Jose Martinez on Hepatitis C Navigations and Harm Reduction

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2024/09/10

Jose Martinez, originally from New York City and currently residing in Buffalo, NY, began his career in harm reduction as a Hepatitis C Navigator at St. Ann’s Corner of Harm Reduction (SACHR), a syringe service program serving the South Bronx. He later took on the role of Young Injection Use Health Coordinator at the same organization. After earning his NYS peer certification, Jose worked across various shelters, where he played a key role in helping organizations build and strengthen their outreach efforts and community engagement strategies. Today, he is focused on PeerUp [Ed. During the first year of PeerUp, the program was funded at $15,000. This year, the funding is $5,000], an initiative dedicated to uniting, supporting, and uplifting peers and community members from undervalued backgrounds.

Scott Douglas Jacobsen: Today, we are here with Jose Martinez from the National Harm Reduction Coalition. You primarily focus on capacity building and serve as a Hepatitis C coordinator. First, start with a superhero origin story since Marvel is famous now. How did you first get involved in harm reduction? How did you find out about it? How did you get employed? Tell us all the important details.

Jose Martinez: Certainly. My background is rooted in chaotic drug use. I was heavily into K2—if you are familiar with that, it is also known as synthetic cannabinoids or spice. I was using other drugs and drinking a lot as well. I was in a really bad place in my life. I used to go to this program, St. Ann’s Corner of Harm Reduction, where I could sit down and have shelter because I was sleeping on the streets at the time. This program was looking for a Hepatitis C navigator.

I used to attend the Hepatitis C groups. I have always been a sponge absorbing information. One day, my current supervisor, my supervisor back then, asked me if I had ever thought about being a navigator. I had not considered it before, but they offered me the Hepatitis C navigator job. That was an eye-opener for me because in 2015—though it was not that long ago—people did not view drug use the way they do now. People looked at me differently because I was Street homeless. I was not in a shelter, had nowhere to shower, and looked homeless. People would not hire me or anything like that. So, when someone approached me and said, “You are a genius; let’s work together,” it opened my eyes.

What opened my eyes was realizing that we have a community facing so many challenges. One of the things they did for me after I became a navigator was giving me the responsibility of opening the organization. I got the keys to the place, would go there at 8 o’clock in the morning, use the organization’s shower to freshen up, and then start my job at 9 o’clock. There have been many conversations from 2015 until now about how being stuck in a certain lifestyle can lead to developing certain traits and characteristics. I was somewhat aggressive, and many conversations had to happen about managing my behaviour, how I talked to people, and how I referred to them, whether anyone was looking or not. Harm reduction is a lifestyle, not just something you talk about from 9 to 5.

Some people talk about harm reduction at work but then revert to calling everyone “crack addicts” once they go home. No, we have to live this as a lifestyle. Those conversations changed my life, and I am grateful to harm reduction for that because not everyone gets this opportunity. That allowed me to figure out what I wanted to do with my life. I realized I needed an apartment and sorted out my housing situation. I got back into a shelter, got an apartment through the shelter program and secured a job.

I have worked as a navigator for what is now the Overdose Prevention Center (OPC) in New York City. I was with them before they were OnPoint NYC when they were known as New York Harm Reduction Educators. Then, I worked for the New York City Department of Homeless Services and other organizations before I joined the National Harm Reduction Coalition (NHRC). I was allowed to learn and make mistakes throughout all those phases, which are opportunities our community does not usually have. I feel incredibly grateful. That is why I do most of what I do now—to give back to the harm reduction movement and the community.

Jacobsen: When you get that kind of opportunity to break through the stigma in hiring, what is the feeling for someone when they make that leap for another individual?

Martinez: Well, everyone is different, but even today, I have had my apartment for about five years going on seven years since 2017. I still shed tears of gratitude because, after a while, being in a certain position, you can succumb to the belief that maybe this is what you are meant to be or do. Going from that to living a completely different lifestyle is unbelievable sometimes.

I remember sleeping on the E train, looking at a marathon poster for eight hours until the sun came up so I could go to a program open for breakfast. My life is completely different now, and I am incredibly grateful.

It’s still unbelievable to me. I’m sure many people feel that way. But the reality is that we cannot get there alone. I was privileged enough to have good people around me who were tolerant of my behaviours and who I was. They understood, and through those moments where people usually write others off, education and lessons were learned. That included my drug use. In that first position I got, I was given so much responsibility quickly, but I didn’t value it.

I was still coming to work drunk and other things like that. One day, my supervisor said, “Look, you’re not in trouble, but you must remember one thing. As a Latino, you automatically have a reputation. Depending on who you talk to, it may be different. You may be seen as a thief, or you may be seen as aggressive. It’s up to you to either uphold that reputation or build another one. That’s the choice you have.”

At that time, that was the exact message I needed. It wasn’t soothing, aggressive, or demanding. It wasn’t telling me what I needed to do. It was simply, “Look, this is the choice you have. Pick one.” It was like Neo in The Matrix choosing between red and blue pills. That helped me. My whole point is that the feeling was good, but much work was put into it. I would not have been able to do it by myself. It was the people around me giving me those messages.

Jacobsen: When people are navigating the complex situation around Hepatitis C regarding diagnosis and manageability, where do you come in to help them? In contexts where that position didn’t even exist in the past, what was it like as a comparison? Those are two points of contact that might be valuable.

Martinez: Yes, as the Hepatitis C guy in NHRC, I provide a general support system to the Hepatitis C navigators in New York City. There are about 30-something programs—37, maybe 36 since one stepped down. I provide them with a general support system, which includes outreach, one-on-one discussions, and monthly group meetings.

When I started as a Hepatitis C navigator, I was part of the second wave of the Check Hep C program under the Viral Hepatitis Initiative, city council funding for New York City. This funding supports a significant portion of the hepatitis work in the city, including hepatitis A, B, and C. I provide support to the Hepatitis C side of things. They didn’t have that in 2015 when I started.

We would get together back then—Diana Diaz, who still runs the program, and Nira Johnson, who now runs DHS. There was another person, and then probably 10, 11, 12 navigators. We would meet every month, and that was it. There wasn’t any regular review of numbers like we do now. We have case conferences if anyone in the group wants to share a story about a patient they’ve been navigating, whether it’s a success story or a challenge. The group provides feedback. We have many activities to promote networking among them because if someone meets a patient in Manhattan who’s from Brooklyn, it’s best to refer them to Brooklyn. After all, that’s home. They didn’t have that when I first started.

So, I bring what I don’t have in everything I do. Even what you see behind me—Peer Up, where we’re talking about providing the community with the skills needed to escape their situation and thrive. In many organizations, they’ll hire someone from the community who has a previous drug use history, maybe even a current one. But there’s no skill-sharing, no empowerment or uplifting of them. It’s just, “Here, do the job,” and that’s it. Honestly, suppose we want to empower the community. In that case, we have to give them the skills to thrive in any field because not everyone agrees with drug use. Not everyone agrees with someone coming in late.

So, we have to condition our people to have those qualities within them. That way, if they get a job—let’s say–in a bank which is not harm reduction-focused and won’t allow anybody to come in drunk or high, they’ll be able to thrive there. We can only do that by teaching folks skills such as punctuality and conflict resolution because conflict resolution in the hood looks completely different than in a 9-to-5 setting.

We need many skills to provide for our community, including independent living skills and support transitioning from living on the Street or in a shelter to an apartment. That can be like a castle to someone, even if it’s just a studio. But that’s what I try to provide—whatever I didn’t have. These are all experiences that I had to go through and figure out on my own.

Once again, I thank the universe that I had a good set of people around me who knew where I came from. So many people behind me now knew me from when I was a participant and were angry, and they’re so supportive of me. Their lines are always open to me, and things like that. That’s what I want to bring back to the community.

That’s the intention behind the care, and that’s what I try to do with the Hepatitis C navigators in general. They’re doing the same thing for community members with no support. As they say, even a psychologist has a therapist, or a therapist has a therapist. They’re doing all these jobs and need that support. That was stressful.

I burned out so fast in my first Hepatitis C job—it was crazy.

Jacobsen: When you mention conflict resolution, that’s important because individuals who might be misusing substances can be dysregulated internally. It may not necessarily have anything to do with the external situation. It could be entirely internal. Suppose someone is in a hood situation instead of a suburban one. In that case, those conflict resolution skills are different, as you alluded to. How do you do it if you’re in the hood and looking to resolve conflict or if someone has internal issues? How does that differ from a context more characterized as suburban?

Martinez: Yes, we go through the Six Principles of Harm Reduction in our harm reduction training. One of them is acknowledging social and cultural factors. This means that where a person comes from is very important. If we’re talking about uplifting that community member from the lifestyle we were discussing to a lifestyle where they’re working, upholding an apartment, and socializing—things you need to do to keep the apartment and the job—we must provide them with different skills.

I like to use this example: If you’re building a dog house, you could grab a hammer, a couple of nails, and a screwdriver. You could build it. But can you take those same tools and build a house? You can’t. The same applies to whatever tools you need to build a regular one-floor house. To build a duplex, you will need a different set of tools. And the bigger the building gets, the more tools you need that are more beneficial to that situation than the last time.

It’s the same thing with our community. I will keep this to myself because I usually speak about situations I was in and how I had to react, but take, for instance, my life, which was panhandling all day. When I wasn’t panhandling, I was getting high and doing what I wanted. If I wasn’t panhandling, I was stealing from Barnes and Noble and Best Buy, selling the games at GameStop, and selling the books to the street vendors on 125th Street. That was my life. There were no rules, no regulations there. Whatever I wanted to do, I did it.

And that develops a certain characteristic in you. So now I am going into a job. Are those values going to benefit me in that job? I had to learn that fast. I had to learn so fast that I could not say “F you” to my boss. At that same job, that first Hepatitis C job I told you about, I got fired for not saying good morning to the boss. These are things that—yes, it’s sad because of those kinds of situations. Still, the reality is that when you’re under an organization, you’re under rules.

You’re under rules, and you’re under certain expectations. This is stuff that I had to learn. Honestly, it wasn’t even the hard way because, once again, I will stand by saying I had a better experience than many people. I had the privilege of messing up.

I had people around me. For some reason, my supervisors were very understanding of me. I had the benefit of being able to mess up and then avoid repeating the same mistakes. But I knew I had to learn that how I acted in one environment couldn’t be the same in another.

The same goes for when we hold our apartments, are in different places, and socialize and communicate with friends, colleagues, and coworkers. We have to have different tools for different situations because what we call a colleague in the hood is completely different than what we call a colleague in an organization. We react differently and act differently around each other. So, there are many conversations we need to have when it comes to uplifting a community from one place to another.

Jacobsen: Yes, let’s explore that. How do you develop capacity, infrastructure, and training nationally so that people can learn more about everything starting in 2015? You’re about ten years in now. How do you provide technical assistance nationally to the community and similar efforts?

Martinez: There are two aspects to my capacity-building efforts. Sometimes, I support organizations in rethinking different approaches. I work closely with the Department of Homeless Services (DHS) to implement peer and harm reduction into the shelter system. We consider the best ways to support them through that process.

However, with Peer Up, I also directly support peers nationwide. How I keep that going and plan on building on that is rooted in the belief that when we bring all our people into one space, we have everything we need. Peer Up has proven that to me. Over the last year, I’ve recruited about 100 peers nationwide. A good number of those 100 people are consistent in our monthly groups, which meet on the first Monday of every month.

Everyone in those groups is responsible for our mission statement and establishing our group rules. We create something together because everyone comes in with different levels of skills, but we all build at the same pace. Everything about Peer Up, from the name to every single detail, was created by its members.

That’s how we do it. Through this process, we promote teamwork, collaboration, and community. We’re also helping to build skills that peers can put on their resumes. As we continue, we’re taking step one because Peer Up is still a baby program—we started it last year with just $5,000 in funding. As we move forward, we’re implementing different ways of including community members in various documentable training programs.

They can add these to their resumes, and employers will see that and say, “Oh, you took that course. I get an idea of the kind of work you want to do or the work you’ve been involved in.” But it all starts with ourselves—skill sharing. Many organizations may not always be unwilling to give folks the skills needed to elevate; sometimes, they don’t have the capacity or know-how.

I want to focus on that because if we talk about community empowerment and want people to think and live differently, why don’t we focus on giving them other skills? Because it’s easy to teach somebody how to survive.

Make sure they know where to go to eat, where to shower, and where to go to sleep. Simple. That’s the message you give to people. If they need other supplies, make sure they know where to get them. But when it comes to how to maintain a job, how to keep an apartment, or what resources to look for if you lose a job while you have an apartment, that’s a whole different skill set that we need to learn.

Many homes are broken, so that’s what we want to do—help the community by implementing these skills. The same applies when we provide technical assistance to organizations. We tell them, “Hey, if you want something to work for the community, you have to find a way to include the community in it.” We talk a lot about community advisory boards and going out to the community, even if it’s not outreach-specific, to see what’s around. Where are the pantries? Where are all the resources you could point your community to?

What’s needed? Sometimes, one or two community walkthroughs can tell you much about what’s needed. It allows you to communicate and converse with the community members—not only the members you’re trying to serve but also everyone else. That includes the people who live in that neighbourhood, even the police officers.

Many people don’t agree with involving the police, but the reality is that they are part of the community. There needs to be a community you can go into where you won’t see a police officer. So, we have to have those conversations with them too. It’s all about the community.

Jacobsen: Are there certain situations or contexts in which an individual comes to a peer group or the organization, and you decide not to deal with them because they are too severe of a case? In other words, when does it become a case for law enforcement or another agency? What are the limits of the organization’s scope?

Martinez: For Peer Up, it’s a bit complex to articulate because we’re so new. While we have an objective, we still need to develop a fully developed theory of change. To be part of Peer Up, you must at least be tech-savvy and know how to get on Zoom. We can teach you the rest once you’re on Zoom; skills can be exchanged from there.

Ideally, I would love it if the people we provide services to—the ones receiving syringes, those who need these programs, these job development skills and supports—could join this monthly call, and we’ll get there. But as of right now, we don’t have the structure in place to teach everyone how to use Zoom or provide job development support. We’re working on building our mission and vision statement and our core principles and values with the community.

As we collaborate more, there will be a point where we can start reaching the broader community that needs these services. We can then provide them with job readiness and personal skills because you can’t work in the professional if you don’t work in the personal—they go hand in hand. So, yes, as long as the conversations are being had and folks stay engaged, that’s a good thing. The more we talk about it, the better the messaging and the clearer the path. I feel that’s the best approach we can take right now.

Jacobsen: Are these programs relatively inexpensive? In other words, are they much less expensive than incarcerating someone who isn’t contributing to society, especially when it’s helping someone get better and not suffer from substance misuse?

Martinez: Yes, I need to articulate this in a specific way. I understand that the prison system gets around $55,000 per person per year or something along those lines. The number is somewhere around that. Peer Up is a program under the National Harm Reduction Coalition (NHRC). Because we’re so new, we have yet to invest much time in getting funding for Peer Up because we were focused on establishing the basics.

But over the last year, I’ve been communicating with folks. We’ve gone to conferences and spoken about many peer-related issues and issues affecting the community. From June of last year, when Peer Up was created, to today, we’ve had $20,000 in funding. We made all of that happen on top of buying community supplies because, out here in Buffalo, I go out and give out wound care kits since xylazine is causing these crazy-looking wounds in our people. With $20,000, we could do all that, including paying a registered nurse.

So, it’s a very cost-effective program. It’s a well-structured and feasible program. Because the more services we want to offer, the more we need to consider adding different elements. Let’s say in Peer Up, we add a Peer Academy where people come to learn different trainings and skills. That would add another cost. But to support the community effectively, with a professional registered nurse, with someone who has lived experience and can provide personal support—that’s an amazing accomplishment. Going out to different places, giving people different experiences, and discussing what needs to be done at well-known conferences is an amazing achievement. We’ve got $15,000 because we recently received another $5,000 this year, which we haven’t even touched yet.

So, the whole thing is that it’s possible. Of course, when the money is short, the energy you have to put in increases. That’s the reality of it. But we need support. The community needs support. The community needs someone to say, “Okay, we don’t have these kinds of resources, but we have this energy,” that’s just as good. We have a resource sheet where everyone communicates with each other. Whatever resources they have, they put it right on that Excel sheet so everyone in the program can see it. Of course, the more we offer, the more we must consider costs. $15,000 is a good number to support the community and provide leadership.

Jacobsen: What type of cases have the least barriers to entry, personal or otherwise, when people come to you? And which individuals have the most? It could give us an idea when they’re coming to Peer Up and harm reduction organizations—this person requires almost no investment because they’re pretty much ready to go. In contrast, others have a lot going on internally and externally, so you must be patient and work with them quite a bit.

Martinez: Yes, so as I said before, everyone is coming to this space with a different level of education about public health, as well as their learning level and knowledge about how to find different resources. So, it’s hard to tell. I’ve never thought about that question the way you asked—who has more or fewer barriers? I would probably say the person who’s not tech-savvy at all. So many people would benefit from having a supportive community. There’s no judgment behind it, but some don’t know how to use Google or jump on Zoom. One of my boys is one year older than me, and I had to teach him to jump on Zoom. 

So, yes, that person is that person. But one thing I strive to do is teach. My friend, for example, didn’t know how to use Zoom. I said, “Yo, I can walk you through this website. Jump on Zoom with me real fast.” He was like, “What’s that?” I had to explain that it’s a meeting platform and that I can share my screen to walk him through it. He was like, “Okay, what do I do?” And even when the meeting was on his calendar, he needed to learn how to pull the calendar up to access the meeting. So, I work with people as much as possible. Even if someone doesn’t know how to use Zoom, I can’t write them off. I have to find a way—email me, and I’ll walk you through it. I’ll send you step-by-step instructions or screenshots or something.

But yes, everyone has different levels of barriers. The only significant barrier would be if they need to learn how to email. I know how to reach you if you need to learn how to email.

Jacobsen: That’s an important point because people who have had substance issues and are off the grid may be out of touch with the rapid changes in technology. It’s a key entry point for you and me. I brought us onto Google Meetings and didn’t realize we had to go to Zoom for a proper recording. So, not only knowing how to use Google Meet but also how to use Zoom, how to record, how to make sure video and audio work—all of those things. I’ve integrated with them because I deal with them daily but haven’t been in these situations. My father has had addiction issues; he’s a long-time alcoholic. He’s estranged at this point.

Yet, in those kinds of contexts, if I were him, I could easily see a situation where, given the predisposition to alcoholism in my case, I could be one of those people who’s unplugged for five years. All these new platforms and applications come online, and someone asks me, “Hey, send me an email on Google or give me a call on Zoom after you send that follow-up email.” First of all, I’m probably tired. I might be dealing with some anger issues and feeling resentful about something else. I might be sleep-deprived and malnourished, so my ability to learn new things would be impeded. All these issues could come up in context, too. How can people contact you for volunteering, financial support, education, or resources?

Martinez: As I mentioned, we use a Google Excel sheet. Everyone who comes to the meeting at least once gets added to that sheet and has access to it. No one has to do anything special; know how to put the website link in the correct box. I walk people through this on our Zoom calls by screen sharing so they see it step by step.

People have a good relationship with me, so if someone needs to learn how to access Google Drive, they call or email me, and I walk them through it. That Excel sheet is the most important part of managing a nationwide program because communication is always challenging. Everyone is in different places, but Google Sheets has multiple tabs for different subjects and resources, a suggestion box, a contact list, and even a heads-up list for people who don’t agree with peers or treat peers a certain way.

In that same folder are meeting notes, presentations we’ve done, and everything else so that everyone can access everything we’ve documented, regardless of their knowledge or location. This allows them to catch up and stay informed. So, yes, that Excel sheet is a lot. It means a lot. 

Jacobsen: From Canada with love.

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In-Sight Publishing by Scott Douglas Jacobsen is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. ©Scott Douglas Jacobsen and In-Sight Publishing 2012-Present. Unauthorized use or duplication of material without express permission from Scott Douglas Jacobsen strictly prohibited, excerpts and links must use full credit to Scott Douglas Jacobsen and In-Sight Publishing with direction to the original content.