Social Abstinence Is Not a Sustainable Pandemic Response

The “just say no” approach isn’t working. But here’s what might.

In These Times Editors August 20, 2020

Harm re•duc•tion


“People will take risks, whether we like it or not. The best thing we can do is give them strategies to reduce harm in those situations. If we don’t do that, we’re missing an opportunity.” —Julia Marcus, infectious disease epidemiologist at Harvard Medical School

1. A prag­mat­ic approach to pub­lic health that aims to lim­it the risk of unsafe behav­iors rather than pro­hib­it them

Why is harm reduc­tion needed?

Because when it comes to risky behav­iors, such as drug use, teenage sex and social­iz­ing dur­ing a pan­dem­ic, the just say no” approach has been proven not to work. As mil­lions of adults who suf­fered through the in-school D.A.R.E. pro­gram know, bom­bard­ing kids about the dan­gers of drugs and alco­hol does not actu­al­ly make them less like­ly to start using. Absti­nence-only sex edu­ca­tion, which the fed­er­al gov­ern­ment has fund­ed with about $2 bil­lion over the past 20 years, has not changed the age peo­ple first have sex — but has often meant they lack infor­ma­tion about dis­eases and preg­nan­cy pre­ven­tion when they do.

There is rarely a one-size-fits-all pre­scrip­tion for healthy behav­ior. Even when there is, attempt­ing to scare or coerce peo­ple into com­pli­ance is less effec­tive than mak­ing the behav­ior as safe as it can be. 

What does harm reduc­tion look like?

Nee­dle exchanges for IV drug users are a huge­ly suc­cess­ful case study. In the 1990s, for exam­ple, drug users in New York were three times more like­ly to con­tract HIV if they did not use a nee­dle exchange. Oth­er exam­ples include des­ig­nat­ed sites for drug use and pro­vid­ing free con­tra­cep­tives for sex work­ers. Replac­ing the crim­i­nal­iza­tion of dan­ger­ous behav­iors with non-judg­men­tal, pub­lic health-based approach­es can help address root caus­es and pro­vide bet­ter social outcomes.

Dan­ger­ous behav­iors” like going to house par­ties or crowd­ed bars?

Yes! Many pub­lic health experts believe that as the pan­dem­ic drags on, we need to adopt a harm reduc­tion approach to social con­tact, espe­cial­ly con­sid­er­ing that ongo­ing quar­an­tine is sim­ply not pos­si­ble for some peo­ple. Rather than con­tin­ue to advise that peo­ple not see any­one out­side their house­holds, even while we know that many are going to bars, safer social­iz­ing” might include, for exam­ple, gath­er­ing in parks where dis­tance can be main­tained, masks are required and hand san­i­tiz­er is plentiful.

It’s not an acci­dent that this sounds a bit like clas­sic Amer­i­can sex edu­ca­tion. Decades-long pub­lic health cam­paigns to edu­cate about HIV/AIDS pre­ven­tion and nor­mal­ize con­dom use have a lot of lessons for the cur­rent moment. We just need to move much, much faster to ward off cat­a­stro­phe.

This is part of ​“The Big Idea,” a month­ly series offer­ing brief intro­duc­tions to pro­gres­sive the­o­ries, poli­cies, tools and strate­gies that can help us envi­sion a world beyond cap­i­tal­ism. For recent In These Times cov­er­age of harm reduc­tion, see Don’t Shame Pro­test­ers and Park-Goers Over Covid-19 Spread­ing — Shame Cor­po­ra­tions and the State,” Harm Reduc­tion: The Anti-Drug” and Should HIV-Pos­i­tive Work­ers Be Allowed in the Sex Indus­try? Some Advo­cates Say Yes.”

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