Harm reduction is probably one of my most favorite things about being a sex educator. Simply put, harm reduction means meeting people where they are at.
Most people are familiar with the harm reduction concept because it is used in reference to alcohol and drug use. For example, needle exchange programs are, in essence, the perfect harm reduction model and here is why--people who work with needle exchange acknowledge that people are IV drug users (notice, there is no judgement here), and provide them with clean needles in order to decrease the transmission of HIV and Hepatitis C. Some needle exchange programs even distribute literature on how a person can shoot up in a way that is going to do the least harm.
As someone who worked in the HIV positive community, I usually identify myself as someone who uses a harm reduction method when talking about sex education.
Ok, but what does that mean?
In a nutshell, it basically means that I acknowledge that most people engage in some type of sexual activity. Once I find out what type of sex they are having, I can talk about ways of minimizing personal risk or risk to others if that is something they are interested in.
In my case, the majority of the youth I worked with were either HIV positive or had an AIDS diagnosis, and sexual activity was the main mode of HIV transmission. The trend I noticed that at first surprised me was just how little HIV positive youth new about safer sex, much less about the HIV virus. This was one of those cases where people required basic sex education as well as specific sex education in relation to them being HIV positive (this is called "prevention with positives").
When working with HIV positive youth, harm reduction can be as simple as showing someone how to properly use a condom. It can also be incredibly complex and it can mean that you literally break down the level of risk involved in any sexual activity they participate in.
Many of the HIV positive people I worked with had their own harm reduction model--only they were not aware of it being a prevention strategy.
Hooking up online is really popular, and unless you met through a HIV poz website, you will most likely not know the HIV status of your newest partner. What I heard time and time again is because the HIV poz person didn't know their partners HIV status, they were more willing to "bottom" bareback. This works as a harm reduction method because 1) they already have HIV and 2) there is less risk of HIV transmission if you are "topping" bareback.
A lot of people take issue with this scenario because there is no HIV disclosure. However, believe it or not, this is harm reduction in action.
Engaging in barrier free receptive anal penetration is the most risky of all sexual activities when it comes to HIV infection. Offering up your ass constitutes harm reduction because it puts your partner at much less risk for HIV infection.
There are A LOT of people who find harm reduction troubling. They may hold certain religious, medical, political, or personal beliefs that are incongruent with harm reduction. The best I could do was hope like hell that these people were not providing any type of HIV treatment, care, or advocacy for my clients. I would have never referred an HIV positive person to someone who doesn't subscribe to the harm reduction model. I'm also someone who tends to be super protective, so it was common for me to accompany my clients to their medical appointments. Because my dad is a practicing physician and my mom was a former nurse, I never had the weird or uncomfortable feelings many have towards medical treatment providers. In fact, I learned that growing up with parents in the medical field was a huge asset when it came to medical advocacy for others.
I've mentioned this before, but it is my experience that disclosing that you are HIV positive is not always commonplace amongst some communities. Many people assume that if your partner doesn't say anything, then they are HIV negative. Also, many people never ASK about the STI/HIV/AIDS status of their partner.
For the record, I strongly believe that YOU need to be an active participant in your sexual health. This means getting tested regularly for all STIs. It also means talking with your partner (even if it is a one time hook up) about their sexual health history. Alternatively, you can use a barrier and stick to sexual activities that are less risky if you don't know your partners HIV/STI/AIDS status.
Let's face it, it is really difficult to make an empowered and informed decision about sexual risk if you don't know what parameters you are working with. Not talking about it doesn't mean that everyone involved is HIV/STI/AIDS negative.
Most people who are not in the sexuality community find bringing up the topics of sex and sexuality to be really, really uncomfortable. I get it. It's not like anyone really teaches us this skill. However, I believe that the majority of your partners will be thankful for you broaching the subject. Incidentally, it is also one of those things that gets easier the more often you do it.
Harm reduction, it's a really good thing!