During the 3rd day of the INHSU 2022 conference, Roberto Perez Gayo, policy officer of C-EHRN, chaired a session on the need for scaling up community-based HCV prevention, treatment and linkage to care services for people who use drugs.

Free Clinic

Tessa Windelinckx of the Free Clinic in Belgium outlined their work and stressed that the clinical component of their programme was dependent upon their peer outreach workers and, therefore, collaboration between medical staff – including doctors and nurses – and peers was vital to reaching the most vulnerable people with viral hepatitis C (HCV) services and to link them with care. In addition, each part of the Free Clinic portfolio of services benefited from having staff with varying experiences working together, such as those running the needle-syringe programme (NSP).
As most vulnerable people are afraid of government services due to the stigma and discrimination that is often prevalent by such healthcare staff, peer-to-peer support by Free Clinic – called C-Buddies – acts as a bridge, or facilitation mechanism, between those in the community and the service providers at Free Clinic fixed sites. C-Buddies are usually people from the vulnerable community who use communication methods to build friendships with vulnerable people within a stable environment. Through building trust, vulnerable people are encouraged to access a range of services offered by Free Clinic, including HCV testing.

Spolecnost Podane Ruce

Lucie Maskova of the Spolecnost Podane Ruce non-governmental organisation (NGO) in the Czech Republic (Czechia) provided information on their services, noting that the country had an HCV elimination plan for people who inject drugs, but that treatment was only available through 22 specialised centres throughout the Czech Republic rather than through NGOs or other mechanisms. Rapid HCV testing through a finger-prick, or a sample of saliva, is facilitated through drop-in and mobile/outreach services as well as part of providing opioid agonist therapy (OAT) and drug treatment and includes counselling by non-medical staff. Approximately 2,000 people each year are tested for HCV. HCV testing is also provided for refugees from Ukraine with trained peers who speak Ukrainian and Russian.

Recently, an infectious disease specialist joined the NGO who will hopefully be able to prescribe direct acting antiviral (DAA) medication in the near future. Challenges facing the NGO include how to address comorbidities and the limited number of trained peers, together with funding as well as the relatively limited number of centres where DAA’s are available; the country also needs a national coordinator for the HCV elimination efforts.

Read the full presentation here.

Fondazione Villa Maraini

Examples of service provision in Italy were presented by Nadia Gasbarrini of the organisation Fondazione Villa Maraini which was founded in 1976 and delivers low threshold services including an emergency unit, drop-in centre, night shelter and services inside prison as well as outreach on the street. OAT, HIV and HCV services are also available, plus higher threshold interventions, including a therapeutic community and outpatient treatment.
On-site and street-based HIV and HCV testing and linkage to care also provide counselling, psychological support – including support to families – as well as peer-to-peer education and, more recently, COVID-19 testing and screening [see images 9 and 10]. In addition to people who use drugs, sex workers, the LGBTQI+ community, the homeless and migrants are also served. However, treatment of HCV involves referral of individuals to a hospital rather than provision of DAA’s through the organisation. To-date, in 2002 there were 536 people tested for HCV. Prior to the COVID-19 pandemic in 2019, the number of people tested was 1,310.

Read the full presentation here.

Group Discussion

Following the presentation, participants joined a group discussion. The key points include:

Important to include harm reduction as part of the medical training curriculum and to provide medical students with internships to work with organisations delivering harm reduction services as part of improving their practical skills in the delivery of client-centred harm reduction services;
Crucially, peer training of public-facing staff at healthcare facilities is important as receptionists and security guards are the first people with whom a vulnerable person will come into contact with.
Legislators/regulators should improve their understanding of how harm reduction services are delivered and be more flexible in the regulations and guidelines used by the medical profession in the provision of standard interventions for people who inject drugs and other vulnerable people. Likewise, harm reduction advocates need to facilitate awareness raising by legislators/regulators of the opportunities to make services more flexible and adaptable to the needs of vulnerable people;
Staff turnover is a challenge within organisations and there is a need to increase the number of peers trained in the delivery of an integrated approach to the provision of health, social and economic support interventions, including housing. It is also vital that trained peers are paid properly for the skills that they provide to service delivery agencies and are not discriminated against by being treated as volunteers due to their prior, or ongoing, lived experience;
The role of trained and trusted peers is vital as most vulnerable people are suspicious of healthcare workers. Therefore, outreach supports vulnerable people, such as providing evidence-based and clear information; answering questions; accompanying individuals, if needed, to healthcare facilities and acting as a bridge for both the client and healthcare staff to communicate and benefit from the available services; and to provide other pathways for a vulnerable person to voluntarily access social and economic services;
The time available for a doctor to spend with an individual client can be very limited due to the number of people seeking assistance and other competing priorities. Therefore, where practical, task shifting should be used to allow nurses and others to perform a range of tasks as this will free up time for a doctor to focus on those people who have more complex health and related needs;
There is a need to integrate services as the opportunities for the individual to return to a service provider could be extremely limited. Therefore, testing for common communicable diseases should be undertaken at the same and, ideally, for results to be available immediately that allows for treatment to begin without delay; this will reduce loss-to-follow-up and allow the client the most pragmatic approach to improving their health. However, at present, many providers –especially for OAT – have different regulations that they follow. Service providers need to show flexibility to improve access and adherence to treatment by vulnerable clients;
In running an effective harm reduction organisation, it is necessary to strike a balance between good levels of peer supervision and avoiding unnecessary meetings or paperwork. In addition, services must not try to micromanage vulnerable individuals as this will likely lead to them not returning again;
Good linkages with local law enforcement is important in facilitating access by vulnerable people to harm reduction services, either at fixed sites or through outreach. Examples from Tijuana, Mexico, were given during the Conference as to how this can be undertaken. Such linkages with police can be either formal or informal in nature but with the same objective of facilitating access to services by vulnerable people in the community. Small steps, such as peer education for police, can be the start of the process that eventually culminates in decriminalisation;
Different agencies of the same government structure can work against each other in reality, such as a health department supporting civil society partners to provide HCV testing in the community but the local laboratory being a barrier to PCR confirmatory testing; funding can also reflect the different priorities of government agencies;
Telehealth can increasingly link clinical providers with vulnerable people as a way of helping clients feel easier about accessing health services;
Stigma remains a major barrier to increasing access to, and full utilisation of, health services by vulnerable people.

Summary

In conclusion, participants stated that the most important issues for service providers to consider in establishing and scaling-up community-based HCV prevention, treatment and linkage to care services for people who inject drugs include:

Gaining the trust of people who inject drugs which can be achieved through trained peers who are paid at the same levels as those without such lived or living experience of drug use;
Ask people who inject drugs what they want; do not make assumptions on their behalf;
Ensure you have a baseline at the beginning of service delivery so that you can calculate changes and impact over time;
Learn from other organisations who have gone through similar processes and models of service delivery; this can include collaboration/partnerships with such agencies;
Ensure that medical practitioners are given the opportunity to learn about harm reduction from people who inject and otherwise use drugs in order to adopt more flexible and pragmatic approaches to service provision; this could include internships while studying at medical school, for example;
Provide access for people who inject drugs to education about the HCV continuum of care, including what medical practitioners require from those who undergo treatment, as well as barriers that clients may face in becoming free of HCV; and,
Provide web-based information to organisations who are considering establishing HCV services for vulnerable people, such as the materials available from C-EHRN.

We are excited to be attending the INHSU 2022 conference in Glasgow, and want to share some key reflections and images from day 1 (October 18th) as shared by Graham Shaw and Roberto Perez.

At the opening, the Scottish Government’s Minister for Public Health, Women’s Health and Sport, Maree Todd, stated that Scotland was close to halving viral hepatitis C (HCV) prevalence and by as much as 60-70% in some parts of the country. However, she also noted that HCV incidence remains high.

Jason Wallace of the Scottish Drugs Forum (SDF), speaking on behalf of the community of people with lived and living experience, outlined the main points from the statement developed by the community forum the previous day. Of particular note was that research must be controlled by the community, including the early involvement of the community in developing all aspects of a research proposal, as well as ownership of research data. He also stressed that poly drug use is the norm, not the exception. The community also demands a defined role of volunteers as well as to be paid equally for being employed in research work, as well as a clear pathway for peer workers to progress in drug-related programmes, together with proper supervision and support within such organisations.

In Andrew McAuley’s presentation, he spoke of the increasing global trend in drug-related deaths (DRD) which have roughly doubled over the past 30 years and exponentially increased since 2014 and that this trend has further climbed since the COVID-19 pandemic, with the USA and Scotland the stand-out leaders in the rate of DRD. Medically Assisted Therapy (MAT), also known as Opioid Agonist Therapy (OAT), Take-Home Naloxone (THN) were notable responses to opioid-related prevention of deaths and Direct Acting Antivirals (DAA) for the treatment of HCV. Drug Consumption Rooms (DCRs) and Drug Checking Services (DCS) are also key to the prevention of DRD but that there are gaps in evidence.

Niamh Eastwood of Release UK outlined the various aspects of how the war on drugs has failed and how non-white people were clearly being targeted by law enforcement agencies who use the war on drugs as an excuse to stop-and-search non-white people around nine times more often than they do with white individuals. However, advocacy continues to push for the decriminalisation of drug use and possession for personal use, including the cost savings arising from decriminalisation. A picture from the presentation is included below.

Impact of the Russian invasion on ART and OAT access by PWID in Ukraine

Jack Stone of the University of Bristol outlined the impact of disruptions to services for people who inject drugs due to the Russian invasion of Ukraine. Modelling shows that short-term closures of interventions could have a substantial impact on the increase in HIV infections even though OAT and ART access continued to increase outside of conflict areas but reduced in the areas invaded by Russia, partly a result of a drop-off of NGO service provision in such Russian-controlled areas of Ukraine. Images from the presentation are included below.

‘What the fresh hell is this?’

Presented by Garth Mullins, the producer of the Crackdown podcast based in the USA. The session discussed the ever developing emergence of new substances promoted through the consequences of prohibitionist policies, as seen originally in the early 20th century in the USA with alcohol. Particular focus was given to ‘benzo-dope’ and how naloxone responses to overdose only impact the ‘dope’ component and not the benzo’s, leaving people with severe memory loss from a few hours to several days. Contributors provided their own ‘benzo-dope’ overdose experiences, including Jason Wallace of the Scottish Drugs Forum who said that Benzos were implicated in an ever increasing number of drug-related deaths. Angela McBride of the South African Network of People who Use Drugs outlined the impact of alcohol and cigarette prohibition in South Africa during COVID-19 lockdowns but that such experience has been easily forgotten. Sione Crawford of Harm Reduction Victoria, Australia as well as Mat from the Canadian Association of People who Use Drugs (CAPUD) all noted the need for a safe supply to reduce overdose events and continued failure to provide a safe supply of substances will allow the black market to prevail and the resultant high levels of drug-related deaths.

HCV care models

Several different examples of HCV care models were presented from South Africa, Iran and Scotland. In all three countries, services were based within the community through building relationships and keeping each step as simple as possible; such an approach helps to reduce the level of stigma and discrimination experienced by people who inject drugs. In Dundee, Scotland, building such relationships helped move from confrontation to cooperation, such as in interactions with a local pharmacy, as well as the inclusion of other health interventions, such as wound care. In Rafsanjan, Iran, a local entrepreneur helped to fund a local response to provide HCV testing and treatment, with the local community identifying an unused bus that was repurposed and used as a mobile HCV unit. The local service was linked with the University of Medical Sciences and this model of micro-elimination of HCV is now being considered for implementation throughout the country. In South Africa, it was noted that advocacy can result in positive change in service provision and SANPUD capacitates fellow networks and organisations to pressure decision-makers for change to allow improved access to HCV testing and treatment services.

Individual choice

The choice of which opioid maintenance approach is appropriate for the individual was discussed within the context of Switzerland and Australia. A relatively wide range of options are available in Switzerland. The process of supporting an individual includes the person’s preferences as to which opioid agonist should be tried, with examples given for various substances available in Zurich and Arud. The future directions beyond medical treatment were also outlined within the context of the changing legislative environment. Key elements of effective OAT were presented together with approaches to the continued use of other substances by an individual.

In Australia, choice is often associated with not being chained to a pharmacy as well as the endemic stigmatisation of people who use drugs. In addition, there are social aspects to using substances and the medicalisation of treatment often negates this component and options also include the continued use of drugs. Also stressed during the discussion was the apparent fear held by prescribes of being held liable if an individual overdoses and the belittling view of people who use drugs held by legislators that results in unreasonable and excessively tight controls being in place for opioid maintenance.

The social sciences perspective of individual choice was reviewed and the key factors that influence individual preferences were outlined. Considerations that ‘professionals’ can make to facilitate choice by the individual were also provided.

Differentiated choice of the best suitable agonist were discussed. The first priority has to be the preference of the person in treatment; subjective experience and side effects are often overlooked and not addressed.

Long acting full agonsists include;

Methadone – frequent interactions, QTc, sedated
L-Polamidon – only in liquid form, less side effects
SROM (slow release oral morphine) – often better tolerated, no interactions, warmer and more lively

Long acting partial agonist;

Buprenorphin – sublingual, induction more complex, alert and less opioid feeling

Key elements of effective OAT;

Accessibility of treatment
adequate provision of information
Respect of autonomy of the person in treatment, no coercion, no sanctions
choice of best tolerated substance in sufficient dose, preferred route of administration
Take homes by default
Individualised goal setting, treatment tailored to the needs of the person in treatment
Diagnosis and treatment of comorbid disorders

On Top Use of other Substances;

Make sure OAT is optimised (substance, dose, route of administration)
No sanctions
Careful use of urine analyses – self report more informative
Address comorbid disorders (self-medication)
Consider agonist treatment of stimulant use disorders (also as stand alone treatment for people without opioid dependence).

“How can professionals enable choice in OPT decision making?”

To the extent possible;

Offer a range of non-stigmatizing treatment options
Provide accessible information in a range of formats to enable informed decision making
Listen to patients and answer questions
Share decision making
Review treatment and treatment decisions regularly and update

Key factors influencing patient preferences;

Personal dislike of particular OPT biodelivery systems
Desired feelings following OPT administration
Perceived effectiveness
Concerns about side effects
Ability to control the OPT
Impact on everyday life
Concerns about OPT-related stigma
Perceived need for adjacent psychosocial support
Personal treatment goals

Correlation’s research officer Iga Jeziorska attended CONSTELLATIONS: An Online Festival on Drugs and Harm Reduction, offering insights and reflections from the 2 days of films, presentations, workshops and discussions.

During the festival, an update on the situation in Ukraine and activities of Polish harm reduction organisations supporting the refugee PWUD were discussed. The situation is difficult, but the harm reduction community works tirelessly. Despite the terrible context of the war, people remain motivated and services are working well. In Poland, unprecedented levels of unity and solidarity could be seen not only in harm reduction, but also in the society at large, when Polish citizens got highly mobilised to help Ukrainian neighbours fleeing from war.

Eurasian Harm Reduction Association [EHRA] has been operating a crowdfunding campaign to support Ukrainian PWUD and activitsts with individual financial support and humanitarian aid. If you are interested and able to support the cause, the bank details for donations are the following:

Name of account holder: Eurazijos žalos mažinimo asociacija

Purpose: Charitable donation for community in Ukraine

IBAN: LT92 7180 3000 0770 0220

Bank name: AB Šiaulių bankas

BIC/SWIFT: CBSBLT26

The festival also featured two advocacy videos on drug consumption rooms by Drugreporter and INPUD:

Metzineres: From Survival to Fighting Back about Barcelona’s safe haven for womxn who use drugs and experience(d) violence. Metzineres offers a “full-spectrum” harm reduction approach, encouraging the dreams and passions of the womxn using their services to create a feeling of encouragement where the womxn can safely share stories and survival methods.

The second video was The Wall of Shame about the history of crack use in Paris and the need for opening a safe consumption site for people using it. The documentary explores the barriers in place preventing the development of a safe consumption space, and addresses the stigma and racial discrimination surrounding crack consumption in Paris.

The videos were followed by a very interesting discussion on the needs of PWUD, racial and sexual discrimination, and (in)effective policies.

The videos were followed by a session on arbitrary detention of marginalised groups, involving Dr Miriam Estrada-Castillo from the UN Working Group on Arbitrary Detention, who explained the methods of work of the group and encouraged to submit the appeals to the Working Group if experienced arbitrary detention. Interestingly, the Working Group works on the basis of the international human rights conventions (also, civil and social rights conventions, and Convention against Torture), with national codes being of little interest. Any person who experienced arbitrary detention (or their family or friends) can submit an appeal to the Working Group, regardless of the duration of the detention, the time that passed since a person was detained, or whether they are already free. If the Working Group confirms the arbitrariness of the detention, a person is entitled to financial compensation from the government. The Working Group’s decisions are legally binding. You can read more about the mandate and operation of the Group here.

Finally, there was a roundtable with Patriic Gayle and Leila Reid about chemsex harm reduction in Greater London, with storytelling on how the grassroots service Gay Men’s Health Collective has finally acquired funding, discussion on the specificity of work with people engaging in chemsex, and presentation of a harm reduction package, which will be distributed in the city in 20.000 copies very soon.

Every year on 1st November, among many organisations, C-EHRN celebrates International Drug Users’ Day by showing solidarity within the harm reduction world, aiming to raise awareness about the importance of community-led harm reduction and peer involvement and advocate for the rights of people who use drugs.

Alongside other vital initiatives, this year, there are two campaigns to which we would like to draw your attention.

INPUD campaign: #PowerOfPeers
As Aditio Taslim, the INPUD Advocacy Officer, states, the COVID-19 pandemic has provided us with more proof that in times of crisis, the community responds first by extending solidarity and supporting each other through challenging times. Nevertheless, still, they are the ones that are under-funded, under-invested and excluded.

The #PowerOfPeers campaign messages boldly highlight:

Overdose deaths’ prevention in communities through naloxone distribution and other direct actions.
Successful advocacy for more direct funding for community-led harm reduction services.
Drug policy reform, particularly in advocacy for decriminalisation.
The development and production of IDUIT (Implementing Comprehensive HIV and HCV programmes with people who inject drugs) provide normative guidance to the Global Fund.

By joining the Campaign, you can help add bricks to the goal to end the War on Drugs with full decriminalisation of drugs with no sanctions.

Check here for the INPUD campaign toolkit to get inspired and, accordingly, to inspire others.

UNAIDS Call-to-action
On this very day, you can also answer the call by UNAIDS for action against the criminalisation of people who use drugs and for community-led harm reduction programmes. Their call aims to end inequalities and AIDS by fully involving communities of people who use drugs to achieve legal reform aimed at decriminalisation and in the organisation of harm reduction programmes at the country level.

Lastly, as you might be well aware, the 5th European Harm Reduction Conference will occur next week between 10-12 November in Prague. The programme includes extensive highlights which are co-organised by representatives of people who use drugs and peer-led networks.

Below are only a couple of the sessions that will touch the groundwork and offer plenty of discussions and knowledge exchange:

Workshop 3 | C-EHRN & EuroNPUD: A starters kit for testing in the community by the community
Satellite II | UNODC HIV/AIDS Section – HIV prevention, treatment and care among & with people who use stimulant drugs
Plenary Opening Session | Drug policy and harm reduction embedded into the broader development of societies in Europe
Major Session 1 | Drug policy decriminalisation
Major Session 4 | Key issues during the pandemic: naloxone and overdoses
Parallel Session 2 | Peer-led Harm Reduction
Parallel Session 3 | Girls Power in HR2
Parallel Session 7 | Supporting person-centred choice
Parallel Session 8 | NPS and mental health
Parallel Session 10 | Objects or Subjects?
Major Session 5 | Peer work and research

Did you know that there will also be live-streaming sessions?
Check out their list and register here if your calendar can be shifted to open room for those you fancy following!

Check out the HR Key Principles, our key innovative output which translates the learnings of the HR4homelessness project into guidance for homeless and other services who support people in homelessness

The HR Key Principles translate the learnings from the ‘HR4homelessness’ Project, which brought together homeless and bustance use services, into guidance for homeless services to improve support provision for people who use drugs and/or alcohol.

For each of the seven principles, strategies for improving support provision are described as well as existing good practices. We provide suggestions for tools that can be helpful for staff and service users, suggestions for further reading and link you up to the respective training video(s). The seven principles are:

Human Rights based service provision: HR aims at establishing quality of individual and community life and well-being – not necessarily abstinence of all drug use – as the criteria for successful actions and policies. HR calls for a non-judgmental, non-coercive access to support and care.
Meaningful engagement of service users: HR engages and involves people with lived experience of homelessness and substance use in the development and evaluation of policies, services and programs that affect them. This is essential for achieving good social and health outcomes and addressing unmet needs.
Reduce risks and harm: HR focuses on reducing the harms related to substance use for the individual and the broader community. It takes into account factors that may exacerbate vulnerability such as trauma, incarceration history, racism, social disadvantage, housing status, age, sexual orientation and gender.
Take on a pragmatic attitude: HR accepts that licit and illicit substance use is part of our world. HR reflects the idea that none of us will ever achieve perfect health behaviors and that ‘perfect’ health behaviors are impossible to define as they are shaped by social determinants and norms.
Person Centered Services: HR services focus on responding to the needs, preferences and values of the individuals and communities they work with. This includes the recognition of the social conditioning of health outcomes, addressing power relationships between care providers and service users, and the promotion of communication and shared decision-making.
Evidence-based services, strategies and policies which are relevant and effective to the communities they serve and which are regularly evaluated and, if necessary, adapted.
Accountability: HR aims to minimize not only the negative health and social impacts associated with drug and alcohol use, but also the harms caused by respective policies, laws, services, and institutional practices. HR promotes processes and systems designed to hold individuals and groups in check for their decisions and actions.

To support people who use drugs and other marginalized and underserved communities, as well as health and social workers delivering services under challenging conditions to bring this outbreak to a close, Correlation – European Harm Reduction Network is developing this Coronavirus Resource Centre. This capacity-building initiative complements our advocacy activities and the J oint Position on the Continuity of Harm Reduction Services During the COVID-19 Crisis that we published together with the Eurasian Harm Reduction Network, and the Rights Reporter Foundation.

This Resource Centre brings together contributions, materials, experiences of our members, partners and allies. New/Updated materials come first, as situations change very quickly.

If you discover any out-of-date links or if there would be any links that could be included, please, let us know at this address: rpgayo@correlation-net.org

GENERAL INFORMATION

WHO | Updates & Guidance on COVID-19 Pandemic

ECDC | Situation Update for the EU/EEA and the UKÂ

European Commission | EU Coronavirus Response Website

EMCDDA | The Implications of COVID-19 for People Who Use Drugs & Service Providers [Last Update, March, 25th]

InfoDrog | News & Information [FR][GER][IT]

STATEMENTS | POSITION PAPERS | ADVOCACY

Coalition Plus, IDPC, HRI, INPUD, C-EHRN, INHSU, TAG | COVID-19: An Opportunity For POlicy Reform [June, 26th]

RCC-THV | Call to Action in Response to COVID-19 [May, 14th]

UNAIDS | Sex Workers Must not be Left Behind in the Response to COVID-19 [April, 8th]

TGEU | COVID-19 & Trans People [April, 6th]

INPUD, HRI, EHRA, IDPC et al | Call to Action COVID-19 – Special Rapporteur on the Right to Health [March, 31st]

Nobody Left Outside | EU and national government COVID-19 responses must reach everyone – including marginalised people [March, 26th]

UN Human Rights Experts | No Exceptions with COVID-19: Everyone Has the Right to Live-Saving Interventions | [March, 26th]

EATG | EATG statement on the evolving COVID-19 pandemic [March, 25th]

PICUM | The COVID-19 pandemic: We Need Urgent Measures to Protect People and Mend the Cracks in our Health, Social Protection and Migration Systems [March, 25th]

EUPHA | Statement by the EUPHA Migrant and ethnic minority health section on COVID-19 – CALL FOR ACTION [March, 24th]

UNAIDS | Rights in the time of COVID-19. Lessons from HIV for an effective, community-led response | Infographic | [March, 20th]

C-EHRN & EHRA | Harm Reduction Must Go On [March, 19th]

Human Rights Watch | Human Rights Dimensions of COVID-19 Response [March, 19th]

Global Rights / Susanna Ronconni | Prisoners Rights Matter! Statement | Article [March, 19th]

FEANTSA | COVID-19: “Staying Home” Not an Option for People Experiencing Homelessness [March, 18th]

ICRSE | COVID-19: Sex Workers Need Immediate Financial Support and Protection [March, 18th]

Penal Reform International | Coronavirus: Healthcare and Human Rights of People in Prison [March, 16th]

DPNSEE | Public Appeal to Protect Vulnerable Groups from COVID-19 [March, 2nd]

GUIDELINES | PROTOCOLS | GOOD PRACTICE

DRUG USE

EHRA | Harm reduction service delivery to people who use drugs during a public health emergency: Examples from the COVID-19 pandemic in selected countries [November 2020]

Manitoba Harm Reduction Network | Outreach Guidelines During COVID-19 [Updated, March, 26th]

EuroNPUD & INPUD & Respect Drug Users Rights | COVID-19: Advice for People who Use Drugs [March, 26th]

Forum Substitution Praxis | Newsletters on COVID-19 and Substitution Treatment [GER] [Update Daily]

Drug Reporter | How Harm Reducers Cope with the COVID-19 Pandemic in Europe? [Last update: March, 20th]

MAINline | 8 Corona-Tips voor Mensen die Drugs Gebruiken [NL] [March, 20th]

AFEW International | Mental Health & Psychological Considerations during COVID-19 Outbreak [March, 20th]

Scottish Drug Forum | Guidance on Contingency Planning for People who Use Drugs and COVID-19 (v1.0) [March, 19th]

Echele Cabeza | Consumo de Sustancias Psycoactivas en Cuarentena [SP] [March, 19th]

Zurich Drug Consumption Rooms | COVID-19 Protocols [March, 19th]

Metzineres | COVID-19 Harm Reaction Poster | Flyer (front) | Flyer (back) [March, 19th]

Energy Control | Party & Drugs in the Time of Coronavirus [March, 19th]

YALE | COVID-19 Guidance: Clinicians & Opioid Treatment Programs [March, 18th]

YALE | COVID-19 Guidance: Patients Engaged in Substance Use Treatment [March, 18th]

YALE | Guidance for People Who Use Substances on COVID-19 [March, 18th]

Arild Knutsen | An Open Letter on COVID-19 and PWUD [March, 17th]

DPNSEE | Instructions on Coronavirus for PWUD [Serb] [March, 16th]

Quality Assurance Commission for Substitution Treatment in Germany | Information on Opioid Substitution and COVID-19 – Advice for Physicians [March, 16th]

LANPUD | Drogas y COVID-19 [SP] [March, 14th]

INPUD | Harm Reduction for People Who Use Drugs [March, 13th]

Drug Policy Network SEE | Basic Protective Measures Against the New Coronavirus [March, 11th]

HRC | Safer Drug Use During the COVID-19 Outbreak [March, 11th]

HRC | Syringe Services and Harm Reduction Provider Operations During the COVID-19 Outbreak [March, 11th]

CREW | Coronavirus – General Hygiene Harm Reduction Tips [March, 4th]

SEX WORK

ICRSE | Sex Workers Response to COVID-19 in Europe and Central Asia [continuosly updated]
NYC Health | Information on Safer Sex during COVID-19 [March, 21st]
Butterfly Asian and Migrant Sex Workers Support Network & Maggie’s Toronto Sex Workers Action Project |Sex work COVID-19: Guidelines for Sex Workers, Clients, Third Parties, and Allies [March, 19th]

HOMELESSNESS

FEANTSA | Seven Measures Authorities Must Take to Protect Homeless People form COVID [March, 31st]
CDC | Interim Guidance for Responding to COVID-19 among People Experiencing Unsheltered Homelessness [March, 22nd]
Canadian Drug Policy Coalition | Homeless Shelter Bed Spacing for COVID-19 [March, 19th]
Welsh Government | Guidance for Substance Misuse and Homelessness Services (v1.0) [March, 19th]

PRISON

Dignity | Global Guidance & Recommendations on how to Prevent & Manage COVID-19 in Prisons [March, 25th]
WHO | Guidance on Preparedness, Prevention & Control of COVID-19 in Prisons & Places of Detention [March, 15th]

GENDER & SEXUAL ORIENTATION

Metzineres | Woman & Gender Non-Conforming People Who Use Drugs Surviving Violence During Quarantine [April, 8th]
NYC Health | Information on Safer Sex during COVID-19 [March, 21st]
GMSH | COVID-19: 2GBTQ MEN [March, 20th]
David Stuart | What does coronavirus (COVID-19) mean in regard to Chemsex? [March, 19th]
Energy Control | Party & Drugs in the Time of Coronavirus [March, 19th]

HIV, HCV & TBC

Alliance of Public Health | Practical Recommendations to Reshape a Sustainable Response to HIV/TB/HCV in the EECA Countries with COVID-19 Context [May, 14th]
WHO | Q&A on COVID-19, HIV & Antiretrovirals [March, 24th]
UNAIDS | What People Living with HIV Need to Know about HIV and COVID-19 [March, 19th]

MIGRATION

IASC | Interim Guidance on Scaling-up COVID-19 Outbreak in Readiness and Response Operations in Camps and Camp-like Settings [March, 17th]
Zolberg Institute on Migration and Mobility | Principles of Protection for Migrants, Refugees and Other Displaced Persons [ ]

CAPACITY BUILDING

STUDIES | REPORTS | ARTICLES

International Journal of Drug Policy | Chang, J., Agliata, J. & Marinieri, M. | COVID-19 – Enacting a ‘New Normal’ for PWUD [July, 3rd]

London School of Economics & Political Science | Saving Lives in the time of COVID-19. Case Study of Harm Reduction, Homelessness and Drug Use in Dublin, Ireland [July, 1st]

INPUD | Survey Report #1 – Health & Rights of PWUD in a COVID-19 Enviroment [June, 30th]

HRI | COVID-19, Prisons and Drug Policy | Global Scan [Last Update: June, 27th]

ICRSE & SWAN | COVID19 Crisis Impact on Access to Health Services for Sex Workers in Europe and Asia [June, 20th]

Open Society Foundations | 10 Lessons from HIV for the COVID-19 Response [June, 12th]

Global Drug Survey | GDS Global Special Edition on Covid-19 Interim Report [June, 2nd]

EMCDDA | EU Drug Markets Impact of COVID-19 [May, 29th]

EATG | Rapid Assessment #2: COVID-19 Impact on PLHIV and on Communities most affected by HIV [May, 28th]

EHRA | Harm reduction programmes during the COVID-19 crisis in Central and Eastern Europe and Central Asia [May, 26th]

EMCDDA | Trendspotter Briefing – Impact of COVID-19 on Drugs Services and Help-Seeking in Europe [May, 12th]

National Monitoring Centre for Drugs and Adiction Czech Republic | Rapid Assessment [April, 6th] | Rapid Assessment [May, 11th]

WEBINARS

FEANTSA | COVID19 & Rough Sleepers [June, 10th]

ISAM | 3rd Webinar on COVID19 and Substance Use [May, 7th]

Alliance for Public Health | COVID-19 Lessons: What can make HIV programs in EECA countries more sustainable? [May, 5th]

ISAM | 2nd Webinar on COVID19 and Substance Use [April, 15th]

INPUD, Medicines du Mond, HRI, UNDOC, WHO | COVID-19 Harm Reduction Programme Implementation [April, 6th]

International AIDS Society | COVID-19 & HIV: What you Need to Know [April, 3rd]

EU Health Policy Platform | COVID-19 European Coordinated Response to the Pandemic [April, 3rd]

CATIE | Coping with COVID-19: Insight from the Front Lines of HIV, Hepatitis C & Harm Reduction [March, 26th]

Institute for Interdisciplinary Innovation in Healthcare | COVID-19: a Systemic Crisis [March, 25th]

ICPA | Response to COVID-19 in Prisons | Slides | [March, 19th]

ISAM | COVID-19 and Substance Dependence [March, 19th]

Foundation for Opioid Response Efforts | Medications for Opioid Use Disorder and the COVID-19 [March, 19th]

HRC | Harm Reduction, COVID-19, and People Who Use Drugs [March, 18th]

INTERVIEWS & DIALOGUES

Drug Reporter Live Sessions | Stories From the Front Line

GDS Corona Conversations | Dialogue Series with Various Guests (selection)

Steve Rolles | Transform Drug Policy Foundation [UK]
Niamh Eastwood | Release [UK]
Judy Chang | INPUD [UK]
Mat Southwell | EuroNPUD

PODCASTS

Crack Down |Emergency Measures [March, 20th]

Ten Percent Happier with Dan Harris |How to Handle Coronavirus Anxiety | Special Edition [March, 14th]

Healing Justice | Coronavirus: Wisdom from a Social Justice Lens [March, 13th]

Correlation – European Harm Reduction Network and the Eurasian Harm Reduction Association, together with the Rights Reporter Foundation, published a joint position on the continuity of harm reduction services during the COVID-19 crisis.

Download the English, Russian, German, Portuguese, Spanish, Polish, Hungarian, Czech, Montenegrin PDF version here!

People Who Use Drugs (PWUDs) can be considered as a risk group in the COVID-19 epidemic. They often live at the margins of society with low or no access to housing, employment, financial resources, social and health care, and face systematic discrimination and criminalisation in the majority of countries. Many of them have multiple health problems, which can increase the risk of a (fatal) COVID-19 infection (including long-term diseases such as COPD, HIV, TB, cancer, and other conditions which reduce the immune system). Harm reduction services are often the one and only contact point for PWUDs to access the health service. They provide health and social services as well as other basic support, and function as an essential link to other life-saving services. We call on local and national governments and international organisations introducing safety measures and to:

1. Ensure the continuity and sustainability of harm reduction and other low-threshold services for PWUDs during the COVID-19 epidemic. This includes, in particular, Opiate Substitution Treatment (OST), Heroin Assisted Treatment (HAT), Needle and Syringe Programs (NSP), naloxone provision, and continued access to Drug Consumption Rooms (DCRs). In addition, essential basic services need to be provided, including day and night shelter, showers, clothing, food, and other services. This is of particular importance to those who experience homelessness and/or live on the streets.

2. Provide adequate funding for harm reduction and other low-threshold service providers, and supply them with adequate equipment to protect staff and clients from infections (soap, hand sanitiser, disposable face-masks, tissues etc.).

3. Acknowledge the important and critical role of harm reduction and other low-threshold services in the COVID-19 pandemic and address the specific vulnerable situation of PWUDs and other related groups.

4. Develop specific guidelines and regulations for harm reduction services, with respect to the vulnerable situation of PWUDs and related target groups. These guidelines should be developed in close cooperation with involved staff and the affected communities, and build on international WHO guidelines, recommendations, and evidence and/or national COVID-19 regulations.

More specifically we call for the following:

5. OST and HAT should be maintained and take-home regulations should be established or extended for patients to have the opportunity to come for treatment rarely then ones a week. Access through pharmacies should be ensured.

6. NSP should provide PWUDs with larger amounts of needles, syringes, and other paraphernalia to minimise the number of contacts. Special bins for needles and syringes should be provided to collect used material at home.

7. Harm reduction services should provide COVID-19 prevention material and information for staff, volunteers, and service users, including soap, alcohol-based hand sanitisers that contain at least 60% alcohol, tissues, trash baskets, and disposable face-masks (if this is requested by national regulations), for people who show symptoms like fever, coughing, and sneezing.

8. Drop-in services, day shelters, and DCRs should advise and support PWUDs in preventing COVID-19 infections. Visitors should be made to sanitise their hands when entering and should stay no longer than is absolutely necessary. Kitchens can prepare take-away food to be eaten outdoors. All necessary measures should be made to increase social distancing among visitors/staff with all possible means, and rooms should be ventilated. Overcrowding in harm reductions services, shelters, and DCRs should be avoided, by establishing safety measures, e.g. minimising the duration of stay, maximum number of visitors, entering only once per day. People with permanent housing should be encouraged to stay at home and come only to pick up needles and other harm reduction paraphernalia and tools.

9. The health situation of PWUDs should be monitored closely. If someone shows symptoms, such as fever and coughing, face-masks should be provided and a medical check-up should be ensured. Cooperation agreements with public health services, related health units, and hospitals need to be established to ensure direct medical support, follow up care, and treatment.

10. Night shelters need to be made available for people experiencing homelessness, with a separation in place between those who are not infected and those who are infected and need to be quarantined but do not need specific medical care and treatment in hospitals. Night shelters have to comply with the overall safety regulations for COVID-19, and people should not be exposed to additional risks for infection through overcrowding and insufficient health care.

11. Group-related services, such as meetings and consultations, should be cancelled and postponed until further notice or organised as online services. New treatment admissions should be temporarily suspended. Coercive measures (e.g treatment referrals made by court/prosecutor/police, probation officer visits etc.) should be suspended. Mandatory urine sampling should be abolished.

12. Harm reduction services should establish a safe working environment and make sure that staff are well informed and protected against infection. Service providers should identify critical job functions and positions, and plan for alternative coverage by involving other staff members in service delivery.

Boosting Communities and Increasing Impact – INHSU 2022