In the midst of her addiction, Sarah had no place to live. She would sleep at different friends’ houses, and many of those friends used or sold drugs.

According to Sarah, they would sometimes reuse or share syringes. Then in 2015, she found out she had hepatitis C.

Hepatitis C is a viral infection that causes liver inflammation and can lead to severe damage. It’s the deadliest infectious disease in the United States and people who use drugs are at high risk.

“I had been out of it for so long, I never even realized what could’ve been going on,” said Sarah, who is originally from Northeast Philadelphia.

When Sarah was diagnosed with hepatitis C, she received another bit of unexpected news: doctors told Sarah she was about 5 ½ to six months pregnant.

“I was in a state of shock,” she said. “You hear about it happening to other people, but you never think it’s going to happen to you.”

Sarah feared her child would be born with hepatitis C, as up to 18 percent of pregnant mothers with the virus pass it on to their babies, said Dr. Gina Simoncini, an associate professor of clinical medicine at Temple University who specializes in HIV and hepatitis C healthcare.

Sarah’s situation isn’t uncommon. People who use drugs contract hepatitis C, HIV and other viruses every day from using contaminated paraphernalia like needles or crack pipes.

According to the Centers for Disease Control and Prevention, an estimated 41,200 people contracted new hepatitis C infections in 2016. The number of reported cases has increased 3.5-fold between 2010 and 2016.

In response to the growing addiction crisis, people and organizations are turning to harm reduction, or actions that reduce unintended consequences of drug use, to meet people where they are and help them avoid health risks associated with drug use.

As part of its services, Prevention Point, a harm reduction nonprofit based in Kensington, provides people with clean needle kits and offers hepatitis C and HIV testing. Harm reduction is the philosophy that one shouldn’t encourage or discourage people’s behavior — including substance use — but instead provide services to help them stay safe.

And since Prevention Point started its syringe exchange program in 1991, it’s clear that when clients there have access to clean needle kits and testing, their infectious disease rates dramatically drop.

In 1991, 48 percent of people with addiction who came to Prevention Point were HIV positive, said Clayton Ruley, the stabilization treatment and engagement program coordinator at Prevention Point. That number dropped to 5.6 percent in 2016.

“I meet people every day that contract a disease such as HIV or hepatitis from using old, dirty, drug paraphernalia,” Simoncini said. She added if someone with hepatitis C or HIV uses any materials associated with intravenous drug use, all of it becomes contaminated — from the tin or spoon used to melt the drugs to the cotton ball used as a filter. Even without blood, the hepatitis C virus can survive on its own inside a needle.

She added that hepatitis C can live outside the body — and on used drug paraphernalia — for 26 to 30 hours.

“The very least thing we could do is keep people as safe as possible, because they are going to do what they want to do regardless,” Ruley said. “We need to meet people where they are and be as supportive as we can.”

In addition to their potential to spread diseases, old syringes can also get dull over time, which may cause abscesses and lead to infection.

“Being preventative is better than being reactive,” Ruley said. “These are human lives at stake.”

But for those who have already contracted HIV or hepatitis C, medications are available. Simoncini said antiviral medications for people with HIV like AZT, also known as Retrovir, can cost someone who doesn’t have insurance up to $1,000 every month for the rest of their lives. And for people with hepatitis C, medications like HARVONI and Zepatier have about a 95 percent cure rate.

Sarah said she wanted HARVONI the moment she saw the commercial for it, and she hopes to begin taking it soon.

“When I realized there is a cure, I started crying,” she said. “I felt like I was getting a second chance at life, a second chance at being a good person, an amazing mom and a great wife, without having that giant monkey of a disease on my back.”

Devin Reaves, the executive director for the Pennsylvania Harm Reduction Coalition, said harm reduction is about helping people who are struggling with addiction and letting them know they will have support when they are ready to go into recovery.

“We as a society have created this stigma that sort of pushes drug users into the shadows through the criminalization of illicit drugs,” Reaves said. “This is a consequence no one was prepared for, and we need to right our wrongs by helping people.”

Mitchell Gomez agrees — he said making drugs illegal creates unsafe circumstances.

Gomez created the national nonprofit DanceSafe, which has a chapter in Philadelphia, to provide health education and harm reduction services to the “nightlife community.”

In an attempt to make drug use safer, Dance Safe allows people to bring their drugs to the nonprofit for testing to make sure there aren’t traces of potentially fatal substances, like fentanyl, a synthetic opioid more powerful than heroin that can be fatal in small doses. Dance Safe also gives out home fentanyl tests.

“Harm reduction is not just a model on how to decrease drug use,” Gomez said. “It’s about education and mitigating dangers created by the prohibition of drugs.”

Evan Figueroa-Vargas, a program manager at the nonprofit Mental Health Partnerships, said it’s also important to educate people about harm reduction.

“People aren’t going to stop using needles, some just aren’t ready,” Figueroa-Vargas said. “We need to educate the community about what harm reduction is, which is reducing the harm from unintended consequences that cause harm to others and within the community,” he said.

In hindsight, Sarah said she regrets not using harm reduction options like these when she was struggling with addiction.

“I wish I had been more careful,” Sarah added. “When you’re in the middle of an addiction, you don’t think anything’s wrong. When you go into rehab, you can’t believe what you just went through. It’s almost like an out of body experience.”

Now three years into her recovery, Sarah is grateful for where she is today. She considers herself one of the lucky ones.

“I have a house and a husband I love and no drugs in my life, and I couldn’t be happier,” Sarah said. “I have my beautiful child, and my beautiful family, and that’s all I need right now.”