1. 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

2. 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

3. Experimentation 2011  Remotely harm reduction service
Launch of the injection equipment distribution by mail
Free service
Voluntary first contact by telephone or
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

4. 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

5. 1
Location
Motivations
25/10/2017

6. 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

7. Ignorance of what exists1
Location
Motivations
Fear of stigma 2
Ignorance of what exists 3
Needs more equipment 4
25/10/2017

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

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. “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

16. Thank you for your attention
Thomas NEFAU, Magally TORRES LEGUIZAMON, Catherine DUPLESSY
25/10/2017