Collaborative Steps: Crafting a Joint European Advocacy Strategy for Improved HIV, HCV and TB Services for People Who Use Drugs

On 30 and 31 January 2024, partners of Correlation – European Harm Reduction Network and the BOOST Project met in Amsterdam to discuss the development of a European advocacy strategy to ensure access to comprehensive HIV, HCV and TB services for people who use drugs in Europe.

The development of a Joint European Advocacy Strategy is unique as it will be supported and implemented by 4 European Networks, including Correlation – European Harm Reduction Network (C-EHRN), the Eurasian Harm Reduction Association (EHRA), the European Network of People Who Use Drugs (EuroNPUD) and Drug Policy Network South East Europe (DPNSEE) and is based on a broad European consultation of nearly 100 experts and members of the different networks.

4-5 Advocacy Priorities and related Advocacy Objectives are identified during the Amsterdam meeting, covering the forthcoming 5 years (2024-2028). The final Strategy is expected to be launched and published in March 2024 and will be implemented with the support of a broader network of European harm reduction and drug policy organisations.

The Amsterdam meeting is part of a greater trajectory of the advocacy activities in the multi-annual BOOST Project. The results will feed into follow-up activities, including the organisation of Policy Webinars, a European Policy Dialogue Meeting during the European Harm Reduction Conference 2024 and the preparation of a series of Policy Papers.

In February, the networks will launch a call for local harm reduction services to support the development and implementation of Local Advocacy Plans in 6 countries/cities.

 

The Amsterdam meeting was co-organised by C-EHRN (coordinator of the BOOST Project) and EHRA, in close cooperation with EuroNPUD and DPNSEE.

Becoming Peer. Learning from Nightlife

To mark the launch of our latest publication, ‘Becoming Peer. Learning from Nightlife’, C-EHRN recently hosted an online dialogue meeting with the authors (Tait Mandler and Roberto Perez Gayo) and other experts in the field of nightlife harm reduction and peer work (Hayley Murray, researcher at Wageningen University and Lynn Jefferys, operations manager at EuroNPUD). The participants of the dialogue, who have diverse backgrounds and living experiences, including those from nightlife, research, substance use, care provision, policy and advocacy or community self-organising of people who use drugs, delved into the ways through which innovative forms of meaningful involvement, health, and evidence can emerge in their respective fields of work.

Becoming Peer was born with the intention of offering a toolbox for reimagining harm reduction, drawing from concepts, experiences and practices from nightlife and other so-called “recreational settings”. The publication invites stakeholders to acknowledge the value of each other’s expertise in developing effective harm reduction practices. Through discussions of common but contested concepts, the authors invite the reader to question and unsettle power imbalances between different actors, practices, and forms of knowledge, making space for more effective community-based responses to arise.

 

Who is considered a “peer”?

Peer workers are generally understood to be people with first-hand experience of a specific activity or setting, and the word ‘peer’ points to similarities and shared status. However, being a “peer” worker does not necessarily mean being in a position equivalent to that of people in similar roles or those on the receiving end of interventions. Peer workers have different positionalities, and asymmetries stand between people with lived and living experiences. To cultivate meaningful peerness, it’s central to recognise and use the generative potential of differences to create new strategies for mutual respect and equality among all stakeholders – including peer workers, researchers and policymakers.

 

Who decides what “healthy” looks like?

Widespread models of health see health as the responsibility of the doctor or the medical establishment, while the patient engages passively, as a “consumer” or as the target of health promotion campaigns. However, from the early history of harm reduction, we learn that health can be understood as a dynamic community practice:

What if health is an activity, not so much a definition of the state of the body? […] However we define it, health emerges in practices of care. And so again, in nightlife harm reduction, there’s a lot of emphasis on ways in which people care for each other. (Tait Mandler, researcher at Wageningen University)

Health can be redefined as a whole concept from the position of people who use drugs, who have long been cast in the position of the “unhealthy”. Being healthy means different things to different people, and it is limiting to define it only within the healthy/unhealthy binary.

Health to someone can mean that they feel at their best. And if feeling at their best means dancing under the influence of drugs in the sand and surrounded by a community who cares about them, then that should also be part of health. (Hayley Murray, researcher at Wageningen University)

Participants of the meeting discussed the importance of trust in successful peer support, which can originate from having a shared experience with a certain substance, a similar background or presentation, and from simply knowing that the other party will not be judgmental, shocked or stigmatising and prepared to tend to one’s needs.

Building trust is really centered on using non-stigmatizing, strengths-based language and creating places for people to have safe conversations around drugs, in an anti-oppression, non-carceral framework. People need to know that you’re a person who isn’t going to be shocked when they say something about GHB or heroin, for example. (Lynn Jefferys, operations manager at EuroNPUD)

 

What counts as evidence?

Harm reduction projects that promote their own version of health from the community often have to produce evidence to show the impact of their work, whether for funding or to affect policy. There is a hierarchy that frames certain types of evidence, such as randomised control trials and statistical analysis, as the most convincing. On the other hand, lived experiences and personal stories are often discredited or taken less into account. 

Yet, the tacit, embodied knowledge and the everyday experience of people who use drugs constitute a precious “living archive” of information. Becoming Peer advocates for the recognition and respect for the expertise of people who use drugs in the harm reduction field and their involvement in developing innovative, community-based strategies and interventions.

As long as evidence is equated with expert knowledge or only seen as useful when produced through particular scientific methods there can be no meaningful peerness […]. An archive, on the other hand, doesn’t prefigure how it is used, doesn’t dictate what’s useful and what’s not. Archives don’t foreclose the future—they allow it to be open ended. (Mandler, T. & Perez Gayo, R. (2023) Becoming Peer: 25)

Expert & Member Meeting 2023

In December, Budapest gave place to C-EHRN’s Expert & Member Meeting, with more than 130 professionals gathering to discuss the key activities of the network!

To find out more about the event and C-EHRN’s key activities, watch the inspiring video by the Rights Reporter Foundation, and look at the summary of the event below.

On Monday the 4th, our focal points discussed the civil society monitoring of harm reduction in Europe process, ways to use the C-EHRN Monitoring data for advocacy purposes and getting familiar with a new data collection and visualisation tool for the C-EHRN monitoring activities. In the meantime, the partners of the Drug-Prep Project had insightful discussions on foresight research and other project activities.

 

A press conference also took place, introducing drug consumption rooms, drug checking in Europe and the example of Portugal’s health-based drug policy approach, sharing the message that “not only the richest countries in the world can implement efficient drug policies based on decriminalisation” (Marta Pinto, University of Porto). As a result, the conference gained coverage in RTL, one of Hungary’s most popular commercial TVs.

At the end of the day, some meeting participants visited Válaszút Misszió Drogkonzultációs Iroda, learning about their services and the Hungarian context.

Tuesday began with C-EHRN’s director, Katrin Schiffer, opening the official programme for all participants of the event, also introducing C-EHRN’s new visual identity which we launched with the event! During the plenary sessions, we discussed various topics including drug policy and harm reduction in Hungary, civil society monitoring and data collection, and some of the network’s main activities, including research on harm reduction in prison and harm reduction and gender.

Throughout the afternoon’s parallel sessions, we also talked about infectious diseases in community-based settings in the context of the BOOST project, while a migration workshop took place through the SEMID-EU project, and those interested could find out about the application of foresight research in the context of the drugs field (Drug-Prep project). In the following sessions, the civil society involvement case studies conducted in 4 European countries were discussed, while we also spoke about drug consumption rooms and mental health.

Wednesday’s parallel sessions gave space for an engaging conversation about C-EHRN’s strategy for 2024-2028, while drug checking and the state of harm reduction in five European cities (Amsterdam, Bălţi, London, Esch-sur-Alzette and Warsaw) were also discussed.

The Semid-EU plenary delved into the needs and (harm reduction) service access of marginalised migrants who use drugs in the EU, after which we reflected on the outcomes of the time spent together at the member & expert meeting.

To capture the event, we bring you a collection of images below.

UN High Commissioner for Human Rights Advocates for Human Rights-Centered Drug Policy Reform in new report

In a report of great significance released today, the UN High Commissioner for Human Rights calls for transformative changes toward drug policies that are based on health and human rights, calling for the decriminalization of drug use and recommending governments shift to responsible regulation in order to take control of illegal drug markets.

The report, titled “Human rights challenges in addressing and countering all aspects of the world drug problem”, underlines the harsh consequences of the ‘war on drugs’ and drug policies focused on punitive practices on human rights. The recommendations include the meaningful engagement of civil society organizations, people who use drugs, affected communities, and youth in shaping drug policies, and calls for the inclusion and support of harm reduction services.

In a statement released in response to the report, 133 civil society and community organizations welcomed its recommendations and called on the international community, the Member States, the Human Rights Council, drug control bodies, and UN agencies to act on the UN human rights chief’s call for systemic drug policy reform.

For more information, read IDPC’s thorough coverage here.

Take a look at the new website that will serve as a resource center for BOOST project outcomes

The new website of BOOST, a project supporting community-based & community-led organisations in providing communicable diseases services, is now available online!

BOOST enhances the implementation of harm reduction interventions by supporting community-based and community-led services that work to counteract the prevalence of communicable diseases including HIV/AIDS and viral hepatitis.

Those interested can read about BOOST, its aims and activities on the new web platform. In later project phases, the resources produced throughout the project activities will also be published here, including an up-to-date overview of the quality of testing and linkage to care services offered by harm reduction organisations in the EU and selected neighbouring countries, good practice examples, webinars and training materials.

Co-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union. Neither the European Union nor the granting authority can be held responsible for them.

BOOST at the HaDEA’s meeting: “Best practices in community-based services for HIV”

The European Health and Digital Executive Agency (HaDEA) brought together 5 exciting projects under the #EU4Health Programme at an online meeting on the 28th of June. The following projects were represented at the meeting:
All 5 projects have received the Action Grant to enhance community-based services for HIV, AIDS, Viral Hepatitis & Tuberculosis. At the meeting, HaDEA aimed to foster collaboration and identify synergies among the projects.
We were proud to be present as the coordinators of the BOOST project and partners in the CORE project!

 

BOOST Project at the Central and Eastern European Summit 2023

The Central and Eastern European Summit 2023 on Hepatitis C, HIV and other infections – screening, linkage to care and treatment took place in Prague on the 15-16th of June and gathered over 200 participants from Czechia and Central and Eastern Europe. The aim was to facilitate knowledge exchange, share good practices and improve care for hard-to-reach communities, particularly people who use drugs.

 
Some elements of the BOOST project were also presented by Tessa Windelink (Free Clinic) and Jukka Koskelo (A-klinikka Foundation), representatives of project lighthouses, with the title “Community management plan – how to improve continuum of care at the local level? Project BOOST” as part of the Local Strategies session. On the second day, a Boost project meeting for members of the project team and interested partners also took place, bringing more clarity regarding cooperation and organisation among the partners.
 
The main aim of the BOOST project is to enhance the implementation of high-quality community-based & community-led communicable disease services as part of a comprehensive, people-centred and integrated harm reduction approach. The project is funded by the EU4Health programme of the European Union.
 
 
Read more about the BOOST project here.

 

BOOST

 

On the 13th & 14th of February, with 45 participants from more than 20 organisations, the first meeting of the BOOST Project took place in the Fondazione Villa Maraini in Rome.

The main aim of the BOOST project is to enhance the implementation of high-quality community-based & community-led communicable disease services as part of a comprehensive, people-centred and integrated harm reduction approach. To ahieve its goal, over the next three years, together with our partners we will focus on four key areas:

INFORM – providing a collection of up-to-date information and data on current practice and quality of community-based and community-led services.
IMPROVE – supporting the organisation of capacity building activities in the field of communicable diseases, indluding the use of digital tools.
SUPPORT – enhancing the scale-up of integrated community-based good practices building up existing models of good practice.
CONNECT & ACT – strenghtening and consolidating existing civil society networks and fostering advocacy interventions for the improved implementation comunity-based and community-led good practices oriented towards the needs of people who use drugs at European, national and local levels.

BOOST Project is founded by the EU4Health programme of the European Union, under the Action Grants to support the implementation of best practices in community-based services for HIV, AIDS, viral hepatitis and sexually transmitted infections. Partners include the Eurasian Harm Reduction Association, EuroNPUD, Free Clinic, Podane Ruce, LILA Milano, Asociacion Bienestar y Desarrolo, IGTP/ICO, ISGlobal, Foundazinone Villa Maraini. Supporting the projects work, the project with count with Scientific Advisory Board and the collaboration of organizations such as DPNSEE, ReGeneration, ARAS Foundation, AIDS Action Europe, among others.

Fostering Community Knowledge

Before its 2022 Annual Data Report launch, C-EHRN is excited to share the first in a series of new publications we have prepared with our Network members and experts.

Communities of people who use drugs have for decades, and before the establishment of mainstream health services, designed and implemented some of the most effective evidence-based harm reduction interventions, such as needle-exchange programs, peer-delivered naloxone and community-based drug checking. However, research collaborations between people who use drugs and academic stakeholders often remain scarce, undervalued, and misinterpreted.

The involvement of harm reduction professionals and community members in research is often limited to serving as interviewees or a gateway to access other, often hard-to-reach participants. Consequently, community members may feel that their meaningful involvement is virtually missing, and research data results in evidence which dismisses the knowledge, experiences, and needs of the communities that are the focus of studies and hence, those who should benefit the most.

The first publication in this new series, Fostering Community Knowledge. Community-based Harm Reduction Research argues the need for inclusion in research of people who use drugs and explores its challenges and potential avenues. With this publication, C-EHRN is also launching a complementary Policy Brief that highlights key areas of consideration and provides recommendations.

The Lighthouse Concept

This new publication discusses the need for scaling-up harm reduction services, and more information on our new BOOST project.

In 2023, C-EHRN will start to implement the European Union (EU) co-financed BOOST project, aiming to strengthen and support community-based and community-led harm organisations in providing high-quality communicable disease services to people who use drugs. These include the scaling-up of good practices in communicable disease awareness, prevention, screening/testing and linkage to care, delivered as an integrated part of people-centred harm reduction interventions. The project consortium includes, among others, the Eurasian Harm Reduction Association (EHRA) and the European Network of People Who Use Drugs (EuroNPUD).

The publication also contains information from the presentation by Roberto Perez Gayo (C-EHRN Policy Officer) on the BOOST project at INHSU 2022.

As well as this, Free Clinic in Belgium, Podane ruce in Czechia, Villa Maraini in Italy, and the A-Clinic Foundation in Finland are discussed as examples in harm reduction for an integrated HIV/HCV approach.