Peer involvement of migrants and refugees to accelerate their access to HIV/HCV/HBV-related information and testing

In Europe, contemporary discourses and policies on migration have crystallized into structural patterns of
exclusion. An example of this is the circumstances in which refugees and migrants who use drugs have seen their access to social services and health care drastically reduced. If we look at the specific situation in Germany, restrictive laws and social barriers also play a role, in addition to the linguistic and cultural barriers that this community is confronted with. As a result, access to information, testing and treatment with regards to HCV, HBC and HIV is greatly affected.

Aimed at improving and transforming this situation, we agreed with the Berlin-based NGO Fixpunkt to develop a ‘Peer Involvement Network’ pilot intervention between June 2018 and March 2019.

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Legal Barriers for Providing HCV Community Testing in Europe

To successfully eliminate Hepatitis C (HCV), it is critically important to reach people who have never tested before, people who do not attend clinical services, and members of key populations. Community HCV testing, offering testing in communities of key populations such as people who inject drugs, has proven to be an effective way to reach these individuals.

To gain a better understanding of which barriers exist for providing community testing in various EU Member countries, we conducted a telephone survey with representatives of harm reduction services and of NGOs that offer low-threshold services to drug users.

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The Civil Society Forum on HIV, Hepatitis and Tuberculosis

We are a member of the Civil Society Forum (CSF) on HIV, hepatitis (HEP) and tuberculosis (TB) and a part of the coordination team. Our Forum comes together twice a year at the premises of the European Commission, DG Santé in Luxembourg; aiming to facilitate the exchange of information between civil society organisations, the EC, supranational agencies such as WHO, UNAIDS, ECDC and EMCDDA.

This year’s first meeting took place on 17 – 18 June. Since EU elected a new parliament, a new Commission is about to be installed, and a new, multi-annual framework for the EU budget is currently under negotiation, leading us towards a crucial period for advocacy for priorities such as keeping health issues and related budgets on the agenda. The Commission shared its efforts to support and monitor the measures to reach the sustainable development goals, to which the states around the globe committed themselves.

On June 17th, CSF members informed each other about recent and upcoming conferences, their focus, impact, the created advocacy opportunities for integrated health policies, and developments at the country/key population level.
We, as C-EHRN, shared information about the European and the International Harm Reduction Conferences, the upcoming Lisbon Addition, and the Hepatitis Community Summit, organised by the network and brought up the launch of our monitoring tool for harm reduction in the EU. (Read our interview about the tool HERE)

The CSF established four working groups last year, working on advocacy issues such as sustained funding, affordability of medicines, addressing stigma and human right violations as well as the implementation of the combination prevention for HIV. Reports about activities and outcomes can be found here.

On the next day, the Eurasian Harm Reduction Network organised an entire morning about the funding of the HIV/Hep/TB response in Central and Eastern Europe. The intervention of Global Fund representatives – who joined the session by video stream –  was remarkable as the withdraw of the Global Fund in countries remains a significant problem for sustainability.

The Fight against HIV and Hepatitis: Our Vision of a Europe for Health

We have made significant progress in addressing HIV and hepatitis in terms of knowledge, treatment and tools.

There have also been international commitments to put an end to these epidemics. However, the European Union and Europe more widely continue to face many challenges in terms of access to prevention and care, and respect of fundamental rights.

We supported a statement to be presented to the new elected EU parliament and the European Commission.

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Tuukka Tammi

1) Can you tell us a bit about your background?

I am a sociologist based in Helsinki where I work for the Finnish Institute for Health and Welfare. I‘ve specialized in drug policy issues both as a researcher and expert in national and international policy contexts. I’ve been a member of Correlation Network since 2006, and always greatly respected the work you do.

 

2) What was your main responsibility for the Monitoring Tool for Harm Reduction Services? 

I’m leading the process together with Eberhard Schatz from the Correlation office and the three thematic experts groups that Correlation has recently established. Important support comes also from a fourth group consisting of researchers. The EMCDDA is represented in that group, too. Together with them, we will report the first results from the monitoring in the autumn.

 

3) Monitoring.. sounds slightly boring. Why do you think that it is important?

I agree it sounds a bit dry. But we’ll do our best to make it interesting if not even exciting… Monitoring is important because we need a reliable and up to date picture of the current reality to be able to advocate harm reduction where it is most needed.

 

4) Why does the tool specifically focus on monitoring from the viewpoint of Civil Society? Do you expect other outcomes than what official data provides?

Like you say, the idea is to specifically address the civil society organisations who do vital work in the harm reduction field. Even if we already have a rather well working drug monitoring system in Europe, the viewpoint of the harm reduction agencies will add to that and presumably tell a bit different story than the official data. It will provide complementary data, and also alternative data in some cases. This is what makes it exciting.

 

5) Is the monitoring planned to be repeated? Or is it only for once?

Yes, it will be repeated annually. That’s the very idea of monitoring: we first take a snapshot of the situation and then follow how the picture changes both generally and in details.

 

6) Harm reduction still is underfunded in many countries, even if there is enough evidence that it works and is cost effective. Why’s that?

You tell me… Because of wrong priorities and tough attitudes towards people who use drugs?

 

7) Finland has very innovative policies, on many levels. Does that apply for drug policy as well?

We do have some success in our harm reduction policies, but there’s lots to do still. I would say we are rather followers and late comers when it comes to innovative drug policies. But we are not totally hopeless either!

 

8) What drives you personally to work in the area of harm reduction?

I like the analytical pragmatism and stubborn humanism that are built in the harm reduction school of thought.

 

9) So finally, please tell us what harm reduction means to you?

To me, harm reduction means innovative ways of supporting people to cope with and save their lives despite drug use.

The first study on the development trends of HCV treatment for PWID in Europe

We organised the first study on the development trends of national action plans, strategies and guidelines on HCV treatment for People Who Inject Drugs (PWID) in Europe.

Between 2013 and 2016, there was a positive trend in recognising PWID as a group of individuals for whom strategic action is needed to increase access to and availability of HCV treatment. In the majority of European countries, DAAs were reported to be available; however, restrictions on their use were reported in almost all of them, of which the most common were fibrosis stage, and current and/or previous injecting drug use.

The study concludes that in order to reduce the HCV-related disease burden among PWID, a radical change in the HCV response is needed in many of the European countries. National strategies, action plans and guidlines that specifically address recommendations for treating PWID with HCV need to be further developed and adopted. Involving all stakeholders, including relevant NGOs, in the monitoring and reporting of national responses would be a significant step forward towards the elimination of HCV as a public health threat, as set out in the WHO Global Health Sector Strategy on Hepatitis, 2016–2021.

Read the study here:  https://rdcu.be/bA4bt

Drug Consumption Rooms in the Netherlands

Since the first formal drug consumption room (DCR) had opened its doors on 10 June 1994 in Maastricht, the Netherlands, the number of drug consumption rooms increased, primarily aiming for the reduction of drug-related nuisance in the streets and public spaces.

Changes in the objectives of DCRs were noted over time, as more facilities now have included health promotion for PWUD as a main target. And since the 2010s, addiction care services are shifting their objectives towards recovery, which includes societal, social and personal recovery. 

The Dutch Trimbos Instituut, together with Mainline, de Regenboog Groep and us have worked on a detailed report on the DCRs in the Netherlands. The report aims to give an update of the current number of DCRs in the Netherlands and to provide insight into the DCRs’ main features such as opening hours, objectives and services on offer. 

We hope that this thorough report gives a valuable and complete vision to the involved and responsive experts among us.

You can find the report here.

Skills Exchange Educators Network

The Skills Exchange Educators Network, the so-called Seen project, has come to an end. Correlation was involved in this Erasmus+ project, which provided the opportunity for outreach workers and social workers to participate in a month-long internship with a foreign service provider.

Together with the project-coordinator Gruppo Abele (Italy) and project partners Apdes (Portugal) and Villa Mariaini (Italy), we have written a manual for service-providers who wish to organize a similar exchange. In it, you can find a description of the participants’ experiences and the lesson’s learned when it comes to organizing work-exchanges.

You can find the manual here.

Harm Reduction Conference

360 participants, 120 speakers in 30 parallel and 3 major sessions: accordingly to the feedback of participants the meeting was a great success. Once again many thanks to the supporting organisations and in particular our local hosts Carusel and Aras.

You can find pictures, presentations and the video wrap up of the meeting here:

PICTURES

PRESENTATIONS

VIDEO WRAP UP

Rapid Assessment and Response Method for Substance Use and Addiction

Harm reduction initiatives improve the lives of people using drugs, but the problems that they are facing differ from country to country, region to region, city to city, even from neighbourhood to neighbourhood. Initiatives that work well in one setting cannot be simply implemented in another setting.

Besides different local situations, health problems pop up instantly and can change rapidly over time. Many public health problems require a quicker response than traditional scientific research generally allows. This has led to the development of so-called Rapid Assessment approaches. The core of this approach is the set of Rapid Assessment and Response (RAR) guides developed by the Centre for Research on Drugs and Health Behaviour at the Imperial College in London for WHO and UNAIDS. Trimbos Institute and CVO refined this method and built a data management tool to enable people who are not scientifically trained to use RAR. This resulted in this manual to map problematic substance use quickly and accurately and generate priorities and ideas for interventions.

On several Correlation conferences in the past years introductions and workshops on the Rapid Assessment and Response method were presented.

Please find attached an online manual to carry out a Rapid Assessment and Response manual to map the situation and develop public health responses for your local situation. The manual contains analysis tools to process the information you collect during the Rapid Assessment and Response process.

We hope you will start to use the tool in the future and we are willing to help and assist you during your Rapid Assessment and Response process.

read more: RAR manual substance use and addiction – pdf

Richard Braam
Hans Verbraeck
CVO Research & Consultancy
Utrecht, the Netherlands
cvo@drugresearch.nl
www.drugresearch.nl