior.
After de Marco’s partner died, they returned from Akron to Philadelphia. They were HIV positive as well, then considered “a death sentence” due to the lack of effective treatment, so they decided to stop working. They spent their nights volunteering with Action Wellness—formerly known as ActionAIDS—a group that provided services to people living with the disease, but still felt a greater need to attack the systemic issues contributing to the crisis.
“Back then I had a lot of anger and resentment at the government for ignoring us queer men,” de Marco says. “Then I met some white anarchist kids in ‘96 or ‘97. They invited me to ACT UP, and that’s where I really cut my teeth on activism.”
The AIDS Coalition to Unleash Power, better known as ACT UP, is an international grassroots political group founded in New York City in 1987 to end the AIDS crisis through direct action. ACT UP was responsible for spearheading early forms of harm reduction, including needle exchange, wound care, and condom distribution in jails.
Eventually, harm reduction–specific groups arose out of ACT UP. In 1991, Prevention Point Philadelphia was founded by John Paul Hammond, an HIV–positive active drug user, to help people who used drugs. “The community itself always knows what it needs best,” Demarco says, so the group was run by active users themselves.
PPP continues to offer syringe services, legalized by former Philadelphia Mayor Ed Rendell in 1992, six days per week. These programs became increasingly essential, as the opioid epidemic hit the city of Philadelphia particularly hard.
The widespread presence of drugs in Philadelphia dates back to the early ‘70s, when industry left the city’s Kensington neighborhood and the drug trade took over. Today, Kensington is known as the largest open–air drug market on the East Coast.
1,276 people in Philadelphia died by overdose in 2021, a record high for the city. The arrival of xylazine, a synthetic opioid up to 50 times stronger than heroin, correlates with this increase in deaths. Known as “Tranq” on the streets, it amplifies and extends a high when mixed with fentanyl or heroin. However, this comes with serious health consequences.
Tranq restricts blood flow through the skin tissue, leaving users with unhealable necrotic ulcers and soft tissue infections that when left untreated, require amputation. Because it is a sedative, Tranq dope—a mix of fentanyl and Tranq—does not respond well to Narcan, which only reverses the former.
First detected in Philadelphia in 2006, by 2021 Tranq was found in 90 percent of street opioid samples in Philadelphia and was laced in the drugs that resulted in 44 percent of unintentional overdoses that year.
When using a harm reduction approach to stop overdose and mitigate other damage caused by drug use, PPP Communications Coordinator Hilary Disch emphasizes the importance of empathy.
“If you’re going to offer services through a harm reduction lens, it’s important that you do it in a judgment–free way,” Disch says. “There’s no expectation that somebody will stop using drugs or stop engaging in sex work because we’re giving them help. We just want to help you make any positive change that you want to make.”
Harm reduction services are geared towards people who use drugs, engage in street–based sex work, or are at high risk of contracting transmittable diseases like HIV and Hepatitis C, Disch says.
The main PPP Building, located in the heart of Kensington, offers services such as one–to–one needle exchanges, whereby old needles are exchanged for new ones, and emergency packs, for which old needles are not accepted in return. Mobile sites allow the organization to provide exchanges around the city.
PPP’s staff of 140 comes from various backgrounds, ranging from MDs and Ph.D.s to people without a GED. A large portion of staff are bilingual to best support Kensington’s large Puerto Rican population. Volunteers also contribute to syringe, drop–in, and overdose prevention services.
Some staff are currently in recovery. “It’s a beautiful thing to see my colleagues be able to offer lived experience out there in Kensington and the knowledge and the daily work of recovery to our participants,” Disch says.
Over its 30 year history, PPP has expanded to include several other forms of harm reduction–based aid. A wound care center offers free, accessible, specialized care for everyone, but particularly those with injection–related wounds. The center has seen a massive uptick in visits recently as a result of the arrival of fentanyl and Tranq.
The organization’s Overdose Prevention Team spreads education, resources, and tools towards ending fatal overdoses. The team engages in outreach both on foot and by car throughout Kensington and the rest of Philadelphia to ensure that the people who are the most likely to need to reverse an overdose are trained and equipped with Narcan, distributing thousands of doses every month.
PPP also hosts a Medication for Opioid Use Disorder Clinic which offers a holistic, medically–assisted approach to reducing or ending opioid consumption. Doctors prescribe patients medication, most commonly buprenorphine or naltrexone injections, to treat addiction while caseworkers guide them through the process.
The organization believes in a housing first approach, hosting 60 to 65 people at a time at the Beacon House, a shelter on Temple University Hospital’s Episcopal Campus. Residents aren’t permitted to use drugs on the shelter’s premises, but sobriety isn’t an expectation. “Our goal is to stabilize residents and support their goals,” Disch says.
Finally, basic social services are offered at a drop–in center, where people can receive aid in a variety of forms ranging from case management support to mail services to coffee to clothing and hygiene products. It’s a place where people can come without fear of judgment.
According to Disch, the majority of people utilizing PPP services face addiction and homelessness simultaneously. “When you’re living with both these things at the same time, it’s really hard to address one or the other,” she says. “You’re just trying to make it through the day. These are generally really strong, really resourceful people.”
To help recovering users balance the different needs associated with homelessness and addiction, PPP aims to provide them with in–house support as frequently as possible. “Once you start sending people across the city to see that doctor or that social worker is when you see people start to drop out of care,” Disch says.
Because needle exchanges are illegal in Pennsylvania outside of Philadelphia and Pittsburgh, participants also travel from outside the city to utilize PPP’s services. People come across the bridge from New Jersey as well as from Delaware, where harm reduction programs are not available on the same scale.
Some people living with addiction seek support and community from the estimated 150 recovery homes throughout the city. But Pennsylvania has no licensing laws for addiction recovery homes, meaning they operate with little oversight. Recovery advocates say this allows some to take advantage of residents, providing low–quality and substandard support.
Sarah Laurel’s experiences living with addiction while unhoused led her to create an alternative to the poor treatment she received in recovery homes.
Laurel recalls one experience in which she was thrown out of a second story window while unhoused in Kensington. She spent ten days in the ICU, focusing on the word embroidered on her dress: “Savage.”
Suffering from memory loss, Laurel found herself repeatedly googling ‘savage,’ with the word “ferocious” popping up at the top of the results. When she got sober, she landed on the name ‘Savage Sisters: Attacking addiction ferociously’ for her program. She still has that dress framed above her bed.
The Savage Sisters recovery house, born in 2017, initially provided free trauma therapy, kickboxing, and in–house yoga to six women. Low–income people often don’t have access to the physical and mental health services that help them recover, so Laurel fundraised to create a space where high quality care could be free.
After two of Laurel’s close friends died in a home with no Narcan, she wanted to return to Kensington and do community work. She started doing outreach from her stoop in support of her “friends that were still out there.” She set up a folding table and invited her ten siblings to help distribute Narcan, safe sex kits, and sterile syringes.
Today, Savage Sisters has grown to encompass six houses, including three for men, and a drop–in house, where people can come to shower or get their wounds dressed. In addition to outreach services, the expanded Savage Sisters oversees statewide overdose reversal training programs and a Kensington beautification project.
Since its inception, Savage Sisters has reached 31,200 people and distributed 19,700 doses of Narcan. All of their funding comes from community contributions.
“We're not trying to be the McDonald's of harm reduction or housing,” Laurel says. “We're culturally relevant to Philly; we're from Philly; we're serving Philly. When the community sees that, they want to donate.”
Today, Savage Sisters is run by a group of five. A team of about 100 volunteers helps to operate the drop–in center, housing, and outreach. Everyone on staff has lived experience with addiction and being unhoused, giving them invaluable insight into how to best reach their intended community.
Laurel says that her teams’ experiences have taught them the importance of allowing people to guide their own recovery. During her personal journey, she was blindly prescribed medication and told what programs to take part in, but rarely asked how she was feeling or what she needed. Now, she strives to approach recovery in a more compassionate way through Savage Sisters.
“We’re trying to change the narrative here,” Laurel says. “We're not addicts and alcoholics; we're people who use substances. These are my friends. We don't approach them with an expectation that they have to behave in a certain way to receive services.”
Laurel aims for Savage Sisters to be “non–professional, effective, and meaningful.” This means staying local, especially as Tranq continues to contaminate Philly’s illicit drug supply. She believes that the presence of Tranq, combined with a sense of apathy from City Council, makes the needs of Philadelphia unique.
Laurel also maintains that the city’s culture—the “underdog energy” and “hustler” mentality—also shapes the appropriate harm reduction approach.
“We are a tough group and we're known nationwide for that toughness,” Laurel says. “But underneath that, we have each other’s backs. If you were to take my aggressive, radical love and my ‘get shit done’ attitude to a different city, it might not make sense. But it's definitely making sense here.”
In addition to taking a community–focused approach, activists emphasize the importance of addressing systemic inequality that impacts access to health care. HIV continues to impact communities of color at a disproportionate rate: 69 percent of HIV diagnoses in 2020 were Black and Latinx people. Jose Demarco says these numbers correlate with privilege and limited access to insurance and education.
Through ACT UP and Black and Latinx Community Control Philadelphia, a wellness–focused committee, de Marco and other activists have been working to bring the needs of people of color to the forefront of the city’s attention.
“The city knows what’s going on, but they still need to hear from the community itself and improve accessibility,” de Marco says. He emphasizes the need to make PrEP, a drug that is effective at preventing HIV, widely accessible in all communities and increase funding for smaller organizations that are focused on supporting people of color and the LGBTQ community, like GALAEI.
Founded in 1989, GALAEI initially focused its efforts on supporting the Latinx community impacted by the AIDS crisis. Since its founding, they have expanded to serve all queer, transgender, Black, Indigenous, people of color “and anyone who comes to our door and needs resources,” Executive Director Tyrell Brown says.
GALAEI holds a program called “Prioritizing Our People,” which addresses HIV prevention and sexual education through a social justice lens. POP also connects people in need to food banks, housing, and college application support.
In keeping with its target population, GALAEI offers a Trans, Intersex, Non Binary, and Gender nonconforming–focused program. The only one of its kind in Philadelphia, T.I.N.G.S offers a similar range of services as POP, with an emphasis on non–cisgender needs.
Student Power Leadership And Activism Together functions as GALALEI's youth programming, including the organizing of queer–straight alliances in schools, prevention education, and other events to support queer youth and their families.
“All of the services on campus focus on delivering resources to our community,” Brown says. “We want to give people that important knowledge of where they come from [and] who they are so that we can chart a path that’s powerful for our community moving forward.”
He points to systemic inequalities that drive need for the services GALAEI offers. Pennsylvania lacks state laws prohibiting housing or employment discrimination, which makes security difficult to achieve for queer people of color.
“Oftentimes in our community of queer Black and brown folks, we don't have the safety net to be able to fall back on—even in our families or our own neighborhoods where we grew up,” Brown says. “We're always working to cultivate that foundation so that people feel empowered to take action.”
GALAEI is currently run by Brown and four others, all of whom are trans or nonbinary, Latinx or Black, and from low–income backgrounds. Because Brown is the only GALAEI staff member with even a two–year college degree, a lot of their knowledge comes from experiences in the community, he says.
“I think [our backgrounds] are a statement to how powerful, strong, and impactful an organization that’s culturally competent and informed on community needs can be,” Brown says.
He hopes to see GALAEI develop into a larger scale organization: “I want us to leave a footprint on Philadelphia. When you come to Philly, I want GALAEI to be a staple and a stopping point for Black, Brown, Trans, Queer, Indigenous and people of color.”
The desire to support Philadelphians in need also extends to Penn’s campus. Last November, College juniors Katelyn Colamesta and Catherine Hood came together to address the lack of a harm reduction–based community at Penn.
“I wanted to start this group because I think a lot of us are numb to the realities of addiction, how rampant addiction is and how it touches so many lives,” Catherine says. “When you walk by someone who’s clearly living with addiction on the street, it’s just accepted as normal. I’m hoping to bring attention to the cause.”
So they formed the Student Harm Reduction Coalition this semester. Now, 28 students are involved in SHARC, volunteering in weekly cohorts at several harm reduction sites around Philadelphia, including PPP, and meeting to discuss their experiences together once a month.
Their roles as volunteers vary day–to–day, but typical responsibilities include packing up safe injection kits and Narcan kits and distributing needles and wound care supplies.
The students involved come from a range of backgrounds. Some have been personally impacted by addiction or are conducting harm reduction–related research. Others joined not knowing much about harm reduction but wanting to learn more.
According to Catherine, volunteering in Kensington has been a way for Penn students to humanize harm reduction work, while making the tough questions about harm reduction feel more approachable and transparent. When SHARC holds conversations together on campus, they often discuss the aspects of their experiences that make them uncomfortable.
“A lot of the growth is in unlearning things you may have thought before,” Catherine says. “People often associate certain stereotypes with addiction, but the reality is that it doesn’t discriminate, and it touches everyone.”
Moving forward, SHARC hopes to create an outreach committee to educate the Penn community on harm reduction. Information about where Narcan is available on campus and in dorms is very unclear. Catherine wants to play a role in changing that by making test strips and Narcan accessible, and offering accompanying training sessions on how to administer it.
“Denying that drugs exist on Penn’s campus is a waste of time,” she says. “But trying to reduce the harm around drug use is not a waste of time. Harm reduction is such a simple thing that can have a huge impact, and it needs to be more available.”
The emergence of harm reduction efforts on Penn’s campus reflect a larger trend towards acceptance and understanding of these approaches in recent years. The passing of House Bill 1393—which removes fentanyl strips from the category of drug paraphernalia in the Controlled Substances Act—and the FDA’s approval of over–the–counter Narcan are important first steps.
Laurel recognizes these strides, but plans to continue fighting for greater access. Her hope is that forms of healing and therapy will eventually be billed through Medicare and Medicaid. She believes safe syringes should be legalized statewide, and that users should have access to unlaced drugs.
Among the most common forms of stigma harm reduction organizations face is the idea that they are enabling addiction. All of the activists push back against this idea.
“I got the question, ‘who enabled your addiction?’ just yesterday,” Laurel says. “And that’s essentially trying to blame my mental health disorder on the circumstances of my exterior life, which is not fair. People are going to make decisions for themselves, and we respect that right. We’re just trying to create safety and autonomy for all humans.”
Disch further emphasizes Laurel’s point, insisting on the need to treat addiction like any other medical issue. “These people have full lives and full histories,” she says. “They’re just going through a tough time and should be treated with just as much care as a type of cancer or someone suffering from diabetes. It’s not that they’re doing something wrong, it’s that they need medical services.”
To combat these stereotypes, Laurel believes in the importance of taking a “less fancy words, more real talk” approach to teaching people about what harm reduction is.
“When you teach it at that very basic level, you create a sense of understanding that breaks down stigma and judgement,” Laurel says. “Any situation can be a harm reduction situation. People are hungry; we give them food. You’re driving a car; you wear a seat belt.”
The HELP Line: 215–898–HELP: A 24–hour–a–day phone number for members of the Penn community who seek help in navigating Penn's resources for health and wellness.
Student Health and Counseling: Counseling: 215–898–7021 (active 24/7): The counseling center for the University of Pennsylvania.
Student Health and Counseling: Medical Care: 215–746–3535: Student Health and Counseling can provide medical evaluations and treatment to victims/survivors of sexual and relationship violence, regardless of whether they make a report or seek additional resources. Both male and female providers can perform examinations, discuss testing and treatment of sexually transmissible infections, provide emergency contraception if necessary, and arrange for referrals and follow up.
Reach–A–Peer Helpline: 215–573–2727 (every day from 9 p.m. to 1 a.m.), A peer hotline to provide peer support, information, and referrals to Penn students.
Penn Violence Prevention: 215–746–2642. Located at 3611 Locust Walk. Read the Penn Violence Prevention resource guide.
Sexual Trauma Treatment Outreach and Prevention Team: A multidisciplinary team at CAPS dedicated to supporting students who have experienced sexual trauma.
Division of Public Safety Special Services: Trained personnel offer crisis intervention, accompaniment to legal and medical proceedings, options counseling and advocacy, and linkages to other community resources.
Penn Women's Center: 3643 Locust Walk (Office Hours: 9:30 a.m.–5:30 p.m. Monday–Thursday, 9:30 a.m.–5 p.m. Friday), 215–898–8611. PWC provides confidential crisis and options counseling.