Limits of Harm Reduction: “Managing” Sexual Assault is Not Enough

Several days ago, I posted slides from my presentation, “Reclaiming ‘Victim’ and Embracing Unhealthy Coping,” which took place during the Harm Reduction Conference.

Much to my surprise, the presentation was received ridiculously well, like, best responses ever. So many people came up to me to tell me how much they appreciated the presentation throughout the rest of the conference, including many who did not even attend the panel but heard about it from someone who did. One person who attended told me that when she saw her friend immediately afterwards and began telling her about what she had just heard, the friend commented, “you look like you are having ecstasy.” I didn’t realize that it was that good, but it was great to have my work appreciated so much.

I think all the positive reactions (which is still good, despite the fact my presentation was about “negative survivorship”) came about because many of the people in the room were folks who work in harm reduction field (as it mostly relates to working with people who use substances), and also are survivors of violence and abuse or know someone who is. They liked my presentation because I made harm reduction principles (which they are so familiar with) applicable to their own personal coping and survival or that of someone close to them.

But during the questions and answers period, some curious discussion came up: a woman asked how harm reduction principles apply to her work with sex offenders, rather than victims and survivors of abuse. I hesitated, because it’s emotionally difficult to engage with the behaviors of rapists, child molesters, and abusers, even in the abstract. But when I heard someone else responding to her, suggesting that harm reduction could be practiced just the same way for offenders as for drug users or abuse victims in order to reduce the harm they inflict, I had to say something: I had to point out the limitations of harm reduction principle, as wonderful and effective it may be in some areas.

A couple of years ago, I went to a workshop about harm reduction philosophy hosted by a local activist collective. The presenter spoke about one of the best examples of harm reduction-based policies, which according to her was the distribution of condoms to U.S. soldiers stationed overseas: condom distribution prevents sexually transmitted diseases, which is good for both U.S. servicemembers (assumed to be heterosexual men) and locals (assumed to be women), as well as other people.

I immediately thought about stories of rape and other forms of violence committed by members of U.S. armed services against native inhabitants of Okinawa, as in (I’m sure) many other places around the world. Under the diplomatic treaties, it is difficult for local police to charge and prosecute U.S. servicemembers with the crime once they return to the base, from which they sent back to the mainland U.S. quickly. That is not to say that consensual sexual acts don’t happen between U.S. servicemembers and locals–but sexual assault is too frequent and too often concealed by both governments for me to celebrate the distribution of condoms (which, I’m not sure if they do in Okinawa specifically) as “harm reduction” measures.

Condoms do certainly reduce the risk of sexually transmitted infections, but they do not reduce the number of rapes committed by members of the U.S. armed services, or the size of the Okinawan land forcibly occupied by the U.S. military (about 10% of all of Okinawa, and 18% of the main isle of Okinawa), which is itself a form of violence, a joint product of dual imperialisms of the U.S. and Japan over Okinawa. It is perhaps true that a rape with a condom is less harmful than one without, but making condoms available does not address the worst harm that is being perpetrated; worse, it may perpetuate even more harm by reducing the risk of the behavior to the rapist.

Some people do in fact advocate for “harm reduction” approach to sexual assault. In an article titled “Relapse Prevention or Harm Reduction? (published in July 1996 issue of the journal Sexual Abuse: A Journal of Research and Treatment), forensic psychologist D. Richard Laws wrote:

In this view sexual deviation would be seen as a chronic, well-established disposition to commit sexual crimes, a condition that could not be cured but could be managed, albeit imperfectly. […] A harm reduction perspective with sex offenders acknowledges that lapses and relapses are probably inevitable and that the job of treatment, at the very least, is to reduce the frequency and intensity of these instances, if they cannot be eliminated.

At bottom, our job in managing sex offenders and reducing harm is, in reality, a sort of social policing. What we are really doing is attempting to contain and limit socially undesirable behaviors. This is not unlike the efforts of law enforcement officials to contain gambling, prostitution, or drug dealing.

In the follow-up article, published in July 1999 issue of the same journal, Laws argued:

However, it will eventually prove necessary to normalize some aspects of sexual deviation including some features of sexual offending. We need to normalize sexual offending in the same way that we have normalized other deviant behaviors such as drug dealing, prostitution, or gambling.

I would agree that we cannot, at least for the foreseeable future, eliminate sexual violence altogether. But I am deeply disturbed by suggestion that sexual violence is “inevitable” and can only be “managed,” as well as by the parallel Laws seems to be drawing between non-violent behaviors such as substance use and gambling and sexual violence where there are clear, direct victims who are harmed by the behavior.

An attitude like this, or like that of the workshop participant who stated that harm reduction approach is equally applicable to working with sex offenders as well as their victims, is symptomatic of how harm reduction has turned into a merely more sophisticated form of paternalistic intervention to modify individual behaviors.

But harm reduction is supposed to be more than just reducing or “managing” harms. It is supposed to be a fundamental reframing of priorities for social interventions that places individual and community well-being, as defined by the individuals and the communities that are affected most. I fully endorse a harm reduction approach to survivor advocacy, which includes embracing of negative survivorship, but it would be a misuse of harm reduction principles to simply lower expectations for sex offenders, child molesters, and abusers when they are not the party most directly affected by the harms their behaviors inflict.