CitiWide Harm Reduction CitiWide Harm Reduction 718-292-7718 citiwidehr.org The ...

The harm reduction approach to chemical dependency views drug users as autonomous human beings. Whereas other philosophies on substance use see users as little more than walking manifestations of addiction?if not criminals?engaging drug users as whole people with families, histories, goals and desires is radical. Though harm reduction can mean different things to different providers, the general idea is to make resources available so that people can create and personalize their own treatment plans.

CitiWide Harm Reduction, founded in 1994 as a syringe-exchange program, is a multiservice AIDS organization with a full-time staff of about 30. Their core mission is to reach and serve New York drug users who are otherwise underserved, marginalized and isolated.

A lack of stable housing is foremost among issues. NYC tends to warehouse people who need housing in SRO (single-room-occupancy) hotels, thus perpetuating transience.

"Even though [NYC] is the epicenter of the [AIDS] epidemic and the epicenter of I.V. drug use in the country, and we have about 50,000 people living with AIDS, in the hotels we have this constant population of about 3000 people who are technically homeless but in the system," says Daliah Heller, CitiWide's executive director. "And the system hasn't been able to respond to them."

Drug users form the majority of the SRO population, as they tend to be the population with which city caseworkers feel the least comfortable. If there's one slot for permanent housing and several candidates, the provider will usually choose the person who's easiest to house rather than the person who arguably most needs the housing. Through CitiWide's housing-placement program, they've been able to find permanent housing for 150 people in the past two years.

CitiWide reaches thousands of people, both at their drop-in center in the South Bronx and through outreach at SROs. The agency's extensive services include syringe exchange, medical and mental health care, housing placement, HIV testing and treatment, transportation for services and a panoply of education and support groups. Through the Holistic Health Services program, participants can receive acupuncture and alternative medicine. The majority of CitiWide's staff is people of color; the majority has a history of substance use. A third of the staff lives with HIV/AIDS and/or hepatitis C. There is also a part-time staff made up of participants who receive incentives for their work.

CitiWide has a strong community-center aspect: People can stop in for meals, coffee or just to hang out. "It's about trying to create a one-stop shopping model for this population that meets intermediate needs and helps transition people into better systems of care for them," says Heller.

Celestino Narvaez and Michelle Cabele are good friends and longtime participants at CitiWide. Both are vibrant, thoughtful 43-year-olds who've survived considerable challenges. They shared their stories with me.

Celestino: "I came to CitiWide when they first started, when I lived in a hotel on 111th. I was a lady of the night, you might say. I was a transvestite by night, and by day I was a regular boy. I wasn't very friendly to [CitiWide] in the beginning, because I didn't like them knocking on my door. Then we became friendly, and I started telling them what was going on. Dope habit, crack habit; it's five years now that I stopped. A couple of times I was near death?I was very, very ill. I came by and they helped me. Ever since then I'm just part of the fixtures. I was one of the first homosexuals to come. They didn't really have anyone who was gay in the organization. I told them about issues regarding gay life and transgenders and ladies of the night/day. So they hired people that could identify and associate with our lives."

Michelle: "I was homeless for a good 10 years. Can you imagine that?the winters, some nights so cold? It was a frightening situation. I had to do it to survive, because no one would reach out and say, come in here and sleep the night. [On the streets] you had to do what you had to do, go out and sell your body. And that's precious. On top of that, I got a drug habit! So how much worse could I do to my life? I do love myself, but at the time I was really killing myself. I had a drug habit, I had a virus in me I didn't even know about yet. One night [CitiWide] saw me out on the streets and gave me their card. I was very sad; my sickness had taken its toll. They gave me some food, condoms, and they told me where to go. So CitiWide really saved my life. That's why I love this place so much."