Learning from Each Other

This initiative drew centrally on in-person, participatory research and dialogue. First, a National Advisory Committee was established to guide the project. It consisted of 12 members, including people who use drugs, representatives from AIDS service organisations and/or hepatitis C organisations who work in the area of harm reduction, representatives from community-based harm reduction organisations and agencies, and representatives from CAS and CHRN. Each of the 5 geographical regions in Canada was represented (Pacific/Yukon, Prairies/Northwest Territories/Nunavut, Ontario, Québec, and Atlantic).

This committee planned a tour of Canadian medium-sized cities to conduct focus groups with people who use harm reduction services and/or illegal drugs, as well as site visits of select organisations. The committee selected cities that would represent a wide cross-section of populations (e.g., women, youth, Aboriginal peoples, street-involved individuals, etc.), drugs of choice, drug use patterns, and harm reduction approaches. In each city, representatives from selected organisations assisted with the recruitment of participants for the focus groups. All participants were former or current drug users; they were given an honorarium and sometimes bus tickets. A member of the community who is known to the participants introduced the 2 leaders, who facilitated discussions lasting about one and a half hours. First, a consent form was read and signed, and the presence of the photojournalist was also explained. Each focus group discussion was recorded and transcribed.

Then, in an effort to ensure broader involvement, from March 30 to April 1 2007 the CAS and the CHRN jointly hosted a national symposium on harm reduction. In addition to providing an opportunity for networking, its objectives were to: showcase and document innovative and effective harm reduction programmes and practices in selected cities and examine how they are integrated in the full spectrum of treatment, prevention, and enforcement activities; and identify how the information garnered in this project would be most usefully delivered to people interested in or currently offering harm reduction programmes. At the symposium, each representative presented the harm reduction work that is taking place in their organisation and city.

The information from the focus group discussions and the symposium was incorporated into a 220-page report [PDF]. The purpose of this document, which is available online as well as in printed format, is to broadly communicate the experience of focus group participants in terms of what works well for them and what does not, the impact of harm reduction on their lives, and ideas about what is needed to improve programmes and services. The site visit interviews provided information on their harm reduction programmes and practices, and revealed the lessons learned in their development and implementation which would be of benefit to others.

In addition, a website was developed to present all the information relevant to this project, including all key documents, photographs, and travel logs. All of the documents are also available here.

Health, Rights, HIV/AIDS.

According to organisers, an important public health concern is the spread of HIV/AIDS and hepatitis C through injection drug use. In Canada, about 17% of HIV cases to date are attributed to injection drug use; an estimated 350 to 650 people acquired HIV through injection drug use in 2005. It is estimated that, among the 240,000 Canadians infected with hepatitis C, approximately 70% are current or former injection drug users.

The primary concerns of this population often include: "cotton fever" (sepsis), "chalk lung" from injecting pills, abscesses, homelessness, hunger, chronic pain, tuberculosis, the risks from drugs of unknown strength and purity, the consequences of imperfect drug use practices, and overdose and death. According to organisers, most homeless people who use drugs also experience mental health issues such as depression or post-traumatic stress disorder, as well as a range of physical illnesses. There are other obstacles as well: lack of housing, employment, education and training, lack of access to acceptable drug treatment programmes, an inadequate diet, and lack of fair and equitable treatment and respect. As a result of stigma, not only are they unable to access services available to other citizens, they may have difficulty getting jobs and obtaining or keeping housing.

"Harm reduction is much more than handing out new injection equipment or safer crack use kits. It is both a goal of service delivery and the philosophy that underpins it. It is an approach to policies and programs for people who use drugs which is directed towards decreasing the adverse health, social and economic consequences of drug use and drug distribution to the individual user and the community. Although abstinence may be the goal for some people whose substance use has become problematic, it is not a requirement for obtaining services and treatment. Practicing harm reduction also ensures that services are provided without discrimination, prejudice or negative judgement and that the quality of those services will not be compromised because of discrimination, prejudice or negative judgement."