The following is a transcript created from the Hawai’i Public Radio interview by Chris Vandercook of Heather Lusk, the Executive Director of the Hawai‘i Health & Harm Reduction Center.
CHRIS: HIV and AIDS may no longer dominate the headlines but more than 2,500 deal with it and its stigma every day. The new Hawai’i Health & Harm Reduction Center has as its mission: “Reducing harm, promoting health, creating wellness, and fighting stigma in Hawai’i and the Pacific.” It’s Executive Director Heather Lusk is with us in our studio.
CHRIS: This is a new organization formed of two existing organizations, tell me about that.
HEATHER: Yes, the Hawai’i Health & Harm Reduction Center, which launched July 1st is combined from two organizations, the Life Foundation which is 35 years old, and the largest and oldest HIV organization in the Pacific; and the CHOW Project which stands for Community Health Outreach Work Project, which is a 30-year-old agency dedicated to state-wide outreach, harm reduction, and runs our state-wide syringe exchange program.
CHRIS: I’m figuring that in the past, their missions pretty much overlapped?
HEATHER: Yes, and ironically, syringe exchange started at the Life Foundation over 35 years ago, then CHOW came along, so they’re kind of coming back full circle to combine. We’ve been co-located for about 7 years and collaborating, so our joke is that we lived together and now we’re married.
CHRIS: Well, many happy returns!
HEATHER: Thank you.
CHRIS: But it’s an increasingly difficult situation that you folks face, and it’s not, as I said in the lead, HIV and AIDS aren’t at the top of the news anymore, it’s not a new crisis right?
HEATHER: Right. Why it’s not a new crisis is we have medications that can basically manage HIV, it’s really a chronic, manageable disease. The reality is in Hawai’i, we still have many people who don’t know that they have the disease, or don’t have access to the lifesaving treatments they need – so that’s a big focus of our work to address the homelessness, the substance use and mental health issues of our whole community. But then using that to leverage and supporting people with HIV in a kind of whole, comprehensive approach.
CHRIS: Because enormous overlap between homelessness, opioid addiction, HIV, you know a lot of HIV is transmitted through needles right?
HEATHER: Exactly. Because of the state-wide needle exchange that started here in Hawai’i in ’89 – we were the first state to have state-wide syringe access – we have lower HIV rates than many states on the continent, but that doesn’t mean it doesn’t still happen. And particularly our folks with HIV now have a lot more other issues, such as I mentioned, substance use, homelessness, mental health, and then we’ve broadened beyond HIV because we now have street-based outreach for homelessness, substance use outreach, we have a street-based wound care, and now a clinic in our office for would care. So we’re trying to use a kind of “no wrong door” approach to be able to get folks into the care they need and then address a multitude of issues.
CHRIS: What’s it like out on the street these days?
HEATHER: Oh Chris, as folks know, homelessness is a very complex issue and therefore we really need kind of complex, multi-sector responses to homelessness. I will admit that as we’ve done a big success in getting folks off the street with housing first, it’s also led to, we believe some instability because we’ve kind of worked with the folks that we were able to more easily able to connect with services. And who’s still on the street they often have many more reasons why they’re still out there. And that’s led – we have seen- to some increased chaos and even violence. So we’re partnering right now, honestly, with HPD (Hawai’i Police Department) and other public safety folks to do more public health, public safety outreach. So on Wednesday night, you may have heard that a group of folks went out with HPD and 23 people were able to get into housing because they could go do outreach in places they may not normally be able to because they had HPD there for the safety part. So I think we’re looking at unique partnerships to be able to address this in a multitude of ways.
CHRIS: Is there housing available and people out on the street who could be in that housing but aren’t, is it just there’s no room at the inn?
HEATHER: Yeah, you’re right. So one thing that we do for these coordinated outreaches, is we get a shelter vacancy count so that we know exactly how many spots and we used kind of all 23 open spots on the island the other night. But honestly Chris, we have 3,000 people on what’s called the binay list, so these are 3,000 people that are homeless that our outreach workers across all of the agencies- they know them, they’re ready, they’ve been assessed, they’re document ready -but there’s no housing for them to go into. So honestly, we have more of a housing crisis than a homelessness crisis. We don’t have the inventory to put people even when they’re ready, willing, and able into housing. We have 3,000 on Oahu ready and we don’t have the spaces for them. So our systems are coordinating better, we’re working with city, state, and our community partners better, but as you know, it’s still a big issue out there.
CHRIS: Well that’s 3,000 documented.
HEATHER: Right. Not even counting those that aren’t documented, exactly.
CHRIS: One of the criticisms that’s been advanced of the point-in-time count is that a lot of people chronically homeless, the last thing they want is someone coming toward them with a clipboard asking them for personal information, is that fair to say?
HEATHER: I think that is fair to say and in order to get them to the list for housing, you have to be willing to share some information about yourself. And so that’s what our outreach workers do every day is build rapport, and go out there and be consistent. We just got someone that’s been 30 years on the street, got them into housing because it took years of relationship building, but when they were ready, the outreach worker was there to do that what we call “warm handoff” to that next level. But it’s constant building. And then working with our business community, we know that they’re very frustrated with what they see as lack of progress, so we’re really hoping that we can continue to build upon the successes we’ve seen over the past couple of years.
CHRIS: A lot of the people, that the frustrated business owners you just alluded to, might see are those who are pretty far gone, and not likely to be filling out forms and able to get a job, and you know, chronically, because now we’re talking about the intersection of homelessness and mental illness.
HEATHER: Exactly Chris, with mental illness. And as we were discussing earlier, our criminal justice system is unfortunately somewhat of our de facto mental health system. We don’t have community mental health, particularly residential mental health services unless you’re involved in the criminal justice system. So there’s really very few options for these folks who don’t even have the capacity to make the decisions that they would need to do to get into the housing.
CHRIS: Is that a growing number? The off-the-books homeless?
HEATHER: Yes. At least the data that we’ve seen. There’s a lot of focus on mental illness this year. I don’t know if you’ve heard of Assisted Community Treatment? which is trying to make it easier for folks that are working with those with mental illness to get a court order so they can get some access to treatment. There’s more and more focus. So this year I’m part of Partners in Care, I’m the vice chair, that’s our homeless coalition, and we’re about to apply for our 10 million dollars from HUD (Office of Housing and Urban Development) for the island, and there’s a focus this year on the chronically homeless with mental illness – that’s who we’re going to really try to focus on for that application.
CHRIS: You know Heather, there are so many brick walls that you hit in the work that you do. How do you hold on to the optimism?
HEATHER: I’ll be honest, for me it’s the staff of Hawai’i Health & Harm Reduction center, we’re rooted in 6 core values of compassion, respect, advocacy, quality care, harm reduction, and integrity. And the staff really reflect that, not just in the way they deliver services, but in the way that we treat each other. We want to, we’re really a sanctuary, not only for those struggling with mental illness, homelessness, substance use, and HIV, but the center also is that sanctuary for the staff. Because they’re out in the streets doing incredible work, they see so much trauma every day, so I think that together we try to highlight the light in someone – I know that sounds a little bit cheesy, but we really are looking at a strength-based model of where’s are, where’s our strength, where’s our community resilient, where they are doing well, and how can we build on that? Instead of focusing on the, all the hard part.
CHRIS: Well the community clearly needs your strength, Heather. Thanks very much for coming in.
HEATHER: Yeah, thank you so much for having me.
Listen to the full interview on HawaiiPublicRadio.org.