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Conferences |
| 19th International Harm Reduction Conference (IHRC) - Barcelona, Spain |
VIVAIDS IHRC Posters Peer support is the key Hepatitis C Treatment in AOD Settings: Core Business or Someone Else’s Problem? Hepatitis C treatment for injecting drug users: towards a peer-based model of care . . . . The sad story of the demise of the peer-supported Healthy Liver Clinic Pharmacotherapy, Mediation and Support Sniffer Dogs: |
| In May of this year, Damon (VIVAIDS EO) and I were very fortunate to attend the 19th International Harm Reduction Conference (IHRC) in Barcelona, Spain. The conference is held every year in different cities and parts of the harm reduction world – the previous year it was in Warsaw and next year Bangkok is to be the host city. The fact that the conference was in Barcelona this year was an added bonus! It has to be one of the most beautiful cities in the world and the opportunity to actually stand inside some of Gaudi’s extraordinary buildings was, for me, quite awe-inspiring. Damon is also a member of the Harm Reduction All Stars Band, a group of musicians, has-been’s and wannabe’s who have performed at most of the major international harm reduction events and conferences over the last decade. So, as well as a conference, Damon had a gruelling rehearsal schedule to attend before playing at the main social event of the conference at Barcelona’s grungiest and grooviest nightclub ‘Razzmatazz’. Conference Theme The theme of this year’s conference was ‘towards as global approach’. As the conference organisers pointed out, despite the achievements of the last 2 decades since harm reduction programs first began, there is still a lot more to be done; they stressed the legal constraints which hamper basic harm reduction and primary health care programs for drug users and human rights abuses which users are still routinely subjected to in most countries. The purpose of the conference, then, was to push ‘the science, policy and practice of harm reduction towards a global approach’ (Conference Program: 3). VIVAIDS @ IHRC VIVAIDS had submitted abstracts on a range of different themes and we were invited to present 6 posters at the conference: 4 were on different aspects of hepatitis C and in particular users’ involvement in hepatitis C screening and treatment; 1 was about the VIVAIDS PAMS program, which provides advocacy, mediation and support for people on pharmacotherapy programs in Victoria, and 1 was on VIVAIDS RaveSafe program and our concerns about the police’s use of sniffer dogs at recent dance and party events in Melbourne and the potential, adverse effects of this sort of policing. All in all, our posters were very well received. There were 3 poster sessions on 3 consecutive days of the conference and our contributions were spread across all 3 days. Posters are hung in the morning on the huge poster boards provided and they remain on display for the entire day. As author(s), you are expected to be available to stand next to your poster to answer questions and engage with other conference delegates during the lunch break (12.30 – 2.15pm). It is at these times that you get to gauge the response from other delegates; it is also an opportunity to talk to other presenters with posters on related themes. For example, our poster on peer Involvement and peer-based models of hep C testing and treatment was right next to a Canadian poster about the “Street Health’ Program in Toronto which works with homeless drug users, a disproportionate number of whom are infected with hep C, to provide access to hep C education and treatment. INPUD Meetings On the day before the conference began there were a number of ‘satellite’ meetings, i.e. tack-on meetings which take advantage of the gathering of key players from all over the world. One such meeting was the INPUD Congress (International Network of People who use drugs) which brought together drug user activists from a vast range of programs and places. INPUD met again on a further 2 occasions throughout the conference; unfortunately, the face to face meetings of INPUD members, which only happens once a year at these conferences, degenerated into a major battle/bunfight between most of the members present and the one paid staff member, Stijn Goossens (INPUD International Director) The opportunity to deal with a lot of pressing issues e.g. establishing a constitution for INPUD, electing new board members, etc, was lost and INPUD is still in a state of disarray as a result. All very distressing! It would be easy for the International Harm Reduction Association (IHRA) to walk away with its funding and conclude that drug users simply cannot work together. However, in this instance, the problem appears to be the director and that his exclusive rather than inclusive approach and lack of accountability is in conflict with INPUD members’ demands for transparency. The major stumbling block was Stijn’s announcement about ‘effective membership’ i.e. members who had signed up at last year’s IHRC in Warsaw!. He claimed that only ‘effective members’ had voting rights which rendered most of those present powerless to play a part in INPUD. No one else had been previously informed of this arbitrary distinction between ‘members’ and ‘effective members’ and it meant that many of the most viable drug user orgs in the world including AIVL (Australia) and VANDU (Vancouver) no longer had a voice! Emotions ran very high - you can imagine the uproar! A smaller informal meeting of INPUD members the following day abandoned this bizarre concept of ‘effective members’; they attempted to move on and to resolve some of the most urgent issues, including the election of an ‘interim board’ comprising existing board members as well as a number of new people. However, Stijn refused to comply and has since renounced these proceedings. He is currently threatening legal action! He has made it clear that he, and those who agree with him, alone constitute INPUD despite the efforts and commitment of many others to get INPUD formed and funded. He is more than happy for everyone else to leave him to it to run INPUD as he chooses. All up, he is sticking to his guns.. . . If the stakes weren’t so high, it would just be silly. But this is the only registered, funded, international organization of drug user activists in the world and as such, it is worth fighting for. The upshot of all this conflict and dissention remains to be seen but it meant that the conference, which we expected to be a celebration of drug user activism, ended on a very sour note for many of us. Update on INPUD The INPUD saga has continued since the conference. Apparently Stijn has agreed to acknowledge the ‘interim’ board elected at the IHRC as the official INPUD board and to address the list of questions and concerns drafted at the time of the conference. Happily, he has dropped his threats of legal action and has committed to moving on and to complying with the members’ demands for transparency – or at least so he claims. We will watch this space . . . . ! You can visit the INPUD website: http://www.inpud.org/ You can also view the INPUD Congress Program: http://hardcoreharmreducer.blogspot.com/2008/03/draft-program-international-drug-user.html The IHRC Conference And so, to the conference . . . . Apart from the main ‘plenary’ sessions in the morning, conference programs are usually divided into a number of concurrent streams or themes of presentations (up to 7 at the same time!). It makes it notoriously difficult to decide what to attend as there are invariably several sessions on at the same time, all of which sound interesting. In the end you just have to accept that you can’t get to everything and that you have to miss more than you see – but it’s very frustrating! The conference program over 4 days is very dense and diverse and it would be impossible to report on it all. I will give an overview of some of the sessions I attended and some of the high points of the conference for me. You can still view the conference program online at the IHRA website: http://www.ihra.net/Barcelona/Home http://www.ihraconferences.com/downloads/HR2008_Conference_Reader_4WEB.pdf Hepatitis C, which was described as a significant but poorly addressed public health problem, was a major theme at the conference this year. In one session, the 4 presenters, described as ‘leading experts’, agreed that the evidence indicates that anti-viral therapy for drug users is feasible and effective when their special needs (e.g. drug dependency and appropriate support needs) are addressed. Dr Margaret Hellard (Burnet Institute) presented on the National ATACH study in Australia which has successfully trialled the treatment of people with hepatitis C soon after infection (i.e. acute cases). At another session on hep C, Michael Carden, one of a team of researchers from the Center for the Study of Hepatitis C, Weill Medical College, Cornell University, New York, reported on a collaborative, multidisciplinary model of hepatitis C treatment for active drug users. Interestingly, the model of care he presented was extremely similar to the integrated, peer-based model which VIVAIDS was involved in developing with Turning Point and other partners (and which was the substance of our posters on hep C). Carden’s research indicated that many of the study participants chose to initiate HCV treatment despite considerable barriers and ongoing active drug use. So far, responses to treatment have been very favourable – participants have tolerated the medications well and none have terminated treatment early because of an inability to tolerate side effects. Attendance at medical appointments has been consistent and adherence to medications has been well above the minimum recommended adherence levels (> 80% of the dose, > 80% of the time). He concluded that treating active drug users for hepatitis C is feasible as long as a model of coordinated care and intensive support is provided. Their data indicates the feasibility, safety and efficacy of treating active drug users for HCV and hopefully it will assist in establishing multidisciplinary models of care in other locations. (Carden et al (2008) Care and Treatment for Hepatitis C In Active Substance Users: Developing a Multidisciplinary Model of Care). There was also an emphasis on overdose in the conference program and presentations from a wide range of different countries, including Spain. Again, however, Australian papers and programs were at the forefront. I found it intriguing that much of the cutting edge research presented on both hep C and overdose were from Australia. It seems that I had to go half way around the world to learn about things that are happening in my own back yard! The surveillance system put in place by Turning Point and the Metro Ambulance Service in Melbourne is regarded as an invaluable and relatively unique source of information to track fatal and non-fatal overdose. By contrast, other countries are hampered in their efforts by a general lack of accurate information and massive under-reporting which makes it hard to assess the extent of the problem. However, I was staggered to learn that there are an estimated 10,000 fatal overdoses every year in the Russian Federation!! Paul Dietz (formerly of TP and now at the Burnet Institute) has continued his program of overdose research; disappointingly, one of Paul’s conference posters about a recent survey in Melbourne reported low and sketchy levels of information about effective overdose response among current drug users. At one overdose session, a Spanish doctor handed out vials of Narcan to all the delegates in the room. The distribution of injectable Narcan to drug users has never gained currency in this country; however it is an important part of overdose response in a number of other countries including Spain, the host country. It begs the question as to why it is not on our agenda in Australia and I suspect it is because we have access to an excellent emergency ambulance service. Although we may take it for granted, calling an ambulance (‘000’) is simply not an option in the event of an overdose in many countries especially in the developing world. Some of the most vital sessions I attended were about peer- based initiatives and programs including a lunchtime session ‘The international network of drug related media’ about a proposed new website ‘DRUM Forum’ under development by Black Poppy, a UK based user magazine. The organisers of the meeting are developing a database to link harm reduction media personnel, many of whom are working in relative isolation, with a view to creating a network, website resource, communication tool and/or e-forum. They hope it will operate as an international network of alliances and contacts, to exchange information, ideas and knowledge which will benefit user-driven publications and in turn their readers. You can visit the site @: http://www.blackpoppy.org.uk/ It was followed by a session about Drug User Magazines: ‘A Voice – A View – A Vehicle for Change’. There were presentations about drug user publications from a range of countries e.g. France, UK, Germany and Canada (and Australia) and issues such as funding, censorship, marketing strategies, politics and magazine survival were discussed. A number of harm reduction writers and editors talked about their experiences working on a variety of publications including the International Network of Street Papers (INSP) which was formed in Europe in the mid ‘90’s to unite street based publications from around the world. I attended several sessions about ‘Harm Reduction in Spain’ to get some idea of the local context. Harm reduction strategies were introduced in Spain in the late ‘80’s and early ‘90’s in response to HIV/AIDS, which has had a heavy impact on the local drug using community. Local presenters reported on a range of innovative programs including a heroin maintenance trial for long term users who have rejected methadone (in Andalusia only), methadone programs in prison, and Safe Injecting Rooms (or ‘Drug consumption rooms’); interestingly, a program which operates at recreational events, similar to RaveSafe in Victoria, also operates a safe drug use area or ‘health room’ as they called it. However, I got the impression that coverage was very patchy and that these sorts of programs are limited to certain areas and parts of Barcelona and Spain. One of the major benefits of attending the IHRC is to learn more about harm reduction responses to illicit drug use in other countries. Inevitably there are areas of similarity as well as vast differences and for me, this had the effect of throwing the situation in Australia into sharper relief and allowing me to view it with more objectivity. By comparison with many other countries, especially resource-poor countries in Asia and Russia, the conference was a powerful reminder of what we have and what we have won in Australia including excellent Needle and Syringe Programs, drug user orgs like VIVAIDS and access to pharmacotherapy programs (i.e. methadone and suboxone). However, it was also a telling insight into how much further we need to go in order to address the myriad health and social issues which still confront many users, e.g. NSP in prisons, no cost pharmacotherapies, low cost housing and employment for users, an end to discrimination and stigma and most importantly drug law reform. I fear that drug related harm will remain a cruel fact of life until there is serious discussion about the decriminalisation of illicit drugs and the people who use them. There is still a lot more work to be done. Time to come back to earth and an end to Barcelona dreaming! Jenny K |
[© 2008 VIVAIDS Inc.] |
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