Good Practice Guide for Employing People who Use Drugs

Good practice guide for employing people who use drugs  – An indispensable toolkit (click link)

PWUD (People Who Use Drugs) have insights and expertise that can help inform the planning, delivery and review of harm reduction and HIV services. When we involve PWUD in the design and delivery of services, our work becomes more relevant, targeted and accessible. Working in partnership with PWUD helps our services to reach and connect with other PWUD more effectively, and to understand and meet their needs. A really powerful way of involving PWUD is to employ them as staff.

Employing PWUD sends out a clear message that they are valued partners and are welcome at all levels of service delivery. It also has a very practical set of benefits, helping services to better understand the needs and lived experience of PWUD. PWUD have the right to be employed. Policies that routinely exclude PWUD from the workplace are discriminatory.

When drug use is a problem (and when it is not)

Drug use is complex, and debate on the rights and wrongs of it can become easily polarised. In this context, the medical (disease) model of drug use tends to dominate. This emphasises the problems of dependence as an inevitable consequence of using heroin and other drugs. As a result, the response to drug use is often described as a treatment or cure for a medical illness. The medical model also dominates many 12-step programmes, such as Narcotics Anonymous (NA). It also influences the way many health professionals, academics, politicians and members of the public understand drug use. They share a belief that PWUD quickly lose the ability to control their drug use, and make conscious, autonomous or rational decisions about it. However, the United Nations Office on Drugs and Crime (UNODC) acknowledged in the World drug report 2014 that only 10% of PWUD will experience problems arising from their drug use.

This implies that many people’s experience of drug use can be non-problematic and often pleasurable. Similarly, some of our staff will have experiences with drugs that are non-problematic and recreational. Although in the alcohol field the concept of controlled drinking is now widely accepted, for many years the possibility of non-dependent and controlled heroin use has been largely ignored, despite evidence that such patterns exist.

This research demonstrates that some people are able to use heroin in a non-dependent or controlled manner. Studies of people using cocaine have also shown well-established patterns and strategies for self-control. These studies highlight the importance of the social context in which drugs are used and its impact on an individual’s experience of drugs and their effects.

We learn from these studies about the importance of context when trying to understand drug use patterns, and question the value of framing drug use as an individual failing or illness. (text taken from the guide itself. To receive a copy of the guide click the link at the top of this page)

Also read:

International HIV/AIDS Alliance (2010), Good Practice Guide. HIV and drug use: community responses to injecting drug use and HIV. Available at: www.aidsalliance.org/assets/000/000/383/454-G ood-practice-guide-HIV-and-druguse_original.pdf?1405520 726

This guide has been developed by the International HIV/AIDS Alliance (the Alliance) as part of the CAHR project, supported by the Netherlands’ Ministry of Foreign Affairs. The International HIV/AIDS Alliance in Ukraine (Alliance Ukraine) led this work, supported by the programme “Building a sustainable system of comprehensive services on HIV prevention, treatment, care and support for MARPs and PLWH in Ukraine”, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

 

Users Unite Around the Globe in Support of their Russian Peers -an overview

Posted on December 5, 2011
New York City Kicked off the global protest on the eve of World AIDS Day, and were followed by 12 other cities

New York City Kicked off the global protest on the eve of World AIDS Day, and were followed by 12 other cities

POST Press Release (please feel free to share this post on your website, but remember to link it back to here! Thanks!)

On World Aids Day, 2011, just a few short days ago, harm reduction organisations led by people who use drugs and supported by the International Network of People who Use Drugs(INPUD) gathered outside Russian embassies in cities across the world in the largest ever global show of solidarity by and for people who use drugs.

The protests, entitled ‘Shame Russia Shame’, was directed at Russia’s highly controversial drug policies which are believed to be driving the EEC regions HIV and TB epidemics. Injecting drugs with contaminated equipment is driving Russia’s HIV epidemic, now the fastest growing in the world and it is reflected in the numbers; as many as 80% of new infections are occurring amongst people who inject drugs (PWID), in a total HIV positive population of approx 1.3million. With this in mind, recent projections forecast an additional 5 million people could become infected with HIV in the near future, unless Russia drastically transforms the way it is dealing with its HIV pandemic.

INPUD member Erin O'Mara says Russia's drug policies are 'brutalising' INPUD member Erin O’Mara says Russia’s drug policies are ‘brutalising’

Erin O’Mara, (editor of UK’s Black Poppy Magazine and INPUD member) who coordinated the global protest said the human catastrophe unfolding in Russia is almost indescribable in its brutality and neglect.”Russia has more heroin users than anywhere in the world yet because they offer no safe alternatives such as methadone or buprenorphine, and corruption has driven the price of heroin above what many Russian users can afford, new home made concoctions like desomorphine (nicknamed krokodil) are gaining ground, with devastating health consequences for the user”. Erin adds, “To scratch the surface of Russian drug policies, you find some of the most brutalizing policies in the world; where their should be harm reduction, regulation, treatment and support, there is neglect, abuse, imprisonment, disease and death.”

New York City groups Harm Reduction Coalition and Vocal NY, led the first of the World Aids Day demos, reading speeches and presenting a statement of demands to the Russian Embassy, which included the demand for Opiate Substitution Therapies (OST) such as methadone to be both legal and accessible to the 2 million or more injecting drug users in Russia.

Mexico lays its candlelight vigil in memory of those who have died of AIDS.

Mexico soon followed, again on the eve of World AIDS Day, with their protest led by Espolea, an organisation who’s young people delivered their heartfelt candlelight vigil to remember those who have died of AIDS and those with HIV facing so much oppression in the Russian Federation. It was a very generous tribute from our young colleagues in Mexico at a time in the drugs war when they are facing such enormous troubles of their own. (see video below).

As December 1st -and World AIDS Day dawned,  the global domino effect began and cities from Canberra, Edinburgh, Barcelona, Berlin, Bucharest, London, Paris, Porto, Stockholm, Tblisi, Toronto, delivered their protests, and a unified SHAME RUSSIA SHAME rang out in front of Russian Embassies across the world.

Londons’ Russian Embassy Protest

Speeches were given and a statement of demands were delivered to the Embassies which included demands to see the introduction of Opiate Substitution therapy (OST) and the scale up of needle and syringe programmes, which although currently funded by outside NGO’s and not by the Russian Government, numbers of services are still shockingly inadequate, with around 50 odd for the entire Russian Federation.

The city of Tblisi also took a brave step and protested outside their Swiss Embassy, which currently stands in for the Russian embassy which has been removed from Georgia for political reasons. Nevertheless, Georgians who have also seen the emergence of the drug Krokodil from across the Russian border were keen to show solidarity with their Russian drug using peers, as history has meant they were very aware of the might of the Russian police forces and their attitudes towards drug users. Georgians took a huge risk protesting in Tblisi but seemed buoyed by recent workshops in drug user organising and empowerment and peerwork with INPUD.

New Vector, in Tblisi in support of their Russian peers, and raising awareness of krokodil

Demonstrators had the special opportunity to read out a letter from Russia, from an INPUD member and drug user activist named Alex, who spoke directly to his peers across the world about Russia’s indifference and the strength he gains from a unified drug using community.

Alex writes: “To my despair, I live in a country where the means don’t justify the ends Where it’s easier to save the lives of healthy people by destroying those who are sick. Where ethics and humanity have given way to contempt and cruelty. Where they evaluate prevention not in terms of possibilities and outcomes but dollars and popularity. I express my deepest gratitude to all of you who share my protest.  For me, World AIDS Day does not exist in Russia. For me World AIDS Day in Russia means white carnations and condolence cards.I’m alive today thanks to your help and your faith in our united strength. I wish us resilient spirits, and that love fills all of our homes. I’m with you today.”

The white slippers and carnations outside the Russian Embassy in Canberra, Australia

Demonstrators from the LGBT community also joined London’s embassy protest to add their voices against Russia’s recently passed St Petersberg bill, which, having already passed the first hearing, would severely further restrict the rights of the LGBT community. The oppression and marginalisation of the LGBT community also adds to a difficult environment to disseminate HIV prevention/treatment information. (click here for more info on this issue.)

 

The global protest was an exciting, moving and empowering event for all concerned, however everyone was acutely aware that Russian themselves were simply not safe enough to protest on World AIDS Day, no matter how peacefully. Although this protest had its roots in Moscow in 2009 on International Drug User Day, when 5 Russian activists were arrested after trying to lay red carnations and white slippers (the Russian symbol for the dead) at the steps of the Drug Control Service, the protest expanded on International Remembrance Day 2011. People in three countries took part, Budapest, Berlin and Barcelona and remembered their peers outside Russian embassies, again laying the symbols of the protest. This world AIDS Day,was a call out to the world that we will not let our Russian peers be forgotten -that we will stand side by side them as we all fight to ensure that Russian citizens have the right to humane, evidenced based, enlightened drug policies and treatment.

For more information and/or quotes from INPUD members and city organisers, please do not hesitate to get in touch with INPUD.

Contact: INPUD Deputy Project Co-ordinatorL eliotalbers@inpud.net who can put you in touch with the right person or answer your questions. For more articles on this issue see the protest website at http://russianembassyprotest.wordpress.com 

NOTE: A huge thank you to the global coordinators based in London – Women of Substance, Black Poppy Magazine, and Ava Project (London)– -and our partners in Eastern Europe: Andrey Rylkov Foundation, Eurasian Harm Reduction Network and all those organisations who took part in this event. INPUD members;  Plataforma Drogologica (Barcelona), Deutsch AIDS Hilfe (Berlin), Harm Reduction Coalition, Vocal NY (New York City) ,ASUD, Cannabis Sans Frontiere (Paris), AIVL, NUAA, CAHMA(Canberra)  CASOP (Porto) Association Intergration (Bucharest),Svenska Brukarforeningen (Stockholm), New Vector (Tblisi), CounterFit (Toronto) Chemical Reaction (Edinburgh) , Espolea (Mexico City)

Peering at Peer Work from Prague…

Hiya,

Sending an update from Prague, having been attending a Correllation event based around peer work and peer support. A great focus for an event, and one that promised to include a deeper look into what peer work is, what makes it successful, the obstacles, why its important etc, with the aim of boosting it and outreach work in Europe. The title was ‘Stimulating Inclusion, Participation and Meaningful Involvement’ (European Seminar on Peer and Outreach Work).

The Czech Drug Situation…(A quick glance)

Anyway, having a quick squiz at the drug situation in Czech Republic on the way over, I was interested to learn a bit more about the Czech peoples relationship with amphetamines, which are apparently the drug of choice over here.  In fact, according to the EMCDDA’s 2010 report on drug use in Europe, the Czech Republic has the highest prevalence of amphetamine use in Europe at 3.2%, (Denmark comes a very close 2nd at 3.1% and then Estonia 2.5%…Ok ok, us Brits are in 4th place with 2.3%!!).

In any case, what is interesting is that its use has risen markedly since data started being collated in 2002. Most of it is methamphetamine in powder form, therefore it’s primarily injected in 90% of cases.  Many eastern and central European countries have seen recent surges in problematic amphetamine use and have been caught unprepared in how they should deal with it, with treatment systems largely organised to deal with opiate users.

It was kinda interesting also to note the Czech relationship with speed

Amphetamine, the prototypical releasing agent,...

Image via Wikipedia

going back to the 1950’s with a few pharmaceutical amphet based preparations proving the drugs of choice. Consumption greatly increased through the 60’s and 70’s until the ol’ meth labs appeared and took the place of the, now banned pharmy meds.

The 1980’s saw the expansion of meth users, mainly quite closed groups that grew up around meth dealers and production areas and by the end of the 80’s an estimated 25-30000 users were dependant on non alcohol drugs – principally pervitin (which is the name used for methamphetamine in Czech Republic and Eastern Europe).

Since 2000, pervitin use has grown beyond these small groups into the wider popluation and is now quite extensive in Slovakia as well. Just to round up, the EMCDDA report mentioned that the surge in pervitin use in Slovakia corrosponded with a drop in retention rates at methadone clinics from 77% in 1999 to 46%  in 2003 (quite a drop). This seem to show that opiate users were using pervitin as well, and were either getting chucked off the methadone clinics or leaving themselves. A change in the philosophy of the clinics whereby meth clients were not excluded from clinics but were given a low-ish dose of methadone (a max of 40mg) and were not required to become abstinent. This appeared to stop the drop in retention rates which, in 2008 improved to about 58%. (Perhaps something for the conservatives abstinence evangelists  to think about!)

Finally on the drugs front, just to throw in that methamphet is reported as the primary drug of choice by around 70% of those entering treatment and is also reported by opiate users as their secondary drug of choice – especially by those in methadone programmes. Searching for, no doubt, something to break the monotonous dullness of long term methadone use!

Back to the Seminar then!

We heard that the Czechs have around 10,000 problematic drug users in Prague, one of the lowest rates of HIV in Europe (although they have low rates of testing), approx 50% of opiate users are in treatment but they don’t have much involvement from drug users themselves in services, as peer workers etc (nothing new there then).

John Peter Kools, one of the conference organisers, urged us over the days ahead to find the similarities that bind peer workers and professionals, rather than the differences. He said he had seen the biggest changes happen when people have started to relate to others and searched for that common ground, finding that ‘win-win’ position. He assured us that it is an uphill battle and that wont change i soon; the political climate around Europe for small government (in other words – do it yourself!) is spreading fast and he mentioned specifically the situation in the UK where a new government policy document had just been written (The Coalitions new drug strategy) and the words harm reduction weren’t mentioned even once. Shocking, to be sure. He urged us to keep engaged because we could, indeed we have in some instances, lose precious hard won ground.

Rhythm and Pace.

Just a highlight from the first day, a speaker (actually from the UK) named Graeme Tiffany, who talked very eloquently about outreach work with young people about successful outreach being the matching up of the Romantic (of the era) and the scientific. He was very clear about such ‘hard to reach’ groups – are not at all that; in fact it is services that raise the threshold too high. So true! When you think about teenagers (and i was a drug using youngster!) – regulations are not of your language then – you need a service that keeps the bar low – that allows you to retain your identity, not one that trys to lift you out of your scene and strip you of what you feel is what protects you: your youth culture, your mates, your sense of belonging, all I think are felt so much stronger when your a teenager. He talked about the directives he gives when training youth workers now, after learning some fascinating work of an agency in Pamplona Spain that insisted its workers go out, and sit on the wall in the street (where the kids hang about) for 6 hours. It was called feeling the ‘rhythm and pace‘ of the community. That you need to stop and ‘feel’ the pace of things, the movement, you have to listen to the street. So often people sit in offices and very rarely go out and see and really feel the local street scene, or as is the case with outreach – rushing out of the office to hurry around the area doing ones ‘work’.

Then it is about ‘proximitie’ the french meaning – to be close enough to ‘hear the request’, hear what is being asked of you – not to think you know what someone needs and lumber in with ideas of what you think is important for them – you need to hear the request; when you have taken the time to tune into their space you will be asked and you will understand what they need from you. Then he talked of ‘accompagne‘ also in the french sense, which means unity and solidarity – to stand by and be with. It really was a wonderful ‘code’ by which to help outreach workers tune into their local youth scene.

Macedonia Rules!

A wonderful woman from Macedonia named Maria Tosheva from the Healthy Options Project in Skopje gave us some truly inspiring news about real peer involvement.

HOPs began as a user led initiative doing syringe exchange out on the streets of Skopje, despite harassment and suspicion from the local police and community. Hops has expanded enormously and become a service in its own right but it has retained its community members as being the most important part of the Hops team.

21 out of the 52 paid workers are drug users – a truly remarkable achievement we just done see replicated enough. Maria said that there is no real meaningful involvement of community members unless they are part of challenging the laws and creating the policies that affect them; changing the main obstacles that they face. She recommended that in order to support and foster this we have to invest in community groups, pay as equals, respect individual ambitions and preferences of those involved, and respect the need for members natural group development and structures; it is not always about the structures that you think will be most effective – you must listen and allow space for the natural development of user groups. Brilliant stuff – and what we KNOW to be true words spoken. Nice one Maria!

Ill end here and try and give an update on day 2, which had me a bit teary at one stage! I always write my blogs too long, hope you’ll forgive me readers. Until later,

Erinx

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