Harm reduction interventions need better funding mechanisms
Harm reduction services need sustainable funding mechanisms to improve testing and linkage to care for people who use drugs
Last week, the three-year European Union (EU) Joint Action on HIV and Co-infection Prevention and Harm Reduction (HA-REACT) has come to its end. HA-REACT had 22 partners, representing 18 EU Member States, with additional expertise provided by 14 collaborating partners, including the European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) who, through their work, have shown how funding and national policies affect harm reduction programmes.
The European-wide project had the ambitious objectives of ending new HIV cases and reducing HCV and tuberculosis (TB) transmission among people who inject drugs (PWID) in the EU by 2020 and focused on three EU countries (Hungary, Latvia and Lithuania) specifically. "In addition to concrete actions in three countries, the European Commission clearly demonstrated with HA-REACT its commitment to harm reduction in all European Union member states," states Professor Jeffrey Lazarus of ISGlobal in Spain. Through a range of activities ranging from HIV and HCV rapid testing trainings, to a condom vending machine pilot project in a Czech prison, and a mobile unit offering harm reduction services for people who inject drugs in Riga, HA-REACT demonstrated the European Commission’s commitment to harm reduction, and the many challenges associated with such services.
Testing and linkage to care
The importance of knowing one’s status, prevention and treatment of HCV, HIV and/or TB infection is unwavering. The workplace is a key place to engage with the population, and Latvia and Hungary implemented training workshop programmes for social workers and people working in the field of harm reduction (HR) to offer the latest testing and counseling tools to be implemented in their places.
“Women who use drugs have very limited access to harm reduction services as a result of harm reduction programmes designed primarily for men. The gender-specific approach in testing and other harm reduction services, which is a part of the HA-REACT training manual on HIV and HCV rapid testing in low-threshold settings for people who use drugs, aims to inform service providers about sexual reproductive health, physical health and psychological health and discrimination of women who use drugs” states Alexandra Gurinova of Deutsche AIDS-Hilfe, Germany.
Scaling up harm reduction
HA-REACT found that factors such as political will, drug policies, the roles of funders and legal frameworks were among the main barriers to harm reduction in countries. This led to the development of the booklet: “Everything you ever wanted to know about drug-related harms but were afraid to ask” for professionals working in testing and treatment facilities. It helps to explain what harm reduction is all about. Additionally, the educational video clip on “What is Harm Reduction for people who use drugs?” explains not only the scientific knowledge about harm reduction, but also its social aspects.
With HA-REACT support, in 2018, the Center for Disease Prevention and Control (Slimibu profilakses un kontroles centrs) in Riga, Latvia, launched a mobile unit to exchange and distribute syringes/needles, disinfectants, condoms, containers and naloxone. Nurses and outreach workers offer tests and consultations for HIV, hepatitis B and C, syphilis and TB. This harm reduction intervention offers low-threshold services to PWID in Riga and has become part of the political agenda. Due to its success, this facility will continue to offer its services after HA-REACT through local funding.
Harm reduction and continuity of care in prisons
Harm reduction services for people who inject drugs are too seldom offered in European prisons. HA-REACT promoted opioid substitution therapy in Polish prisons and piloted condom distribution in a Czech prison. Study visits, trainings, and workshops offered prison professionals opportunities to get acquainted and discuss good practices like, for example, the case of needle and syringe programmes, condom provision and a safe tattoo studio in prisons in Luxembourg. All training materials can be found at www.harmreduction.eu.
Integrated care and sustainability and long-term funding
Joint workshops brought together health professionals, NGO workers, pharmacists, police, people who use drugs and more. The aim was to provide better quality of care for PWID who often have to visit several institutions due to their multiple problems and may drop out in between service points. A policy brief was prepared in order to promote better quality of care.
Recommendations were made to update national programmes and overcome barriers that restricted responses to HIV, HCV and TB needs for PWID in EU, specifically in the focus countries. The guidance on funding mechanisms, which outlines funding sources and mechanisms for programmes that provide harm reduction and other health services to PWID in the EU, was developed to illustrate the variety of funding arrangements, which are often quite complex.
HA-REACT demonstrated that harm reduction interventions need better funding mechanisms for practical services through national programmes. However, in some countries, the political situations are restrictive and are not open for funding harm reduction services at all. On the other hand, HA-REACT helped change professionals’ practices and attitudes, and allowed new harm reduction interventions to be implemented.
The materials developed will be of value to the entire European Union and accessible online at: www.hareact.eu.
HA-REACT publications and other materials:
- WP4 Leaflet. It's Good To Know. 2016 (English, Russian, Hungarian and Latvian)
- WP4 Training Manual. Training maual on HIV and HCV rapid testing in low-threshold settings for PWUD. 2018 (English and Russian)
- WP5 Booklet. Everything you ever wanted to know about drug-related harms but were afraid to ask. 2018 (English, Lithuanian, Latvian and Russian)
- WP5 Brochure. What is Harm Reduction for people who use drugs? 2018 (English)
- WP5 Guideline. Guideline on population size estimates of people who inject drugs and Harm Reduction coverage. 2018 (English)
- WP5 Video clip. Harm Reduction Services in Synergy between Institutions and NGOs: The Croatian Experience. 2018 (Croatian and English)
- WP5 Video clip. What is Harm Reduction? 2018 (English)
- WP6 Brochure. Przewodnik po Terapii Substytucyjnej w Jednostkach Penetencyarnych - Brochure on Infectious Diseases. 2018 (Polish)
- WP6 Guide. Przewodnik po Terapii Substytucyjnej w Jednostkach Penetencyarnych - Opioid Substitution Treatment in Custodial Settings. A Practical Guide. 2018 (Polish)
- WP6 Guidelines. "My first 48 hours out" - Naloxone-on-Release: Guidelines for naloxone provision upon release from prison and other custodial settings. 2018 (English)
- WP6 Report. European Mapping of Harm Reduction Interventions in Prisons. 2018 (English)
- WP6 Leaflet. Broszure przygotowało Krajowe Centrum ds. AIDS dla Centralnego Zarzadu Słuzby Wieziennej. 2018 (Polish)
- WP7 Policy Brief. Improving the delivery of integrated services for people who inject drugs. 2019 (English)
- WP8 Guide. Guide to funding mechanisms for harm-reduction programmes in European Union Member States. 2017 (English)
- WP8 Report. An assessment of barriers to access to HIV and HCV services for people who inject drugs in Europe. 2019 (English)
- WP8 Report. The financing and sustainability of harm reduction services in the EU. 2017 (English)
- WP4-WP8 HA-REACT E-Learning Tools (English, Polish, Russian and other languages)