Damon Jacobs

What comes to mind when you hear the term “harm reduction”? Many people in public health or in the community may think of needle exchanges or safer sex practices. PrEP can be a form of harm reduction, since it can allow you to enjoy the sex you want to have while at the same time reducing the harms that can come from condomless sex.

Because I’m an advocate for the health of people in the LGBTQ community, I’m also concerned by harm coming from something else in our community: tobacco. Did you know that LGBTQ people smoke at a higher rate than heterosexual people, and people living with HIV smoke at rates two to three times higher?

I probably don’t have to tell you that smoking tobacco causes many kinds of cancers and health problems. Interestingly, it’s the tobacco—and not nicotine—that is the source of those health concerns. Which means that other forms of nicotine-delivery agents, like vaping products and e-cigarettes, can be better for your health (harm reduction!) if they’re used instead of cigarettes.

What do e-cigarettes have to do with public health?   

E-cigarettes are battery-operated devices that deliver nicotine to users in heated liquid vapors instead of smoke. After hitting the market in 2006, they became quite popular among consumers because they satisfy nicotine cravings without delivering the toxic carcinogens and combustibles found in tobacco that are known to cause so much damage. Although e-cigarettes are not completely harmless (there have been cases of burns and poisonings), there is no tobacco in vaping products.

A review by Public Health England stated that by de-coupling nicotine from tobacco, vaping may reduce the risk of serious tobacco-related health problems like lung cancer by 95%.  An analysis by New York University’s College of Global Public Health estimated that 6.6 million American lives could be saved in the next ten years if cigarette smokers switched to vaping. Even the American Cancer Society now recognizes the role of e-cigarettes in helping smokers quit (although they state that the long-term health effects are not yet known), though the Food and Drug Administration has not yet approved e-cigarettes as a smoking cessation method.

We can think of vaping as a form of harm reduction—a practical public health philosophy that, at its heart, empowers people to reduce potential harms from sex, drugs or other substances without requiring abstinence. Vaping gives people the drug—nicotine—without the carcinogens and tobacco found in cigarettes.

For the same reasons that we encourage people who inject drugs to use sterile needles and other clean injection equipment—and provide people with those supplies freely—we can recognize that people may want the option to use vaping products to quit or reduce harm from nicotine addiction.

The problem I have with San Francisco’s Proposition E

On June 5, 2018, voters in San Francisco will vote on Proposition E which stands to ban the sale of flavored tobacco products, including products like menthol cigarettes and cigarillos, as a strategy to prevent “Big Tobacco” from appealing to children and hooking new users.

To be clear, I’m not against policy changes that may prevent people from starting to smoke or help people reduce the amount they smoke. I’m well aware of the devastating impact that tobacco is having on my community. But there’s a stunning flaw in this proposed ordinance that compels me to speak out against it: The ordinance lumps in e-cigarettes as a flavored tobacco product that would be forbidden from sale.

Proponents of the ordinance argue that tobacco companies have unfairly targeted LGBTQ adults, communities of color and children with flavored products. They say that children must be protected from the dangers of smoking. They want to stop new people from starting to smoke. Yes, I agree! But are there ways to do this without blocking a method of harm reduction from people who already smoke?

I take issue with denying adults, who already consume nicotine, the opportunity to use harm-reduction tools to do so.

Let’s be real. Quitting smoking cigarettes is DIFFICULT. Only about 6% of adults can successfully quit smoking, although about 70% report wanting to quit. The drug in cigarettes, nicotine, is highly addictive. For those people who are using electronic cigarettes as an alternative to smoking—what happens if the product is taken off the shelf?

San Francisco can proudly call itself a leader in providing harm reduction tools for its communities. Volunteer groups in the late 1980s were one of the nation’s first to successfully use needle exchange programs to prevent HIV. More recently, the city’s Getting to Zero consortium has committed to being the first to reach zero new HIV infections, with PrEP and treatment as prevention being critical strategies to reach this goal. These groundbreaking approaches share the common approach of harm reduction—meeting adults where they are to offer interventions that improve health and quality of life. The proposed ordinance runs counter to these harm reduction approaches.

E-cigarettes do need to be regulated and prevented from getting into the hands of children, but banning all flavored vaping products for adults just doesn’t make sense. It is quite possible to prevent nicotine addiction in children and help adults stay alive at the same time. I ask people to use science, logic, and compassion when going to the polls on June 5th.

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Damon Jacobs is a Licensed Marriage Family Therapist in New York City, who specializes in working with individuals and couples in the LGBTQ community, and is the founder of the PrEP Facts: Rethinking HIV and Prevention and Sex Facebook group. Read more from Damon Jacobs on BETA.

The opinions expressed in this article are those of the author alone. They do not reflect the opinions or positions of BETA or of San Francisco AIDS Foundation. BETA serves as a resource on new developments in HIV prevention and treatment, strategies for living well with HIV, and gay men’s health issues. Our goal is to inform, empower, and inspire conversation.