New York City has boasted low COVID-19 numbers throughout the summer, but in March through May, the virus ravaged the city, killing more than 20,000 and leaving many homeless folks scared to go into crowded shelters—then additionally bereft when the city began closing the subway system, a reliable nighttime refuge for homeless folks, between 1 a.m. and 5 a.m. Additionally, many harm-reduction agencies that serve the sizable, heavily Puerto Rican drug-using population of Upper Manhattan and the Bronx shut their doors, cutting folks off from much-needed daytime sources of food, shelter, services, showers, laundry, case management, and other services.
That’s precisely why Tamara Oyola Santiago, Alexis Del Rio, and Nelson Gonzalez, the trio that started Bronx Móvil, risked their own health to hit the Bronx streets at night to make sure folks had what they needed to stay safe from both injection-drug-related illnesses (such as HIV, hepatitis C, and, of course, overdose) and COVID. TheBody chatted with Oyola Santiago to find out how, starting with no money or labor but their own, they did it.
Tim Murphy: Hi there, Tamara! Thanks for making time to talk to us. So give us a little background on Bronx Móvil and your work pre-COVID.
Tamara Oyola Santiago: We started in April 2018. I’m the program leader, Alexis is education leader, and Nelson is outreach leader. We’re all Puerto Rican. Alexis and I migrated to NYC in the early 2000s. We’ve all been doing harm-reduction work [such as distributing clean needles and educating drug users on how to educate one another] for decades. A large proportion of Bronx folks who are homeless and use drugs are Puerto Rican. That’s a very complicated history that has to do with colonialism and migration, taking drug use with you when you migrate from Puerto Rico to NYC.
Alexis and I were both at [the Bronx’s] CitiWide Harm Reduction, where, more than a decade ago, we were thinking about how harm reduction in NYC was starting to cut their hours, how syringe services programs [SSPs] were cutting back to a 9-to-5 schedule. We both wondered, what is going on at night when we’re closed?
So in 2018, we decided to take this 10-year conversation we’d been having and reach out to Nelson. So the three of us started going out into the city late at night, not knowing what we’d find. We’d chip in for a rental car to drive around and see what the need was, doing it out of a deep love for our community, and after the second time out, we realized we needed to do something. So we started Bronx Móvil, and the Harm Reduction Coalition became our fiscal sponsor.
So, two years pre-COVID, we were going out once a month—just the three of us, no funding. We were what’s called a PDSE, a peer-delivered syringe exchange, in which you go to a standing agency and tell them you’re part of a community of drug users, and they give you condoms and lube plus syringes, cookers, and tourniquets [equipment for injection-drug users], as well as swabs and bandages [for wound care] and naloxone [brand name Narcan; a drug to reverse potentially fatal opioid overdoses], and you get trained by the agency to promote and distribute these harm-reduction tools and education within your cultural network.
So we’d rent a car for 24 hours, hit the streets Friday from 7 p.m. until 1 to 3 a.m., then go home, sleep, and hit the streets again until it was time to return the car. We covered holidays. Over time, we built up a volunteer team of six.
Our focus was definitely in the South Bronx, the epicenter of the opioid overdose crisis in NYC, especially the 149th Street corridor. Some folks are in encampments, and some go to shelters. In the winter, when temperatures drop below a certain point, Lincoln Hospital opens up its ER to homeless folks, which is a citywide rule, but it’ll be interesting to see what happens this coming winter, with the pandemic.
TM: So what services would you provide upon finding people?
TOS: We’d see between 60 to 80 participants, which is the word we use for those we engage, over those 24 hours. Polysubstance use is very common. It’s not just heroin or opioids, it’s also cocaine, crack, speedballing. Pre- and post-pandemic, it’s common for people to chip in for a bag [of drugs], which actually promotes harm reduction, because people shoot up one at a time in a group to watch for overdoses, so others can administer naloxone if they have to.
The participants are mostly men who immigrated to NYC from Puerto Rico as adults, who often started using in prison in NYC or in Puerto Rico.
TM: So that was the usual picture. Then, in March, comes COVID ...
TOS: The three of us knew this was coming, so we asked, “OK, what info is out there for our participants?” So in mid-March, we printed Spanish-language documents from the CDC and the NYC health department and put those flyers into all our harm-reduction bags, and we took the time during interactions to say, “Mira, muchacho, here’s what you do if you start feeling sick.” We told people that the [street] drug supply could go down, so we said, “Every time you buy, save a little, and because the syringe service providers might close down, stock up on syringes and naloxone.”
Then the city went into lockdown, and we decided to not use any more volunteers—that if we were going to take health risks, it’d just be the three of us.
In April, we started to do walkabouts. Alexis and I both live in the Kingsbridge-Fordham area, surrounded by people who are homeless and use drugs. Our hypothesis has been that, as gentrification hits the South Bronx, vulnerable homeless people who use drugs were going to get displaced up here, so we harvest the raw data of where we see participants, a geographic map of ethnographic notes on drug use and police presence.
Around the pandemic, those numbers increased up where I live. I started to see people in my neighborhood who I recognized from the South Bronx, so I started to go out and walk the neighborhood twice a week, my backpack filled with food, water, and syringes.
And then the NYC DOHMH [health department] found out about the work we were doing, just as about six harm-reduction sites closed, because folks got sick. The city asked me, “How are you doing this? Would you be interested in getting funding so that you can continue doing this work during the pandemic?” And that funding translated into us doing outreach every weekend between April 25 and July 5.
TM: What did you see out there?
TOS: Our folks out there understood that this was a highly transmissible virus, and that the shelters weren’t going to offer the necessary physical distancing. So even though there was a big push from the NYPD and outreach teams to get people into shelters, they resisted. Instead, they created very strong social bubbles, encampments of active injection-drug users who were also homeless, people who were already exposed to one another. One said, “I know if I get sick, my community will take care of me.”
TM: Were there outbreaks?
TOS: Not that I know of. This is anecdotal, but I think that the stigma and isolation that homeless people face protected them, because they were not interacting with broader circles at the height of the pandemic.
TM: Can you tell us some more stories?
TOS: One late night, we were doing outreach outside a shelter on 182nd Street, and a participant looked at us and said, “Harm reduction on the streets—love is love.” That made our night. Also, we started getting boxes of beautiful cloth masks sewn by hand—we have no idea who’s sending them.
Also, once I was doing outreach, and someone in the community got out of a car and approached me and asked me for a bag of harm-reduction supplies, and I asked, “Do you use drugs? Because I have syringes.” And he asked [disapprovingly], “Why do you have to do that?” And one of our participants actually said to him, “This stuff saves lives and prevents HIV and hepatitis C.” I didn’t have to say anything!
The mutual-aid networks that have arisen are beautiful. The Church of St. Francis of Assisi in Herald Square gave us an average of 100 meal bags every time we went out.
TM: You had said that the pandemic affected drug supply chains such that there was less heroin and fentanyl circulating and more crushed pills. Given how dangerous fentanyl is, is that a good thing?
TOS: It depends on what was being crushed. It’s dangerous if you combine Percocet and Vicodin, or if you don’t know the dosage. The crushed pills may have byproducts in it. Also, because what you’re injecting is not as strong as what you’re used to, you may need to inject more often, reusing needles that have become blunt. We’ve seen an increase in wounds at injection sites and have had to provide more wound-care kits.
TM: Did the reuse of needles lead to an increase in HIV and hep C?
TOS: It’s too early to know. This population has a very high prevalence of hep C to begin with. The health department is probably going to try to determine that.
TM: Are the various Bronx harm-reduction agencies still closed?
TOS: They slowly started reopening, starting in May, from two to three to more days per week, a slow increase in hours. What continues to be limited is access to daytime drop-in services where people can hang out, shower, do laundry, access case management, and eat in-house. People instead are just grabbing syringes at the door, with only two people at a time allowed inside, by appointment.
TM: That’s a huge loss of daytime services and necessities.
TOS: Oh my God, it’s huge. Water for bathing, drinking, laundry. One weekend, the church was able to donate socks. As soon as people saw those socks, they took off their shoes, used hand sanitizer to clean their feet because there was no running water, and put on new socks. So when, for example, people on the Upper West Side complain about the homeless population on the streets outside the hotels that have become temporary homeless shelters, it’s because the social contract has frayed since COVID [and homeless folks have nowhere to go inside during the day].
TM: What do you foresee the rest of the year being like?
TOS: When the temperature drops and it gets rainy and snowy, that’s going to present a real challenge, because the people who have decided this summer to stay on the streets, in encampments, will probably seek shelter in typical cold-weather spaces like ERs, but they’re not going to be allowed in because of physical-distancing rules. If the subway remains closed between 1 a.m. and 5 a.m., we’re going to [have even more of a problem].
TM: What should happen? Best-case scenario?
TOS: This is all about social justice and equity. Long-term, we have to address the issue of people who don’t have stable, secure housing. It’s an economic issue. Hotels [which the city is paying to temporarily house homeless folks] is a band-aid. We need more of the Housing Works model where people have long-term housing with supportive services for primary care and mental health. But do we have the political will to do that? I doubt it.
TM: If you had more funding, what would you use it for?
TOS: In the city that never sleeps, harm reduction needs to be 24-7. How do we make that a reality? We need funding to make sure that, across all the boroughs, there is a mobile team hitting the streets that asks people, “What are your goals? To be abstinent? To moderate your use? To make your life and use less chaotic?” We need to go into shooting galleries [where people shoot drugs], under the bridges, and give culturally and linguistically centered support. If we had the funding, we’d be hitting the streets every single night. We wanna actually hire participants, drug users we’re connecting with, to become peer-education leaders who have an income to support them. Our long-term goal is for half of funding to go to peers.
I also want to take a moment to shout-out the Peer Network of New York, an inspiring collective that’s also been doing mobile outreach work in the Bronx and other areas of NYC during the pandemic.
TM: Amazing, Tamara. Final question: What has this whole effort been like for you emotionally?
TOS: Alexis, Nelson, and I had a sit-down in March where we realized that the pandemic was going to make our people more isolated and vulnerable than ever. So we decided to take the risk and get out there. It’s been exhausting, stressful, and rewarding—all of that. It’s hard to be out there and see the despair and the sadness, to see how frayed the system is. There was real anger when the subways closed [from 1 to 5 a.m.]. That was unnecessary, an eviction of an entire population. I wouldn’t be able to do this work without my comrades, Alexis and Nelson. There’s strength in solidarity.