Harm reduction programs, in which health workers work to reduce dangerous behaviors with both education and materials as near in time and space as possible to those behaviors, still get opposition in health departments. But for years we've known that teenagers who join abstinence-only programs are actually less likely to use condoms when they do have sex, and that they have STD rates nearly equal to teens who do not. Just last month, needle exchange was legalized in D.C., ludicrously late.
Yesterday afternoon, I talked to Joshua Volle. For the past few years he's been the New York City Department of Health director of HIV community prevention programs; his last day at work was Friday. (We talked for a column I wrote for today's New York Observer about the ongoing rise in new H.I.V. cases among young gay men, and it probably isn't something most of you here want to read, as it is lewd, crude and sarcastic, so maybe don't!) Volle, 50, left DPH largely because he has become a minister, but also: "I wasn't in a place, in a position, where I could speak the truth that I know from my experience," he said. "I was basically a bureaucrat middle manager, and that's not my personality—nor is that why God sent me on this planet."
There are still, Volle indicated, policy camps in conflict in the Health Department over HIV prevention policies. New York State has something called the Sanitary Code; in the City, it is still used to shutter gay sex establishments from which reports of unsafe sex are received. But in the rest of the state, closure is used as a threat—and establishments are not closed if such places work in cooperation with community-based organizations that promote safe sex on-site.
The City is now assessing its current policy, and is in receipt of recommendations from "a local alliance of health professionals, activists and club owners."
"I don't know if I've ever seen an incidence where a government has been able to control people's behavior," Volle said. He used Prohibition and drug laws as an example of how government crackdowns push people to the margins, away from the reach of harm reduction workers. Now, in New York City, private sex parties have become ever more difficult for health workers to find and enter. (Volle stressed that he was a fan of his former boss, Department of Health Commissioner Thomas Frieden, and called him a smart man who obviously cared deeply about the health of New Yorkers.)
"We are still seeing an increase in HIV," he said, "so if the Sanitary Code was actually working, wouldn't we not be seeing that increase? If we try going in full force with our community partners, to do risk reduction, maybe we could get a handle on this epidemic. But we don't know, because we've never been given a chance. "
"What we'd like to see is sex venues be kind of certified by the Department of Health, if they have these partnerships set up by community-based organizations," he said. "And those that refuse? Guess what, you're still out on a limb, you could be shut down, because the law is still on the record."