By the Rank-and-Filer, April 2011
This piece is a personal account of my first job in New York at a syringe exchange program in the South Bronx. The agency administration were abusive and racist to their staff. These dynamics, I argue, in part come from the history of institutionalization of syringe exchanges and the harm reduction movement. Since, I’m excited to say, the agency has improved a lot. I wrote this for a forthcoming zine anthology on the messed up dynamics of nonprofits.
A little over seven years ago I moved to New York City to take a job at a South Bronx syringe exchange program. I had been working as a trans token at Philadelphia’s major AIDS service provider. Philly’s community of trans activists, particularly low-income trans women of color, taught me a great deal about the struggle to build and transform social services to meet people’s basic needs. A year of coalition work with the city’s other AIDS and trans service providers left me awed by harm reduction as a radical form of direct service. Through my new job, I found tremendous dignity and compassion among the former and current drug users that made up its staff and participants. The racism and abuse of the agency’s administration, however, served as a painful example of the dangers faced by social movements institutionalizing into nonprofit agencies.
Harm reduction gained prominence in the 1980s and 90s as a social movement of active drug users, service providers and their allies. The devastating impact of HIV and AIDS on intravenous drug users motivated harm reduction activists to establish syringe exchange programs, linking the distribution of clean syringes to a range of supportive services and forms of political organizing. Rather than treating abstinence as the only legitimate goal or condition of services, harm reductionists engaged users “where they’re at”. They worked to support people in concrete ways against the violence, marginalization and disempowerment routinely facing drug users. Harm reduction activists located the experiences and leadership of active users at the heart of community-based efforts to combat AIDS, mass incarceration, and urban poverty.
One such harm reduction activist motivated me to apply to the new job. I had heard of her celebrity as the “grandmother of harm reduction”, and had attended a talk she gave on the history of harm reduction organizing. I was impressed with her charisma, intelligence and passionate dedication. We began to correspond. She co-directed this New York syringe exchange, and invited me up to the city to interview. A few months later I made the move and started work.
The job was tremendously fulfilling. Nearly all my coworkers had spent years as dealers and users on the streets, and brought to their work a profound wisdom developed through their life experience. Many of my coworkers took pains to call me out on my own racism, classism and arrogance with a remarkable gentleness and compassion. I met hundreds of participants for whom the agency was the only institutional environment they could visit without encountering judgment or disdain. The agency’s work had saved thousands of people’s lives through preventing HIV and Hep C transmission. More than anything, the principles of harm reduction recognized the worth of each person’s life and the crucial urgency of the survival of their communities.
The two directors further moved me. The woman who had invited me to apply led the agency with her partner, an out and flaming trans woman. I had never before encountered a trans woman in a position of institutional authority or employed in social services. I was inspired by her work and role, and initially took her as a model for my own growth at a trans social service worker and activist.
Over the first few months I became increasingly horrified by the behavior of the two directors. I saw them humiliate their staff in front of others, belittle any signs of critical thought, and show pervasive racism. They accused people of color on their staff of theft or treated them as children. I saw them rapidly promote and praise white staff who carefully avoided challenging the directors in any way. I soon fell out of favor with them for advocating that we incorporate elements of social justice organizing in our work. But I was never treated with the level of casual contempt that I saw turned against many people of color who had far more experience and dedication than me.
The experience was heartbreaking. Witnessing these problematic dynamics at the agency sparked a personal cycle of depression, and fed a consuming hopelessness at the possibility of ethical social service work. If things could be so horrible at one of the rare agencies that claimed a strong social justice framework for its services, how much worse could they be everywhere else? The tremendous courage of my coworkers seemed constantly undermined by staff meetings that left us all shaken and scared. The overall environment of racism and fear made it difficult for everyone to do the work, fueled interpersonal conflict and acting out among staff, and spilled over into stress between staff and participants. I saw the administrator’s abuse fuel chaotic drug use of two agency staff. Both staff died soon after.
The betrayal felt particularly acute to me given the absence of trans women as role models for my own practice. Often staff would link their analysis of the director’s racism to her transsexuality, weaving their own transphobia with legitimate frustrations. I found it difficult to respond, neither wanting to invalidate the violence of racism nor condone transphobia.
Eventually, I moved on to another job. Later I heard that the directors had been pushed out by the agency’s board, and thankfully the agency survives today. It seems the directors suffered together from highly chaotic drug use, severe medical problems, and mental health issues.
Understanding what had gone so wrong at this agency, however, cannot be reduced to the individual behavior of the directors. As I learned more about other exchanges and harm reduction agencies in the city, I began to recognize that some of our problems were systemic. At one nearby agency, I heard stories of the Director screaming at her staff. At another I heard only that the Director was “horrible,” “crazy,” and “a nightmare.” Rumors of agency heads pressuring staff or clients into sex were common. It seemed no two Executive Directors of the city’s syringe exchanges could easily meet in a room without major conflict. Whatever was wrong at my agency, parallel problems pervaded the field.
As I learned more about the history and context of syringe exchanges through discussions with my colleagues and comrades, I began to make sense of a few factors shaping the dysfunctional dynamics of agency directors.
First, the constant crisis of legitimacy and survival for syringe exchanges discourage anyone from holding directors accountable. Staff, Boards of Directors, funders at the AIDS Institute of the State’s Department of Health—all fear that if they challenge problematic management, they would immediately jeopardize an agency’s survival. Tens of thousands of people depend on the handful of exchanges for access to clean syringes and to stay alive. Syringe exchanges are under constant scrutiny and attack from police, community boards, local business owners, abstinence-oriented drug treatment programs, politicians, media, and others who incorrectly see harm reduction as enabling and encouraging drug use. Periodically, reporters manufacture new sensationalist coverage of syringe exchanges, reminding everyone of the constant threat of closure.
Several colleagues pointed to the profound negative impact of nonprofit institutionalization on agency cultures. Radical activists started exchanges in New York City in the 1980s to battle the AIDS epidemic among intravenous drug users. Systematic disinvestment by city government, mass incarceration, institutionalized racism and capitalist underdevelopment destroyed the capacity of many neighborhoods and families from being able to care for each other. These forms of structural injustice lead to the heroin epidemic of the 1970s and later the explosion of HIV and AIDS in the 80s. Users, radical service workers and grassroots activists started the early exchanges. My own agency, for example, began as a spin-off project of the militant AIDS activist group ACT-UP. These pioneers of harm reduction fought the massive criminalization of drugs, widely held conceptions on drug abstinence and popular stigma to defend the survival of their own communities in the face of a massive crisis. Through their aggressive organizing, these early syringe exchanges won city and state legalization and funding by the mid-1990s.
These same activists became the agency’s first administrators. They stuck around in the following decade, weathering many organizational challenges and political controversies.
As the agency’s institutionalized, they faced new pressures. As they began to depend on government funding to pay staff, exchange directors found themselves in bitter competition with each other over a constantly inadequate funding pool. Directors fought over the limited legitimacy and respect harm reduction gained in the late-1990s and early-2000s. The one person of color serving as a director faced institutional racism, my agency’s director faced transphobia, and many faced stigma as current or former users in this increasingly vicious competition for legitimacy and funds. Major elements of the culture of harm reduction activism became problems as the agencies institutionalized, including a lack of clear sexual, personal, and professional boundaries and the absence of systems of community accountability.
As these agencies hired staff and expanded their budgets, they increasingly depended on government contracts. In many cases, grant officers from the state health department were far removed from poor people of color using drugs on the streets of New York City. As is typical in nonprofits, these funders primarily engaged agency directors. Staff, participants and community members had little control over the grant process, and hence were largely unable to hold directors accountable.
Further, the priorities of government funding limited the work of these organizations. Funding was based on reducing HIV transmission or pushing HIV positive people in treatment, not actually saving people’s lives or reducing their suffering. New York City offers little to no harm reduction services for crack users, for example, despite the massive community havoc crack abuse and crack criminalization has caused. Crack users might need help, but their use poses no major HIV risk and hence is considered largely irrelevant to public health officials.
The rigid hierarchies typical in nonprofit agencies—with a clear line of authority from the board, to the director and down—enabled destructive and abusive behavior by agency administrators with little recourse available to staff. As syringe exchange programs transformed themselves into social service nonprofits, they lost the dynamic, responsive and creative interpersonal engagement characteristic of early AIDS movements. Where the collective, consensus-based openness of ACT-UP might have been able to directly grapple with such dynamics, the increasingly entrenched structures of nonprofit agencies gave few such opportunities. The problems I encountered at the exchange in the Bronx were profoundly rooted in this problematic history of institutionalization.
While precarious legitimacy and stigma intensified these problems for syringe exchange programs, these core problems are inherent among other nonprofits embedded in poor communities. Nonprofit social services and organizing projects depend on outside funding for their survival, often either government grants or large private foundations. Nonprofit organizations offer funders many mechanisms to maintain accountability. Rarely, however, do nonprofits have established and consistent ways to take strong direction from their own constituency. Poor people and working class people of color are neither able to provide the sufficient fiscal resources to maintain nonprofits, nor readily able to exert direction or control over the work and direction of nonprofit agencies in their own communities.
Despite these problems of syringe exchanges and other nonprofit services, the legacy of harm reduction remains uniquely transformative. Syringe exchange programs continue to do extraordinary work throughout New York and the world saving people’s lives, bringing dignity to social services, and showing the radical power of linking AIDS activism to direct services. These agencies need to be supported by all of us. I ask all readers of this essay to not make any effort to identify the specific agency I worked for, or use anything here to attack particular people. While institutional racism is carried out by individuals, we must address it as the structural and systemic problem that it is. We need to find creative, loving and effective ways to transform nonprofit organizations. Together, radical social service workers and poor communities can build effective social services rooted in the struggle for popular liberation.
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Acknowledgement and thanks to my former coworkers, the brave colleagues who agreed to talk with me about this essay, and to the heroes fighting to make harm reduction a movement that shows everyone dignity.
About the Rank and Filer and other contributors.