Resourcing Harm Reduction Blog Series: The Health Foundation of Greater Indianapolis
Recently, FCAA released a data spotlight illustrating the intersection of HIV and people who inject drugs (PWID). Given that PWID are 22 times more likely to acquire HIV than the rest of the global population, we felt that it was important to understand where private philanthropy was supporting harm reduction programs. As we worked with partners to analyze the data, it was clear that the numbers tell only one part of the story. We wanted to dig deeper, to understand what challenges grant makers and recipients are facing in funding and implementing these programs.
How did your organization begin/enter into funding harm reduction work?
Early on in the HIV epidemic, there was a need for strong advocates who would lay the foundation for harm reduction in Indiana (consisting of 92 counties). The late Larry Pasco, a local public health worker, began harm reduction work in Indianapolis (Marion County) in the late 1980’s. Pasco invested his personal resources and secured funding from private organizations that supported harm reduction work. He developed a needle distribution program and was an early catalyst for initial attempts to legalize and develop syringe services throughout the state.
Starting in the early 1990’s, The Health Foundation of Greater Indianapolis (THFGI) nurtured relationships that have led, and helped the community embrace, harm reduction work as a means of limiting new HIV infections and enhancing access to substance use/abuse services. For example, we partnered with the Marion County Public Health Department on a coordinated approach through the Treatment Plus Program, a SAHMSA-funded (Substance Abuse and Mental Health Services Administration) five-year study to enroll participants into programming that addressed HIV prevention, testing, and access to care, including substance abuse disorders. Additional Treatment Plus partners included, but not limited to Fairbanks, Pathway to Recovery, and the Minority Health Coalition of Marion County – continued to work with THFGI on influencing change in policy and programming. These organizations agreed early on to prioritize establishing harm reduction that influenced, lawful, compassionate services (including a Housing First model). In the early years, we sought support for syringe exchange programs focused on the establishment of a two-year pilot program. There was support from the Division of Mental Health, but not from the Pharmacy Board, both of which were needed. This led to a standstill in progressive harm reduction policy for several years.
Over time, efforts to establish more programming were met with pushback from conservative politicians who held a deep skepticism for the need for harm reduction. Despite years of research results clearly demonstrating harm reduction programs help decrease the spread of HIV and Hepatitis C, many policymakers still legislate based on false assumptions. For instance, Indiana’s public health suffers from city, county, and state politicians who insist that providing syringes enable drug use rather than encourage recovery. In fact, it took an epidemic number of diagnoses in 2015 to enlighten Hoosier politicians on the need for harm reduction services. In Scott County, 235 new HIV infections were found. The vast majority of these new infections were found in Austin, a city with a population of only about 4,000. This was the largest outbreak in U.S. history, and was the turning point for many in Indiana who previously struggled to see harm reduction as a legitimate means toward ending the HIV and Hepatitis C epidemics.
At a meeting with the Centers for Disease Control (CDC) to discuss the outbreak, then-Governor Mike Pence was advised to allow for harm reduction programming. After praying on it, the Governor approved syringe service programs (SSPs) to be implemented on a restricted and county-by-county basis. Since then, roughly a dozen counties have established their own programs, though some waiver from time to time.
What is one major challenge you have had to overcome in funding harm reduction work?
Indiana does not have a statewide provision for syringe service programs. Each individual county is required to establish a public health emergency, which expires every two years. This lack of coordinated direction on a state level leaves room for interpretation by each county. Despite research and decades of successful programs showing that harm reduction works, many continue to be reluctant about adopting them. Some counties reference a lack of drug use. Many county leaders have perceptions of drug users based on racial bias, believe all prescribed drugs are safe, or marginalize drug users. Worse yet, they turn a blind eye because of all three misperceptions.
Respecting the unique values and autonomy of communities is of the utmost importance. Some have been more open to adapting programs when they are heard and respected rather than being bombarded with data about “other communities.”
The Indiana State Department of Health, a partner of THFGI, manages non-syringe harm reduction programs. These offer communities a compromise, or at least a great place to start.
Although many regions have supported progressive advances in harm reduction, it is unlikely to be successful in Indiana without first giving local communities space to establish their level of readiness and to align with their cultural values. Once that is in place, the most appropriate interventions may be introduced.
What is the most effective strategy, tool, piece of data, or resource that you have used to successfully overcome a barrier to funding harm reduction work?
The CDC recently shared resources that are very effective in taking the ambiguity out of case studies. We are currently using these materials in our discussions, as they help move the conversation from fiction to fact, that harm reduction works.
Are there other ways your organization has been able to take part in the response without directly funding harm reduction work?
Advocacy takes many forms. We have been purposeful in our alliances to ensure they reach all centers of influence. A consultant who is in law enforcement travels the state to advise local programs because he has productive relationships with police officers he can help train, educate, and influence this audience. He works with the local authorities and first responders, who may be in the position to make more well informed day-to-day decisions within their respective communities. Through grassroots coaching, he encourages proactive involvement.
What is your biggest success story as a funder of harm reduction work?
In April of 2019, Indianapolis welcomed, after a unanimous vote by the City County Council, Safe Syringe Access Program (SSAS). THFGI, Fairbanks, and the Marion County Public Health Department partnered to ensure the first sanctioned SSP in Indianapolis would be fully equipped to meet the needs of communities who have demonstrated the highest need through the use of a mobile unit in preventing the further spread of HIV and Hepatitis C.