The HIV epidemic is closely intertwined with the U.S. drug overdose crisis–and drug overdoses soared during the COVID-19 pandemic.
In New York City, overdose deaths reached unprecedented levels in 2021, increasing 25% from 2020–and fully 80% from 2019, according to the NYC Department of Health and Mental Hygiene. Social isolation, stress, and solo drug use were all contributors, according to the National Institute on Drug Abuse–as was fentanyl, which was involved in 80% of NYC overdoses.
Harm reduction around substance use is an important part of GMHC’s nonjudgmental and supportive approach to HIV prevention and care. GMHC’s substance-use treatment staff do extensive outreach and training for safer drug use to prevent both overdoses and HIV.
Stress, trauma, and other types of mental distress increase people’s vulnerability to substance use disorders, so the agency’s harm reduction initiatives include peer support, individual and group counseling through the Women Empowering Women and Methamphetamine Ryan White Harm Reduction Services programs. All programs are led by certified mental health and substance use professionals.
People who use drugs can face a higher risk of HIV infection from having sex without condoms or sharing equipment like syringes. “If you’re under the influence, your mind can be clouded and you may not be as careful,” said Christina Melendez, a senior substance– use program specialist at GMHC. “We encourage people to be prepared and be safe–both for substance use and sex, by using clean equipment and latex barriers like condoms.”
The agency offers free syringes, Narcan (naloxone) kits to reverse opioid overdoses, and fentanyl test strips to detect its presence in drugs like heroin, cocaine, and marijuana–along with training on how to use them properly. The need is high, Melendez said. “We’ve noticed a drastic increase in training requests for Narcan kits since COVID-19 started. There are a rising number of overdoses.”
“We want people to have a Narcan kit and a fentanyl strip and a safety plan in place. We’re not here to judge. We’re meeting them where they’re at,” she added. “When they’re ready to stop, they know where to go.”
Melendez often combines Narcan trainings with safer sex workshops. “I talk to anybody and everybody who needs my help. It could be individuals, health care workers, police officers, firefighters, churches or schools,” she said, adding that fraternities and sororities will contact GMHC before spring break for safer sex workshops. “They come in and get Sexual Health 101, and also learn about HIV and AIDS and how to administer Narcan.”
“I also train at AIDS Walk New York,” she added. “Put me at a table with Narcan kits, and I’m going to train away.”
Syringes for All at Risk
GMHC resumed its Expanded Syringe Access Program at the beginning of March 2023, led by outreach specialist Juanita Chestnut. The program supplies one voucher per week to anyone in need, which is good for 10 new syringes at the agency’s on-site pharmacy.
Chestnut travels all over the city to connect people with new syringes. “I go to a lot of adult entertainment spots here in Chelsea and distribute my flyers to let people know if they need syringes to come to GMHC,” she said. “I go to the Village, and I go to the piers.”
In addition to intravenous drug-users, transgender people also need clean syringes to inject hormones, she said, and so do older people who are diabetics, because their insurance may cover insulin–but not syringes. “I am out there reaching anyone who may be at risk,” Chestnut said. She takes syringes to one regular client, who’s homeless, in Penn Station.
Chestnut makes a point of being available, keeping office hours at GMHC from 11 a.m. to 1 p.m. on Tuesdays through Fridays. People can also call her direct line or email and she’ll arrange to meet them. “I try to make sure they stay safe and healthy,” she said.
Women Empowering Women
Harm reduction for women can be overlooked when it comes to HIV prevention and safer substance use, so GMHC’s Women Empowering Women program serves women-identified clients who are living with HIV and have histories of substance use.
Melendez is one of three GMHC counselors for the program, which meets Mondays through Fridays in both English and Spanish. Migdalia Martinez leads the Spanish-speaking group, and Durell Knights co-leads the English-speaking one with Melendez. Knights also facilitates the Methamphetamine Ryan White Harm Reduction Services program for crystal meth users, which is a sex-positive space to learn about safer usage for gay and bisexual men and transgender women.
“I have a real rapport with the women I serve on my caseload,” said Melendez. “For some, the group is their only family. I say it’s okay just to put one step forward. We’re here for you. You’re not alone.”
Both the RE-CHARGE and Women Empowering Women groups are supportive communities where clients learn daily coping tools for situations that can trigger or increase substance use. “We talk about anything and everything in the group. It’s their safe space,” said Melendez. The conversation can be about how to deal with traumas like grief or sexual assault, but music therapy and daily meditations are also part of the mix. “Everything doesn’t have to be doom and gloom,” she said.
“When clients share milestones completed–that they’ve returned to the workforce or are back in school, are no longer in the shelter system and have their own apartment–it lets me know that the work I’m doing is very important,” she said. Melendez, who has served on GMHC’s staff for a decade, first joined the agency as a volunteer in 2004, motivated by friends and relatives who’d lost their own battles with HIV or substance use.
She and her co-workers take their work to the streets, visiting shelters and methadone clinics in New York City’s five boroughs that have a high population of women. “It could be women we see in the street–or someone just coming out of prison with an HIV diagnosis. We let them know that if they need help, they can come to GMHC for a food pantry bag, HIV care, a Narcan kit, or fentanyl strips. GMHC is a one-stop shop,” she said.
“When I hear in the field that someone has stopped using, it makes me feel good,” Melendez said. “If I can turn one life around, I’m okay with that.”
“We’re all human. We all need support–to know you matter,” she added. “At GMHC, you’re not a number. You’re a person and you matter.”