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MAY14

Meet Sarah Ziegenhorn: Harm Reduction Powerhouse

Sarah Ziegenhorn is the Executive Director and co-founder of the Iowa Harm Reduction Coalition (IHRC), a grantee of the Syringe Access Fund, which is managed by AIDS United. She oversees the organization’s community outreach, overdose prevention, legislative advocacy, and harm reduction education programs, as well as development and evaluation.

May is Hepatitis Awareness Month, so we caught up with Sarah to learn more about the intersections of drug use, HIV, and Hepatitis; her state advocacy work; and what inspires her to keep fighting.


Tell me a bit about yourself and how you got involved in this work?

My name is Sarah Ziegenhorn and I am the co-founder and Executive Director of the Iowa Harm Reduction Coalition (IHRC). I also attend medical school in my spare time and will complete my MD sometime in 2020. I'm a native Iowan, and grew up partially on a small family farm near the Mississippi River, and partially in the town I currently call home, Iowa City. A few years back, I moved to Washington, DC for a job and quickly got involved with the local syringe access program, HIPS. I had a background in HIV care and sex worker health research, but coming to HIPS was extremely transformative. Working with HIPS clients added a lot of meaning and connection to my life, but it was also the first time I had been lovingly welcomed into a community where the stigma surrounding substance use, mental illness, trauma, and poverty was not present. I grew up in a family that experienced all of those things, and the harm reduction world was one of the first places I was able to associate those experiences with anything other than shame and secrecy. When I moved back home to Iowa in 2015, I was angry that there were no syringe access programs and that distributing syringes to people who use drugs could land a person in jail or hit with a large fine. That's when IHRC got started.

What are you hoping to achieve through your local advocacy supported through the Syringe Access Fund? Why is this so important?

IHRC is working to legalize syringe exchange programs in the state of Iowa. While much of the U.S. has recognized the value of needle exchange in preventing the spread of HIV and hepatitis C while preventing other bacterial infections like endocarditis and abscesses, Iowa has been slow on the draw. Even as other communities move towards implementation of safe consumption spaces, Iowa has failed to create the necessary policy change to allow for the implementation of syringe services programs (SSPs). Our advocacy work focuses on educating legislators, law enforcement officers, health care providers, students, and more about the role of SSPs in improving the health of communities.

In late 2017 the CDC sent a letter to the Iowa Department of Public Health, warning the agency that Iowa is at risk for an HIV outbreak. Rises in hepatitis C (HCV) cases are seen as a sort of canary in the coal mine for HIV outbreaks. In the last several years, Iowa has seen a remarkable uptick in HCV cases. The largest growth in new cases has been among people under 40. Between 2000 and 2016, Iowans ages 15-39 saw an 1100% increase in HCV diagnoses. Of new cases diagnosed during this time period, 76% reported a history of injection drug use to the diagnosing physician. By legalizing syringe exchange programs, Iowa can reduce the transmission of HCV and avoid an HIV crisis.

There is a spotlight on opioids and injection drug use in the media today. Has this affected your work at all?

I think the media enchantment with opioids is a double-edged sword. On the one hand, the focus helps to drive conversations in our communities that can be used to mobilize people into taking action, building power together, and sustaining momentum to work for change. But on the other hand, the most basic media narratives about opioid use shut down opportunities for more nuanced conversation and thought. In Iowa, opioid use is increasing (just like in every other state), but methamphetamine is still used at much greater rates. When it comes to IV drug use and HIV/HCV transmission, people who use meth make up a huge percentage of IV drug users and those at risk of or infected with HIV/HCV. However, the larger conversation about opioids in the media leaves little room for discussion of meth use. The media's exclusive focus on opioids essentially erases the stories, concerns, and needs of people who use meth and other stimulants. These choices about which drugs to spotlight (and which drug users' stories deserve a spotlight) are both a benefit and a hindrance to our work, but ultimately make it more difficult to have nuanced and complex conversations with policy makers and community leaders about stimulants and the health of people who use them.

What role do you see syringe services programs playing in combatting the opioid epidemic and its intersections with HIV and HCV?

SSPs have the only role! I don't think there are solutions to combatting the opioid crisis and related HIV/HCV rises other than syringe exchange programs. The opioid epidemic is a crisis because people are dying from overdose in alarming numbers. From a public health perspective, if you want to curb these deaths, you need a way to reach out to and access active drug users. In Iowa, public health, social services, health care, and law enforcement don't really have good points of connection in communities of people who use drugs (PWUD), because none of these systems are necessarily designed to work with, by, and for PWUD. If we can create legal syringe access programs in Iowa communities, then we have an opportunity not only to reduce the transmission of HIV and HCV, but we also have an opportunity to flood communities with naloxone to prevent overdose.

When we talk about drug use and drug user health, we face mountains of stigma and misinformation. What is one misconception or myth about syringe service programs or drug user health that you want to dispel?

The most common misconception about syringe service programs I hear from Iowans is that distributing syringes enables people to use drugs. One response to this claim that I hear repeatedly from some of the harm reductionists I admire most, is that yes, giving out syringes IS enabling: it is enabling people to take control over their health. It is enabling people to prevent contracting HIV or hepatitis C. It is enabling people to not re-use or share syringes, thus preventing against abscesses cellulitis, endocarditis, and sepsis as well. It is enabling people to create positive change in their lives.

A second myth that I can't resist an opportunity to talk about is that drugs have infectious properties. I often come across this idea that exposure to an illicit chemical (like heroin, meth, or cocaine) will instantly transform an individual person into an "addict" in the same way that infection with a virus or bacteria can transform a healthy person into a sick one; using hard drugs one time will immediately lead to addiction. But we know that only 10 percent or so of substance users will develop a dependency on or addiction to a substance, and that the vast majority of people who use drugs will never develop an addiction to them. I think this myth about the addictive nature of drugs is behind a lot of the skepticism people have towards syringe exchange programs, because it supports the idea that providing a syringe could assist in rapidly transforming a person into an "addict."

You can help fight stigma that surrounds drug use and support our work by shopping our online store.

How do you stay motivated in your work?

Well I'm a Scorpio, so motivation to do this work is in my nature.... In all seriousness, I draw a lot of motivation from the participants in Iowa's underground syringe access programs. I see folks coming to pick up safer injection supplies and over time forming close relationships with other participants, volunteers, and staff. Initially many folks will tell you that they feel lonely, isolated, and relatively worthless, but over time you see people go through all types of transformations and start coming to the SSP with policy questions and ideas about how to make our community safer and new friends that they trust and rely on. Syringe access programs do more than just reduce the risk of HIV - they create opportunities for people to feel love and connection, and that is absolutely worth fighting for.

Thank you, Sarah!




Posted By: Sarah Hashmall, Communications Manager - Monday, May 14, 2018



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