ABSTRACTS A451-A500
BY ABSTRACT NUMBER
A451
The Tribunals and harm reduction concerning chemical dependents
Omar Alejandro Bravo, Brasil
Issues: The American model of tribunals for chemical dependents is trying to be implemented by the justice of Distrito Federal, Brazil. Therefore, with the allegation of treating illegal drug consumers, the drug users are under the obligation of treating their supposed disease, diagnosed in magistrate's court by a judiciary authority. A refusal to the treatment implies in a legal punishment.
Approach:It was used, as a methodological analysis of the documents that describe and justify these policies, an analysis of the method of speech that with an hermeutical judgement, tries to show the ideological characteristics of the texts and discourse according with an hermeutical approach and its concerning to wider discursive formations.
Key Points: It is understood that these policies of compulsive treatment of drug users results in penalizing the drug users themselves, placing them with the double stigma of being sick persons as well as criminals. These initiatives have a relationship with the denominated "zero tolerance" policy that try to incriminate social groups and an even wider roll of subjective types.
Implications: The Justice's increasing demand of mental health professionals to become members of this legal circuit places them amid an ethical and political challenge. In order to affirm a damage reduction policy, it is necessary to oppose to these judicial initiatives another type of attendance and prevention methodology to the drug users. Therefore, in the mark of the well-known initiatives as of reduction of damages, imply another concept of health and another subject dimension of society. The community's participation is fundamental in this task.
A452
THE “WAR ON DRUGS” RELATED HARMS
Hurtado, Gustavo; Inchaurraga, Silvia; Vázquez Acuña, Martín Argentinean Harm Reduction Association (ARDA) - Asociación de Reducción de Daños de la Argentina, Juan Bautista Alberdi 1251 – 1406 – Ciudad de Buenos Aires – Argentina, 54-11-4431-5139, gustavo_hurtado@ciudad.com.ar; sinchaur@sede.unr.edu.ar
ISSUE: The main goal is to analyse the effects in Argentina and in Latin America of supporting a policy based on the “War on Drugs” mentality developed by the US administration during the last twelve years. We will focus on how the argentinean legislation has been and still is influenced by the US´s drugs laws. We will discuss the regional consequences of the movement of the public treatment of the drug issue toward a bellicose argument.
APPROACH: ARDA since several years is trying to develop the debate in Argentina about the social and individual costs of prohibition and the problem of the drugs persecution, the dangers of drug use and specially of the prohibition, adulteration, lack of information about them and the related risks and harms.
KEY POINT: In several national and international forums our experts have argued how the criminalisation of the possesion of drugs for personnel use put the drug user in a situation of illegality and criminalisation that caste them out of the health system and the possibilities of HIV/AIDS prevention.
IMPLICATIONS: To leave the misunderstanding of drugs in terms of war or “menace to the national or regional security” as Estate policy. To decriminalise the figures of “possesión of drugs for personal use” and “simple possesión” . To support a carefully use of the Penal System to ensure that the intervention does not cause more personal, social and public harms than the ones trying to avoid. To promote the role of public health agents encouraging prevention, assistance, scientific research and health promotion and not in repressive tasks and activities of social control, for which they are not trained. To promote action plans that facilitate a social and health approach to the drugs use and the HIV/AIDS epidemic, involving advances based on the harm reduction model in other countries.
A453
HISTORY AND PERSPECTIVES OF THE ARGENTINEAN HARM REDUCTION ASSOCIATION (ARDA)
Hurtado Gustavo; Inchaurraga Silvia; Vázquez Acuña Martín, Argentinean Harm Reduction Association (ARDA) - Asociación de Reducción de Daños de la Argentina, Juan Bautista Alberdi 1251 – 1406 – Ciudad de Buenos Aires – Argentina, 54-11-4431-5139, gustavo_hurtado@ciudad.com.ar, sinchaur@sede.unr.edu.ar
Issue: Social and health harms related to drug use in Argentina seems to be increasing, specially on intravenous drug users. The low contact with the health system shows the failure of a drug police based on abstinence and repression. Since several years ARDA has been working hard trying to modify official drug policies, encouraging harm reduction interventions and developing local experiences and training in several cities.
Objectives: ARDA involves professionals, institutions, NGO’s and drug users, being a net of people and organizations that promote harm reduction strategies in Argentina, with the main goal of supporting activities aimed at preventing health and social harms associated with unsafe and illegal drug use, as HIV and other infections and criminalization and social exclusion.
Project: We will present the harm reduction experiences under development actually. From the involvement of the harm reduction model in public hospitals and the first pilot substitution treatments in South America to new iniciatives as harm reduction itinerary services and injection equipments distribution. We will present the impact of ARDA ´s programs and messages. We will analyse the process in which harm reduction programs have been approved and supported by National and Regional AIDS Programs.
Conclusion: We will discuss the perspectives, consequences of the National Secretary on Drugs Resolution accepting harm reduction, the development of harm reduction interventions in an abstinence–based framework, the obstacles and recommendations to face future stages. The ARDA has been playing an increasing role in the country, amplifying their programs on several argentinean cities and adapting them to local realities, showing that harm reduction despite the difficulties faced and the official drug approach -based on abstinence - is possible.
A454
PROMOTION OF HUMAN RIGHTS, DRUG USERS AND THE HEALTH SYSTEM
Vázquez Acuña, Martín; Inchaurraga, Silvia; Hurtado, Gustavo
Issue: Argentina enforces Law 23737 criminalizing drug possession (art. 14, para 2); drug users are syndicated as criminals inducing the health system to treat them as second-class citizens, thus lacking full rights. This context clearly affects the approach of health institutions to users, both qualitatively and quantitatively.
Setting: The ArgentineHarm Reduction Association (ARDA) organized training activities on human rights in public hospitals in the city of Buenos Aires, and also trained health professionals in the cities of Buenos Aires, Rosario, Mendoza, La Plata, Bahía Blanca, and Córdoba. It also trained Executive Branch officials as well as other government officials.
Project: ARDA organized training courses and conferences on human rights for health professionals and other persons working at health centers, aimed at familiarizing them with issues concerning respect to the principle of ethical autonomy, privacy, health, and freedom, as well as with all the other rights which make to the dignity of drug users. ARDA has also distributed material about these issues.
Outcomes and lessons learned: ARDA has humanized the service granted to drug users by health professionals as they became more respectful of human rights, thus facilitating the approach of drug users to health centers.
A455
THE MONAR ASSOCIATION AND HARM REDUCTION PROGRAMS
Jadwiga Wladon, The MONAR Association, Poland
During 20 years of its activity, Monar has developed a network of services and methods in effective tackling drug-use related problems and respond to the need for treatment and support for non-addicted youth, recreational users, drug-addicted individuals, and their environment (families, peer-groups, school or work environment); social assistance; also increasing public awareness, and involvement of local community. The Monar Association is one of the few organizations in the world which have managed to draw together two philosofies: “drug-free” and Harm Reduction. The Monar Association has created over 50 centres for counselling, in-patient and out-patient treatment. Monar penetrates drug-users’ environment with the help of street workers’ groups, Monar emergency service, and mobile consulting units “Profibus-Monar”. Monar runs 27 therapy and prevention counselling centre and 27 in-patient rehabilitation centres all over the country. Besides, Monar provides care and support in the post-treatment and re-socialisation period, providing 9 hostels, re-adaptation flats, and 3 settlements for poorer people and for those who cannot adapt themselves fully in society (“Solidarity Plus” Association). The Monar Association targets work with active drug-addicted population, and especially, with those whose motivation and range of opportunities to change their lifestyle is extremely poor. Owing to such approach we are able to reach larger groups of drug-users, and offer them relevant assistance in the situation they currently find themselves.
a456
critical remarks regarding the dutch experience with safe rooms for drug users
Daan van der Gouwe, Netherlands
In the past few years in the Netherlands, about 25 safe rooms for drug users have been set up. In many cases the main reason to start a facility like this was to reduce drug related harm to the neighborhood rather then to improve living conditions for drug users. Drug services are merely involved with these safe rooms. In this presentation I will focus in the Dutch safe rooms for the point of view of users, and will mention three main obstacles in the effectiveness of the facilities: lack of user involvement in set up and daily practise, lack of possibilities of buying drugs in safe rooms, general clinical atmosphere of the rooms. Also I will focus on local alternatives such as the Basements in Rotterdam, locations for smoking crack cocaine set up and run by a "social" dealer.
A457
TOWARDS A SOCIAL WAY OF DEALING
van Dam Theo, Netherlands
More and more inhabitants of cities with many drug users are confronted with drug related harm especially from dealers who travel around and do their business on the streets, using mobile phones. Also drug users themselves do not find this current way of buying drugs very comfortable. The lack of relationship with a dealer leads also quite often to quarrels about the quality and the price, or one simply buys fake dope. Training drug dealers could be a solution to this as well as organising them in a network. Dealers, users and the neighborhood all benefit from dealing in a social way. In my opinion a good/social dealer: keeps fixed hours of selling drugs; sells steady quality, knows what he is selling, knows to whom he sells, keeps a good quality/price mix, does not cause harm to his neighborhood. In this way both users and neighborhood will benefit.
A458
DRUG USER ORGANIZING IN CENTRAL AND EASTERN EUROPA AND FORMER SOVIET UNION: OBSTACLES AND CHALLENGES
van der Gouwe Daan, Netherlands
Aim: Harsh repressive drug policy, high rates of HIV infections among IDUs and lack of money necessary for user organising are common among all countries in this region. In this session major obstacles in drug user organizing will be identified and the exchange of experiences to improve the effectiveness of user groups in their advocacy work is looked after. The session will encourage the active participation from members of user groups from other parts of the world in order to share experience and solutions.
A459
User organizing in CEE/fSU: practical support from Western Europe
Daan van der Gouwe, LSD/ Dutch National Interest Group of Drug Users
User organizing is not a new phenomenon. It has been practised throughout the world ever since heroin and cocaine became available on the drug market. The Netherlands have a longstanding experience with user groups; the first Junkie unions started out in the late seventies in Rotterdam and Amsterdam. LSD, the national network of user groups, started in the early nineties and gained a lot of experience with promoting the ideas and needs of drug users and also advocacy is a major topic.
LSD is being subsidized through the Dutch Ministry of Public Health, Welfare and Sports, which is quite essential for its relative success. During its existence, LSD noticed that parts of its work are easily transmittable to other countries. LSD supported user initiatives in Belgium and Slovenia.
With support from Open Society Institute in New York, LSD started in 2000 a project aiming to organise drug users in CEE/fSU. This presentation will explore obstacles and challenges in organising users in this part of world where a harsh, repressive drug policy and dramatically increasing HIV rates among IDUs are present. This paper will also be used for increasing sustainability among existing user groups in CEE/fSU, leading to a interregional network of user self help groups.
A460
PROMOTING THE INTERESTS OF DRUG USERS: THE EXAMPLE OF LSD
van Dam Theo, Netherlands
LSD, the Dutch National Interest Group of Drug Users, exists for 8 years now and is being subsidized by the Dutch Ministry of Public Health, Welfare and Sports. LSD has managed to set up a number of user groups in the Netherlands and abroad. Yearly LSD organizes a special Drug Users Day, on November 1 to focus attention on issues that are of importance to users. LSD managed to raise the voice of drug users on local, regional and national level, and is taking part in
many meetings. Quiet often drug users come up with solutions for drug related problems (such as safe rooms, needle exchange) long before social workers and drug services think about this, usually.
This paper will focus on the reasons for the relative success of LSD and will also highlight major obstacles and challenges in advocacy work for drug users in the near future.
A461
VALIDITY OF DRUG USE REPORTING IN YOUNG DRUG USERS: SELF-REPORTS COMPARED TO HAIR TESTS
E.A.E. Welp, I. Bosman, M.W. Langendam, M. Totté, R.A.A. Maes, R.A. Coutinho, Municipal Health Service, Amsterdam, The Netherlands
Objective: To assess the relationship between self-reported amount of drugs used and concentration of the drug and/or its metabolites in hair of young regular drug users (YDUs) in Amsterdam.
Design: Subjects were 95 YDUs (using heroin, cocaine, methadone and/or amphetamines at least three days/week) aged 18-30 who participated in a longitudinal study in Amsterdam in 2000/2001. At intake, the YDUs were asked to report their amount of drugs on average over the past two months, and a hair sample was taken. Specimens were analyzed for the presence of cocaine, its metabolic compound benzoylecgonine, two metabolic compounds for heroin, namely morphine and 6-acetylmorphine, and methadone, using gas chromatography/mass spectrometry. The correlation coefficient was used as an index of association between the reported drugs used and the drugs as measured in the hair analysis. Linear regression analysis was performed in order to check whether additional variables improved the association.
Results: One third of the 95 YDUs are women, with mean age 26. Cocaine was reported by 94%, heroin by 75%, methadone by 64%, and amphetamines by 12%. No negative hair test results were attained. The correlation coefficients from multivariate models adjusted for ethnicity, amphetamines, frequency of healthy meals, gender, education, and hair color were 0.65, 0.60, 0.66, 0.70, and 0.73, for cocaine, benzoylecgonine, morphine, 6-acetylmorphine, and methadone, respectively.
Conclusions: This study shows that drug users in a low-threshold setting without sanctions against drug use are very well able to report drug consumption validly when compared to a biological ‘gold standard’.
A462
HIV/AIDS PREVENTION AMONG IDUs and CSWs IN UKRAINE.
Olena Kucheruk, Ukraine
ISSUE: In recent years Ukraine has become the epicenter of the HIV/AIDS epidemic in the region of Eastern and Central Europe. According to the official data quantity of people living with HIV exceeds 40,000 whereas World Health Organization estimates that number as 500,000 persons. In this connection, since 1997 International Harm Reduction Development Program has been operating in Ukraine implementing HIV/AIDS prevention measures among the most vulnerable layers of society.
SETTING: The Program has involved 23 organizations from the most endangered locations in the country creating a network of NGOs able to efficiently influence the situation. Initially the intending audience of Harm Reduction Program's activity was IDUs (75% of persons living with HIV in Ukraine are IDUs), at present target group broadened: 7 projects implement IHRD program strategy among CSWs and one project works with prisoners.
PROJECT: The implementation of the program is based on multilevel approach: 1-direct granting the projects; 2- support of networking the projects for resolving majority of their problems by themselves without the program direct intrusion. IRF in cooperation with OSI-NY provide financial support for NGOs implementing the program in the amount of $250,000 per year. A technical assistance group comprising the most advanced professionals from the most experienced project teams was created. Their goal is to provide direct assistance for the projects lacking proper experience. One should note creation of an all-Ukrainian national web site http://harm.reduction.org.ua covering all aspects of IHRD Program strategy. In addition to that, some support is provided on the central basis: media support as well as lobbying progressive legislative acts in the Parliament of Ukraine. The main goal of the HR program of today is the development of legal and professional grounds for the maintenance (substitution) therapy (MT) for IDUs. Since 2001 IRF funds the assessment of Ukrainian law concerning the MT and is going to establish the pilot projects on the MT next year.
OUTCOMES: As an outcome of the project one may mention creation of a network of NGOs successfully implementing IHRD strategy in HIV prevention activity among vulnerable layers of society.
A463
An International Doctors Letters Form for MMT-Patients
Hans-Guenter Meyer-Thompson, Drogenambulanzen Hamburg GmbH, DA Altona, Holstenastrasse 115, D-22765 Hamburg, Germany, DAALTONA@aol.com
A growing number of patients in methadone-maintaninance-treatment is living global: as tourists, as working people or as migrants. They usually face lots of problems by moving to another country for a couple of days, weeks or even a longer time.
From the perspective of a drug clinic with annually some dozen patients from abroad an international doctors letters form would be desirable. This letter could be used for reffering patients from one country to another.
An internetbased working group will present a doctors letters form and will discuss with the audience the practice of referring MMT-patients from one country to another.
A464
CHILDREN AND DRUGS
Diana Taratuta, Stop Drugs!, Russia
Drug addicts demonstrate loss of control over physiological functions in absence of narcotics. This leads to delay in development of higher forms of thinking and moral orientation. Certain abilities, already developed, may be lost. That is why this project, submitted to the Council of Europe, Youth Directorate, relies on specificity of child psychology in order to create and reinforce negative attitude to drugs in children. Counselors should use curiosity and creative minds of children, their vivid imagination and attention to outside world, their observation skills and persistence in achieving their goals. By the age of 11, children develop sense of time perspective, i.e. they start planning for future. At this particular time, pre-teens or teens actively search for their identity and experiment in various roles. It is crucial that at this stage kids do not harm their health irreversibly by taking drugs. Considering that at this age children go through life orientation, anti-drug propaganda should be conducted through inter-active role-playing and provocative discussions, with the use of game theory techniques. Kids must train how to refuse drugs. Since pathological changes happen even after first drugs experiments, it is crucial to clearly explain the mechanism of the drugs impact and their harm. We must talk more with kids about the beauty of the world, involve them into creative activities. I will display examples of creative work by kids at the conference.
A466
PHASE II: WHO IDU MULTICITY STUDY - BOGOTA RAPID ASSESMENT AND RESPONSE ON HIV/HEPATITIS B/C AMONG IDUs IN BOGOTA, COLOMBIA: A MULTI-METHOD STUDY
WHO team
This report presents the rationale, methodological framework and findings of a rapid assesment undertook in Bogota, Colombia as a part of WHO Phase II Drug Injecting Study. The study wasdesigned according to the guidelines of the Rapid Assesment and Response Guide on Drug Injecting, developed by The CRDHB and WHO. Data were collected using multiple methods and sources of information.
The study was designed using two strategies: one informal and the other instititional. The informal strategy was developed to get a social and geographical mapping of IDU in the city and to explore patterns of injection drug use, risk behaviours, drug use rituals and norms, in summary to identify factors that could be encuoraging or discouraging the spread of injection, and factors that coul be exacerbating or ameliorating the adverse health consequenses. This strategy was developed applying 3 types of questionnaries (Q1 to informal workers and people from community in areas where drugs are sold and used; Q2 to heroin dealers; Q3 to drug users in order to apply inclusion criteria for questionaire or focus groups); survey questionaire and focus groups.
The institutional strategy was carried out to gather existing infomation, to identify gaps, to identify institutions offering social, treatment and health services to drug users, to identify and describe the existent and/or needed policies and interventions in prevention, health promotoin and treatment targeting IDUs, transition patterns and adverse health consequences. It also aimed to assess perceptions towards IDU in Bogota, groupas involved and helath risk practices, as well as the existent capacity to face a potential spread of the practice in our context. The strategy was developed reviewing previous surveys, surveillance systems, information of existent policies and programs, visiting treatment facilities and health care centers.
A total of 51 IDUs (39 current IDUs and 12 dormer IDUs) were interviewed using the survey questionnaire designed by the National Research and Development Institute in New York; 26 current IDUs, 7 never IDUs (opiate users), 2 injectors in 1 or 2 occasions and 1 former IDU participated in 6 focus groups discussions; 19 drug treatment facilities and 10 health care services were visited. Some informal interviews were held with key informants as well as direct observations in natural settings.
The demographic characteristics of respondents were: 80,4 % males and 19,6 % females, 27 years of age in average (min 16 y. / max 49 y.), 70 % working in informal sector (street seling) or in illegal activities, including drug dealing; 60,8 % single and 23,6 % divorced; 94 % belonging to low and miiile social class.
The IDU usually starts at the age of 20, with heroin in most of the cases, followed by cocaine (mostly with close friends). Poly drug use is the common pattern among respondents mainly of alcohol, marihuana, basuco (coca base), cocaine and tranquillizers. Heroin used to be inhaled or smoke (with marihuana) before injection began, “chasing the dragon” is not a common mode of administration in our context. Injection of several substances were reported as well, among them alcohol (drinking and methyl alcohol), cocaine and benzodiazepines dissolved in alcohol, barbiturates, morphine, street methadone (pills dissolved), basuco, marihuana (fermented in alcohol), amphetamines and hallucinogens.
Patterns of injection are perceived to be spreading gradually, availability of heroin in the sreets have been increasing recently with variable quality and purity. Although, the IDU ise percived as a negative, dangerous and extreme psttern is rather fashionable in some groups, as a final stage of an extended drug-using career. Nevertheless, injection of alcohol and other non-injectible substances occur within experimental stages in drug use.
Given the lack of injecting tradition, basic norms of safe injection are unknown, sharing of needles/syringes is not a common practice (due to risk perception) but it happens among close friends and sex partners, indirect sharing (cookers, rinse water from a common container and filters) is very common. Hygienic injection is rare and overdoses are highly prevalent among those who use heroin. Injection commonly occurs in private and close settings given the stigmatization and authorities harassment. Sexual risk behaviour are common; condom use is limited with primary and casual partners. Level of information about HIV, HBV, HCV and other communicable diseases are limited too.
Sterile equipment is highly available in any pharmacy, but there is an absence of policies, programs and outreach actions targeting IDUs, discouraging injection ar preventing transitions to injecting. Few pilot experiences have implemented paraphernalia exchange schemes and methadone substitution but those are limited in coverage and extent. Scarcity of funds threatens the continuity and impact of those experiences. There is a lack of infrastructure to properly face a potentional spread of IDU and opiate’s dependence.
Lack of accurate information concerning injecting drug use leads to ignore the real extent of the practice at a local and national level, and undermines the options to include IDUs as a priority groups of programs and plans in HIV/AIDS and drug use fields.
An action plan was discussed with members of the advisory body including alternatives of interventions in prevention, helth promotion, treatment, policy and research fields considering priority, feasibility, resources needed, afficacy among other aspects.
A467
SUBSTANCE USE PREVENTION FOR REFUGEES, ASYLUM SEEKERS AND ILLEGAL IMMIGRANTS
Trautmann, F., Trimbos Institute; Braam, R., Verbraeck, H., Centre for Addiction Research (CVO)
Background/Objectives: In different European Member States local, regional and national (health) authorities are facing the inflow of a growing number of refugees coming from different countries and from different sociological and ethnic background and staying in a member state of the EU for several months or years or even permanently. Different sources show that substance use among refugees is one of their more prominent health problems. However, generally information is lacking on the extent and nature of substance use among refugees and on their specific needs concerning substance prevention and demand reduction. Therefore, Landschaftsverband Westfalen-Lippe (LWL) together with Trimbos Institute and the Centre for Addiction Research (CVO) developed a European project with the following aims: to get a picture of substance use among the target group in a number of EU member states; to identify the needs of the target group in EU member states concerning information about substance use; to initiate and support the development of new approaches and information material.
Methods: To assess the nature and the extent of substance use among the target group a Rapid Assessment and Response approach (RAR) strategy has been developed, based on the WHO RAR approach but adding tools for a systematic management of the information collected. This approach has been used successfully in fields of illicit substance use where rapid changes make that a quicker response is needed than traditional scientific research generally allows. Drug trends can develop very quickly. This has been followed by regional surveys in regional projects in six EU member states. These surveys have focused primarily on the nature of drug use, the (legal and illegal) substances used, the routes of administration, recreative and problematic forms of use, backgrounds of drug use, the specific needs of refugees concerning drug prevention, etc. Based on the results of these regional surveys in every region interventions have been developed.
Conclusions: RAR has proved a useful tool to get relevant indications about the nature of substance use among asylum seekers and refugees, among other things about risk groups, meaning of substance use in specific sub-target groups and connections between substance use and general living conditions of the target group. Furthermore, RAR enables a direct response and facilitates the development of regional networks, necessary for realising preventive interventions.
A468
Harm reduction experience in a public hospital of Buenos Aires, Argentine. Psychologist function in a HIV AIDS service
ALICIA DONGHI, Argentine
AIDS have appeared and have brought very big social troubles, difficulties in health system and problems to contact it.
This work pretends to show the experiences and researches that a group of professionals of ARDA (Argentine Harm Reduction Association) have done. This group is compound by physicians, infectologists, inmunologists, social workers staff and psychologists from Durand Hospital Bs As, Argentine. Patients are received; in a 70% are drugs consumers. The counseling interviews are very important to keep the patient and give it information to deal with prevention or treatment. The psychologist's function, in this kind of interviews of results devolution is to rescue patient’s subjectivity, despite the result. Habitual associations match to be a HIV carrying with death, separating the way that each patient carries through this relation. The ethic problem is the following: Is really necessary for a patient very ill to tell him that he has AIDS? We have three different periods in this kind of interviews, paying attention to the relation between the psychologist hearing and inmunologic changes, reducing notably negative effects of virus.
The work will be develop by the following periods. Communication period: commotion, sadness, confusion, bewilderment; Paranoiac period: punishment fantasies and social isolation; Aceptation period: passage from grief to the part before the result, from the announced death to the chronicle infection.
A470
THE DRUG ABUSE TREND AND HARM REDUCTION APPROACH IN ASIA
Jih-Heng Li and Yinn-Wen Lu, National Bureau of Controlled Drugs, Department of Health, Taiwan, R.O.C., 6 Lin-Sheng South Road, Taipei 100, Taiwan, 886-2-2351-7109, 886-2-2341-1635, nnb01@nnb.gov.tw
Drug problem is not a recent creation in Asia. In the 19th century, opium was the main theme whose trade culminated in the well-known Opium War between China and U.K. In the 20th century, heroin, a semi-synthetic derivative of opium, replaced opium as the major drug of abuse in Asian countries. Nowadays, heroin is still one of the most predominant drugs as evidenced from the data of seizures and consumptions. However, while the seizures of traditional drugs such as heroin and cocaine remain stable, a drastic increase in the manufacture of, trafficking in and abuse of amphetamine-type stimulants (ATS) has been observed in the past several years in East and South-East Asia. ATS seizures almost quadrupled over the 1990-1998 period. UNDCP has warned the danger of ATS becoming the main global problem of the 21st century. The data from both supply and demand sides also support that ATS will be the major drugs in many, if not most, Asian countries. Unlike opioid drugs that can be treated with substitutes such as methadone and buprenorphine, current treatments for ATS addiction and psychosis are only supportive. Therefore, harm reduction appraoches to ATS problems are desperately needed among Asian countries.
A471
PECULIARITIES OF REINFORCEMENT OF HARM REDUCTION PROGRAM IN TOGLIATTI
Michailova L.A., Russiati, non-gntal organization “Parents against Drugs”
Issue: The first RSA was conducted in 1999. The average age of first injection was 15. Nearly all IDUs were informed about the danger of unprotected sex as well as of sharing paraphernalia. In May 2001 outreach team together with Imperial College, London have conducted the second RSA. It found out the high-risk behavior remains in town.
Setting: The population of Togliatti is 730000. The average age is 35. To 01.09.99 there were 4500 officially registered drug users and 10 HIVcases. To 01.09.01 there were 5400 HIV cases and 98% of them were IDUs. Heroin remains the most popular drug.
Project: The harm reduction program started in July 2000. The program was financed by the City Health Department. In December 2000 an additional funding was received from OSI. 2 needle exchange outlets operate in the city with the support of an outreach team. Volunteers of the program provide secondary exchange. RSA conducted in May discovered new needs of the projects. Trainings on different topics were held for the project’s team. Trainings for the Illicit Drug Trafficking Division (IDTD) were being held. The 3d fixed and a mobile needle exchange are now being implemented. The project’s team took part in 19 trainings during their work. AS the result of this the project’s team became more close, their personal safety increased, gave them confidence during the street work, increased their selfappraisal and motivated them to decrease or to stop drug use. The relationships with mass media have also been strengthened. The amount of contacts with IUDs is 11927, 2140 from them are primary, and 1040 are women. 39000 syringes were exchanged.
Outcomes and lessons learned: It is important to broaden the work of the outreach team in terms of geographical distribution as it would increase trust and attract other IDUs and commercial sex workers. It is important to continue training programs for people from Internal Affairs and to provide the outreach team with motivation work skills.
A472
THE EPIDEMIOLOGY AND HEALTH SURVEILLANCE OF NON-FATAL HEROIN OVERDOSE. CASES VIA QUEENSLAND AMBULANCE SERVICE (QAS) DATA
J. White, M. Clark, A. Bates, R. Henderson (Australian Centre for Prehospital Research, Queensland Ambulance Service, Australia) and J. Davey (Queensland University of Technology)
BACKGROUND/OBJECTIVES: Heroin overdose (HOD) represents a significant public health problem in Australia, with fatal overdoses amongst adults aged 15-44 increasing from 6 in 1964 to 600 in 1997 (Hall, 1999). Although epidemiological data is available on fatal overdoses, there is little information available on the prevalence of nonfatal overdoses within Queensland. This presentation reports findings from the “Queensland Ambulance Service (QAS) Heroin Overdose Project,” which monitored the prevalence (n=672 during 2000), trends and characteristics of non-fatal HODs in Queensland during 2000.
METHODS: The project involved the development of a research database based upon Ambulance Report Forms (ARFS) pertaining to all HODS that QAS paramedics attended in Queensland during 2000.
RESULTS: Reported analyses focus upon (a) the demographic characteristics of HOD patients, including age (M=27yrs, Range=15-60yrs), gender (Male = 69.8%) and ethnic status (indigenous vs. nonindigenous), (b) their clinical condition(s), (c) temporal trends, circumstances and locations (private residences = 45.7%, public streets = 17.9%) of overdose events, (d) risk taking behaviours and polypharmacy associated with HODs, (e) the appropriateness of bystander assistance (EAR, positioning), (f) the type(s) of prehospital, emergency medical care provided by QAS and outcomes, and (g) any medical complications arising at emergency scenes.
CONCLUSIONS: The QAS is in a unique position to provide reliable and up-to-date epidemiological information on non-fatal HODs. It is the “front-line” provider” most usually involved in the emergency medical management of drug overdose cases, providing potentially lifesaving services such as basic/advanced life support, Oxygen, opiate antagonists (Naloxone) and Midazolam (hypoxic seizures). Most HODs do not involve police attendance (83.9%) and many patients refuse transport to hospital (38%). Thus, data on ambulance attendances represents a unique and valuable source of information regarding trends in heroin use and overdose within Australia. Data is also collected at a state-wide level, allowing QAS to conduct population-based research and to advance understanding of the circumstances and outcomes associated with HODs in Australia.
A473
THE COMMUNITY RENEWAL ADOPT-AN-AMBO PROJECT: DRUG AWARENESS & SAFETY. EDUCATION IN PRIMARY SCHOOLS
Authors: J. White, M. Clark, R. Henderson, & H. Kadel (Australian Centre for Prehospital Research, Queensland Ambulance Service, Australia)
ISSUE: The drug problem in Queensland, Australia is growing at an alarming rate, with recent increased use of inhalants, party drugs and amphetamines (McAllister, 2000). Worryingly, the problem is spreading to primary school children, who are reportedly experimenting with drugs in Years 6 and 7 (Age 10-12). Most existing drug education programs primarily target high school students. However, this may be too late in many circumstances.
SETTING: The Queensland Ambulance Service (QAS) in consultation with other Government Departments (Housing, Education, Health and Police) and community reference groups is currently implementing and evaluating an “Adopt- an-Ambo Program” that aims to implement drug-awareness strategies in primary schools in socially-disadvantaged, metropolitan areas in Brisbane (Queensland).
PROJECT: The Adopt-an-Ambo program aims (a) to provide drug and safety awareness training for children aged 5-12 years through adventure-based activities and first-hand information from paramedics on the potential complications associated with drug abuse, (b) to build long-term community relationships based on trust that would assist in providing realistic strategies for young people to make informed decisions about drugs, and (c) to provide ongoing assistance and advice to teachers and members of parents’ groups. The project is funded and implemented within a Community Renewal Policy Framework (Department of ousing, Queensland Government). This framework has a strong whole-of-government focus, which promotes an integrated, multi-agency approach to planning and delivering services designed to improve the quality of life of people living in socially disadvantaged regions within Queensland. Community Renewal also promotes the involvement of local residents in the implementation of Renewal projects so as to develop realistic solutions that address complex community issues.
OUTCOMES AND LESSONS LEARNED: The Adopt-an-Ambo Project has generated a strong level of community interest and support. It has provided a good opportunity for the QAS to develop effective local partnerships with primary school children, community residents, and other Government Departments involved in service provision in disadvantaged regions. The drug-awareness education program is also unique in that it (a) involves paramedics who have extensive first-hand experience in dealing with drug overdoses, and (b) it seeks to involve local residents and service providers in planning and implementation so as to create tailor-made resources that specifically address the needs of people living within socially disadvantaged regions.
A474
Implementation and Evaluation of the Dutch Self-Control Information Programme (SCIP) in other European Countries
Edith A.S.M. Cramer, The Netherlands
Based specifically on the 'Harm Reduction' line of reasoning, a self-control-enhancing programme has been developed in the Netherlands. It aims to help drug users accelerate natural recovery processes by including the following omponents. (1) Helping drug users to realistically assess both the advantages and isadvantages of drug use and those of 'kicking the habit'; (2) Helping them to view 'kicking the habit' as a process that can be gradual, rather than all-or-none; (3) Helping drug users to view controlled use that is integrated within the context of a conventional lifestyle as a success in the right direction; (4) Helping them to assess the present quality of their life and compare it with the life that they are striving for; and (5) Helping them to formulate a step-by-step strategy for attaining the quality of life for which they are striving. The SCIP consists of a self-help booklet entitled "Kicking the Habit: An upward Spiral", a workbook and a facilitator’s guide for counselors who want to use the booklets in interaction with their clients.
The programme (used in a four-session format) has been pilot tested in out-patient treatment centres, as well as in prison settings. Results were promising. Accordingly, it has become widely used in the Netherlands and, in consequence, attracted the attention of helping professionals in more than twelve other European ountries. Recently the European Community has decided that this groundswell of interest in SCIP needs to be consolidated into a concerted course of action. Between 2002 and 2004 the EC will fund three SCIP-model projects (in Belgium, Germany and Greece), two randomized controlled trials (in Wales and the Netherlands) and an European wide feasibility study: a survey on facilitative and inhibiting factors in implementing the SCIP in various countries.
In our presentation we will share experiences with the SCIP, that we already obtained in five different European countries, but we would also like to give interested IHRC-participants the opportunity to express their expert opinions on the issue of the feasibility of implementation of SCIP in their own countries.
A475
Surviving the Sex Trade: A Two Cohort Comparison of HIV Infection and Risk Behaviours Among Street Involved Women in Canada Who Inject Drugs
Patricia M. Spittal, Julie Bruneau, Mark Tyndall, Cari Miller, Francois Lamothe, Amy E. Weber, Kathy Li, Natalie Lachance, Micheal V. O’Shaughnessy, Martin T. Schechter
The present study compares demographic characteristics, sexual risk behaviour, risky injection practice, drug use patterns and HIV prevalence of self-identified female sex trade workers and other female injectors in two prospective cohort studies of injection drug users in Canada. Between September 1999 and September 2000 women participating in VIDUS in Vancouver and the St. Luc Cohort in Montreal completed interviewer-administered questionnaires. Analyses were conducted to compare sex trade workers and non-sex trade workers. Logistic regression was used to identify factors independently associated with exchanging sex for money or drugs in both cities. HIV prevalence at the study visit (September 1999 – 2000) was 36 (33% for STW and 37% for non-STW) and 12 %(11% for STW and 12% for non-STW) in Montreal. While patterns of sexual risk were similar, the risky injection practice and drug use patterns in the two cities were markedly different. Logistic regression analysis of cross sectional data revealed that in Montreal, independent behaviours associated with the sex trade were lending needles and using IV cocaine, and in Vancouver they were IV heroin, smokeable crack cocaine, non fatal overdose and younger age. Creative, client driven interventions are urgently needed in both cities for women who sex for money or for drugs.
A476
Love, Intimacy and Needle Sharing: Exploring the Influence of Severe Heroin Dependancy and Dope sickness on Drug Related Harms in the DTES, Vancouver
P. M. Spittal, N. Laliberte, R. Brooks, Mark Tyndall, M. V. O’Shaughnessy, M. T. Schechter.
Objectives: In Vancouver, female IDU are seroconverting faster than male IDU, and recent studies have suggested that sexual risk factors may partially explain this trend. Few studies have examined the interaction between gender, power, abuse, intimacy, and sexual and drug related harms. To address the question ‘Why is it that female IDU are being preferentially affected by HIV, despite access to clean syringes’ this study qualitatively explores the socio-cultural, relational and intimate contexts of drug related vulnerability for women who are frequent needle exchange attenders.
Methods: Data for this study were collected through focus groups and in-depth interviews with a total of 30 female injection drug users with access the needle exchange in the Downtown Eastside of Vancouver. Key themes and issues were identified and analysed with the aid of NU*DIST an ethnographic software program.
Results: Childhood trauma, including sexual and physical violence, serves to propel girls and women into environments of risk, including survival sex work. Continuums of drug-related vulnerability as adults include: intimate partner violence, sex-for-drugs-related ‘bad dates’ and rapes, poly-drug use including cocaine and heroin, frequent injection, and unprotected sex. Qualitative analyses demonstrate an uneasy continuum of risky sexual and injection practices that are directly associated with severe heroin withdrawal. This dynamic exists within intimate sexual relationships. Combined, trust and fatalism limit the extent to which women can negotiate both ‘safe sex’ and ‘safe needle use.’
Conclusions: Needle exchanges attenuate drug related harms, however, its benefits are compromised by the social and relational conditions of women’s lives. Risks for sexual transmission are as important as other risks, including risky injection practice. Further ethnographic research into how sexual behavior is influenced by drug using behavior is necessary. The need for women-centered behavioral interventions aimed at overcoming obstacles, including ability to negotiate safer sexual practices, is underscored.
A477
Potential Health and Economic Impacts Associated with Implementing a Heroin Trial among Chronic Injection Drug Users in a Canadian Setting
Cari L. Miller, Martin T. Schechter, Patricia M. Spittal, Kathy Li, Micheal V. O’Shaughnessy, Julio S. Montaner, Robert S. Hogg
Background: The increasing health-related costs for IDU has captured the attention of policy makers to find ways to better prevent blood bourne infections and decrease the costs for health care among this vulnerable population. We undertook the following analysis to determine potential benefits of implementing a heroin trial.
Methods: In this hypothetical exercise, we modeled the potential impact of a heroin trial on eligible IDUs in the Downtown Eastside (DTES) of Vancouver over a five-year period. We used baseline sociodemographic parameters to estimate the size, health status and socioeconomic status of eligible Vancouver Injection Drug Users Study (VIDUS) participants. Baseline hospitalization rates and emergency use were estimated from crude and age-specific estimates. Criminal activity was based on estimates obtained from the Vancouver Police force. In addition to these demographic parameters, we used estimates obtained directly from the study monograph outlining the experience of researchers in Switzerland for the Swiss Heroin Trial. Total costs are expressed in 2001 Canadian dollars.
Results: There was significant drop in hospital use and emergency visits as well as criminal charges over the study period. Accompaning these decreases was a moderate increase in employment and a large increase in life expectancy. In regard to hospital and emergency care cost, there was a 63% decrease in cost (5.0 million dollars) for trial participant compared to non-trial participants. A similar and large decrease was noted in criminal activity related costs (62% decrease or 4.4 million dollars). In total
Discussion: There is the potential to reap economic benefits, decrease mortality and increase the social functioning among IDUs with few associated risks through implementing a heroin trial. We have shown a potential cost savings of 9.4 million over 5 years for 989 people.
A478
A Public Harm Reduction Policy based on principles of Community Organization and Governmental Integration - A Case Report- Porto Alegre - RS – Brazil
Mirtha Sendic Sudbrack, Brazil
Porto Alegre has had an injecting drug use reduction program through the Municipal Office of Health since 1996. It is one of the most important and active programs of its kind in Brazil and was developed by health professionals, users and former drug users. This program has tried to build actions that promote and protect health among individuals that make use of injecting drugs, starting from a relationship of respect and valorization of users' rights, considering that 38% of all the new cases of AIDS in the city are related to injecting drug use. However, our main difficulty since the beginning of its existence has been to articulate the actions developed by other public social policies executed by the local government and by the Organizations of the Civil Society and Municipal Councils. Since 1999 there have been efforts to integrate through the Harm Reduction Program the actions developed by this program and those of other City Hall Offices (Education, Social Services, Mental Health, Family Health and Human Rights). We also reached the possibility of engaging organizations from the Civil Society and Municipal Councils.
The program develops several actions such as the sensitizing of the health care system, field activities which access users in the 'Use Scene' and educational-preventive actions close to the local communities. From 1999 on the program has started working with Schools, Human Rights Commissions, the Police Department, the Public Ministry, Municipal Councils and non-governmental organizations, building a Strategic Planning for the city in relation to the actions developed by Harm Reduction with the different partners in charge. The results obtained up to now are of extreme importance. The different accessed partners have become true collaborators in the fight against the AIDS epidemic through the preventive actions of injecting drug users, finally understanding the importance of a program of this nature.
A479
ALLIANCES – THEIR FORMATION AND ROLE IN TOBACCO CONTROL AT A NATIONAL AND LOCAL LEVEL
B. PRINGLE, WEST LOTHIAN DRUG AND ALCOHOL SERVICE, SCOTLAND
TOBACCO USE IS THE SINGLE, BIGGEST CAUSE OF PREVENTABLE DEATHS IN THE UNITED KINGDOM, WITH A HIGHER PROPORTION OF PEOPLE WITHIN LOW INCOME GROUPS SMOKING THAN HIGHER INCOME GROUPS. IN ADDITION MORE FEMALES ARE STARTING TO SMOKE THAN MALES. REDUCING SMOKING HAS BECOME A PRIORITY ISSUE WITH TARGETS BEING SET AT A NATIONAL LEVEL. TOBACCO CONTROL ALLIANCES HAVE BEEN IDENTIFIED AS USEFUL VEHICLES TO ADDRESS SMOKING ISSUES, AND HAVE INCREASED IN POPULARITY SINCE THE PUBLICATION OF THE BRITISH GOVERNMENTS 1998 WHITE PAPER ON TOBACCO CONTROL, “SMOKING KILLS”.
IN THIS PRESENTATION I WILL DESCRIBE TWO TOBACCO CONTROL ALLIANCES WORKING IN SCOTLAND. THE SCOTTISH TOBACCO CONTROL ALLIANCE (STCA) HAS A NATIONAL REMIT, AND THE WEST LOTHIAN TOBACCO ISSUES GROUP (TIG), FUNCTIONS AT A MORE LOCAL LEVEL. BOTH THESE GROUPS FUNCTION ON A MULTIAGENCY BASIS WITH REPRESENTATIVES FROM STATUTORY AND NON STATUTORY ORGANISATIONS. THE PRESENTATION WILL DETAIL THE FORMATION, STRUCTURE, FUNCTIONS, SUCCESSES AND CONSTRAINTS OF THESE ALLIANCES. IT WILL DEMONSTRATE THE POSITIVE AND CONSTRUCTIVE ROLE THAT MULTIAGENCY ALLIANCES CAN HAVE IN DRIVING, INFLUENCING AND IMPLEMENTING TOBACCO CONTROL ACTIVITY AT NATIONAL AND LOCAL LEVELS. EXAMPLES OF INITIATIVES, ACTIONS AND CAMPAIGNS WILL BE PROVIDED TO EVIDENCE THESE BENEFITS, INCLUDING THE CREATION OF A POST FOCUSSING ON SMOKING IN WOMEN, YOUNG PEOPLE AND LOW INCOME COMMUNITIES.
A482
ACCES AND ADHERENCE TO TREATMENT IN DRUG USERS
Rodriguez, Maria Graciela ,Inchaurraga Silvia ,Trincheri Natalia ,Escudero Mara
Issue: When we talk about effectiness treatment or acces to life saving treatments in argentina We know that aids epidemic closely linked to inequality,discrimination and social exclusion relation about injecting users.
Aproach: In Argentina the drug-related policies and drug enforcement are characterised by very low tolerance, the mechanism and strategies adapted by the local authorities are focused on represion, compulsory drug treatment and abstinence.
Key points : Health care based on drug-free programs are disadvantage for drug users. In Rosario Argentina We worked in a program created to reduce the risk of HIV transmission among the injecting drug users and their sexual partners, through the provision of education,sterile syrings other harm reduction modalities such as condoms, counselling, and referals for substance abuse and other health care services.
Implications : In Argentina the drug related policies and drug enforcement are characterised by very low tolerance. Harm reduction perspective takes importance the HIV/AIDS epidemic and the promotion, development and defense of the citycen rights recognizion. That is the reason of building in Argentina, strtegies of harm reduction on a platform of respect to human rights, and providing special shellters and health care programs for injecting drug users .
A483
Drugs and Crime prevention work with young people and children
Ernst Udras
In order to have healthy people, families, children, environment, we have to work with young people and children at the beginning of theirs childhoods. It is very important to create all possibilities for the work of youth centres, youth comities, leisure-time, to develop it and control during actual work with teenagers. If we do not pay attention on such issues at all, it will get over to crimes, drugs usage, violence, etc. Other words, we have to guide them, support youth activities, create youth centres and it will lower rate of future crime committers, drug addicts, etc. It is too late if we will start working with teenagers at the end of theirs education cycle. To influence on mental abilities of children, we have to work with them at pre-school period of time and guide them through period of formation (maturing). Otherwise we will spend a lot of money on rehabilitation centres, prisons, psychologists, and other related to that issues investments. Most important thing is how to organize youth activities at school, universities, to attract teenagers in social, political and economical life inside of the country.
A484
drug use and sex work; activities, experiences and results
Janevska-Nikolovska, Natasha, NGO Healthy Options Project Skopje, Kapan An lokal br. 3, Macedonia, +389 2 130 038, +389 2 130 038 natali_1313@yahoo.com
At the beginning of 2000, HOPS started with the activities for the MARIJA project for women involved in prostitution and their families.
The goals of the project were: re-socialization, social re-integration and prevention of HIV/AIDS and other sexually and blood transmitted diseases among women sex workers and their families.
The project was exclusively carried out in the field. The field work concerned distribution of free condoms, educational and informational materials about safe sex, safe injecting and services provided by a social worker. Communication was achieved with 30 sex workers.
50% of the girls we are in contact with are intravenous drug users and do not keep in contact with any other organization other than HOPS.
The most frequently used drug is heroin. In the beginning, the girls refused to come to the stationary part of the needle exchange where they can get basic medical help for treatment of improper injections and advice from a social worker , besides the exchange of sterile equipment.
The project activities continued also the following year, when the project grew from a pilot into a serious project with broadened activities. As an upgrade to the existing ones, new activities focused mainly on free gynecological examinations for those women who don’t have any health documents, establishing a fund for documents for women without any financial means, establishing a multi-expert working group which will work on these issues, carrying out regular practical classes for the students from the Faculty of Social Work and Social Policy in Skopje.
A487
BUPRENORPHINE AND HEROIN USE
SJ Lord
BACKGROUND / OBJECTIVES : VIVAIDS (the Victorian Drug User Organisation) has received numerous calls from drug users who are currently on a buprenorphine maintenance treatment program. This group have requested information on the pharmacology of buprenorphine, how they are supposed to ‘feel’ when on this program and what will happen if they use heroin whilst on this program. Therefore, VIVAIDS, has undertaken a small study to investigate these issues.
METHODS : This research study is peer based and user driven. Two focus groups were held with 5 buprenorphine maintenance clients in each group to investigate users’ experience of this treatment, of using heroin whilst in this treatment, participants understanding of the pharmacology of buprenorphine and what information or resources are required to understand this treatment.
RESULTS: The study highlighted the widespread use of heroin amongst this sample group whilst on this treatment, the experience of using heroin on buprenorphine maintenance programs, the range of side – effects of buprenorphine treatment, issues of limited take – away doses and supervised dosing problems, the limited understanding some doctors have of buprenorphine and buprenorphine programs and the need for more widely available peer based resources to assist consumers to understand this drug and how it works.
A488
SUPPORTING USER ORGANIZING: CHALLENGES & APPROACHES FROM A DONOR PERSPECTIVE
Matthew Curtis, International Harm Reduction Development Program, Open Society Institute (USA)
In developing comprehensive harm reduction advocacy and service delivery programs in Eastern Europe and the former Soviet Union (CEE/fSU), it is critically important to move beyond a “client”-based approach in order to involve drug users in program development and implementation. Users are frequently active in outreach and other roles within harm reduction sites in the region. However, because of the harsh political and legal climate and the relative newness of harm reduction compared to elsewhere in the world, few organized user groups exist in the region. Many countries have no established user groups. This paper will examine the challenges of supporting user organizations in CEE/fSU from a donor organization’s point of view, and will suggest practical approaches that will assist other donors who may wish to become more active in this area. The primary goals will be to explore the best ways in which to support sustainable user-led organizations that effectively advocate for user needs, and to better integrate the unique and vital skills of users into all harm reduction programs. Topics of discussion will include: mechanisms for funding user groups; timing of funding and other support; finding appropriate partners (incl. established user groups and harm reduction sites); training and research; sustainability; institutional relationships; building networks; information sharing.
A491
International Experience with Harm Reduction in Prisons: What the U.S. can Learn
Andrew Reynolds, Tenderloin AIDS Resource Center (TARC), United States of America
The United States has the world’s largest criminal justice system, with 6.3 million adults in prison, jail, probation or parole. There are currently over 2 million adults incarcerated, with drug offenders accounting for over 80% of the population. Although HIV and HCV rates occur at 8-10 times higher in prison than for the general public, there has been no effort to implement harm reduction programs into the U.S. prison system. There are no bleach distribution or syringe exchange programs in any jail or prison. Methadone maintenance programs are not readily available, nor are traditional drug treatment programs. Currently, condom distribution only occurs in two state prison systems and four county jail systems. Unlike the United States, the effort to promote harm reduction programs in Canadian, Australian, and European prisons are guided by pragmatism and the principle of equivalence. These countries recognized that intravenous drug use in prison serves as a high risk activity for HIV, HCV and other blood-borne diseases. To that end, there has been a concerted effort on the part of these countries to adapt prevention programs that have a proven track record in the community, and implement them within their prisons. Examples include, but are not limited to condom and bleach distribution in Canada, syringe exchange in Switzerland and Germany, and methadone maintenance in Australia. The U.S. needs to take its lead from these countries and begin harm reduction programs of its own.
A492
Understanding polysubstance use in young people – can studying drug use functions help?
Annabel Boys, Institute of Psychiatry, London
Approximately half of all 16-22 year olds in the United Kingdom have used an illegal drug and substantially more have been in situations where they have declined an offer to use. Against this background there is limited understanding of the processes through which initial use becomes regular or problematic. This presentation explores how an individual’s perceived reasons (or “functions”) for use can help us to understand patterns of drug consumption and associated problems.
Data on alcohol, cannabis, amphetamine, ecstasy, LSD and cocaine hydrochloride use were collected from 364 young polydrug users who had no history of contact with treatment services. As well as helping to explain patterns of use, functions for use were significantly associated with problems when the effects of peer use and current consumption levels were controlled.
The findings will be discussed in terms of their potential practical implications in the field of adolescent substance misuse. It is suggested that adopting a functional approach to studying drug use could increase understanding of the dynamics of substance use in young people as well as informing practical responses.
A493
RESEARCH PROJECT RAISING PUBLIC HEALTH AWARENESS ON OPIATE OD PROBLEM
A. Sarang, B. Sergeev
Background/Objectives: Presently in different regions of the RF the number of opiates overdoses is increasing. It can be accounted to the major shifts at the drug-scene from home-made opiates to heroin. The other reasons is low awareness of need for preventative and educational measures among medical specialists, drug-service providers and drug users themselves. And at last, due to the factor of little research and low awareness, the provision of health services is very poor. For Hr projects it means lack of resources to develop informational materials and educational activities and for governmental health services it leads to very poor conditions of the ambulance services (in many regions there is no Naloxone, no diagnosis test systems, etc so doctors have very limited resources to help prevent or diagnose lethal ODs. The main objective of research was to assess significance of the problem and share this information with health authorities on both federal and local level. Methods: A structured questionnaire was developed on the basis of a focus-group with outreach workers and field volunteers from 10 cities. The total number of 761 questionnaires were undertaken in 16 cities. In addition, in some cities focus-groups with drug users were carried out. Results: The data is currently, being analyzed. The full survey report will be ready in November, 2001
Conclusion: The survey will have a practical implications on PH practices. Even on the process of survey implementation the attention of Health Departments in different regions was drawn to the problem. In some cities it led to practical improvements, such as provision of ambulance services with Naloxone.
A494
INFORMATION MANAGEMENT OF HARM REDUCTION PROJECTS IN UKRAINE
Anatoly Volik, Andrew Protopopov, Charitable ”Anti-AIDS“ Fund (Ukraine)
Issue: summary of outcomes and results analysis of realization ”Information management of Harm Reduction projects in Ukraine“ Program. Intended audience: coordinators and information managers Harm Reduction projects. Objectives: skill sharing on information management in Harm Reduction projects. Job title of information manager is incorporated 14 cities of Ukraine, where are realized Harm Reduction projects. Initiators Program: Open Society Institute (New York, USA) and International ”Renaissance“ Fund (Kiev, Ukraine). Position of information manager is designed to assist Harm Reduction projects in communications with each other, Public Health Program of Open Society Institute and International Harm Reduction Development program as well as other organizations, including with donors. Outcomes and lessons learned: determined new job description of information manager, created information strategy of Harm Reduction projects, designed methodical base of information management training, created information network of Harm Reduction project in Ukraine. Job title of information manager is recommended for the installation to all Harm Reduction projects for the creation united information network and efficient communications.
A497
SERVICES FOR STREET SEX WORKERS WHO USE DRUGS IN VILNIUS
R.Kriksciukaityte, Vilnius Substance Abuse Treatment Center, Lithuania
Health problems related with IDU and sex work are increasing in Lithuania. In 1999 there were registered 26 administrative offences related with prostitution, in 2000 – 198. It is estimated that in Vilnius it could be 1000-3000 women, who are engaged in commercial sex work. Street prostitution consists about 50 % of all sex business in the city. CSW are Lithuanians as well as immigrants from the NIS. May 2001 the project was started for CSW who use drugs. This kind of project is a new phenomenon in Lithuania. Services are provided from a van, which stops at the places in the city, where CSW and IDU s use to group. Services in a van include needle exchange, provision of condoms, education materials, counseling. The so-called “The Blue Van” is operating 5 days per week 8 hours per day. The contact in the project is maintained with 3777 IDUs (30 percent women). The average age is 26. The project covers 353 CSW (average age is 25). Health examination of 142 CSW showed that 23,9 % percent had sero-positive reaction to syphilis, 14.8 % had gonorrhea, 14.8 % chlamydia, 12.7% trichomona infections, 59.8% bacterial vaginosis, 29% HCV, 12,7 HBV, 1.4% HIV. Currently services which are accessible for CSW includes telephone hotline, information centers (information about women, who disappeared), social support (food, clothes, night shelter), harm reduction.
A498
PSYCHIATRIC MORBIDITY AMONG FEMALE DRUG USERS IN GLASGOW, SCOTLAND
Gail Gilchrist, Greater Glasgow NHS Board; Laurence Gruer Public Health Institute Scotland; Jacqueline Atkinson, University of Glasgow, Scotland, UK
Objectives Study 1 examined the prevalence of psychiatric morbidity among a sample of female drug users attending three services in Glasgow. Women beginning methadone treatment were re-interviewed eight weeks after the initiation of treatment for study 2, allowing comparison of psychiatric morbidity before treatment and once stabilised on methadone.
Methods 266 women were interviewed by trained researchers for study 1. 79 women were recruited for study 2 and 62% were followed up. Neurotic symptoms were measured and ICD-10 diagnoses calculated using the Revised Clinical Interview Schedule (CIS-R).
Results The most common disorders were depressive episode (47%), obsessive-compulsive disorder (37%) and generalised anxiety disorder (32%). 71% in study 1 reported a level of symptoms likely to need treatment. Lifetime experience of emotional, physical and sexual abuse was high and mean CIS-R scores were significantly higher for women who had suffered such abuse. Although there was an overall reduction in neurotic symptoms from study 1 to study 2, the proportion reporting moderate to high severity symptoms increased for worry and obsessions. Conclusions Although eight weeks was sufficient time for stabilisation on methadone to see improvements in drug use, it may not have been long enough for any significant improvement in anxiety symptoms. This study provides a better understanding of the prevalence and nature of psychiatric morbidity among female drug users. Future service planning should recognise the high rates of lifetime trauma and psychiatric problems among this client group and the potential need to raise core competencies among drug workers to deal with these problems effectively.
A499
BULLETIN MONAR NA BAJZLU: EDUCATION AS A PART OF HARM REDUCTION
Grzegorz Wodowski, MONAR-KRAKOW DRUGS PROJECT
IDU’s education is the worthiest element of every harm reduction program. It’s indispensable part of our work in this field. Lack of efficient an easy to approach form of education brings about the fact that other things’ influence is not full and only temporary. There are not too significant to conscious changes in IDU’s behaviors.
In 1997 (a year after needle exchange program began) we have published the first edition of a bulletin “MONAR NA BAJZLU”, MONAR is the name of our organization and BAJZLU is the informal name of the drug black market. It included basic information about way of HIV transmition, simple sketches demonstrating safe and risky places of injection on the body, and other issues. Then it became clear that our readers didn’t want to be only receivers – they wanted to be also creators of this magazine. In the next edition, materials written by IDU’s have appeared. They wrote about their experiences related to drug using, about individual’s and whole groups’ needs.
At present bulletin is published four times per year and includes materials written by persons who work on harm reduction field (social workers, physicians, outreach workers), by users participating in needle exchange programs and by methadone patients. There are also articles translated from similar foreign bulletins. Issues are various: needs and problems of the people who use illegal drugs; information about blood transmitted diseases and safer injection techniques; low issues; various methods of addiction treatments (drug-free, detox, methadone and buprenorphine maintenance, ibogaine treatment and so on); opinions of the persons who are on MMTP and their needs; information about medical and social services.
The bulletin reaches also other people who work in the drug field in various programs and polish cities. The main goal is, in this case, to propagate harm reduction philosophy and practice.