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Why I Gave Condoms, Lube and Conversation to a Drug-Addicted Sex Worker

Why taking a harm-reduction approach is sometimes all you can do to change a life.

Thick shining copper hair. That’s what I picture when I think of April. I try to block out the rest of the memory: the hair splayed on a dirty linoleum floor, the purple slip barely covering a body ravaged by hard living, the heroin needle stuck in her arm.

 “April,” I said, shaking her gently. “April, come eat your cake.” She came groggily awake, lashes fluttering through swollen eyes, and the slip strap slid down a saggy, freckled arm.  

“You haven’t eaten the cake we brought you,” I said. “It’s your favorite.”

She mumbled something I couldn’t make out, perhaps an apology. Two co-workers and I helped her up and lead her to the living room, where we cut her a generous slice of tres leches cake and handed it to her on a paper plate.

“Thank you,” she murmured, but instead of eating, she slumped forward, tilting the plate dangerously. Someone intervened before the milky, spongy layers splattered onto the floor.

“Happy birthday,” we said. She’d just turned twenty-nine.


The first time I met April on the warped porch of her home in Durham, North Carolina, she wouldn’t look at me. Eyes darting to and fro, she scratched an abscess on her arm and asked repeatedly if I was a cop.

I handed her my peace offering, a box of condoms, flavored lubricant, band-aids and triple antibiotic ointment.

“Would a cop give you this?”

“Who sent you?” she asked in a thick Southern accent.

“I told you. I work for the  North Carolina Harm Reduction Coalition. I’m Molly’s replacement.”

April squinted. “Molly?” Then she added, “Oh, yeah.”

We sat down and she shuffled through the box. Glancing at her arm, I winced at the abscess protruding from a grid of collapsed veins and scabs.

“You should have that arm looked at,” I said. “Do you want me to drive you to a clinic?”

She frowned. “I ain’t goin’ to no hospital. They treat me like shit. Always think I’m there for drugs, even when I’m sick.”

I was silent as April continued her appraisal of the supplies. Presently, a van pulled around the back of the house and a man emerged in a greasy mechanic’s uniform.

April sighed. “A client.” She picked up a condom. “Good thing you brought these.”

I nodded and took my leave.

In the coming months I continued to visit April at her home where she lived in a sunken ruin wallpapered in nicotine stain. Each time I delivered a box of supplies: condoms, clothing, hygienic items to prevent infection from drug use, even food, as during one visit I’d glanced in her refrigerator and found nothing but a half-empty bottle of Sunny Delight orange juice. As an employee of a harm reduction agency, I visit many people like April, those at high risk for HIV, hepatitis C and drug overdose. We offer educational resources, supplies to reduce the risks of death and disease, and if the person requests, referrals to drug treatment, vocational training programs or social services.  

During my three years at the agency, I’ve often been asked why I don’t tell people like April that they should “get a real job” or stop using drugs. As someone with a middle class background, I was taught to divide people into those who “deserved” help and those who didn’t, assured that a little tough love was necessary lest the undeserving become complacent, or worse, dependent. It is difficult to watch April sink deeper into addiction and not to judge her choices, but I’ve never told her to stop for the same reason I don’t harass every overweight person I meet about exercise. I don’t know if a person’s situation resulted from poor choices, genetics, stress, or something deeper. But I do know that the sting of judgment, the silent accusation that their plight is self-inflicted, the constant refrain from society, family, friends and even strangers, “if you would just fix yourself…” does not often motivate change. If anything, piling stigma and shame onto an already fragile self-esteem leads to resignation, self-hatred, depression and hopelessness. Cocooned in my privileged home, it was easy to avoid drugs and sex work. But if life had handed me April’s shoddy decks of cards, what makes me so certain I wouldn’t make the same choices she has? April might well be following the most rational path, given her options. So as a harm reductionist, I try to offer my services in a spirit of non-judgment. I don’t always succeed, but the more time I spend with April, and the more I learn about her background, the easier it becomes.

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