Sex, drugs and harm reduction policy

Last month, the University of Sheffield’s students’ union made headlines for its controversial decision to offer students advice on how to take illegal drugs safely, via a webpage with guidance on dosage and precautions for a range of substances.

The union ended up removing the text from its website and instead linked to the information, which came from drug safety charity The Loop. Sheffield SU’s welfare officer Katharine Swindells published an article in the Metro defending the union’s decision to offer this guidance to students.

In the same week, the University of Brighton SU provided the media with ammunition about morals and wayward attitudes by having the Sex Workers’ Outreach Project (SWOP) run a stall at its freshers’ fair. SWOP is a confidential service which offers advice and support to improve the safety and wellbeing of women working in the sex industry.

The Sunday Times suggested the stall offered students “tips on how to be a prostitute” while Rotherham MP Sarah Champion took aim at the union for “colluding with organised crime and abusers”. The university has since announced an investigation into SWOP’s presence at the fair and said – in a statement to The Independent – that it does not “promote sex work to students”.

What connects both of these issues is the moral basis of the criticism they receive. It can be characterised as backlash against activities that are widely seen as not only unhealthy life choices, but also as not to be encouraged among young people for reasons of acceptability within society.

Risk of normalisation

The first line of attack levelled at SUs over these types of issues is that addressing them in a way that isn’t damning of the practice in question risks normalising it, condoning it, or even endorsing it. Feminist campaigner and writer Julie Bindel, who co-founded the law reform group Justice for Women, took this angle, describing the stall as an example of how the sex trade is “normalised and pimped to women”.

The root of this concern is communicative. Critics are concerned about the message sent to students and whether this will contribute to higher incidence of the dangerous behaviours in question. But this worry often fails to address the reasons that students engage in these activities in the first place, and we need to draw a clear distinction between the two: while students may take drugs recreationally, engaging in sex work is not usually a leisurely pursuit.

SWOP activist and sex worker Molly Smith (pseudonym) writes in The Guardian that students, like other sex workers, go into sex work as a result of their “material conditions”. For Molly, reducing the number of students going into sex work would require an improvement in their material conditions – more affordable housing, more maintenance support or other ways to ease financial pressure.

But are we really suggesting that a student would turn to hard drugs or sex work as a direct consequence of seeing a stall at their freshers’ fair? It is conceivable that the availability of this information to students who were already thinking of undertaking sex work or taking illegal drugs may facilitate their doing so. It may reduce the chances that a student who is later offered drugs says no to them. But even allowing for this to be the case, the conclusion is no different – if we take issue with students wanting to do either of these things then the place to start is addressing the conditions that make them want to, and why these are something to worry about.

In her article defending the union’s decision, Sheffield SU welfare officer Katharine Swindells emphasised that the union did not “condone” drug taking and that its decision to share The Loop’s guidance was a sign of “taking precautions to reduce risk”. She explained that the union has a zero tolerance policy towards illegal drugs, but added that keeping students safe, however, is “not as simple as that” when faced with the reality that a sizeable proportion of students have taken drugs while at university.

What did students say?

There is plenty of research to suggest that Swindells is right about the reality of student drug use. Earlier this year the National Union of Students (NUS) published the results of its 2018 survey of 2,810 UK-based students, asking about drug use. Thirty-nine percent of respondents said they currently use drugs, and a further 17% reported having used them in the past, with many reporting that poor mental health played a role in their decision to use drugs. Eighty-four percent of students said they did not feel under pressure to take drugs while at college or university.

Hot on the heels of NUS’ release, HEPI and the University of Buckingham published joint analysis on student drug use, which found that far fewer students used drugs – 29% compared with NUS’ finding of 56%. It found that most students wanted universities to take a tougher stance on the issue, in contrast with NUS’s recommendations that universities take a less “punitive” approach. HEPI has put the vastly different results down to the different student samples used by each survey – the two had different methodologies, with the latter conducted by YouthSight’s panel.

A moral dilemma

There is another (often overlooked) critique, which suggests that drug use – alongside binge drinking, casual sex and other activities which will make headlines if young people at university are seen engaging in them – are hedonistic and not to be encouraged among our young. It is a more paternalistic, and less evidence-based concern. I won’t comment on this in depth here other than to highlight the distinction between the use of illegal drugs and undertaking sex work from this lens – while this concern may apply to the former, sex work is often not taken on primarily for the pleasure of the undertaker. The critiques of both may be largely similar, but arguably this is due to a misapplication of principles to these issues, and a misunderstanding of their root causes.

In general, we also fail to differentiate between the range of possible motivations students may have for engaging in either. For instance, recreational use of illegal drugs is a very different practice to repeated and addictive drug abuse.

And this is all without mention of the incentives for the press to report on issues of sex and drugs at university both to support their stances in the broader culture wars, in which universities are a key battleground, and to publish highly clickable images of young people, often women, in states of reduced personal control.

Comparative issues

It is widely accepted as a risk reduction measure to offer students access to free condoms, STD testing and sexual health advice, and to even include condoms in freshers’ welcome packs to reduce the potentially harmful effects of having sex on students’ health and to lower the risk of unplanned pregnancies. It’s hard to find widespread criticism that giving students access to condoms in any way encourages them to have sex, or endorses “casual” sex, even though many do not agree with the idea.

There are a few clear differences in terms of the legality of having sex compared with taking certain drugs, and many aspects of sex work. But many of the criticisms levelled at unions come from a moral standpoint rather than a legal one, which begs the question – is the difference in the treatment of these issues because we believe that illegal drug-taking can’t be done safely? And if that’s not the case, why is the harm reduction approach to university policy met with more criticism in the context of drug abuse and sex work than it is when it comes to reducing the risks associated with sex?

It’s a threshold thing

Our responses to these sorts of occurrences are more often intuitive gut reactions than they are considered and evaluated responses. However, to let these sorts of intuitions influence policy over the available evidence would do students a disservice, especially considering how often the debate simply comes down to where we decide to set thresholds for certain behaviours.

We know from cultural stereotypes of the UK first-year student that drinking alcohol is widely considered a “normal” and expected part of university life here, whereas in the US students of the same age are covertly drinking in dorm rooms. The weekly maximum number of units of alcohol offered as a guideline by the UK’s chief medical officer was reduced in 2016 from 28 and 21 units for men and women respectively to 14 for both. Cannabis has just been made legal to sell in Canada, making it only the second country in the world to legalise its possession and use recreationally. Moral thresholds are constantly shifting and as such are not the strongest indicators by which to set policy aimed primarily at reducing health and safety risks.

Harm reduction approach

A harm reduction approach to drug abuse at university would acknowledge that it is inevitable and seek to reduce the harm caused by it rather than disregarding its existence as a problem. This involves understanding that some methods of drug use are safer than others.

Harm reduction approaches implemented outside of university settings have proved successful – the opening of a supervised injection site in Vancouver, Canada saw the number of those sharing needles fall from 40% in 1996 to 1.7% in 2011 and accompanying falls in the numbers of those who contracted new HIV infections and began methadone treatment over the same period. Public Health England has also published a guide advocating for the benefits of a harm reduction approach to treating drug misuse.

We have to provide support for students engaging in any sort of activity that puts their physical or mental health at risk, but this only forms one part of a comprehensive harm reduction approach – another element of which would make clear the legal and health risks associated with certain activities. There is room for discretion in all of the above, whether that’s in the way that this support is communicated to students alongside the legal and health risks of what they may be engaging in, or discretion in terms of what is being targeted – not all illegal drugs pose the same level of concern, and the issues associated with each are different. The only thing there isn’t room for is the idea that total abstinence is the best and only way to address these complicated issues.

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