Transcript Street work and Harm reduction

Street work and Harm reduction
Dr.Katsiki
Vaso
MDM Greece
Street work
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Street work is a new model of social work
Move the act of social assistance from the office desk to
the clients themselves to the street
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Street work programs focus their activity on helping
people as :homeless, domestic abuse ,prostitutes ,old
people ,drug users ,run a ways
work with people on their own terms and at a pace that
suits them
Offer immediate crisis support
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Street medicine is an emerging collaboration of health
care professionals ,formerly homeless ,outreach workers,
that has been happening globally since 1990
Provide health care and related services to those living
on the streets
Street medicine programs are strategic as an interface
between the street homeless and the larger community
Harm reduction
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HR refers to a range of public health policies designed
to reduce the harmful consequences associated with
recreational drug use and other risk activities
(prostitution, alcohol )
Use methodologies that safeguard the dignity ,humanity
and human rights of people
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HR strategies meet DU where they are addressing
conditions of use along with the use itself
(Denning 2001)
This open nurturing help build relationships and get these
addicted persons reconnected again (Greenberg /Mitchell 1981)
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HR focus on the harm caused by problematic substance
use rather than substance use per se
Recognizes that realities of poverty, class racism ,social
isolation sex based discrimination and other social
inequalities affect both peoples vulnerability to and
capacity for effectively dealing with drug related harm
HR programs serve the needs of those who are not in
treatment ,do not presently wish to be and may not be
ready to discontinue their substance use
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Entails goals witch can lead to a healthier
life for DU and healthier community for
everyone
Categorization of harm reduction activities
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Hr
has a wide range of interventions witch take place in
different settings ,have varying goals and are directed
toward diverse populations
The objectives of the interventions have been divided
into three overlapping categories (Marlatt 1998 a,b/ Wodak 1994)
→
staying alive
→ maintaining health
→ getting better
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The interventions that are centered on keeping people
alive tend to be aimed at preventing people from dying
or seriously damaging themselves due to the direct
effects of drug and alcohol use
The focus of these interventions is frequently very
immediate
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The approaches that focus on helping people stay
healthy include those that attempt to protect the
substance user from HIV ,hepatitis B/C and other
consequences that can come from the direct use of
drugs and alcohol
The getting better group includes interventions that look
to control and reduce use if not necessarily eliminate it
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The strength of the HR approach is in the ability to
connect and form relationships (Tatarsky 2003,Westeneyer 2009 )
There also something compelling about the creation of
centers or subcultures for drug users in which they
receive acceptance and welcome and where they are
created with the attitude of what can I do to help you
rather than of here is what you must do
Services related to HR
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Needle exchange programs
Safe injection sites
Methadone therapy
Alcohol HR programs
Cannabis HR programs
Safer sex programs for prostitutes
Harm Reduction in practice
Needle exchange
 Replacement therapy
 Drug consumption rooms
Are the most effective interventions to reduce drug related
harm
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Needle exchange
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Sharing syringes and other equipment for drug use is a
well known route of HIV /hepatitis transmission
Drug use is linked with unsafe sexual activity too
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National Institute of Health in USA estimate that
15%-20% of IDU have HIV and 70% Hepatitis C
In Greece a significant increase in HIV infections
occurred in late 2010
In first 10 months of 2011 show more than 50%rise in
new infections and 63% among IDU (compared with the
same period in 2010)
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Simple act of exchanging clean needles for use ones
can have dramatic effects in reducing the rate of HIV
infection among IDU
Exchange programs require used syringes for an equal
number of new syringes (others do not have this
requirement)
N/S Exchange Programs Offer
also
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HIV and Hepatitis B/C testing
Alcohol swabs (for before injection)
Dry cotton (for after injection)
Bleach water and normal saline (as rinse eye drops)
Sterile filters
Aluminum cookers
Containers for needles
condoms
The distribution of material is accompanied by
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Prevention counseling on the risks related to drug
consumption
Health and drug education
sexually transmitted diseases screening
Psychological counseling
Medical referrals
Booklets of information
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SNEp provides a social benefit in reducing health cost
and also provides a mean to dispose of used needles in
a safe manner
Protect not only attainders but also ensure a safe
environment for their social network such as sexual
partners children or neighbors
Services related to HR can take on a wide rage of
configurations
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Primary needle and syringes programs
Secondary NS programs (incorporated within health
service
Mobile or on call service
Dispersing machine distribution
Prison based facilities
Distribution of bleach or other cleaning equipment
(rather than needles/syringes)
Countries were these programs exist are
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Netherlands, Canada,
Brazil,
Australia
Switzerland,
UK ,
Ireland
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N.Zeland ,
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Iran ,
USA,
Latvia,
Poland
Moldova,
Portugal,
Slovenia,
Bulgaria,
Estonia,
Belarus
Drug consumption rooms
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Legally sanctioned medically supervised facilities designed to
provide a hygienic and stress free environment for drug consumes
The facilities provide –sterile injection equipment
-information about drugs
-basic health care
-treatment referrals and access to
medical staff
Some offer counseling
Most programs prohibit the sale or purchase of illegal drugs
Many require identification cards
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Methadone therapy reduce an array of drug related
harms including , deaths ,HiV infections and crime
Alcohol related programs
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In some countries there are programs serve a glass of
wine to homeless shelters instead seeking alcohol from
unsafe sources as mouthwash , rubbing alcohol or
industrial products which in frequent use of emerging
medical facilities
Safe sex street work programs
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support a sexual education which emphasizes the use of
protective devices like condoms and dental dams to
protect against unwanted pregnancy and the
transmission of sexually transmitted infections among
prostitutes
In Greece Street work programs are being performed
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OKANA syringes /equipment for safe use
KEELPNO mobile units for primary health care and
HIV/hepatitis testing
MDM program Streets of Athens , exchange syringe and
primary health care (immediate care of emergency cases
infections treatment of wounds abscesses etc program)
Thank you