‘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