THE BLUEPRINT FOR HARM REDUCTION IN LOS ANGELES

BY: ILANNA SHARON MANDEL, MA

This report is devoted to providing a blueprint for advocacy in harm reduction in Los Angeles
County. The term harm reduction is often misunderstood and many agencies and services
state that they work in harm reduction, or they offer harm reduction strategies. The Harm
Reduction Coalition is dedicated to reducing the harm related to drug use, HIV/AIDS,
Hepatitis C, and incarceration. To effectively address these five issues specific policies are
needed which will be offered in this blueprint.
The City of Los Angeles is coping with a complex health crisis - the continued spread of HIV
and all forms of hepatitis, but especially Hepatitis C. LA County has the second highest
number of AIDS cases in the country. The City of LA actually accounts for 56% of all
HIV/AIDS cases in all of LA County. This translates into the reality that HIV/AIDS impacts
LA more heavily than almost any city in the US. As one of the largest metropolitan areas in
the country, Los Angeles is a set of interconnected communities which are highly multicultural
and geographically separated by large distances. One of the unique problems in LA is that of
distance. Many neighborhoods and services/agencies are often so far apart from one another
that they may literally never see one another, or encounter one another except for
extraordinary circumstances.
In a city where there is a prevalent number of services devoted to working with people who
use drugs, LA is still in need of a cohesive harm reduction strategy. There are numerous efforts
being organized in order to try and cope with and introduce creative yet practical solutions to
the citys problems. One of the key problems is lack of coordinated efforts. There are many
agencies working on their own and doing what they can but many of these agencies do not
know what other agencies are doing. As such, efforts to try and stem the tide of the HIV/ADIS
1 | Page

epidemic in LA lacks coordination. A lack of a coordinated effort often translates into lost
opportunities. This also translates into a need for stronger and more meaningful partnerships
between agencies. Strong partnerships imply good communications and an understanding of
each others goals and direction.
Another important aspect of this problem is the continuing stigma and discrimination faced by
people who are HIV positive, persons who are Hepatitis C positive, people who have been
incarcerated and individuals who openly identify themselves as injection drug users. The war
on drugs has been the consistent yet ineffective response to these issues.
While these efforts exist, the number of people contracting HIV and Hepatitis continues to
climb. Reports demonstrate that men who are injection drug users and have male to male
sexual contact are the second highest group of those who contract HIV/AIDS, with persons
who are injection drug users as the third highest group. Among women, those who are
injection drug users are the second highest group of persons contracting HIV/AIDS. Injection
drug use is reported as a risk factor in a substantial and steadily increasing proportion of
Americans diagnosed with HIV and is largely responsible for heterosexual and perinatal
transmission of HIV.
It is an unfortunate reality that race continues to be a factor in the contraction of HIV and
African-American men have the highest rate of HIV/AIDS of any sub-group in LA County. A
disproportionate number of men of African-American, Latino, Native American and
Asian/Pacific Islander backgrounds contract HIV/AIDS. While the highest rate is among men
who have male to male sexual contact, the second highest rate is among men who are injection
drug users. Another important part of the overall picture is the Transgendered community. It is
estimated that 22% of Transgendered persons in LA may be HIV positive but their needs have
almost been completely ignored.

Another primary concern is the growing challenges related to HIV/AIDS and persons who are
incarcerated in LA jails and prisons. [] the prevalence of HIV among US incarcerated
2 | Page

populations is five to seven times that of the general US populationFurthermore, about 25%
of people living with HIV in the US have been incarcerated. These statistics substantiate the
need for ready access to HIV testing, treatment and prevention by means of behavioral
interventions and harm reduction strategies in correctional facilities. 1

The growing numbers of people who have contracted Hepatitis C (and the growing numbers at
risk for contracting the virus) is another critical health care issue in Los Angeles. Groups such
as the LA County Task Force on Hepatitis C are driving this concern and determined to try and
create workable strategies for the problem. Hepatitis C is also a blood-borne virus and as with
HIV/AIDS, persons who are injection drug users are greatly at risk. Presently, they represent
the highest group of people who are contracting the virus. Stephen Simon, AIDS coordinator
for the city of Los Angeles, told health officials gathered for the Third Annual Los Angeles
County Hepatitis C Summit on Thursday,as KPCC'sreports. Simon said one in 50 U.S. adults
and as many as 650,000 California residents are infected with the virus, which is the leading
cause of liver transplants in the U.S. Those people who are at greatest risk for contracting
Hepatitis C are persons who are injection drug users, persons who live in poverty, veterans,
and persons who are homeless. A factor which complicates this issue is that injection drug use
is also highly connected to HIV/HEPATITIS C co-infection.

Challenges and opportunities for HIV care in Jails and prisons in the United States, Anne S. De Groot,
Madeline Dilorenzo, Mary Sylla & Joseph Bick, In International Journal of Prisoner Health, September 2006,
2(3), 173-191.

3 | Page