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February 2014 |
drinkanddrugsnews
| 17
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Profile |
Mat Southwell
Mat Southwell talks to
David Gilliver
about how things have changed over
his three decades of work in advocacy and harm reduction
‘I
didn’t know that wasn’t what you were meant to do in the drugs field,’
says Mat Southwell of the participative approach he adopted when he
first started working in the sector. ‘It was what I’d learned, so when I
came to London I just automatically worked with people in the same way.’
An early HIV worker in the late 1980s, his introduction to the field
was volunteering for an HIV centre and helpline established by the gay community
in Brighton. He moved to London to work as an HIV counsellor and went on to
become professional head of service for East London and City Drug Services, an
organisation he’d helped to build up.
‘That participative approach was also partly because I didn’t really know very
much about methadone and that sort of stuff – that wasn’t my background in
drugs, so I had to ask people,’ he says. ‘So there was partly a pragmatism to my
participative model and partly a philosophical commitment, but it opened up a
whole array of different work that allowed us to constantly respond to new drug
trends and issues, because we were working with people on the frontline of the
east London drug scene which was where many of the new trends hit.’
He also developed the showcase Healthy Options Team (HOT), which ‘really gave
me the credibility in the field’, he says. ‘It was what I brought from working with the
gay men’s organisation where my director was a gay man living with HIV who was
also a social worker, so I really got that model of community organising. This is where
I started to get involved in championing responses to issues like HCV prevention and
injecting, crack, heroin chasing, dance drugs and, most recently, ketamine.’
*****
Although his career in the field has in many ways been defined by the struggle for
the human rights of people who use drugs, for the first ten years it was defined by
their health, he stresses. ‘In that acute period of the UK’s HIV epidemic we saw 60
people die of HIV when we cared for them in east London. The consequences of
that public health crisis were very real for us. We really felt we were fighting to
stop our community from being decimated.’
Despite being an activist deeply opposed to Margaret Thatcher, the irony, he
says, was ‘living through an era where she created an environment that we could
do work in that was incredibly innovative and very pragmatic, involving drug users,
building collaborations with GPs and moving away from the traditional addiction
model. We did some amazing work, and services really flourished.’
At that point he wasn’t publicly known as a drug user – although he was
employing several people who were – but by the end of the 1990s he’d decided it
would be more beneficial to ‘stand publicly’ as someone who used drugs. ‘The
problem is that it’s always the people on the margins who are forced out into the
open because of health or legal or other issues, and I wanted to make a choice to
politically stand in solidarity with those people and fight alongside them,’ he says.
‘Of course when health crises arise we have to respond to them but we wouldn’t
be in this health crisis – at least not so deeply – if it wasn’t for the stigma and
discrimination and criminalisation.’
Although the NTA period that followed meant new investment, it also brought
‘stifling bureaucracy’, he feels, ‘and this fear of actually talking about what works.
And we’ve now crashed into this recovery period which is fundamentally
ideologically based. The irony for me as a global advocate is that I go around the
world teaching people as a technical support provider how to do the British model
while we reverse away from it as rapidly as we possibly can. I really worry about
what the implications of that will be.’
The UK is ‘naïve’ if it feels insulated from major problems with HIV and other
blood-borne viruses, he believes. ‘There was a second spike in the HIV epidemic
here that coincided with crack arriving, and it was only really because we had good
harm reduction and treatment services in place that it didn’t become a more fully
fledged epidemic. We could get an outbreak linked to legal high injecting, for
example, and we’d be very ill-equipped to deal with it. What seems like a trickle of
a problem to start with can suddenly become a really big problem if you don’t
manage it. And I fear that we don’t have the harm reduction infrastructure that we
used to – the lack of fixed site needle exchanges is quite shocking.’
He’s also involved in HIV issues on a global scale, working as the International
Drug Policy Consortium’s (IDPC) drugs and HIV consultant, a role that focuses on
advocacy between drugs civil society and the United Nations Office on Drugs and
Crime’s (UNODC) HIV team. Does he get the impression that the UNODC is beginning
to open up a little more, after years of what many people perceived as intransigency?
‘In the last year or so we have seen an opening up, whereas historically UNODC
was very reluctant to talk to civil society,’ he says. ‘Through some robust advocacy
from civil society we’ve managed to force an engagement. There were discussions
around the selection of which countries UNODC would be working in and what the
priorities for those countries would be and civil society took part in that
conversation. Are we 100 per cent listened to? Absolutely not. Do we have fully
aligned positions? Absolutely not. But at least we’re talking to and working with
each other, which is a huge step forward.’
A lot of people worried when Yury Fedotov took over as UNODC head (
DDN
, 19
July, page 5), but he hasn’t proved to be as hardline as many feared. ‘I think the
thing to remember about Fedotov is that he’s a skilled diplomat – he understands
how to manage the system. I wouldn’t be naïve around him, but I think the neglect
of the drugs and HIV agenda up until about a year ago was causing such concern –
not just within civil society but also with UNAIDS and other UN partners – that it
just became unsustainable.’
Part of the initial worry about Fedotov was that he was Russian, a notoriously
hardline country when it comes to drugs policy, and with catastrophic
consequences in terms of HIV (
see news focus, page 6
). ‘I think the climate is
changing, with America shifting position and all the experiments around drug
policy – the problem is the entrenchment in places like Russia, who seem to have a
complete disregard for human life. People who use drugs are seen as part of that
outsider group that are treated appallingly. They’re using scapegoating as a
strategy, and drug users are one of the groups being scapegoated.’
The challenge is to maintain a watchdog function on Russia while at the same
time trying to counteract the country’s influence on its neighbours, he believes.
‘You try to then get more progressive drug policy and harm reduction practice
pushing in, and that’s where UNAIDS and UNODC have both said “let’s start
focusing on priority countries so that we actually work in fewer countries but
demonstrate how the work should be done.” By putting more resources into some
countries you get case studies to show that you can shift the epidemic, which then
hopefully drives more domestic funding.’
*****
In terms of that international engagement, his latest venture is Coact, a technical
support agency with nine consultants he’s running alongside business partner Tam
Miller. ‘The aim is that we go around the world teaching people harm reduction,
drug user organising and drug treatment. All of us are ex or current drug users but
we also have a dual professional background in drugs or HIV so it’s very much this
function of bridge building – as well as standing up for the drug user community I
also hold onto my identity as a drugs worker very proudly. One of the things we’re
trying to do is help build bridges so we can all work together more effectively.’
When it comes to working together, does he feel that some of the old barriers
between recovery and harm reduction are finally starting to break down – are things a
little less polarised? ‘I think there are figures on both sides of recovery and human
rights/harm reduction who share views and are looking for points of connection and
trying to collaborate,’ he says. ‘There’s a whole lot of people who are trying to respond
very healthily. But I think there’s a smaller group of recovery people who are much
more politicised and fighting a whole political agenda that has bugger all to do with
science. I get frustrated when people claim that I’m being divisive by critiquing those
people. For me it’s about saying that these people are denying our human rights.
‘When the government’s own evaluation of recovery says it doesn’t work then
we’re saying, “back your claims up”,’ he continues. ‘Our claims around harm
reduction and humane drug treatment are well evidenced. This is where I feel that
the recovery movement at its worst moves into being something like a cross
between an evangelical church and a National Socialism rally, where if you object
then people say “you’re letting all us down by not agreeing” or “you’re in denial”. If
that’s the level of debate then we move into a different type of engagement.’
Mat Southwell is partner in Coact and associate consultant, drugs and HIV, at
IDPC. www.co-act.info.