Methods

2. Methods • National Advisory Committee • Harm Reduction Symposium

3. Methods • Site Visits and • Walkabouts in • Selected Cities • Whitehorse YT • Victoria BC • Edmonton AB • Winnipeg MB • Rouyn-Noranda QC • Ottawa ON • Québec QC • Halifax NS • St. John’s NL

4. Methods • Site Visits and • Walkabouts in • Selected Cities • Whitehorse YT • Victoria BC • Edmonton AB • Winnipeg MB • Rouyn-Noranda QC • Ottawa ON • Québec QC • Halifax NS • St. John’s NL

5. Methods • Focus Groups

6. List of Visited Sites and Programs

7. List of Visited Sites and Programs

8. Focus Group Results • Whom we talked to: • n = 50 men; 30 women • ages 18 to 64: • 30% 18-34 • 35% 35-44 • 31% 45+ • 62.5% urban • diverse ethnocultural • identities • 63.8% current users • 26.2% on methadone • 18.8% HIV; 53.5% HCV • 33.7% often or always • worried about food • 23.8% homeless or • hidden homeless

9. Treatment & Counselling • “I can get by just about everything… if I’m low on food, if I need a crack pipe, or condoms or anything, clean clothes… I can find it. The only thing is, is if you want to straighten out or something, there’s a problem there.”

10. The Canadian National Coalition Pilot Addictions Treatment Model Specifically for Sex Workers “We wanted to be in a centre that used a harm reduction approach, that didn’t have the ‘You have to have 30 days clean before you can get in; if you’re caught using, you’re kicked out.’… They have the whole continuum on site, they have detox, they have 28 residential beds. They were very open and excited about piloting this model.” -- Lauren Casey, Executive Officer, CNCEW

11. Methadone Maintenance “I find that with the methadone the only thing that helped me because it put that much time, like three years now between me and the drug. I’m not saying I've been clean the whole time, but 99% of the time I have been clean, and then I had counselling.” “I wish we had something for crack addicts like they do for people that do the opium, the methadone. I really think there’s a need for that.”

12. Direction 180 Low Threshold Methadone Maintenance Program “We’ve got people since day one that will use drugs ‘til the day they die and they don’t want to stop, so by keeping them engaged in the process, we’re keeping them alive,” -- Cindy MacIsaac, Executive Director, Direction 180

13. Peer Involvement “And it’s been really beneficial. I’ve done a lot of public speaking in the last year since I really got involved with the user groups and started them off and… it’s really been good for the self-esteem and it’s given me a goal to shoot for. It was the main thing that got me straight, and I think that’s great, and it was that people listen to me now. Yeah, if I can prevent even one kid [from going] through what I did for 30 years, then I am a success, right?”

14. Needle Distribution “If I had prompt access to free needle exchanges when I was actively using just prior to catching HIV… if I was given the knowledge early on and access to harm reduction strategies, there is a good chance that I would not be HIV positive.”

15. Point de repères – Community-Based Needle Distribution – “Street Guides” Mario Gagnon, Executive Director at Point de repères, won the 2008 Kaiser Foundation’s National Award for Excellence in Reducing the Harm Associated with Addiction and Substance Abuse for his work in community programming.

16. Drop-In Centres and Shelters “Socially, for me, having [a place] to hang out with every day… makes me feel part of a family. I don’t have any direct family here… and having the drop-in centres… is really helpful for me. Every day I enjoy waking and look forward to go getting a coffee and talking with my friends at … drop-in centres around town.”

17. Tommy Sexton Centre “We seem to be getting more and more people who inject drugs and… wanting harm reduction because a lot of the other shelters are not able to handle that and support the residents as much when it comes to the harm reduction model. We are fine with it. As you can see, we have our needles, everything is laid out... We just want to make sure that they are safe and that they are doing it safely.” -- Richard Baker, Housing Coordinator, Short Term Shelter

18. Health Professionals & Service Providers “And I got a really big sore on my leg. The last time I used, that’s where I used. And like he’s been saying to me, ‘Go to the hospital, go to the hospital.’ But I’d rather take a month for it to heal on its own, or let my leg fall off, than go to a doctor… because they, you know, you go in, they treat you like shit.”

19. Award Winning Health Professionals in Abitibi-Temiscamingue Clinical Innovation Award - Quebec Order of Nurses: • Danielle Gélinas, Suzanne Fiset and Pauline • Clermont in 2006 for the Clinic project and its • multidisciplinary approach • Pauline Clermont, Suzanne Boucher-Veilleux and • Isabelle Cornet in 2007 for the Pikatemps Program Danielle Gélinas, Coordinating Nurse - Jill Sullivan Award for Excellence in Clinical Practice by the Canadian Association of Nurses in AIDS Care in 2007 

20. Information Dissemination “More knowledge of consequences… If I knew back then what I know now, I wouldn’t have suffered like I did half as much, about hep C, about AIDS, about sticking needles in my arm, about leaving scars in my arm.”

21. Outreach Services “Bring the services to them because a lot of people won't come.” Female Respondent: “I remember … I was scared to just to walk up to the needle van.” Male Respondent: “There’s a lot of shame.”

22. No Fixed Address Outreach Van and Safer Crack Use Kit Program “The safer crack use kit program has overtaken the needle exchange program with 62% of clients accessing the fixed site program at Blood Ties solely for safer crack use kits.” -- Patricia Bacon, Executive Director, Blood Ties Four Directions Centre

23. Challenges and Lessons Learned

24. Contact Us: Lynne Belle-Isle Canadian AIDS Society Email:lynneb@cdnaids.ca Telephone: +1.613.230.3580 ext 126 Toll Free: +1.800.499.1986 www.cdnaids.ca/learning_from_each_other Walter Cavalieri The Canadian Harm Reduction Network Email: Telephone: +1.416.928.0279 Toll Free: +1.800.728.1293 www.canadianharmreduction.com/project

25. Acknowledgements Members of the National Advisory Committee Patricia Bacon, Blood Ties Four Directions Centre, Whitehorse, YT Mario Gagnon, Point de repères, Québec, QC Cindy MacIsaac, Direction 180, Halifax, NS Gillian Maxwell, Keeping the Door Open: Dialogues on Drug Use, Vancouver, BC Marjorie McNeill, Play It Safer Network, FlinFlon, MB Chantale Perron, Liaison Officer, Méta d’Ame, Montréal, QC RytaPeschka, Oasis, Ottawa, ON Carol Romanow, Society Of Living Intravenous Drug Users (SOLID), Victoria, BC Christopher Smith, Toronto, ON Marliss Taylor, Streetworks, Edmonton, AB Focus Group participants, everyone who helped with the site visits, walkabouts and written material, and the contractors.

26. Thanks to our Funders This project has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada. Support for the work of a photojournalist in association with this project was provided by the Ontario HIV Treatment Network and an anonymous donor.