We are the experts in our own lives
Roxie Corrigan still remembers the anger of being berated at a drug rehab facility they went to at age 19.
“The manager of this place said something like, ‘You’re not going anywhere. You’re going to be stuck like this forever.’ It was awful, being treated like that,” said Roxie, who is now a drug checking technician at SFAF.
“A few years later, I was introduced to harm reduction. That’s when the whole world opened up to me. I thought… ‘What a concept. No one’s going to yell at me for relapsing. I’m not going to get shamed by an entire room of people if I decide to pick up.’”
This is a feeling Roxie, and other educators, counselors, and clinicians at SFAF know well–and take care to incorporate into their purposeful engagements with clients and participants.
“We are the experts in our own experiences,” said Roxie. “No academic, no doctor, is going to be able to tell us what we’ve lived through.”
Roxie provides health education and harm reduction information to people who use drugs as part of their role with SFAF’s Syringe Access Services team. Providing people, they explained, with information about the drug supply, overdose prevention, and safer use strategies. And, at the end of the day, empowering people to make decisions about their use and what will work best in their lives.
“I love the work that I do. It’s so important. I got inspired to get into this work because of the people that I’ve lost in my life. I do this for them,” they said.
Marion Pellegrini, RN, MSN, FNP-C, AAHIVS, clinical manager at SFAF, says this philosophy–honoring clients as experts in their own lives–comes through in the care delivered at our health center Magnet but particularly through our TransCare program.
“I start visits by asking people what their goals are. I ask things like, ‘What do you want to achieve from hormones?’” said Marion. “With transition-related goals, there’s a lot of flexibility that people have.”
Marion said a philosophy of “shared decision making” underpins the client-centered care offered at Magnet.
“It’s very much a personal choice–whether you decide to take PrEP (and if so, if you take daily oral PrEP, injectable PrEP, or 2-1-1), or use Doxy PEP, for instance,” he said. “We start the conversation, talk about a person’s history, talk about risk and benefits of certain treatments or options, and share the best evidence. Providing options, and information, is key.”
Tyrone Clifford, manager of contingency management services said the substance use counseling and treatment services offered by the Stonewall Project all incorporate the philosophy of clients being the excerpts in their own lives by allowing clients the autonomy to set their own treatment goals.
“To access services, you don’t need to be abstinent,” said Clifford. “You might not want to quit, but you might want to cut back. Or, you may decide to stop taking one thing–for instance, decide to work on your meth use–but not want to quit others. That’s totally cool. We’ll help support you in cutting back, or in figuring out what types of groups will help support you with your goals.”
Clifford said that in one group he supports, PROP, clients can earn gift card incentives for urine screens that are non-reactive for stimulants. Although abstinence may be the goal for some, others attend PROP for the peer support, the accountability of attending group three times per week, and the community they become part of when joining the group.
“I could give someone a list of what they ‘should’ or ‘shouldn’t’ be doing,” said Clifford. “But that might not work for them. And I’m ultimately not the one who’s in charge of someone else’s recovery process or decisions around substance use. And at the end of the day, it’s empowering to sit down and say, ‘I decided that this is how I want to do it, and it worked. I made this decision, and it worked for me.’”
Peer-run programs are another way that SFAF staff honor the wisdom and knowledge of community members.
“A lot of the community work we do at SFAF is about providing resources to the community–financial, emotional, and professional–so that community members can be part of the work. How can we put these resources directly into the hands of the people who are going to benefit?,” said Seth Katz, community programs coordinator at SFAF.
Seth, who leads community groups through our Syringe Access Services program, engages in this work first-hand. The groups he facilitates and leads provide compensation to community members who act as “secondary” syringe exchangers–and bring safer use and overdose prevention supplies into community spaces to bypass barriers that may prevent people from accessing services at harm reduction centers and needle exchanges.
“We [community organizations and public health] don’t need to be gatekeepers of these resources,” he said. “The community is and has already been doing this work. Let’s remove our preconceived notions, remove ourselves from the situation as much as possible, so that we can honor the experiences of the people we are here to serve.”