Harm Reduction Center of Southern Oregon

Transitioning to a Harm Reduction Model

       After closing Ruby House in 1998, we traded the home to Mercy Medical Center for a storefront office near the entrance of Gaddis Park and began doing business as the HIV Resource Center.  The Center started developing strategies to insure that people in high risk categories knew their status, and knew how to prevent the spread of HIV.

      At that time there were three staff, all either house aides or case managers.  Community partners, clients, volunteers and board members all participated in this planning process.  We agreed to target youth, injection drug users and their partners, homosexual men, the female partners of homosexual men, and sex workers. 

The process was about as grassroots as it could get.  The group would chitchat a thought for weeks. Ideas evolved into processes developed by the people on the frontline. They were presented to the board of directors and turned into a course of action.

We had recently launched our first formal outreach program, Positive Speakers in the Schools. Two very dynamic young men spoke to schools throughout Southern Oregon. One is an injection drug user from Grants Pass who was placed at Ruby House in 1993, the other contracted HIV while incarcerated in Lompoc California.  Both were bright young straight men, stereotypes agreeable to most rural boards of education. 

They also conducted presentations to recovery groups, self-help programs ands shelters.  These presentations, labeled AIDS 101, were designed to reduce barriers to HIV counseling and testing.  Testing served as an opportunity to get people, one-on-one, talking about the risks they take.  Our goal was, as it is today, to help people develop a plan to reduce risky behavior.

One of those outreach workers introduced the group to the concept of Harm Reduction.  He portrayed it as a public health philosophy.  One intended to be a progressive alternative to the prohibition of certain lifestyle choices. A good example of Harm Reduction is the "designated driver program." No one says it's a good idea to over indulge, but if you do you must not drive.  It’s common sense!

He proposed supplying out-of-treatment injection drug users clean syringes, alcohol swabs, antibacterial ointments, literature and supplies necessary to inject drugs safely.  He also wanted to recruit secondaries, people living in the drug cluture who would provide safe injection kits to other users.

Early efforts centered on the outreach worker meeting clients at all hours all over town.  Armed with pager and cell phone he exchanged hundreds of syringes those first months throughout Roseburg.  One Saturday he hosted a class on safe injection practices at our office in Roseburg for the secondaries.  He trained them to interact with their peers and to educate drug users about the risks of injection. By the end of the year, he was exchanging a thousand syringes a month with an eighty percent exchange rate.  For every 100 syringes he distributed, he collected 80 used needles.

In 2002 the Center received a two year capatity building grant from the state to target women at risk of contracting HIV in Douglas, Coos and Curry Counties.  The following year a recovering addict with extensive Hepatitis C experience joined the staff, and we began integrating Hep C education into the program.  This grew into the Community Outreach Program.

The HIV Resource Center in Roseburg merged with AIDS Support And Prevention in Grants Pass in 2005 and became the Harm Reduction Center of Southern Oregon (HRCSO).  Operating syringe exchange sites in Roseburg and Grants Pass, and speaking at public, alternative and charter schools, treatment programs, corrections, Job Corps, women's self-help programs, homeless shelters and other alternative programs. HRCSO staff and volunteers reduce barriers to screening by offering HIV testing at most presentations and providing scheduled monthly test sites in each of the towns along the southern coast.

Ruby House: 1988-1998

Ruby House served as a home for people with AIDS.  It was home for people recovering from acute infections, adjusting to chronic conditions, and a place for people to die.  The home opened in Winston in 1988 and moved into Roseburg in 1991.  It served the community until 1998.

During this time, 110 people lived at the home, 87 of whom died there. They ranged in age from 21 to 72.  They came from all walks of life, concert pianists died alongside homeless.  The older men and women had relatively peaceful ends.  Most of the young died hard, their hearts beating, their lungs sucking air long after there was no hope left.  All we could do was keep them clean and relatively comfortable.

In those early years, the dying years, people succumbed to opportunistic infections: cancers and microbial diseases that normally do not harm people with a healthy immune system.  Most common was a pneumonia, PCP, caused by a one-celled animal and a rare, relatively benign, cancer which normally occurred in elderly men of Mediterranean ancestry, KS. Less often a flesh eating microbe, MAC, literally ate people alive. If you want to learn more about a subject, Google the acronym with HIV or AIDS.

A typical scenario was that families took care of their own.  The person living with AIDS slowly deteriorated to the point where they could no longer be cared for at home.  For a young white person that period was usually 18-24 months.  By comparison, a black woman living in New York City had an average life span after diagnosis of just three weeks.

A local youth was placed with us when MAC ate through the roof of his mouth into his sinus cavity.  His loving parents had cared for him at home for two years.  They were exhausted.  They couldn’t take any more.  He lived another six weeks at Ruby House.  In the end, he drew breath through the breach. 

KS usually began as tiny purple spots on the lower legs, often spreading to the upper body, head, internal organs, and joints.  One Winston man had football size lesions on his back.  Lacking circulation, the inner tissue became gangrenous. 

A Eugene man had a lesion on his ankle joint. Before he died the lesion almost totally separated his ankle from his foot. Another moved into Ruby House when the lesions destroyed his digestive tract. 

PCP, the pneumonia, slowly suffocated its victims.

Besides being the worst health care crisis of our lifetime, it was extremely politicized. GAY Related Immune Deficiency (GRID) was its original name.  Then it was AIDS, ARC, SIDA in Spanish.  The Virus was first identified at HTLV-III.  Now it’s called HIV.  No one was immune from the politicizing. 

A culture of fear and misinformation permeated the times.  The worst among us called it God’s Wrath.  Many blamed homosexuality and/or drug use.  Some even blamed the Haitians!  This was the 1980s.  Politics and medicine made queer bedfellows.

It wasn’t all horror.  There was a strong sense of solidarity at the house.  It served as a community center to a mix of clients, family and volunteers.  People laughed and loved. 

Volunteers from the local homosexual community were first to volunteer at Ruby House. There was a Gay & Lesbian Community Center in Roseburg.  It was the only one in the State at the time.  Volunteers were recruited from its numbers.

UCAN (Umpqua Community Action Network) was the first social service organization to support the AIDS home.  They provided funds to help clients keep a roof over their heads.  Mercy Medical Ceter soon followed with financial and nursing support.

Mainstream churches made commitments.  Besides volunteers, the church groups brought home-cooked meals, transported clients and offered moral support.  Students from UCC joined in.  The Psychology and Sociology programs gave students credit for volunteering at local social service agencies.  Nursing and theater students also participated. 

Volunteers started making presentations to community churches, college classes and high school health classes. The message, backed by the reality of Ruby House, was well received. A group of students from Roseburg High School came out and cooked lunch for the residents one day. During the holidays, carolers filled the house with song. There was always something going on.

The home put a face on AIDS.  It was no longer something exotic and far away.  By example, the volunteers educated the community about HIV transmission. 

The powerful combination of medications introduced in the late 1990s had redefined HIV disease.  It is no longer an imminent death sentence.  Now most people living with HIV, like most people living with chronic conditions like Diabetes, have to take medication for the rest of their lives.  They have to live a healthy lifestyle, no excessive drinking and drugging.  And they have to be in the care of a physician.  Medications for HIV disease cost, at a minimum $20,000 a year.  It’s an expensive illness. But most important, HIV is still contagious.

1991 Protest

   I like to say that I wiped the tables and swept the floors of the early post-Stonewall period of the modern homosexual rights movement.  In my early twenties, just back from Viet Nam, I participated in and witnessed this period in history.  I volunteered at the Gay Activist Alliance’s Firehouse in New York and with the Gay Liberation Front in L.A. at what is now known as the Gay and Lesbian Center.  These were powerful times to be queer.
   Our leaders back then were heroes.  They risked everything by simply organizing those of us willing to coming out.  They destroyed their careers.  They lost their families, and in some cases they risked and gave their very lives.
   Around the time Harvey Milk, the first openly gay city supervisor, was murdered at San Francisco City Hall in 1978, a shift began to occur in the leadership of the homosexual rights movement. Heroes were replaced with Gay YUPPIEs. The dying years of the AIDS epidemic essentially finished off the male heroes.
   Portland, Oregon can rightly take credit as a principal in this transition. Where San Francisco was distinguished as a magnet for the most exotic amongst us, Portland drew the most aggressive self-serving. Men and women who never missed an opportunity to prosper.  Where the heroes spoke with a flourish these bureaucrats just flourished.
   I say all this so that you, the reader, might understand my harshness towards the AIDS leadership in Portland at the time of the 1991 Protest.  Then, like now, the Portland leadership was dominated by self-serving, agriphobes who cannot see outside the Willamette Valley.
   As an addendum, there was little difference between the Portland and Eugene leadership.  Eugene had two service organizations.  Two Boards of Directors, two offices, two sets of paid staff, all competing for the AIDS service dollars.  Meanwhile, they turned their backs on their dying.  Many ended up at Ruby House, arriving here alone, some prostrate on the back seats of taxicabs.  While services in Eugene have improved tremendously since the early 1990s, they remain an aggressive arrogant neighbor.
   Please keep in mind that these are my personal journals, papers that I kept through the last quarter of the Twentieth Century. I never intended for them to be seen in my lifetime, so I am sometimes brutally blunt. When I interject in the present, I do so in [brackets].

February 8, 1991
Yesterday I discovered that Oregon is getting $513,000 this year from the Ryan White CARE Act, a federally administered program.  With the help of the State Health Division, flatland faggots have already divided it up among themselves –OR at least they think they have.  I intend to get a fair share of that money.  If I can’t do that, then I’ll do everything I can to stop them from getting it.  I’m tired of being ignored; I’d rather they all hate me than ignore me.

February 9, 1991
I’m still angry about the way the flatlanders tried (emphasis on “tried”) to split up that half million dollar grant for care.  At Eight A.M. I called the State Health Division and asked the secretary to provide me with a list of names and phone numbers of CLHO committee members (County Local Health Officers).  I asked them to fax the info to Mercy (Mercy lets me use their fax machine). Fifteen minutes later [the HIV Program Manager] called to see if I was having a problem.  I screamed the roof down.  Essentially, I told him that they had no right to divvy up that money without considering Ruby House and that I would use every means at my disposal to see that no one got the money if they insisted on ignoring us.  I reminded him that there is no enemy worse than an enemy who has nothing to lose.

February 10, 1991
I’m still hurt and angry about this Ryan White CARE Act money.  Late Friday another condition was added [The HIV Program Manager agreed to consider directing some of the grant money our way if I met certain requirements]—another hoop for me to jump through…. I probably shot myself in the foot when I alerted the other rural projects to the grant.  I feel that I have a moral obligation to share that kind of information with other rural communities; otherwise, I’m no better than the Flatlanders.  I also suggested that we form a formal coalition and work directly with the State HIV program.

February 14, 1991
Yesterday I sent off the proposal to the State HIV Division….

I have also begun a systematic attack on the Eugene service organizations.  I hope to contribute to the dismantling of Willamette AIDS Council (WAC) and the reorganization of SHANTI in Oregon.  [Another Eugene man had recently arrived at Ruby House’s door by taxi.  He was so dehydrated I took him directly to the ER.  I was feeling murderous.]

February 20, 1991
Today two people from SHANTI are joining us for lunch.  Suddenly, this Eugene organization is interested in my work.  They say it has nothing to do with my recent attacks on the flatlanders….

February 22, 1991
My visit with the SHANTI people went very well…. They were having a SHANTI/WAC board meeting the next day (yesterday).  I gave them two messages for their boards: stop pretending to be statewide; and you owe me $3,500 for caring for Eugene residents.

March 2, 1991
…I billed Lane County Commissioners for $3,500.  That’s the difference between what the state paid and what it cost to care for Eugene residents.  This week there was a flurry of newspaper articles and evening news coverage regarding my bill…. The past month has been very good for me.  Although I’m not sleeping much (3-4 hours each night), I’ve been free of the burden of bedfast residents for over a month now.  It’s very nice.  I hope that it will stay that way until the $30,000 grant is final.  It won’t be so bad when I can hire help.

March 10, 1991
I’m still putting the boot to Eugene.  They’re paying attention to me now.  They’re having another joint (SHANTI/WAC) board meeting soon to discuss my bill….  I’m sure that they’ll just talk about it and do nothing….

March 17, 1991
The media window is opening again.  Two Eugene TV stations and the Register-Guard are doing stories on Ruby House…. [Regarding the Ryan White CARE Act money, the State eventually ran out of obstacles to throw at us, and we finally received the first of $30,000 on August 4th.] 

August 20, 1991
The health division put out its first draft for distributing CARE Act money next year. We are left out again.  I intend to use every means available to discredit the overpaid bureaucrats responsible.  Two of them are visiting Ruby House this afternoon.  I’ll be polite, but I’ll let them have it too.

August 25, 1991
The meeting with the Portland people was uneventful.  Basically I told them that it made me sick that they skimmed their salaries off the top of the AIDS budget, then used the bulk of the remainder to justify their well paid positions.  I also asked [one of them] for printouts showing all the money that has come into the HIV Program and where it went.  I tried not to be personally threatening to him, but I also made it clear that I could care less what Portland’s bureaucrats thought of me.

[The other one], a well paid program coordinator from CAP [Cascade AIDS Project] tried to get me to join Spark Plugs again. [I steadfast refused to be a part of the so-called Statewide HIV Coalition.  I boycott it to this day].

September 12, 1991
…I read a letter from [The HIV Program Manager].  He’s coming for a visit on October 3rd.  I plan to have a hundred people here to talk to him: professionals from the community, people living with AIDS and their families.  He’s heard everything I have to say, maybe hearing from others will sway him.

September 27th
[The HIV Program Manager] is arriving on Wednesday afternoon, October 2, and spending the night.  I have a barbecue planned for that evening where he’ll get an opportunity to meet and talk to people with AIDS and their families.  The next morning we’re having an open house….  I hope to have a hundred people here over the two days.  I figure this is my last chance at getting that money.

October 6, 1991
Wednesday evening 27 people showed up for the barbecue welcoming [The HIV Program Manager].  The informal discussion that followed was very productive  While some got emotional, no one was discourteous to him.

The open house/reception the next morning was also very productive.  Before Nine A.M. the mayor, police chief, and city manager of Winston dropped by and Sister Jacquetta from Mercy.  By One P.M. over sixty professionals and community leaders had expressed their support for Ruby House.  They mayor of Roseburg was unable to attend, but he called and talked to [him].  [The HIV Program Manager] also received a call from the Oregon President of the Mormon Church Wednesday before he left Portland [Our first women resident was a Latter Day Saint from a very rural part of the state.].

At One P.M. on Thursday, I spirited him off to Jesse C. Corder Memorial Park where we lunched on barbecue spare ribs from the Green Tree In.  Once we were alone at the park, I told him that I would like to be a part of the family of AIDS organizations that enjoy the support of the Health Division.  I told him that my second choice was to be their worse enemy: there could be nothing in between.  I explained that the people he met Wednesday evening were more than just faceless applications and forms.  I told him I would do everything in my power to keep this place open.  I told him that I wouldn’t hesitate to steamroll over every bureaucrat in Portland, if that was what I had to do.  I tried not to be personally threatening to him, and I feel that I was successful to that extent.

November 12, 1991
At the Sunday dinner [we hosted a popular community potluck every Sunday afternoon] I announced that I would host an ACT-UP-like meeting at the farm [Jesse C. Corder Memorial Park] Wednesday evening.  I hope to bring the more radical elements of the AIDS community together to fight our enemies in Portland and Eugene.

I don’t use the word enemy lightly.  The AIDS professionals in the Willamette Valley are robbing the rest of the state of the ability to develop AIDS services  Too much of the limited funds available are going into the salaries of these people.

November 14, 1991
We’re trying to get an ACT-UP-like chapter going here.  I want to use it to apply pressure to the state.  I remain angry and disappointed by what passes for statewide advocacy, and I will try to do something about it.

November 20, 1991
We had our first AIDS action meeting Sunday.  There were six of us present…  We discussed a number of things and decided to form an informational picket line at the [statewide planning meeting] at the Newport Hilton next month.

Steve Henson from Coos Bay visited two Sunday’s ago….  I sent a letter with him to the Sparkplugs [statewide planning] meeting last week.  In it I proposed that the AZT Drug Assistance program receive less funding.  It gets over half of the measly $500,000 available), that Sparkplugs support a three year moratorium on funding new projects which fail to provide services to disabled people living with HIV, and that they oppose any new layers of statewide AIDS advocacy.

According to Steve [and our board chair] my proposals were not well received.  CAP and SHANTI/WAC opposed them vigorously.  I’m not surprised.

November 23, 1991
Yesterday’s AIDS Action Committee meeting went very well.  The same people showed up [plus one].  We chose slogans for the ten picket signs and developed a statement of purpose.  I actually enjoyed the process. 

December 10, 1991
The picket line last week went very well.  There were 23 people all together….  We posted ourselves under the canopy at the entrance to the Newport Hotel during registration on Friday afternoon.  It was a long haul and a lot of work preparing for it.

It served my purpose--and the groups.  The State found out about our effort on Wednesday when a reporter for the Register-Guard called them.  I had alerted the media on Tuesday.  I didn’t return the State’s call.  That evening I had [one of the organizers] call them and explain that we were calling an informational picket line to draw attention to three issues (distribution of funds, balance in services, and so-called statewide advocacy).  Ray asked them to sanction the picket line by allowing us to use the canopied area at the entrance….  [They] said [we] couldn’t do that, but we were welcome to meet in a back hallway.  As per my instructions, [he] told them to see what they could do and that we’d call them back before we arrived in Newport.

I drove the Ruby House van….  We stopped for lunch about fifty miles from Newport,  [we] called [the State] from there to see if we could meet under the canopy.  [They said no.  We said we’d discuss it when we arrive.]  Meanwhile we had already decided that we were going to use [the canopied area] if they like it or not.

The picket line went as planned.

The evening before the picket line, Steve Henson called to inform me that the AIDS Consortium is discussing regional advocacy instead of statewide advocacy.  Steve feels that that is what they will recommend to the Health Division.  I consider this to be a substantial step towards balanced services.

September 10, 2007 An Addendum
Regional distribution of CARE Act funding was implemented throughout Oregon.  As a result rural AIDS Service Organizations sprung up and flourished all over the State.  Southern Oregon had programs in Roseburg, Coos Bay, Grants Pass Klamath Falls and Ashland.

The State dismantled regionalization in 1998.  Today there is only one community based organization left in Southern Oregon, The Harm Reduction Center.