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Harm Reduction International |
Vilnius, 2013
important to ask people what they needed from their outreach service, in the
context inwhich theywere living. Issues to consider included cultural barriers, family
values and complex circumstances around relationships, such as intimate violence.
Working closely with psychiatrists, Stella explored different models of
support, including motivational interviewing, and tried to make sure their clients
were offered choices. ‘Harm reduction should be a philosophy to apply to
different types of social work,’ she said. ‘We need to help people make choices in
the global context of their health.’
CONSTANT RISK
ADDRESSING TB AMONG PEOPLEWHO USE DRUGS SHOULD
BE A PUBLIC HEALTH PRIORITY
‘Access to TB services remains horribly low,’ said Annabel Baddeley, in a session on
harm reduction relating to the tuberculosis epidemic. ‘We need to encourage
stakeholders to be more mindful of TB in collaboration with services.’
Injecting drug users were more at risk of TB, she said, as their immune system
could be impaired by lifestyle factors such as poor housing and nutrition. Those in
prison were entering ‘highly infective centres’ and the risk of TB was consistently
higher in inmates, particularly those sharing equipment. Stigma, discrimination
and lack of continuity of care after release could add to the risk.
‘Addressing TB among people who inject drugs is a public health priority,’ she
said. ‘Harm reduction stakeholders should increase efforts to reach this at-risk
group by including TB interventions in their services.’
TB had become an increasingly important issue for the drug using community,
said Mat Southwell, who got involved in developing a practical advocacy guide in his
role as a drug user activist. Referring to HIT’s document,
TB advocacy guide for people
who use drugs
, he explained how drug users fromaround the world came together to
contribute to a ‘rich resource’. The key messages included challenging stigma and
criminalisation while giving access to anti-retroviral therapy and integrated services.
‘We have to bring services to a common place, rather than expecting people to
run around looking for them,’ he pointed out.
Dickens Bwana, a programme manager in Tanzania, gave his experience of work-
ing at grassroots level, particularly inmakingTB care possible at home.Witnessing the
exclusion and stigmatisation of a drug user attempting to gain access to treatment
had prompted his organisation to integrate harm reduction into their services.
‘With stigma attached to drugs, plus HIV, plus TB – you can see that these
people need help,’ he said. TB was the leading cause of mortality among injecting
drug users, exacerbated by poorly ventilated consumption rooms – a breeding
ground for infection – and interrupted treatment. Harm reduction education was
needed on how to inject drugs and the importance of using condoms, as well as
places to test for and treat the disease. Médicins du Monde had supported the
opening of the Down to Earth medical centre in Dar es Salaam, a ‘friendly open
door’ where trained volunteers offered interventions such as TB screening, HIV
testing and referral to methadone programmes.
In addition, TanPUD (the Tanzanian network for people who use drugs) were
giving training sessions to educate on treatment. ‘Addressing TB among drug users
should be a harm reduction priority,’ he said.
‘Addressing TB among drug users
should be a harm reduction
priority...’
DICKENS BWANA
Keep the promise:
Representatives of Demetra – an association of HIV-affected women and their families – along with other
national and international organisations call on Lithuanian leaders to change their HIV and harm reduction policies. Despite Lithuania’s
achievements compared to other countries in the region, there was still a need to scale up evidence-based interventions, they stated.
‘We strongly encourage our politicians to take the responsibility to keep their commitments and implement international guidelines and
recommendations,’ said Demetra head, Svetlana Kulsis.