Transcript Poster_Lisbon Addictions_final_finalx

[IN-Mouraria/GAT LOGO]
Harm reduction and HIV/HCV responses for several populations: the
challenge of integrating responses
Ricardo Fuertes, Adriana Curado, Diana Silva, João Santa Maria, Marta Luz, Magda Ferreira, Rosa Freitas, Luís Mendão
GAT – GRUPO DE ATIVISTAS EM TRATAMENTOS
[email protected]
Introduction
HCV infection is hyper-endemic among people who use drugs, especially those injecting. Injection drug userelated HIV infection also accounts for a substantial proportion of the total cases of HIV in Portugal (1). In this country
HIV and HCV treatment and care responses are based hospitals. However people who use drugs are in many
occasions reluctant to use traditional healthcare services and are more comfortable to request health support in
harm reduction services, opioid substitution treatment or addiction services. For that reason reallocating or colocating HIV/HCV treatment and care services in harm reduction settings could have benefits in access and
adherence.
On the other hand some services that are already available in harm reduction services - such as rapid testing - could
also be extended to other populations exposed to sexual or drug-related risk (sex workers, MSM, some communities
of migrants) and general population, creating access to those services without duplicating responses and costs.
HIV/HCV integrated services in harm
reduction – towards a new model?
Combining interventions in a single setting
- harm reduction + HIV/HCV testing &
treatment + social support + peer
education + advocacy
Providing services in a community-based setting. Task
sharing and the involvement of lay workers and peers
can help to address the needs of key populations
reluctant or unable to access conventional services.
Offering case management services (including
escort services) – referrals to prevention,
treatment and care services (linkage to different
levels of care).
Integration in local policies – clear strategy and longterm action plans, re-allocation of resources and
responsibilities, greater community support,
sustainability of harm reduction services.
Working with different key populations addressing multiple vulnerability HIV/HCV factors
(and opening some services to general
population).
What are the challenges
in Portugal?
Stigma associated with drug use is a barrier to
place integration of services in the political agenda.
Different approaches and concepts between
conventional healthcare services and harm reduction
services.
Economic and administrative barriers to access
specialized care or to perform interventions outside
the NHS – e.g. hepatitis C treatment
No guidelines and specific criteria for HCV testing. HCV
treatment guidelines are not clearly targeting active drug users
Inadequate model of harm reduction services and funding,
focused on fragmented interventions (syringe exchange,
methadone treatment, outreach work).
No professional recognition of harm reduction workers. Harm
reduction training is absent from university curricula. Low
wages, job insecurity and lack of career prospects are the
norm (2).
Peer work is rare and not recognized. Very often is
performed in a voluntary basis.
To increase access to care and treatment, social
structural barriers should be addressed – e.g. unstable
housing and other basic needs. That is specially
challenging in a resource-constrained setting.
Prevention should not be based only on syringe exchange and
information. Drug consumption rooms and harm reduction in prison
settings are needed. Tailored HCV prevention for other most at risk
populations also needs to be developed (e.g. HIV positive MSM, MSM
performing fisting or other risk sex practices).
IN-Mouraria case example
IN-Mouraria is a harm reduction centre, started in 2012 by GAT, an organization of people living with HIV/CV. The center
is located in an urban quarter of Lisbon where migration, drug use, sex work, and homelessness coexist. The project
goals include increasing awareness, activism and participation of people who use drugs and performing harm reduction
interventions and HIV/HCV rapid testing. Services are provided to clients without an appointment, free of charge, and
without the need for personal identification. Trained health professionals, lay workers and peer counsellors perform the
tests and provide information. Active referrals to hospitals are offered to all clients newly or previously diagnosed
HIV/HCV positive, regardless of migrant’s legal status. Those who request, can be escorted by peers to medical
appointments.
Testing and other services (condom/gel distribution, information) are also available for general population. IN-Mouraria
was included as a case example in the World Health Organization´s Consolidated guidelines on HIV testing services (3)
published in July 2015.
During the first 3 years of activity, 500 different people registered as regular clients, mainly people who have drug
and/or alcohol problems and - in a lower number - clients with other vulnerabilities (homeless people, sex workers,
socially vulnerable migrants).
References:
(1) . Departamento de Doenças Infeciosas do INSA and Programa Nacional para a Infeção VIH/SIDA. Infeção VIH/SIDA: a situação em Portugal a 31 de dezembro de
2013. Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa; 2014
(2) Marques J, Queiroz J, Santos A, Maia S et al. European professional profile of the outreach worker in harm reduction. APDES; 2013
(3) World Health Organization. Consolidated guidelines on HIV testing services. WHO, Geneva; 2015
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