HA-REACT

On 14-15 January 2016 in Vilnius, Lithuania, the European Union Joint Action on HIV and Co-infection Prevention and Harm Reduction (HA-REACT) held its first Partnership Forum to kick off activities.

Implementation of HA-REACT is taking place primarily in three focus countries (Latvia, Lithuania and Hungary), with attention given to preparing toolkits and guidelines that will benefit the entire European Union.

“There is a real opportunity to eliminate debilitating infections among vulnerable people in Europe within a decade. By working together, the HA-REACT partners and the EU Commission will support the focus countries to achieve this goal,” said HA-REACT Coordinator Mika Salminen, who is the Director of the Department for Infectious Disease at Finland’s National Institute for Health and Welfare.

“The implementation of this Joint Action will facilitate the exchange of good practices among all participating EU countries, and build alliances among government institutions, municipalities and NGOs in improving the EU-wide response to HIV, TB and viral hepatitis among people who inject drugs,” says Dr. Emilis Subata, Director of the Vilnius Centre for Addictive Disorders.

“We now have most of the knowledge and tools to end HIV, AIDS and hepatitis C among people who inject drugs in Europe. However, political will and cost remain as top priorities,”adds Luis Mendão, co-chair of the EU HIV/AIDS Civil Society Forum.

HA-REACT has the following objectives:

• To significantly contribute to the elimination of HIV and to reductions in cases of TB and hepatitis C among PWID in the European Union by 2020. This objective is aligned with strategic action plans issued by the European Union, the World Health Organization, UNAIDS and the United Nations Office on Drugs and Crime.

• To focus particularly on Member States where there are obvious gaps in effective and evidence-informed interventions, or where such interventions are not being implemented extensively enough.

• To encourage the implementation of comprehensive harm reduction programmes at sufficient scale and of sufficient quality in all Member States as an essential strategy for improving prevention and treatment of HIV, TB and viral hepatitis.

Specific HA-REACT work packages will focus on increasing PWID access to testing for HIV, TB and viral hepatitis and strengthening linkages to care for people tested; overcoming barriers to the scale-up of harm reduction services for PWID; improving harm reduction and health services in prisons; and promoting patient-centred integrated care for PWID. The project budget is EUR 3.7 million, and it is co-funded (80 %) by the Health Programme of the European Union. HA-REACT is coordinated by the National Institute for Health and Welfare, Finland and led by a Steering Committee consisting of the work package leaders.

Partner organisations come from the following countries: Croatia; Czech Republic; Denmark; Estonia; Finland; Germany; Greece; Hungary; Iceland; Italy; Latvia; Lithuania; Luxembourg; Malta; Poland; Portugal; Slovenia; Spain

Collaborating partners in addition to ECDC and EMCDDA include organisations based in Belgium, Cyprus, the Czech Republic, Lithuania, Norway, Spain, Sweden and the United Kingdom.

Contact HA-REACT: Prof Jeffrey Lazarus, Telephone: +45 5152 9226, Jeffrey.Lazarus(at)regionh.remove-this.dk.

Website:www.HAREACT.euTwitter:#HAREACT.

Zielsetzung: Improved access to harm reduction services and continuity of care in prisons

Ausgangssituation: Drug use, Infectious diseases – in particular the human immunodeficiency virus (HIV), tuberculosis (TB) and hepatitis C (HCV) – are a major health concern in prisons, evidenced by the fact that prevalence rates tend to be substantially higher among prison populations than in the general population. The TB notification rate in prisons, for example, ranges from 11 to 81 times higher than in the general population, and in some countries is as much as one hundred times more likely in prisons. Rates of HIV and HCV among prisoners in many countries are also considerably higher – global HIV prevalence has been estimated to be two to 50 times higher among the prison population than in the general public, while HCV rates are discernably higher. Prisons and other places of detention are high-risk environments for the transmission of infectious diseases for a number of reasons, including the over incarceration of vulnerable and disadvantaged groups who carry a disproportionately high burden of disease and ill-health; the criminalization of drug users and high levels of injecting drug use; overcrowded and substandard prison conditions; inadequate health care; and the denial of harm reduction services. Considering that all people deprived of their liberty come into contact with prison staff and visitors on a daily basis, and eventually return to their communities, this also has clear public health implications

WP 6 contributes to the Joint Action with new knowledge and insight on the most important barriers to accessing harm reduction and HIV, hepatitis and TB services in prisons in the focus countries and draws on European Union and other relevant examples of how they can be overcome. Examples of good practice are very important to implement evidence-based practice in prison settings. Thus, within the work package there will be an exchange of experiences and good practices which might stimulate other countries to follow by learning the strategies to implement harm reduction measures. The objectives correspond with existing priorities in the field as described in the EU Health Strategy, the Action Plan on HIV/AIDS in the EU and neighbouring countries 2014–2016 and the Public Health Programme - Work Programme for 2014. WP 6 builds on the one side on previously EU-funded projects focusing on harm reduction in prisons in order to utilize their results and existing networks: e.g. “Throughcare”, “Connections”, “Access”, “Care”. Existing networks of previous EU-projects will be utilized to get an overview of the situation and health care needs for the target groups. On the other side WP6 builds on the expertise of other workpackages have gained (WP5 and WP7). Within the above mentioned previous EU-projects some policy briefs and an overview of harm reduction measures in prisons and existing obstacles have already been elaborated. This has to be updated and made more specific.

Methoden:

• Improvement of the capacity of medical, social and other professionals in prisons to work with PWID who have multiple health and social problems through a conference, trainings and other interactive forms of knowledge exchange (e.g. website, e-learning modules).

• Provision of trainings and guidance especially on harm reduction, OST, prison-based needle exchange, condom provision and psychosocial care for health and social care personnel in prisons

• Stimulation of discussions and increasing awareness plans on harm reduction measures for PWID in prisons (especially needle exchange in prisons based on the “Handbook for starting and managing needle and syringe programmes in prisons and other closed settings” (UNODC)).

• Development of IEC (information, education communication) material and strategies for PWID in prisons by participation of the prisoners.

• Building on previous EU-projects and EU-networks to utilise results for multiplying effects.

• Building on results of the evaluation of the harm reduction recommendation of the Council of Europe

Erwartete Ergebnisse:

• Situation analysis / mapping of needed support in the participating countries implemented

• Medical, social and other prison professionals trained to work with PWID and to provide harm reduction services (incl. OST, NSP, condom provision and psychological support)

• IEC materials developed for PWID and staff in prisons

• Practical toolkit for prison staff on harm reduction in prisons (as part of the JA training toolkit)

• Condom provision and other harm reduction measures piloted in one prison

• Policy brief based on experiences from the component Auftraggeber: EU-Kommission

Volumen: €86,000

Laufzeit: 2016 ─ 2019

• The Prison System in Luxembourg
  Mr. Luc Reding, Ministry of Justice, Luxembourg
• The medical service of the Luxembourg Prison
  Dr Romain Stein, MD, head of the medical service, Centre Hospitalier de Luxembourg Mrs Jocelyne Roberty, head nurse, Centre Hospitalier de Luxembourg
• Infectious diseases in Luxembourg Prisons
  Dr Vic Arendt, MD, infectious diseases specialist, Centre Hospitalier de Luxembourg Ms Jeanny Meyers, nurse, Centre Hospitalier de Luxembourg Ms Valérie Klein, nurse, Centre Hospitalier de Luxembourg
• Follow-up after release – the importance of working together with NGO’s
  Mrs Sandy Kubaj, director in charge, HIV Berodung Luxembourg Mrs Laurence Mortier, psychologist, HIV Berodung Luxembourg
• Opioid Substitution Treatment
  Dr Marie-Laure Foulon, MD, psychiatrist, Centre Hospitalier Neuropsychiatrique Ettelbruck Mr. Paul Bäumler, psychiatrist nurse, Centre Hospitalier Neuropsychiatrique Ettelbruck
• The Program TOX
  Mr. James Larquey, educateur gradué, Centre Hospitalier Neuropsychiatrique Ettelbruck Mrs Anja Höhle, psychologist, Centre Hospitalier Neuropsychiatrique Ettelbruck Mr. Hugo Leite, psychologist, psychotherapist, Centre Hospitalier Neuropsychiatrique Ettelbruck
• Needle and Syringe Exchange Program and Condom use
  Ms. Jeanny Meyers, nurse, Centre Hospitalier de Luxembourg Mr. Marco Christophory, nurse, Centre Hospitalier de Luxembourg