Black Harm Reduction Politics in the Early Philadelphia Epidemic

This essay examines the efforts of Rashidah Hassan (now Rashidah AbdulKhabeer) and the organization she co-founded Blacks Educating Blacks About Sexual Health Issues (BEBASHI) in early path-breaking harm reduction efforts in Philadelphia. Within a context in which the city and gay advocacy organizations ignored the disproportionate impact of HIV-AIDS on the city’s Black communities Hassan extended a legacy of Black health activism in the context of the new epidemiological and social conditions of the late twentieth century. Under her directorship, BEBASHI created new interventions that combined practical harm reduction information to help people avoid new infections with a political analysis of the relationship between Black women’s (and other groups’) social vulnerability and their susceptibility to HIV. BEBASHI engaged in trenchant structural analysis of the conditions of Philadelphia’s HIV-AIDS crisis moving beyond simple biomedical models emphasizing individual bodies, their contact with the virus, and the eventual manifestation of disease. They interpreted the city’s disproportionate Black susceptibility to the virus as part of the historical and ongoing marginalization and violation of vulnerable Black communities, marking it as part of a longer trajectory of disproportionate morbidity and death. At the outset BEBASHI was largely ignored by public health officials and Black communal institutions alike. Nevertheless, the organization opened a broad front in Philadelphia and beyond against willful ignorance in relation to Black suffering from HIV-AIDS. Their early path-breaking analysis and practice was an imporant historical antecedent to ongoing harm reduction work, demonstrating the central role Black health activists and practitioners played in shaping these discourses from the outset.

Introduction

In the mid-1980s, The Smart Place at the corner of Ninth and Arch Streets in the Chinatown section of Philadelphia was one among a handful of bars catering to the city’s Black queer communities. Although it was not a local neighborhood bar, as were the majority of corner taverns serving as veritable communal institutions in the maze of late twentieth century Philadelphia’s blocks, it nevertheless functioned similarly as a locus of shared affinity and belonging.1 In particular, Black gay men drawn from across the city animated the humble converted row house through the communal bonds of cultural affiliation and social-sexual community.2 While in daily life the majority of Black gay men and other Black queer groups integrated themselves into heterogeneous Black neighborhoods and into workplaces and other leisure spaces alongside the broader urban population, the Smart Place represented a gathering site meaningful to many regulars as a place of specifically Black queer self-fashioning and belonging. Defined by drinking and through the sharing of intimacy and sex, shade and affirmation, this community was a source of vitality. However, in the mid 1980s it was also a community defined by its proximity to death.3 As bartender Peppi Highsmith noted to a journalist in 1986, at least five of the bar’s regular patrons succumbed to AIDS in the course of the previous year. By the close of 1986 the Smart Place had closed.4

Despite the devastating effects of the epidemic, public health organizations created to combat the city’s epidemic ignored Black social-sexual communities like The Smart Place. The generic characterization of HIV-AIDS as a condition of libertine sensuality and promiscuity associated with bathhouses and other sites primarily utilized by white gay men for cruising, precluded early recognition of the unique geography of Black susceptibility to the virus. The specific routes to the virus’s transmission among Black Philadelphians, the sites and places within their social networks where the epidemic was taking its destructive toll, remained hidden, unthought, and undertheorized. Black queer communities were disproportionately impacted by the growing list of the dead and infected and they were part of a larger epidemiological trend in Philadelphia’s emerging HIV-AIDS crisis where in 1986, nearly half of the 267 confirmed cases affected Black people despite the fact that Black people composed thirty eight percent of the total population.5

Within and responding to this milieu of denial, silence, and ineffectual public health Black health activists and harm reductionists, especially Rashidah Hassan (now Rashidah Abdul-Khabeer) intervened. Hassan along with Wesley Anderson co-founded Blacks Educating Blacks About Sexual Health Issues (BEBASHI) in 1985 to call attention to and intervene as the AIDS cases attributed to the city’s Black population ballooned in proportion to the cases associated with white gay men. Under Hassan’s directorship, BEBASHI highlighted the social and political ecology of the disease, emphasizing the emergence of AIDS as part of a larger historical dynamic of Black suffering. In a context in which public health advocates sought to examine the proliferation of the disease through narrow accounts of sexual behavior or drug usage, resulting in limited interventions, BEBASHI sought to explode behavioral models incapable of accounting for racism, patriarchy, economic segregation, and history. BEBASHI created popular education materials and outreach programs designed as culturally sensitive and appropriate interventions to communicate basic harm reduction information along with social and economic analysis. They worked across a range of social institutions serving working class Black Philadelphians. BEBASHI distributed condoms and information at cruising sites centering Black gay men, held information sessions for residents of public housing across the city, worked with Black religious leaders to convey information about the virus to congregants of churches and mosques, and built sexual health education programming for the youth in Philadelphia’s foster care system. In the process they empowered vulnerable communities to prevent further transmission, and identified as “fundamental causes” of the disease the accumulated effects of racism, deindustrialization, and patriarchal violence.

Black harm reductionists, though largely unremembered in the popular representations of HIV activism centering white gay men, provided galvanizing energy from the outset of the epidemic in Philadelphia. They worked in the critical initial years to halt the rapid transmission rates among those left exposed while also connecting the condition to a broader political agenda to transform the conditions Black communities faced in a crumbling city.6 BEBASHI (and similar organizations in Philadelphia and beyond) engaged in trenchant structural analysis of the conditions of Philadelphia’s HIV-AIDS crisis moving beyond simple biomedical models emphasizing individual bodies and their contact with the virus and eventual manifestation of disease. They interpreted the city’s disproportionate Black susceptibility to the virus as part of the historical and ongoing marginalization and violation of vulnerable Black communities. At the outset BEBASHI was largely ignored by public health officials and Black communal institutions alike. Nevertheless, the organization opened a broad front in Philadelphia and beyond against willful ignorance in relation to Black suffering from HIV-AIDS. Their early path-breaking analysis and practice was an important historical antecedent to ongoing harm reduction work, demonstrating the central role Black health activists and practitioners played in shaping these discourses from the outset, long before mainstream public health practitioners embraced these forms of analysis.

BEBASHI and Rashidah Hassan’s Harm Reduction

Despite the disproportionate impact of the early HIV-AIDS epidemic on Philadelphia’s Black communities, resources to address the mounting epidemic remained largely concentrated among white organizations, further exacerbating the public profile of the disease as white and gay, and precluding vital early harm reduction interventions among the city’s Black communities. The Philadelphia AIDS Task Force and other organizations charged with responding to the disease remained at best taciturn in their response to the number of deaths among Black gay men, Black heterosexual women, and Black intravenous drug users, seeking instead to fund information and outreach in gay social institutions that were almost exclusively white.7 In 1985–6, when the Philadelphia AIDS Task Force (PATF) received $400,000 in funds for an education program, it targeted gay organizations and groups composed primarily of white members and issued information at white gay bars and in white gay publications.8 Emphasizing anal sex between unknown partners as the primary route to new infection, they failed to take stock of the complex social matrix shaping the epidemic in its devastation of Black Philly. These miscalculations about the geography and the social nature of the epidemic represented missed opportunities on the part of the city’s public health and governmental agencies for practical harm reduction interventions, the effects of which continue in the city’s disproportionately Black HIV rates.9

In response Black health activists extended into a new epidemiological and social-economic terrain, a legacy of Black health activism stretching back to the early twentieth century.10 They worked to democratize valuable health information and to disseminate it in spaces marked within emergent neoliberal discourses as inherently and fatalistically dangerous. They pushed back against the dominant organizational efforts centering white gay men, seeking an integrative analysis of HIV’s epidemiological profile within a wider terrain of violence and economic and social isolation. They sought to empower ordinary people, even those inhabiting the edge of social-spatial existence in the crumbling infrastructures of the postindustrial city, in their negotiations of their bodies and their health.

Rashidah Hassan in particular attempted to push the collective response from one of simple repulsion and dangerous ignorance to practical harm reduction and political education. In the process, she exposed the deadly anti-Black caesura in the emerging epidemiology of the virus. She advocated for the cultural specificity of Black communities in relation to sexual health, co-founding BEBASHI in 1985 in response to the conditions of stigma, shame, and ignorance perpetuated by the City’s limited allocation of resources to address the growing epidemic in its pernicious effects on poor Black communities across the city.11 BEBASHI’s co-founders sought to extend resources aimed at prevention, compassionate care for those already suffering the effects of AIDS related illness, and the embrace of the vulnerable irrespective of their sero-status, sexual proclivities, or drug use.12

Before, in the midst of, and after, BEBASHI’s founding, Hassan consistently called out the City’s as well as white gay men organizations for their limited response to the crisis in relation to Black and other nonwhite people. In 1986, she spoke as a panelist at the Philadelphia Lesbian and Gay Task Force Conference in Center City. She noted forcefully that the City’s Black communities along with its Latino and Asian communities suffered more than fifty-five percent of the documented cases of AIDS. She contextualized this within cultures of shame and stigma related to queer sex. Hassan along with the other panelists lamented the growing violence of what Rita Addessa described as the City’s “AIDS-phobic environment.”13

In a pointed September 25, 1986 oration she later dubbed her “Malcolm X Speech,” Hassan renounced the lack of support for resources allocated to address the mounting crisis in the City’s Black communities. She grounded the growing health crisis and its disproportionate impact on Black communities within what she described as a longer history of “suffering prayerfully, but suffering nonetheless” that had defined Black experiences in the US since the era of the Atlantic slave trade. By rooting the public’s indifference to these communities’ suffering within the history of slavery and its attendant sexual and racial violence, she pushed back against the historical amnesia and conceptual lacuna inherent in viewing HIV as a disease divorced from the racialized, sexualized, and classed landscape of its expression. Situating the disease within a history of Black suffering, Hassan engaged in an important epistemic reordering of mainstream public health, especially the temporal coordinates of epidemiology that in the name of efficiency center the acute unfolding of a condition without addressing its macro-temporal coordinates, those of history. Black communities, queer and heterosexual, continued to suffer the effects of social-sexual isolation, a legacy of what Carolette Norwood describes in the context of Cincinnati as the ongoing “Jim Crow geographies” of the city, in the 1980s.14

Hassan further excoriated the institutions tasked with responding to the epidemic for their lack of mobilization or resource allocation addressing the specific needs of Black communities. She called on officials to commit resources to the development of culturally respectful education and testing. She went so far as to threaten that if these organizations did not respond she and BEBASHI would “haunt” them for their lack of critical attention. By intentionally rustling the feathers of the already established HIV-AIDS network of service providers and researchers in Philadelphia, Hassan hoped to get them to transform their inattention into action.15

Alongside advocacy with policymakers and public health workers, through BEBASHI, Hassan worked to create new interventions. As part of its campaign to spread information about risk, testing, and care, BEBASHI engaged in targeted pedagogical campaigns to get the word out to the vulnerable about the possibilities for reducing harm related to HIV infection. BEBASHI targeted sites frequented by Black gay men for condom distribution, it created pedagogical and outreach projects to Black working class communities in housing project community centers and religious institutions, and created an information campaign for youth in coordination with Philadelphia’s foster care system.16

One of BEBASHI’s most important tools was a series of educational films targeting heterosexual Black women that they used as a popular education tool along with outreach to the City’s Black community organizations including its religious and civic ones. The films highlighted the intersectionality of geographic, economic, social, and political violence and its relationship to Black women’s susceptibility in contracting HIV. These films pointedly represent BEBASHI’s work under Hassan to attach practical harm reduction with analysis of political, economic, and social conditions in their efforts to awaken ordinary Black Philadelphians to the dangers of HIV.17 BEBASHI worked with actors from a theater in West Philadelphia to dramatize the conditions shaping the unique vulnerability of Black women in relation to the condition. One of the short film scenes they produced opens with a Black woman conversing over the telephone with one of her friends. She wears an arm brace and confides in her friend the way that her partner inflicted physical and emotional violence on her as well as her daughter. Although she strikes a confident tone while chatting with her friend, the return of her partner precipitates a sudden shift to shrinking subservience. Despite her actions to prevent the escalation of violence, her partner is provoked first by her inquiry about where he spent the previous night and then by her daughter’s failure to acknowledge his presence “as the man of the house.” To prevent the partner from exacting further harm on her daughter, she softens his anger through recourse to seduction. The clip suggests that her use of sex to mitigate the blows of violent patriarchy are what inadvertently lead her to contract the virus.

Another short scene produced by BEBASHI opens with a woman calling her former partner from a women’s shelter to inquire about her health benefits card which she left in his possession by accident. She reveals during the conversation that the as yet unseen partner induced her to heavy drug use and used coercion and violence to force her into sexual relations with his friends. “Man I felt like a piece of pussy” she exclaims as she attempts to get him to deliver her card without her having to enter his home. She eventually goes to get the insurance card and the partner, who has a number of cocaine lines on the table coerces her into sex.18

Another of BEBASHI’s scenes is staged as a daughter takes video footage of her mother who is dying of AIDS which is evidenced from her deep and painful sounding cough. The daughter records her mother for posterity—for her yet unborn child—in anticipation of the grandmother’s death. As she outlines her life to her grandchildren, the grandmother’s explicit public health message drives home the point of BEBASHI using videos as education tools. She says explicitly that she never engaged in intravenous drug use and to her knowledge never had sex with any queer men. Yet, as she remarks, she does not have much time to live. She goes on to further contextualize her contraction of the disease in the unbalanced power relations of patriarchal social order, in a context of economic and social instability, attributing her infection to the sexual violence she experienced at the hands of an often drunk partner years before.19 The grandmother recording her story for her yet unborn grandchildren also contextualizes her own premature death within the longer history and context of Black vulnerability, reinforcing Hassan’s and the organization’s wider efforts to diminish ignorance of the condition as well as stigma and to understand it within a longer history of unnecessary Black suffering and dying. The grandmother justifies the recording in passing acknowledging that “I never knew none of my grandparents though I wished I really had.” These scenes reinforced BEBASHI’s message that Black women and other groups not affiliated explicitly in the public imagination with AIDS, remained vulnerable, especially given their situation within a wider ecology of social violence and vulnerability marking the late twentieth century transformation in urban political economy and governance.

In many ways the complex behavioral framework BEBASHI and Hassan outlined, laid early conceptual and practical groundwork for the critical social and geographic research in HIV by creating robust analyses of social, economic, and political conditions shaping decisions about sex, drug use, and other more proximate behavioral associations and HIV.20 By situating Black women’s deadly contact with HIV within a matrix of gendered and racialized economic and social vulnerability, these films explode the emergent interpretations of “risk” as a reductive characterization of behavior within an ultimately moralistic frame of “good” and “bad” or “responsible” and “irresponsible” action. Rather, these films, beyond simple harm reduction, realistically portray the complex negotiations poor Black women (and by extent all Black people) face as part of surviving the intimate effects of structural violence and economic transformation. They vividly and convincingly illustrate how the gender imbalances and economic desperation of deindustrialization, exacerbated by the emergent carceral order compound dwindling resources to produce unique forms of susceptibility.

Hassan’s and BEBASHI’s work broke conceptual and theoretical ground in harm reduction by attaching practical solutions to the transmission of HIV with multi-temporal analyses of HIV-AIDS’s social, geographic, and economic characteristics. Hassan’s and BEBASHI’s efforts represent useable histories in relation to the ongoing fight against the spread of HIV as well as the vampire-like narratives of acute behavior and risk that too often truncate discussions of the epidemic as functions of Black people’s supposed poor decision making. The models forwarded by BEBASHI continue to help us view HIV-AIDS as part of a social and geographic dynamic defined by broad economic and social crises experienced as interpersonal violence and resulting in susceptibility. BEBASHI’s structural analysis combined with its culturally specific health information program remain models for situating susceptibility to various conditions within their social, economic, and political contexts. BEBASHI’s early harm reduction work shows the central role Black health activists and practitioners played in combating HIV-AIDS. Hassan and BEBASHI advocated for the practical dissemination and democratization of health information without recourse to violent shame or disregard.