Access the recently published article on the HIV epidemic among people who inject drugs in Thessaloniki

In Thessaloniki, Greece, ALEXANDROS, a community-based program targeting people who inject drugs helped identify a new outbreak of HIV infection during the COVID-19 pandemic. An article with an analysis of the outbreak has been recently published in the International Journal of Drug Policy and can be accessed here.

The analysis showed that homelessness and syringe sharing were risk factors in HIV acquisition and underlined the importance of peer-driven initiatives in the improvement of the access of people who inject drugs to HIV care.

The case of Thessaloniki might serve as a relevant good practice example for other contexts.

INPUD Policy Statement

INPUD have released a policy statement in response to the Conceptual Zero Draft Instrument.

The Conceptual Zero Draft Instrument is on pandemic prevention, preparedness and response (PPPR), and negotiations are currently underway for the finalization of the instrument.

INPUD have released a statement in reponse to the draft, discussing  the impacts of marginalisation and criminalisation, support for community-led and peer-based responses, strengthening policy and service delivery responses, and community engagement and accountability.

‘This statement is a response to the proposed new instrument from INPUD on behalf of people who use drugs globally and is informed by recent community-led research on PPPR among our networks and communities, as well as research conducted by INPUD during the Covid-19 pandemic.’

Minister of State Niall Collins commends Ana Liffey’s Mid West Team

 

Limerick County TD, Minister of State Niall Collins commends Ana Liffey’s Mid West Team in their tenth year of operations.

At the celebratory event, marking ten years of Ana Liffey Drug Project operating in the Mid West Region; Limerick County TD, Niall Collins the Minister of State for Skills and Further Education thanked the members of Ana Liffey’s Mid West Team for all their work over the past ten years; and particularly thanked Team Leader, Rachel O’Donoghue, and her team for the work they did throughout the COVID-19 pandemic. Acknowledging that they were the only drugs outreach team working on the streets of Limerick City throughout the restrictions, the Minister of State said,
“When fear and uncertain was permeating society across Ireland; and no one knew what was going to happen…this small team adapted quickly, stayed out there, and continued to meet the needs of those they serve. Maintaining contact with people; busting myths about COVID-19; and providing people with equipment and advice to keep them as safe and healthy as could be. The net result of this work was not only the maintaining of engagement with the people the team already knew; but, also the creation of meaningful relationships with literally hundreds of other people. Well done to all involved!”
At the event the Minister of State:
• Welcomed the findings of the new research carried out by the University of Limerick: ‘Doing More – The Health and Social Impacts of Crack Cocaine use in Limerick City’. The research findings were presented for the first time by Dr Dervla Kelly at the event.
• Welcomed the allocation of funding from the State under the ‘Community Services Enhancement Fund’ to support Ana Liffey to employ two addiction outreach workers in the Mid West Region, one worker specialising in reaching, and case managing, members of the LGBTQI+ community; and the other worker with a similar function focussing on the Traveller Community.
• Launched Ana Liffey’s new mobile health unit purchased with a grant from the JP McManus Benevolent Fund. Referred to affectionately as the Mid West ‘VanaLiffey’ – this is a significant service development which helps to deliver harm reduction services to people in a flexible and accessible manner; and to reduce the risk of overdose, and other drug related harms, in Limerick City and across the Mid West.
 
At the event Tony Duffin CEO of Ana Liffey Drug Project said,
“Our Mid West team work in Limerick City and also travel significant distances across the region to support people with complex and multiple needs. We are very grateful to the JP McManus Benevolent Fund for their support to purchase and fit out a new mobile health unit! Fondly referred to as the Mid West ‘VanaLiffey’ the vehicle is designed to help us meet people where they are at. Whether in an urban setting or a rural setting, we now have a fit for purpose private space that can roll in and out of an area. My sincere thanks
to Minister of State Niall Collins for taking the time today to launch the vehicle for us.”

INHSU 2022 Day 1 – Key Reflections

 

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;

Long acting partial agonist;

Key elements of effective OAT;

On Top Use of other Substances;

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

To the extent possible;

Key factors influencing patient preferences;

Testing and care of viral hepatitis among migrant populations in the EU/EEA

On Tuesday, the ECDC hosted their webinar on testing and care of viral hepatitis among migrant populations in the EU/EEA; aiming to strengthen EU/EAA countries’ capacities and capabilities to prevent and control viral hepatitis among migrant populations.

Chronic HCV/HBV in European migrant populations

Milosz Parczewski [European AIDS Clinical Society – EACS]  presented data on chronic HCV/HBV in European migrant populations. Milosz shared multiple figures on the data such as the one below.

Milosz emphasised the urgent need to collect current data from this target group, including updated vaccination data from the refugee population. He also highlighted the need for more outreach testing programmes as these numbers are still too small.

Novel model of care for testing HBV

Next, Camila Picchio presented a novel model of care for simplified testing of HBV in African communities during the COVID-19 pandemic in Spain. The model consists of two field visits; firstly, information regarding hepatitis b is provided by a community coordinator before the screening takes place with a blood extraction. During the second visit, the participants are given their blood results, offered their HBV vaccine, and those with past-resolved infection or prior vaccination are offered post-test counselling.

“This  community-based HBV screening program provides an effective model for identifying and providing care to migrant populations at high risk of HBV infection, who may otherwise not engage in care”

Take away messages from the model were;

Testing and management of viral hepatitis for refugees from Ukraine

The final presentation was by Mojca Matičič, MD, PhD. A pre-war data set of the situation in Ukraine was presented, with data showing Ukraine was second largest HIV epidemic in the WHO EU Region, second highest prevalence of HIV/TB coinfection, and the fourth highest TB incidence rate among WHO EU region countries. HBV and HCV infections were identified as key public health issues in Ukraine.

“By October 11 2022, 4,350,995 refugees from Ukraine registered for temporary protection (or similar national protection schemes in Europe)”

Mojca reinforced the need for community healthcare providers to ensure access to services and continuation of vaccination programmes for Ukranian refugees, and highlighted the harm reduction services across Europe for refugees from the Ukraine which are described in the C-EHRN Ukranian snapshot.

Call for Youth Voices

Are you between 16 and 29 years old? Do you live in Europe or central Asia? For the #Youth4Health Tirana 2022 Health and Well-being Forum for Youth, we are calling young people to submit short clips.

We want to hear from you on the following questions:
Youth engagement
  • Why is it important to engage youth in health and well-being decision-making?
  • How would you ensure that youth is involved in decision-making to build a better, healthier future?
  • What do you want doctors and policymakers to know about young people’s health and well-being that they forget or often do not understand?
  • What else would you like to share?
Youth health 
  • What health issues matter most to you?
  • What inspires and enables you to look after your health and well-being?
COVID-19
  • How has the COVID-19 pandemic impacted on your life? 
  • What helped you to cope during the pandemic?
How to record:
  • Choose one question and record about 20-30 seconds 
  • Record with your phone or laptop in landscape format
  • You can submit videos for multiple questions
  • Please share in the highest resolution possible
Deadline: 18 September 2022
The clips will be shown at the #Youth4Health Tirana 2022 Youth and Well-being Forum, in Tirana (Albania) on 25-27 October 2022 and on WHO and its partners’ web and social media channels.

Production of Long Acting PrEP

ViiV have agreed to enable generic production of long acting PrEP to 90 countries.

ViiV and the Medicines Patent Pool have enabled access to generic formulation of long acting Cabotegravir for PrEP to 90 low- and lower-middle income countries.

This comes as progress in the global HIV response has slowed, and a rise in infections in many countries has been identified.

UNAIDS Deputy Executive a.i. Dr Matthew Kavanagh said;

“We urge all companies developing long-acting HIV medicines to commit to sharing technology through the Medicines Patent Pool, and all governments to act rapidly to secure affordable access to the newest technologies for all who would benefit from them. There must be no repeat by any company of the deadly delays in rolling out HIV products that we saw early on in the AIDS epidemic and that has recently been repeated with COVID-19 vaccines and therapeutics. Sharing technology is essential for stopping pandemics.”

 

Read the full announcement on the UNAIDS site here.

 

New UNAIDS Data on HIV Response During COVID-19

The data from UNAIDS of the global HIV response has shown that progress has faltered and resources have shrunk during the last two years of COVID-19 and other global crises.

As a result, millions of lives are now at risk. Communities that were already at a greater risk of HIV are now even more vulnerable due to an increase of 75 to 95 million people being pushed into poverty.

The data shows that the progress against HIV is slowing, with the smallest drop in new HIV cases being reported in 2020 since 2016.

 

 

The report also shows how UNAIDS responded to the unjust war in the Ukraine, with US$ 250 000 being disbursed to preserve key HIV services.

 

Read the full report here.

Online Webinars 2022

Correlation – European Harm Reduction Network is excited to invite you to the online webinar series of its Civil Society Monitoring of Harm Reduction in Europe in 2021. In the coming months, we would like to invite you to join us in discussing the main key findings of our Data Report 2021 in a series of dialogues with harm reduction professionals, policymakers, researchers and European agencies, among others:

Webinar 01 | Launch Monitoring Report 2021
11th of May 16:00h – 16:45h

Webinar 02 | Hepatitis C & Drug Use
15th of June 16:00h – 17:00h

Webinar 03 | State & Challenges of Overdose Prevention 
13th of July 16:00h – 17:00h

Webinar 04 | COVID-19 Impacts on Harm Reduction
14th of September 16:00h – 17:00h

Webinar 05 | Monitoring New Drugs Trends
12th of October 16:00h – 17:00h

Monitoring Data Report 2021

 

The main aim and purpose of C-EHRN monitoring activities is to improve knowledge and information and complement existing data and monitoring efforts in Europe in specific areas of harm reduction based on the perspective of civil society organisations (CSOs). The data collected helps us to assess the implementation of certain drug and health policies at the national and local levels and supports our advocacy efforts at the European and EU Member State levels.

The adapted 2021 civil society monitoring incorporated the experiences from the past years. During evaluation meetings with our expert groups, it was decided to keep most of the questionnaires in 2020 intact for 2021. That was done both because the questionnaire of 2020 has worked reasonably well and also to allow for comparisons between 2021 and the previous year.

We kept our focus on the situation at the city level which allowed for more accurate and precise information. Consequently, the information provided in this report sometimes represents the situation in a particular city or region. Although this information is not representative of a country, it reflects the fact that the situation in a country is diverse and most often dependent upon the approach at the city level. Small modifications were made for clarity in the sections on essential harm reduction services, overdose prevention, Hepatitis C, civil society involvement and new drug trends. More modifications were made in the COVID-19 section to cover a new phase of the pandemic.

In addition to the survey, and on an experimental basis, the expert groups decided to try new forms of data collection. In 2 countries – Finland and the UK – online Focus Group Discussions (FGDs) will be performed to gather data on new drug trends. That was decided due to the low response rate in the online survey and also due to feedback from our Focal Points that this remains the most difficult section of the survey to complete.

More than one hundred organisations and individuals from 34 European countries have contributed to this Monitoring Report. Thanks go to our Focal Points and associated experts at the national and local levels who have filled in the online questionnaire and provided all information and data on time. Without their dedication and commitment, we would not have been able to produce this report.