Side event: Comprehensive community based HIV, HCV and TB prevention

Organised by the Government of Poland, the Polish National Bureau for Drug PREKURSOR Foundation for Social Policy and Foundazione Villa Maraini/Red Cross and Red Crescent Partnership on Substance Abuse.

Artur Malczewski Moderator.

Dr Massimo Barra (Foundazione Villa Maraini)

With new drugs/substances, it is possible to kill the viruses. The medications give a new perspective of life. In this world, the services for drug users are very strange, which makes accessibility difficulty. There are a lot of obstacles to enter. If a person has good motivation to stop, they can access. But the government should also provide services for people who also aren’t ready to stop. These are a group that we must support. We must be more aggressive. The idea for the government is to know all the drug users, as they are more dangerous if they are not known. We need to work with prisons and pharmacies. There is a gap that needs to be bridged, and the best way to do this is with NGOs and civil society, over government. In Italy, when a drug user is arrested, we bring methadone if needed, which has reduced the aggressiveness of harm. We try to increase the power of drug users. Usually therapeutic communities reduce the power, but we want to increase it. We need to be useful to them, provide needle exchange services, and provide a relationship.

Mauro Patti (Foundazione Villa Maraini) 

“HIV/HCV Continuum of Care Model Among Hard to Reach Drug-Addicted – Meet, Test and Treat”

We use the humanitarian approach, and advocate around the world to give drug users access to public health and harm reduction programs, and provide alternative measures to prison. We founded the International Partnership on Substance Abuse in 2012. The Villa Maraini Foundation is the Italian Red Cross Agency for drug abuse. Our harm reduction programs include outreach activities, provision of clean needle and condoms, HIV/HCV counselling, and facilitate a network between the Red Cross. We have two caravans, since 1992 we’ve reached 21000 drug addicts in the streets, delivered more than 1 million needles. in 2016 HIV/HCV prevalence amongst drug users by rapid testing is 15.6% and 80.9% respectively. Our goal is to investigate among hard to reach drug addicted to better estimate real HIV/HCV prevalence, and improve access to health services and treatment. And of course to save lives.

Our method is to MEET –> TEST –> TREAT; according to harm reduction principles. We do this through NSP and Sex Worker Outreach, hold events of public testing and awareness, provide pre-counselling, post-counselling, and treat if positive. We choose rapid tests as they are cost-effective, innovative and accurate. We also sometimes use saliva tests. In 2016, 1204 were screen, 101 subjects received a preliminary diagnosis of positivity (11 for HIV, 91 for HCV). Most subjects were men, and only 10% were foreigners. 58.9% answered ‘yes’ to ‘have you ever used drugs?’. 37% of subjects said they have shared injecting equipment.

Magdalena Bartnik (Prekursor Foundation for Social Policy)

Prekursor is a coalition of NGOs working together in the fields of public health and social policy. We also work in harm prevention, harm reduction, HIV/HCV and STI prevention and treatment, drug policy, homelessness, sexual education and mental health. Our harm reduction program is the only one in Warsaw and biggest in Poland. We have a outreach program which will be soon based on peer work, and we provide needle syringe programs, support and counselling.

Problem areas and resulting needs (being a drug user in Poland): we do our best, and we do have support, but our laws are some of the harshest in Europe. The idea of working with users is not mainstream. We treat alcohol use very differently to other substance use.

  • Extremely limited access to harm reduction services
  • Low accessibility to substitute treatment
  • Lack of social and treatment support
  • Lack of needs-based response
  • Lack of education opportunities
  • Lack of cooperation between health-care institutions/assistance strategies
  • Legal situation
  • Harm reduction functions outside the assistance programs

What we should be focusing on is drug users, and not those who are so lucky to have stopped using. To have effective prevention, you need to combine all interventions, such as those listed in ECDC and EMCDDA. We think a crucial and possible response includes community-based prevention and care, accessing those who don’t already access our service; peer involvement; and outreach work (including rapid testing, mobile units, provision of overdose prevention medication). Services and outreach need to be tailored to fit their needs. These services would also provide data on the needs of those who inject drugs.

Artur – Question time

From Germany – I have visited your services in Italy and have been very impressed, and has been very useful in shaping German harm reduction services. We now have drug consumption rooms in Europe. We are now working in Asia trying to set up similar programs. In Australia they’ve already started a national strategy on Hepatitis C, which is what we need to do in Germany – we now have the opportunity to provide the new Hepatitis C treatments under insurance in Germany. Hepatitis C prevention and treatment needs to be further integrated into CND resolutions.

To Villa Mariani – you’ve convinced people not to use drugs, but how have you convinced law enforcement prosecute harm reduction?

Dr Barra – We work together with the police and law enforcement – first of all, we created a good mutual understanding with them. Of course at the beginning they were repressive, but step by step we’ve been able to change perception. We haven’t had to change any laws to support harm reduction. Harm reduction is part of therapy, there is no contradiction. No doctor wants to increase harm.

Slovakia – What is the conclusion of European Council on drug demand reduction?

Artur – Thank you for this question – it will actually be answered in our next side event on Friday

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