The need for Safer Spaces in

HIV Prevention and Care Among Marginalized,

Criminalized, and Oppressed Communities

Lindsay Roth & Kahn Miller of

Is it ?

Has there ever been a time when a client left your organization and you weren’t sure why?

Who We Are, What We Do

All volunteer, grassroots direct-service and advocacy organization for women in Philadelphia’s street-based sex trade

Kensington:• One of the poorest neighborhoods in Philadelphia with

prominent open air markets for heroin, powder and rock cocaine, street-based sex trade

• Philadelphia has HIV/AIDS rate three times higher than national average

Barriers to care are material, social, and structural

• Late Night Street Outreach• Bad Date Alerts• Home Deliveries

• Case Management• Health & Safety Tips

• Overdose Response Training• Rape and Assault Referrals

• Women Identified-Only Drop-In

Our Services:

What is Harm Reduction?

What is Harm Reduction?

• A public health theory addressing behaviors that carry risk.

• We all do things we know are bad for us, and only the individual can decide what measures to take to mitigate harm

• Those who engage in these behaviors should have a leading voice in any organization or program they utilize

• Meeting people where they are at• Non-judgmental

• Community involvement and leadership

• Addresses material needs and structural oppressions

simultaneously

This is a safer space

A big thanks to SWOP- NYC/SWANK for sharing their guidelines with us!

• Confidentiality: What’s shared here stays here, what’s learned here leaves here.

• One Mic • Make Room, Make Noise • Ouch/Oops• It’s okay if you feel uncomfortable• If you don’t know - ask!• Speak from the “I”• Please do not record this presentation

(slide show with bibliography and notes will be made available)

Some guidelines

Workshop Objectives• Define Safe Space and connection to

harm reduction philosophy

• Why they are an effective and necessary tool in HIV prevention and treatment

• How to create and maintain a safe space

• What do you want to take away?

Intended Audience

Providers: D/A

Counselors, Case Mangers, Doctors, RNs,

Social Workers, Therapists,

Researchers, Supervisors,

HIV Testers & Counselors

People: Just because you might not have letters after your name, this is for you too! Lived experience cannot be overvalued.

What else makes a space “safe”?

• Area or forum where a marginalized group is free of standard stereotypes, discrimination, and tactics of silencing • Physically safe: free from sources of physical and institutional violence, i.e. law enforcement• These are guidelines: “trolling” should not be tolerated

Good for At-Risk Communities

• Skill share/peer education

• Ownership and self-actualization, especially for extremely marginalized/criminalized populations and those with intersecting oppressions

• Decreases isolation from prevention resources

Why safe spaces are an effective and necessary tool for HIV

prevention & care

Good for Organizations• Community

involvement builds trust• Builds knowledge of

lived experience and on-the-ground realities where research falls short -especially situations that are a product of structural issues

• Narrows the gap between provider and participant

Why safe spaces are an effective and necessary tool for HIV

prevention & care

Good for Organizations• Community

involvement builds trust• Builds knowledge of

lived experience and on-the-ground realities where research falls short -especially situations that are a product of structural issues

• Narrows the gap between provider and participant

Good for At-Risk Communities

• Skill share/peer education

• Ownership and self-actualization, especially for extremely marginalized/criminalized populations and those with intersecting oppressions

• Decreases isolation from prevention resources

Why safe spaces are an effective and necessary tool for HIV

prevention & care

Sonagachi Project, Kolkata, India

3 Rs: respect for sex work and those involved in it; reliance on sex workers to run the program; recognition of sex workers’ rights. Condom use rose from 27% in 1992 to 86% in 2001; HIV prevalence in sex workers dropped.

Canadian Aboriginal AIDS Network (CAAN)

While Aboriginal Peoples make up 3.8% of the population, they accounted for 12.5% of all new HIV infections in Canada. A federal initiative to address HIV/AIDS prioritized positive Aboriginal women through the use of safe spaces:

• Use and create opportunities for culturally competent, arts-based approaches to HIV prevention, such as drum-making, ceremonial skirt-making, and digital storytelling

• Make gathering spaces as inclusive as possible, creating spaces for children and attending to barriers to participation

• Recognize that women are part of a larger community, offer opportunities for women to learn alongside their families, partners and children

• Honor the sacred role of Aboriginal women by learning about and celebrating women’s traditional cultural roles

The Stonewall Project, San Francisco

Screenshot from www.tweaker.org

Positive Prevention Efforts

Safe Spaces have been a crucial tool in HIV prevention with PLWH/A

Peer support groups,Post-test clubs,

Classes, Group therapy,Positive-living Programs,

Collaboration in Information, Education and Communication Campaigns,Income-Generating Activities

 “I worked in groups on this idea of prevention ...The main principle is to help people to become responsible for themselves, their bodies and their rights. When people become aware of their situation it is possible to promote change.” – HIV positive service provider, Clinica Condesa, Mexico City 

Intentionality and Framing

• Without intentionally, there is almost always a reproduction of structural oppressions within the organization or program

• Strategic Essentialism – for the most marginalized of populations it is sometimes necessary to reach out to a specific group so that they may self-actualize

Logistics• Low-threshold• Location/time

accessibility• Help meet

immediate needs (tokens, food, supplies)

• Sometimes personal relationships can trump logistical barriers

• If mandatory program (incarceration, court ordered drug treatment), theories and practices of safe spaces can be included

• Consistency• Think outside the

box

What not to do• Don’t offer advice

unless asked but DO recognize behavior change that comes from within

• Don’t assume a singular identity; don’t generalize

• Don’t try to do it all at once; the small things count

• Don’t exploit the space or the participants

Reception

• Be patient, don’t take it personally• Hire within the community and provide

proper training, including tools for de-escalation

• Appropriate imagery and visual representations in front office

• Paperwork

First point of contact, establishes relationship and trust between client and service provider

Direct Service Provider

• Office/workplace presentation• Reflect clients’ language• Do your homework, know laws and

policy• Be honest about internal biases – you

can still be a great provider! But also know when to refer

Coordination of services, advocate, maintains primary relationship between client and organization

Supervisor

• Model affirmative language and client-centered approach

• Hire within the community• Facilitate appropriate staff trainings

(beyond accreditations) and interventions

• Safe spaces are for employees too!

Fosters and maintains successful environment for safer spaces; less direct interaction with clients

Encountering Resistance?

Encountering Resistance?

Keep it simple - Assert your position without starting a new conversation

Encountering Resistance?

Keep it simple - Assert your position without starting a new conversation

Go further – Challenge existing attitudes, systems, and client/provider dynamics

Encountering Resistance?

Keep it simple - Assert your position without starting a new conversation

Go further – Challenge existing attitudes, systems, and client/provider dynamics

Confront – Identify the problem and a path or process to begin to address it within your organization

Encountering Resistance?

Keep it simple

Go further

Confront

Encountering Resistance?

Keep it simple – Continue with affirming language

Go further

Confront

Encountering Resistance?

Keep it simple – Continue with affirming language

Go further – Correct co-worker’s misgendering comments

Confront

Encountering Resistance?

Keep it simple – Continue with affirming language

Go further – Correct co-worker’s misgendering comments

Confront – Set up system to ensure correct pronoun use and gender affirmation

Participants as Consultants

• They know more than you do; avoid privileging institutional learning, degrees, and resumes

• A truly safe space necessitates direct community involvement and leadership

• As with any other consultant they should be compensated fairly and financially, their expertise respected as such

Consultation & Self-Advocacy

• VANDU, Nothing About Us Without Us• Young Women’s Empowerment Project

(Chicago), Girls Do What They Have To Do To Survive: Illuminating Methods used by Girls in the Sex Trade and Street Economy to Fight Back and Heal

• Canadian Aboriginal AIDS Network, Environments of Nurturing Safety

And a note to participants…

How to get your needs met and build a successful community-led space:

• Never assume someone knows how you feel • Follow the rules set forth at your organization • Work within the system to self-advocate when you

feel someone is breaking the rules or breaking your trust; don’t lose your temper, talk to them directly or talk to their supervisor

You are the expert: You have an important set of skills to share

with people.

What if everyone had a safe space to be heard?

Imagine if you had a safe space at your organization or in your workplace where you could

really listen to your clients?

Think how you could implement some aspects of a safe space –

or even how you are already doing so.

Thank You!