Thomas NEFAU, Magally TORRES LEGUIZAMON, Catherine DUPLESSY Postal based harm reduction service for hard-to-reach injecting drug users Thomas NEFAU, Magally TORRES LEGUIZAMON, Catherine DUPLESSY 25/10/2017

Genesis of the project Requests from the users Interview Mail Threads on internet forums Poor access to syringes and paraphernalia Rural locations Non flexible opening hours Diverse restrictions Cost (in pharmacy) Limited quantity (in pharmacy and low threshold facilities) Little-known facilities Personal reserves: fear, shame… Genesis of the project 25/10/2017

Experimentation 2011  Remotely harm reduction service Launch of the injection equipment distribution by mail Free service Voluntary first contact by telephone or e-mail Individual and personalized material delivering by mail without limitation Appropriate quantities For all practices Harm reduction counselling Proposal for orientation towards low threshold centers or treatment centers for substance abuse  Remotely harm reduction service Experimentation 2011 25/10/2017

Experimentation assessment Welcome new users Experimentation assessment New users Users who have left Number of users In June 2017 Number of users 2017 = 807 Cumulated number of users > 1122 permanent increase 25/10/2017

1 Location Motivations 25/10/2017

No low threshold structure Number of users in 2015 Fill the gaps No low threshold structure + French overseas territories 11 5 5 36 53 4 49 The high number of requests leaded to the opening of a low threshold structure in Annecy 30 8 18 30 30 8 21 8 10 49 One city with many disabled users. There is a mobile NEP but only every 6 weeks 28 35 16 40 1 25/10/2017

Ignorance of what exists 1 Location Motivations Fear of stigma 2 Ignorance of what exists 3 Needs more equipment 4 25/10/2017

Experimentation assessment Improvement of material use Experimentation assessment (6 months) First: only distribution of injection equipment Then: all other consumption paraphernalia 25/10/2017

Practices improvement User survey about unsafe practices (June 2014) Practices improvement 25/10/2017

Motivations 1 Location 2 Fear of stigma 3 Ignorance of what exists 4 Needs more equipment 4 Opening hours 5 Cost in pharmacy 6 With a different profile 7 25/10/2017

Welcoming a specific audience A wider female audience than in the low threshold structures The male audience is increasing with the slammers or MSM A well-integrated audience With a job With an apartment + user with long-term sickness Severely disabled Loneliness 25/10/2017

Motivations Other motivations For specific equipment Unable to move Anonymity Doesn’t want to go to the low threshold structures Can’t talk about his/her consumptions Feels constantly judged Problems with the team of the low threshold structure During the holidays when some structures are closed Needs more/specific harm reduction advices Doesn’t feel safe in the low threshold structures Motivations 25/10/2017

5 good reasons to conduct this program Target new profiles (from those who frequent the low threshold structures) New tool to obtain qualitative information about hard-to-reach drug users and their practices Improve accessibility to injection equipment (and more) Facilitates the appropriation of the harm reduction tools and/or messages by the users Improve the rapprochement between the users and the medical and social services 5 good reasons to conduct this program 25/10/2017

Link with the local structures For some users: first contact with harm reduction services There is an important desire to meet professional IRL General improvement of health conditions (e.g. less abscesses)  rebound of confidence  come back in the healthcare circuit The link is not always easy lack of local services opening hours not adapted … Link with the local structures 25/10/2017

“Only few limits” Perspectives Find a good system to ensure anonymity Find an adequate and sustainable funding meet the needs without limitation Self HCV testing (blotter) distribution To reach a maximum of drug users “Only few limits” Perspectives 25/10/2017

Thank you for your attention Thomas NEFAU, Magally TORRES LEGUIZAMON, Catherine DUPLESSY catherine.duplessy@safe.asso.fr 25/10/2017