What is Harm Reduction?

Harm Reduction is defined by the National Harm Reduction Coalition as “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.”1 Harm reduction keeps people safe. It doesn’t judge people for sex work or drug use — it just tries to lower the risks. It puts safety, rights, and dignity first. The idea is simple: meet people where they are.

By The Numbers

40 states treat unused syringes as “proof” of drug use, so people are scared to carry them.2 25 states force HIV tests on people arrested for sex work, with no promise the results stay private.3,4 Overdose is the #1 cause of accidental death in the U.S., and most of these deaths are preventable.5

What Harm Reduction Looks Like In Practice

  1. Education and Outreach — safer-use tips and “know your rights” guides for sex workers.
  2. Syringe Access Programs — unused needles in, used needles out, safely.
  3. Supervised Consumption Services — legal sites where medical staff can respond fast if something goes wrong.
  4. Emergency Medical Response — training community members to reverse overdoses with naloxone.
  5. Health Services and Support — free, judgment-free care, sometimes delivered by mobile units.
  6. Decriminalization — no arrest risk means people can stay safer.

Where Are We Now?

Criminalization is a huge barrier to harm reduction. Fear of police is the #1 reason people don’t call 911 during an overdose, even when it could save a life,6 and fear of arrest keeps people from asking for help or being honest with doctors. 

Criminalizing drug use and sex work adds another layer of risk, making it harder for people to access harm reduction tools and services that keep them safe.7 These policies undermine harm reduction efforts by punishing people for drug use or sex work:

  • “Condoms as evidence” laws let police in some cities treat carrying condoms as proof of sex work — so people carry less protection, not more.8 
  • Syringe laws punish carrying unused needles, hitting transgender people who use needles for hormones especially hard.9 
  • Visa rules still make people disclose sex work or drug use history just to travel.10 Under U.S. immigration policy, applicants who have engaged in sex work within ten years of applying for entry or used drugs may be deemed inadmissible and denied a visa.11
  • The passage of federal laws SESTA/FOSTA knocked sex workers off the websites they used to screen clients safely, pushing more work onto the streets and raising the risk of violence.12

What Can Be Done?

  1. End the War on Drugs13 and ditch drug-induced homicide laws and mandatory minimums, which have fueled mass incarceration of Black and Latine communities through harsher drug sentences.
  2. Repeal SESTA/FOSTA — stop pushing sex work further underground.
  3. Expand Medicaid coverage for harm reduction — free up syringe programs, addiction medication, fentanyl test strips, and naloxone should be covered, not out of reach due to a lack of funds.
  1. Repeal or modernize state HIV criminalization laws and drop sentence enhancements for sex workers or drug users living with HIV.
  2. Fund syringe access and supervised consumption programs — and stop capping or criminalizing syringe possession.
  3. Decriminalize sex work and end “condoms as evidence” policies.

Resources

Special Thanks To Our Contributors!

  • Bee (Brandi) Velasquez
  • LaDawn Tate
  • Melanie A. Reese
  • Kneeshe Parkinson
  • Valerie Pinkston
  • Brooke Davidoff
  • Alyssa Crawford

And a huge shout out to our past intern Treasure Welle for writing our updated factsheets!

1: National Harm  Reduction Coalition, Principles of Harm Reduction (2020), https://harmreduction.org/wp-content/uploads/2022/12/NHRC-PDF-Principles_Of_Harm_Reduction.pdf
2: Legislative Analysis and Public Policy Association, Drug Paraphernalia: Summary of State Laws (April 2022), https://legislativeanalysis.org/wp-content/uploads/2022/04/Drug-Paraphernalia-Summary-of-State-Laws-FINAL.pdf
3: Center for HIV Law and Policy and National LGBTQ Task Force, The Intersection of Sex Work and HIV Criminalization (Washington, DC: CHLP/National LGBTQ Task Force, n.d.), 2, https://www.hivlawandpolicy.org/sites/default/files/Sex%20Work%20HIV%20Toolkit%20FINAL%20R2_0.pdf.
4: Sandra Norman-Eady, HIV Testing, OLR Research Report No. 98-R-1096 (Hartford, CT: Connecticut General Assembly, Office of Legislative Research, September 24, 1998), https://www.cga.ct.gov/PS98/rpt/olr/htm/98-R-1096.htm.
5: Matthew F. Garnett and Arialdi M. Miniño, “Drug Overdose Deaths in the United States, 2023–2024,” NCHS Data Brief No. 549 (Hyattsville, MD: National Center for Health Statistics, January 2026), 1, https://www.cdc.gov/nchs/products/databriefs/db549.htm.
6: Emily van der Meulen, Sandra Ka Hon Chu, and Janet Butler-McPhee, “‘That’s Why People Don’t Call 911’: Ending Routine Police Attendance at Drug Overdoses,” International Journal of Drug Policy 88 (February 2021): 103039, https://doi.org/10.1016/j.drugpo.2020.103039.
7: HIV Racial Justice Now! A Declaration of Liberation: Building a Racially Just and Strategic Domestic HIV Movement. November 8, 2017. https://www.pwn-usa.org/old-policy-agenda/a-declaration-of-liberation-building-a-racially-just-and-strategic-domestic-hiv-movement/.
8: Ayako Miyashita Ochoa, Bianca D. M. Wilson, Kimberly Fuentes, Rae Jones, Katherine Lee, and Moriah Macklin, Risk of Criminalization Among Sex Workers Carrying Condoms (Los Angeles: Williams Institute, UCLA School of Law, May 2023), https://williamsinstitute.law.ucla.edu/wp-content/uploads/CA-Sex-Work-Condoms-May-2023.pdf
9: Legislative Analysis and Public Policy Association, Drug Paraphernalia: Summary of State Laws (April 2022)
10: Immigration and Nationality Act § 212(a)(2)(A)(i)(II), discussed in “Inadmissibility Due to Controlled Substance Violations (Drug Offenses),” YEK Law, July 26, 2024, https://www.yeklaw.com/blog/2024/july/inadmissibility-due-to-controlled-substance-viol. 
11: Immigration and Nationality Act § 212(a)(2)(D), 8 U.S.C. § 1182(a)(2)(D) (2024), https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title8-section1182&num=0&edition=prelim.
12: SESTA/FOSTA is a set of federal laws passed in 2018: the Stop Enabling Sex Traffickers Act (SESTA) and Fight Online Sex Trafficking Act (FOSTA). Although their names suggest they directly address human trafficking, critics argue the laws have endangered sex workers and trafficking survivors. Decriminalize Sex Work, What is SESTA/FOSTA. https://decriminalizesex.work/advocacy/sesta-fosta/what-is-sesta-fosta/. See also AIDS United, Sex Worker Criminalization: A Landscape Analysis (Washington, DC: AIDS United, September 2023), https://aidsunited.org/wp-content/uploads/2023/10/Sex-Worker-Criminalization-Landscape-Analysis-Sept-2023.pdf. 
13: Drug Policy Alliance, The Drug War Had 55 Years. We Need Healthcare and Freedom. June 17, 2026. https://drugpolicy.org/resource/the-drug-war-had-55-years-we-need-healthcare-and-freedom/.