In recent weeks, workers at St. James Infirmary listened closely to the high-pitched declaration of “emergency” for the Tenderloin, coming from centers of power in San Francisco. We agree that there is indeed a state of emergency in the Tenderloin, SoMa, across San Francisco, and far beyond: the overdose epidemic, the prevalence of untreated addiction, and the number of people living unhoused are emergencies. As overdose rates skyrocketed in 2020, a slogan became popular in the harm reduction movement: “every overdose is a policy failure.” These horrifying trends should have and could have been reversed long ago, and they warrant immediate action on the part of the city. But the Mayor’s emergency order will not uproot the causes that underlie and reproduce these crises–in fact, coercive and repressive governance will exacerbate drug addiction, overdose, homelessness, and crimes of poverty.

The “Tenderloin Emergency Initiative,” as it was publicly announced, purported to be a strategic plan for ending the overdose epidemic, a cause we care about deeply, and work on every day. But what we observe in the media, policy documents, and initial actions by the city is not the prevention of accidental deadly overdose. Instead, we’ve seen an increase in homeless sweeps and police-assisted crackdowns in the Tenderloin, resulting in streets “cleaned” of tents and makeshift dwellings. Now, at the dawn of a new year, in the wake of repeated sweeps from Taylor Street to Hyde to Willow Alley, many areas of the Tenderloin once teeming with people are quiet, the streets bare. As the Coalition on Homelessness has carefully detailed and exposed, and as we have personally witnessed, city operations with the Department of Public Works at the helm frequently terrorize street people, coercing them to “move along,” disposing of their belongings, without offering the resources necessary to transition out of poverty. We saw an increase in sweeps like this in late December and early January. Mayor Breed has threatened further police presence, potential enforcement of “sit/lie,” and related repressive measures.

Indeed, all the actions from our local government, beginning with Mayor Breed’s speech and local, public appearance on December 14th, to the rash of sweeps, appear to have “overdose prevention” slapped on to an already-underway operation to control public space in the Tenderloin; we are sold the lie that this state violence is occuring in the service of public health. As supervisor Peskin stated at the second Board of Supervisors meeting on this issue, on January 4th, the city’s emergency actions have been “packaging a police response with a public health response–and then asking everyone to just ignore the police response.” It is painful for us, at St. James Infirmary, to observe the exploitation of the overdose crisis in the service of “cleaning up the streets.”

We write this statement to respond to the actions of the Mayor, the Board of Supervisors, and the Department of Emergency Management, as well as the San Francisco Police Department, who are responsible for this crackdown. We are offended by the “crime and punishment” rhetoric that promises a renewed war on drugs, and a renewed war on the poor in San Francisco–in which most of the targets will surely be people of color, immigrants, and poor people. We oppose this continuation of the pro-police “war on crime” governance that has resulted in underfunded public and social services, alongside the privatization of public space, and a thriving police and prison industry across the United States.

In San Francisco, we are used to the veneer of liberal governance masking the reality of a war on the poor. We understand why business, tourism, and political interests lobby for “clean” streets, zones where homelessness is not visible, areas of the city that can be easily gentrified. And yet, as a sex workers’ organization, in which our priority is to serve workers in the sex industry who are the most vulnerable to poverty and violence, we have a different understanding. We are most attentive to the concerns of people who lack basic resources for survival; securing resources for the most oppressed is primary for us–not the comfort of those walking by.

The realities on the ground tell a different story from the stated purpose of Mayor Breed’s written emergency plans. Community based organizations are named as partners to the plan, but the plan is not based on the collective wisdom of service providers in San Francisco; nor was any service providing organization at the table when these plans were created. Mayor Breed has explained the proposed shift in policy in the following way: “We are not giving people a choice anymore. We are not just going to walk by and let someone use in broad daylight on the streets and not give them the choice between going to the location we have identified for them or going to jail.” Statements like this define what has been called “open-air drug use” as a criminal offense. But it is well-known that drug use and addiction are best understood as health issues–not criminal ones.

While addressing commonplace fears about the prevalence of drug use among people experiencing homelessness, in a terrifying shift, the public discussion about services in San Francisco has turned to conservatorship for people using emergency medical and mental health services. In such a context, we must state clearly: St. James Infirmary opposes all coerced services. From our life experiences and our decades of work, we know that we need meaningful alternatives for people who want to overcome addiction and for people who need a route out of poverty. As sex workers and former sex workers, we ourselves object to any disingenuous “savior” orientation to the oppressed. We will never support the provision of services as an alternative to punishment.

We have heard, from centers of power, a myth of “service resistance” by homeless San Franciscans. But there are reasons why people who are living on the street, and involved in street economies, resist services that are not appropriate for their life circumstances. Current shelter options are inadequate, contributing to endemic homelessness in San Francisco. For our participants and workers, many experiences have shown that gender and sexuality, as well as race and nationality, ability, drug use, and mental health, remain realms through which people experience stigma and marginalization. We believe that all service provision should be formed to specifically respond to cultural difference, with a vision of equity, community, and self-determination. St. James Infirmary is structured to provide such services, offered by and for sex workers. We do this culturally competent work at St. James Infirmary in all of our service provision, from late night sex worker outreach, to our recent transgender housing initiative, which is conceived, led, and operated by transgender people. To combat social isolation and to embody the tenet of “no one left behind,” we utilize a small-group, peer-to-peer model and evidence-based practices to produce respectful, holistic service provision. We use this same model in our drug user community health services, and we hope to see the continuation and expansion of such grassroots, peer-to-peer initiatives, which warrant material support and expansion.

To end the overdose crisis, harm reduction organizations like ours need consistent, abundant public funding and support, which we lack. In policy-making forums, harm reduction organizations are often blamed for the degraded life conditions and poverty that people who use drugs experience. The truth is that we do not have the means to address the problems that we, and our participants, face. The only way to mitigate the harm that can arise from the conditions of poverty and violence that beset the Tenderloin is to offer dignified housing options, housing first and housing for all; job opportunities and low-barrier entry to educational programs; and access to equally low-barrier healthcare, including mental and emotional health services, and for people who use drugs, decriminalization, harm reduction, safe supply, and low-barrier access to a spectrum of treatment options, from medically assisted to other forms of recovery services.

There is one group of people who have far outstripped any service provider in combating the overdose crisis in San Francisco. That group has been left out of the conversation: it’s people who use drugs, mostly users of fentanyl and methamphetamine, who reversed 6,000 accidental overdoses in San Francisco in 2021, according to the DOPE Project. They are the first responders to the overdose crisis. Shortly following the Mayor’s media splash, a group of St. James Infirmary’s syringe access providers and program participants gathered for a public ritual to “Sweep the Police,” demanding an end to the criminalization of people who use drugs, and a community-based response to poverty and overdose. Policing, and the criminalization of drugs and people who use drugs, have been shown to increase the risk of accidental, deadly overdose; one potential outcome of the Tenderloin crackdown could be an increase in accidental deadly overdoses. Without direct investment in people who use drugs–in the Tenderloin, SoMa and beyond–the “Tenderloin Emergency Plan” may produce cleaned streets, but it will not offer a route to survival for people who are living through the converging pandemics of covid, homelessness, addiction, and the overdose crisis.