A Community Assessment Tool to Measure Syringe Access Readiness

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  • 1. A Community Assessment Tool to Measure Syringe Access Readiness H a r m R e d u c t i on Co a l i t i o n ( H R C) N a r e l l e E l l e n d on, R N1 Katie Burk, MPH
  • 2.  Overview of the Harm Reduction Coalition and CBA for SAS Mobilization team  Reviewing Syringe Access Services (SAS) in the US  Defining the A PLACE model  Applying the A PLACE model to community assessment work2
  • 3. Harm Reduction Coalition Founded in 1994 to work with individuals and communities at risk for HIV infection due to drug use and high-risk sexual behaviors. The Harm Reduction Coalition is a national advocacy and capacity-building organization that promotes the health and dignity of individuals and communities impacted by drug use. 3
  • 4.  The Institute @HRC ◦ Capacity Building for Syringe Access Services Mobilization ◦ HIV Prevention Capacity Building Initiative for CBOs ◦ Harm Reduction Training Institute ◦ Overdose Prevention Programs (SKOOP/DOPE) ◦ LGBT Project  Policy Advocacy  National and Regional Conferences ◦ Next National Conference: Portland, Oregon in Nov. 2012 ◦ Harm Reduction in The South; NC Sept 20114
  • 5. Provide technical assistance to Community Based Organizations, Health Departments and Communities to address IDU (Injecting Drug Users) Health Needs, including HIV Prevention. Provide expertise to: Establish, Expand & Improve Effectiveness of Syringe Access Services (SAS)5
  • 6.  Syringe access programs are the most effective, evidence-based HIV prevention tool for people who use drugs.  Seven federally funded research studies found that syringe exchange programs are a valuable resource.  Incities across the nation, people who inject drugs have reversed the course of the AIDS epidemic by using sterile syringes and harm reduction practices.6
  • 7.  Every year 32,000 people get infected with HIV/AIDS and Hepatitis C in the US by sharing contaminated syringes(1).  Nationally, injection drug users represent 12 % of annual HIV infections and 19 % of people living with HIV/AIDS. 1) Drug Policy Alliance, http://www.drugpolicy.org/facts/drug-war-numbers7
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  • 9. Significant shifts toward support of syringe access programs on a federal level: Lift of the federal ban in 2009 ◦ Federal funds can now be used to directly support syringe access programs National HIV/AIDS Strategy (NHAS) 2010 ◦ Calls for minimizing HIV infection among IDUs ◦ Specifically sites syringe exchange as an intervention that will reduce the HIV infection rate among IDUs National Hepatitis plan 2011 ◦ Call to enhance IDU access to sterile syringes Sources: http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf, http://www.hhs.gov/ash/initiatives/hepatitis/actionplan_viralhepatitis2011.pdf9
  • 10. • Mobilize community • Mobilize communities • Intensify prevention National HIV/AIDS Strategy CBA for SAS Mobilization HHS hepatitis action plan resources to prevent to provide effective efforts in communities viral hepatitis caused SAS (an evidence- where HIV is most by IDU based intervention) heavily concentrated • Ensure that IDUs have • Expand efforts to • Establish/Expand SAPs access to hepatitis prevent HIV using to provide HIV testing, prevention services evidence based linkages to SA tx, approaches hepatitis education • Provide IDUs with and screening, access with access to medical care • Promote a holistic care and SA treatment approach to health to prevent that addresses transmission and • Build leadership, comorbidities with disease progression alliances, community STDs and hepatitis C awareness10
  • 11.  Reducing new infections ◦ Main focus of CBA for SAS Mobilization  Access to care and improving health outcomes ◦ Support people living with HIV with co-occurring health conditions and those who have challenges meeting their basic needs, such as housing.  Reducing HIV disparities and health inequities ◦ Adopt community level approaches to reduce HIV infection in high-risk communities  More coordinated national response to the HIV epidemic ◦ Increase the coordination of HIV programs across federal, state, and local governments11
  • 12. Develop Community Mobilization Model (A PLACE) Identify services to provide, recipients of services, process, and outcomes Provide trainings and TA to targeted communities Increased utilization of SAS should emphasize other services related to prevention12
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  • 15. Build and/or Expand :  Community AWARENESS of the need for SAS  Understanding around POLICY issues that impact SAS  LEADERSHIP to champion SAS  ALLIANCES that support and aid the establishment & expansion of SAS  IDU CULTURAL competency of SAS  Capacity to ESTABLISH SAS  SAS capacity to EXPAND to meet IDU health needs15
  • 16. A • AWARENESS What is the existing level of community awareness around HIV & HCV transmission among IDUs?  How does the community regard SAS as an intervention for their jurisdiction?  How does the community obtain information about IDU health issues?16
  • 17. P • POLICY  What are the current policies that impact SAS? Are any advocates or groups working on SAS-related policy?  How does the community perceive & implement these policies?17
  • 18. L • LEADERSHIP Who are the leaders who work to address IDU health issues?  What are the capacity needs of leadership to address the needs of new or existing SAS?18
  • 19. A • ALLIANCES  What alliances address HIV or HCV prevention, IDU issues, and/or SAS?  Who are the constituents of the alliances?  What are the capacity needs of alliances to address and/or champion SAS?19
  • 20. C • CULTURAL COMPETENCY How do agencies or programs meet IDU health needs? In what ways do new or existing SAPs and other programs promote consumer involvement?  What data/research/evaluation is available to assess IDU needs and effectiveness of services?20
  • 21. E • ESTABLISH/EXPAND  What are the capacity needs to establish SAS?  In what ways do can existing SAS be improved to better meet the needs of IDUs?21
  • 22. Leveraging the strengths of…  Communities  Leaders  Advocates  Programs  Alliances in order to address barriers to SAS.22
  • 23. State of SAP Obstacles Aw P Aw. . P L GOALGOAL Al. L Al. C E E C 23
  • 24.  Key informant interviews  Surveys  Strategic planning processes  Expansion of existing needs assessment processes  Support for community coalitions  Focus groups24
  • 25. Applying the needs assessment model to thejurisdictions in the CBA for SAS Mobilizationteam’s work plan 25
  • 26.  5 new pilot SAPs in the state  Leadership in 5 programs to form an alliance, become HR experts in NJ  CBA for SAS facilitating planning process for Harm Reduction Partnership of NJ (HRPNJ)26
  • 27.  Key informant interviews with 6 leaders of the 5 NJ-based SAPs Interviews transcribed Qualitative analysis of data by CBA for SAS Mobilization team SWOT analysis employed with results of qualitative data Report drafted on interviews and SWOT analysis, disseminated to HRPNJ 27
  • 28. Guiding HRPNJ’s strategic planning process:  Solidify and expand alliance (HRPNJ)  Increase awareness of law enforcement  Improve IDU cultural competency of programs ◦ Create more avenues of consumer involvement at SAPs ◦ SAPs as leader/model of IDU cultural competency for other local programs  Expand reach of existing programs ◦ Expand hours, other program models ◦ Providing OD Prevention, hepatitis education, food28
  • 29.  Improving drug user cultural competency— CBA activities ◦ Drug User Stigma training ◦ Syringe Access and Law Enforcement training ◦ Focus groups at 2 sites  Strengthening alliances—Creation of policy and procedures, bylaws for HRNJP  Focusing on awareness of program and its usefulness (working with law enforcement)29
  • 30.  Boulder has 3rd oldest program in US, had been operating under the radar before legislation passed  Recent SAS legislation passed statewide, called for local buy-in  Restrictive city ordinance in Denver posing barriers to establishment of SAP30
  • 31.  Syringe access affinity session during APHA conference in Denver, Nov 2010  Key informant interviews with 6 key informants who are involved with IDU- related serviced in CO  Interviews transcribed  Qualitative analysis of data by CBA for SAS Mobilization team31
  • 32.  Political and legislative barriers Limited cross-jurisdictional support among programs working with IDUs Strong leadership in harm reduction field and IDU health Impressive IDU cultural competency of programs 32
  • 33.  City ordinance in Denver amended, RFP released  Building capacity of leaders  Boulder to advocate for Narcan availability  Strong cross-jurisdictional alliance between Boulder, Denver, Fort Collins  Trainings on Drug User Stigma, Building Alliances between SAPs and Law Enforcement, Improving Health with Drug Users33
  • 34.  Interest in initiating SAS among county health department staff in Washoe County  NV-based needs assessment processes pointing to need for SAS  No legal or underground SAPs, no enabling legislation  CBA for SAS working to support IDU CC, community awareness, leadership34
  • 35.  Syringe access legislation did not pass in 2011  Before next political process an establishment of the program, need to build up… ◦ SAS leadership ◦ Alliances ◦ IDU cultural competency ◦ Awareness of the effectiveness of SAS35
  • 36.  Limited SAS, high rates of HIV incidence and prevalence  Legislation restricting SAS in many states  Lack of awareness, IDU cultural competency, alliances & leadership on drug user health issues  Pockets of effective harm reduction advocates and providers in different parts of the region.36
  • 37. Focus on building awareness, alliances, and IDU cultural competency: ◦ Southern Network google group ◦ Southern HR Conference Sept 2011 ◦ Collaborating with agencies also doing work in the South (LCOA, ACRIA) ◦ Supporting & showcasing working models of SAS in the South (NCHRC, AHRC) ◦ Building our understanding of Southern drug user community issues to provide specific SAS CBA jurisdiction work37
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  • 39. Syringe Access Community Mobilization http://www.harmreduction.org/article.php?id=1146 Narelle Ellendon (NYC) ellendon@harmreduction.org 212 213 6376 x16 Katie Burk (Oakland) burk@harmreduction.org 510 444 6969 x1339