The Hawaii Health & Harm Reduction Center is the upshot of a merger of the Life Foundation, an HIV/AIDS advocacy organization, and the drug-use-focused Community Health Outreach Work Project.
Heather Lusk, HHHRC’s executive director, describes harm reduction services as stressing recognition of the dignity and worth of every individual while providing quality care.
The center aims to reduce harm and fight stigma tied to HIV, hepatitis, homelessness, substance use, mental illness and poverty by “cultivating relationships between our participants, community members and providers through advocacy, training, education and capacity-building,” Lusk said. “Our overall objective is to foster health, wellness and systemic change in Hawaii and the Pacific.”
In tandem with her work at the nonprofit, which took shape last summer, Lusk is active on more than a dozen task forces and groups tackling community issues. Among recent efforts: Oahu’s participation in the annual Point in Time count, a nationwide homeless census, conducted in January. In 2018, Hawaii continued to lead the country with the highest per capita rate, 6,530 homeless people.
A Michigan native, Lusk moved to California after college graduation, to manage a bookstore.
At that time, she also started volunteering at the San Francisco AIDS Foundation.
“It was 1994, prior to the invention of life-saving medications, and I could see the impact of HIV everywhere and was compelled to get involved. I volunteered on the AIDS hot-line and later that year, got my first job working with young people living with HIV.”
She continued: “Not only was HIV a crisis that meant life or death for many, but the stigma and silence that surrounded the suffering really motivated me to get involved in the larger social justice movement. I saw people dying from discrimination and shame, needlessly.”
Lusk went on to become the California Department of Public Health’s first hepatitis C health educator. In Hawaii, she served as the state Health Department’s Adult Viral Hepatitis Prevention program coordinator for several years before moving back to the nonprofit sector.
Question: Who is included in HHHRC’s core group of participants, or clientele?
Answer: Our efforts are focused on those disproportionately affected by social determinants of health, including: the lesbian, gay, bisexual and transgender community; people who use drugs; people living with and/or affected by HIV and hepatitis; and the Native Hawaiian community. We have robust outreach and case management teams that work with people to address housing, mental health, substance use and other health conditions.
Q: The center has launched health clinic services at its site on Ala Moana Boulevard. How’s that operation going?
A: Our Emmalina Health Clinic started as a wound care clinic, which grew out of street-based wound care and outreach efforts in Chinatown. HHHRC now conducts street-based care twice a week, and encourages people to come in for more comprehensive care.
Also, last year, we started our sexual health clinic with testing for sexually transmitted infections. This month we are starting our hepatitis C treatment clinic on Wednesdays to increase the number of people who have access to the hepatitis C cure. We will soon open a Suboxone clinic for people who are struggling with opioid use.
Many of our clinical services are provided on a walk-in basis and free of charge for those without insurance.… Our dream is to have a mobile health clinic that takes our services to the streets and to the parts of our community that have the most need.
Q: Any other new HHHRC services on the horizon?
A: Our latest project, Law Enforcement Assisted Diversion, is a collaboration between local law enforcement and social service providers to increase linkage and retention in housing, health care and other services.
Q: What were your takeaway impressions from last month’s Point in Time count?
A: We had a great response from the community. … A record number of volunteers signed up … to support our regional leads. This demonstrates that many in our community want to be part of the solution to help end homelessness.
Our count is separate from the neighbor island count, which is coordinated through their coalition, Bridging the Gap. Our hope is to coordinate a report with them to show trends across the state. For example, this year we added a question about homelessness because of disasters, such as the (Kilauea) eruption.
Q: As you see it, what is (or would be) the best way to combat homelessness here?
A: Address the behavioral health issues faced by so many of the unsheltered, especially mental health and substance use. The unmet demand for mental health and substance use treatment is large. Individual and public health would benefit greatly by building the capacity to provide treatment upon demand.
Current treatment infrastructure is far too confined by cost-cutting insurance demands and by the intervention of the criminal justice system. Criminalizing those with mental health or substance use issues is dehumanizing and exacerbates stigma and related harms. Keeping health-challenged individuals under protracted criminal supervision does not work from a health or justice standpoint. Evidence-based, medically supervised treatment does work at relatively low cost.
Also, increasing the stock and variety of truly affordable housing should be given sustained consideration by policymakers. Affordable micro-unit apartments and micro-homes would meet basic housing demands for many. The model that is currently used at Puuhonua O Waianae might be replicable in other rural communities where generations of a family experience housing instability.
… We desperately need more affordable housing. In many ways, we have more of a housing crisis than a homeless crisis as we have the systems to place people in housing if we just had more affordable options.
Q: What’s the center’s annual budget? And what’s HHHRC tracking at the Legislature this year?
A: Our annual budget of over $5 million is supported by state and federal grants, foundations and private donations.
During this legislative session, we’re monitoring several bills related to homelessness, including those that increase the stock of affordable housing and provide sustained funding for proven programs like Housing First to move the unsheltered into shelter. Also, we support changes to our mental health laws to facilitate needed care … for vulnerable members of our communities; an increased minimum wage and a living wage; and the current effort to ban gender-based conversion “therapy” for minors. We oppose all forms of conversion therapy for every age.
In addition, HHHRC supports reform of Hawaii’s criminal justice system, including bills that would reduce the criminal consequences for possession of drugs for personal use. … The HCR 85 Corrections Reform Task Force recently issued its final report to the Legislature. It proposes many reforms that deserve legislative attention. We support bail reform and asset forfeiture reform so that those facing socioeconomic challenges are treated fairly by our justice system.
Q: What sorts of volunteer opportunities are available through HHHRC?
A: Our biggest need for volunteers is the Honolulu AIDS Walk, now scheduled for June 30. We have over 2,000 walkers. … We have opportunities with other events throughout the year. And we are always seeking those with experience to support our street-based wound care and other outreach activities. More information is available online, www.hhhrc.org.
Q: What do you find most satisfying or rewarding in your work?
A: I love my staff. They are passionate, dedicated and resilient and work every day to save lives despite barriers and broken systems of care. Every day they are in the streets, on the front line and witnessing extreme suffering and yet rarely lose hope for a better tomorrow.
I am inspired by many of my staff who come from the community we serve. About half our staff … have walked in the shoes of our participants. It is so rewarding to see our participants transform through the compassion and aloha they receive from us and our programs.
