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4 – Daily Update – DAY ONE – Monday 26 April 2010
In the mid 1980s Liverpool was known as
‘smack city’. An influx of cheap heroin
had given the region problematic drug
use way beyond the capacity of its treatment
services – which, like the rest of the UK,
were concentrated mainly on getting people
off drugs.
In 1985 the Mersey Regional Health
Authority set up a drug information centre,
with a converted toilet housing one of the first
needle and syringe programmes. ‘This was
based on honest information, no scare stories,
just factual information,’ says Pat O’Hare, who
became the centre’s director in 1987. ‘The
funny thing is we used to speak about harm
reduction but never called it that at the time.’
This was the era when the threat of HIV
and Aids loomed large and public health
information campaigns were governed by
fear. It took a brave decision by some key
figures working in public health and health
promotion in Merseyside to try a different
approach, focusing on practical advice and
better services for drug users to prevent them
from catching the virus from shared injecting
equipment. Their pioneering efforts became
known as the Mersey Harm Reduction Model,
and drew inspiration from a multi-agency
approach to Aids prevention that seemed to
be getting results in San Francisco.
‘Drug users came out of the woodwork
who had never been to a drugs service – 25-
year injectors with the most horrendous
abscesses,’ remembers Professor O’Hare.
Visitor numbers rocketed and the
converted toilet was replaced by the Maryland
Centre, to make room for healthcare and HIV
prevention services. There was tangible
reduction in needle and syringe-sharing
behaviour – borne out by the fact an HIV
epidemic did not materialise in Merseyside.
While HIV rates were still climbing in
Manchester, just 30 miles away, the virus
became ‘statistically insignificant’ in Liverpool,
according to the regional epidemiologist.
Active involvement of local police seemed to
contribute strongly to the strategy’s success.
‘We worked closely with the police in that
we told them what we were going to do, and
eventually they felt ownership,’ he says. ‘The
head of Merseyside’s drug squad used to go
to conferences and talk about “our harm
reduction project” – there was this real
sense of pride.’
Soon after, Prof O’Hare helped share
progress in Merseyside on an international
stage, when he was encouraged by Mersey’s
regional director of public health, John Ashton,
to organise a conference. Despite ‘not even
knowing what an abstract was’, he found
himself with the job of organising the first
international conference on his home turf.
‘It was totally international from the start,’
he says. ‘I vividly remember being in our
training room on Maryland Street the
Saturday before the event. We were packing
the conference bags, and saying “do you
realise that people are flying here from all
over the world?” It was amazing.’
And so the IHRA conference took off – to
Barcelona next, then Melbourne, Rotterdam,
Toronto, Florence, Hobart, Paris, Sao Paulo,
Geneva, St Helier, New Delhi, Ljubljana,
Chiang Mai… By 2004, with his enthusiasm
for travelling exhausted, O’Hare realised that
he couldn’t take the association to the next
level. He became IHRA president, and public
health sociologist Gerry Stimson was
Harm reduction
comes of age
THIS MORNING IHRA continued welcoming
delegates through the doors of the Echo
Arena in Liverpool. For Paddy Costall,
managing director of the Conference
Consortium which organised the event, it
will be the culmination of more than a
year’s hard work and many meetings.
Mr Costall has a professional background
in the drugs, alcohol and criminal justice
field. He first became involved in the IHRA
conference in 2007 as director of services at
Cranstoun, which at the time managed the
European Network on Drugs and Infections
in Prisons (ENDIP). When ENDIP got
involved in a joint bid with the fledgling
Conference Consortium to run the event in
Warsaw, it was natural that he should find
himself in the organiser’s shoes, as he was a
key figure in developing the Consortium.
It was the beginning of a long-term
relationship between IHRA and the Consor-
tium, which would see the conference arrive
at Barcelona, Bangkok (during a state of
emergency for the country!) and Liverpool.
‘The Consortium brings continuity and
stability for IHRA in the way the conference
is delivered’, explained Mr Costall. ‘Our
strategic development gives IHRA even
greater scope to develop a diverse and
inclusive programme year on year. It goes
hand in hand with the expansion of IHRA’s
work on behalf of the Department of Inter-
national Development.’
‘It’s an incredibly challenging event to
put on,’ he added, ‘but people have a real
investment and get a real kick out of
On your marks,
get ready…