The year 2020 was extraordinary. Nobody saw the Corona pandemic coming. Yet, as a harm reduction organisation, we were able to draw lessons from the past. 

The fear of an unknown disease. Not knowing who is going to be hit. The concerns about vulnerable people and the impact of a new disease on our daily contact with others. We've all been there before. With hepatitis, for example. And with HIV / AIDS. Familiarity does not always endear, but our experiences at the minimum made us resilient in crisis year 2020. 

Before you lies Mainline's annual report on the strange year 2020. A year in which we made ourselves very useful despite everything. A year of adapting and persevering. With great results. A year also in which we were reminded of the importance of human contact, solidarity and compassion. In short, a year in which the harm reduction values turned out to be - extraordinarily - important.

Enjoy the read,
The Mainline team

Mainline's fieldwork team had to overcome major challenges in 2020. But our field workers persisted, via telephone, e-mail and Corona-proof visits. And the international work also continued at full speed.  

First, we said goodbye to the iconic Mainline bus. For almost 20 years Mainline toured the fringes of the country to open the bus doors everywhere for a cup of coffee and a good conversation. But the bus was getting old, and Corona left him with little to do. We were also no longer able to spontaneously visit drug consumption rooms, methadone posts and social pensions. But our field workers persisted, via telephone, e-mail and Corona-proof visits. We made ourselves useful by monitoring the impact Corona and its measures had on people who use drugs. We published a "Corona Monitor" four times together with the Trimbos Institute and the MDHG. 

We closely followed new drug trends such as 3-MMC and noted the increasing popularity of crystal meth - particularly in the gay scene - and "wheelie bin" use (poly-drug use) among young people.

The international work also continued at full speed. For several years now, Mainline has been trying to put harm reduction for people who use stimulants (speed, crystal meth, coke, 3-MMC) on the map. And we finally properly succeeded in this in 2020. A good example is our work in Indonesia, where we combined research with setting up harm reduction for people who smoke meth. In Vietnam, with partner SCDI and with the support of Open Society Foundations, we established up a "field lab": a regional expertise center for stimulant harm reduction. The field lab’s field workers pay a lot of attention to mental health. This is also an important theme in Indonesia, where we trained a large group of health professionals on mental health and where the local university Atma Jaya developed a practical mental health guideline. 

The year 2020 offered Mainline the opportunity to work more intensively with young people. Mainline is part of the "Young, Wild and .. Free?" project, funded by the Ministry of Foreign Affairs. In 2020 we trained community researchers from Kenya, Russia, Vietnam and South Africa. These peers then investigated what young drug users experience and need. In 2021, we will start two pilots for young people who use drugs based on their assessments: one in Kenya and one in South Africa. In the Netherlands, we will also focus more on young people in 2021, within the new Peer2Peer project.

2020 was the final year of the Bridging the Gaps programme, in which Mainline has been active for almost 10 years in total. Through Bridging the Gaps we financed harm reduction projects in Indonesia, Kenya, Nepal, Pakistan, Tanzania, Vietnam and South Africa for many years. With the finish in sight, we achieved a number of wonderful successes with our partners. 

For example, four of our pilots in Pakistan were scaled-up in the new Global Fund programme in Pakistan. One of the pilots showed an HIV prevalence among non-injecting drug users of more than 6% (<1% in the general population). This study gave 2,000 of these people access to HIV services. Another example: investments through Bridging the Gaps allowed more than 1,000 persons who use drugs to access a viral load test every month.

In Tanzania, Mainline supported the key harm reduction organisation in Dar es Salaam: Mukikute. Something easier said than done, given the repressive government and limited resources. Through Bridging the Gaps, a number of Tanzanian colleagues were able to visit Kenya to learn from their work with female drug users. And in addition to offering support for basic harm reduction services, we worked on a study to prove the effectiveness of needle exchange. A research report shows that needle exchange is not only effective in preventing HIV infection, but also in improving the quality of life of drug users in many ways.

The work with women who use drugs in Kenya received significant recognition in 2020. For example, their work was described in the report "The Impact of Global Drug Policy on Women: Shifting the Needle". The training for outreach workers developed by Mainline with MEWA was incorporated into the national HIV curriculum in 2020. And as a result, outreach workers across the country now have the opportunity to improve their skills with this training. MEWA already provided a number of training courses on outreach in 2020.

In both Indonesia and Vietnam, Mainline worked steadily with partners Karisma, PKNM, Atma Jaya University and SCDI to improve harm reduction for people who use crystal meth. In Indonesia, health workers have been trained to provide better support for meth users, including by paying attention to mental health. A "Stimulant Field Lab" has been formally established in Vietnam. It is a place where grassroots organisations from the region can learn about stimulant harm reduction: knowledge for which there is an enormous demand. Both initiatives have been evaluated. Mainline will remain involved in this initiative in 2021 and participate in the expansion of the hub.

Finally, in South Africa, Mainline worked with its partners FPD and TB / HIV Care on offering mental health and psychosocial support (MHPSS). We looked to improve the situation of people who use meth and of female users. Mainline's work in South Africa is nicely summed up in a track record that was released in 2020. In addition, in 2020 we started work with young drug users within the project Young, Wild and..Free?

Now that the Bridging the Gaps programme has been completed, we would like to thank all the partners with whom we have worked for all those wonderful years. We will continue to work with most of them: Mainline will remain active in Kenya, Pakistan, Vietnam and South Africa in 2021. We have built partnerships for life and learned a tremendous amount. We would also like to thank all Alliance partners within Bridging the Gaps: INPUD, COC, SOA AIDS Netherlands, AFEW International, NSWP, MPact, GNP +, ITPC and of course Aidsfonds. Finally, we thank the Dutch Ministry of Foreign Affairs for its support, confidence and flexibility. The harm reduction field will not soon forget your support! The final evaluation of the Bridging the Gaps programme can be found online.

Mainline has been working in the Dutch chemsex scene for many years and continued to do so in 2020. We are committed to improving the health of gay men who use drugs intensively during sex.

Despite Corona, we were able to continue the fieldwork and support groups for men from the scene. Working online made it even easier in some respects to get national coverage. We made a lot of information available on our website and worked on various publications. In 2020, we started a major study as a follow-up to our 2016 ‘Tina and Slamming’ study. The results will be published in 2021.

In 2020 we also explored drug use in "other" sexual settings: among swingers, for example. More about this will follow next year.

Because the emerging production of crystal meth is a major concern in the Netherlands, Mainline is regularly approached by the media. De Volkskrant published a large article in which we could nuance the sometimes heated public debate. And we posted extensive information about meth on our website. We also wrote blogs to counter common misperception of meth. In addition, Mainline gave advice to professionals who work with men from the scene and we expanded our training offer on chemsex.

In the meantime, the demand for information about chemsex and effective ways to support men in the rest of the world is increasing. Mainline developed an e-learning about chemsex and included lived-experiences from Asia and South Africa. A second part of the e-learning is under way and is expected to be released in mid-2021. Mainline was active in all kinds of international meetings, especially in the Asian region, to share our knowledge about chemsex.

Mainline provided all kinds of training courses in the Netherlands and abroad in 2020. 

There is a particular demand for training on the harm reduction approach, drugs and its effects, addiction, and institutional policy on drug use. Mainline expanded its training offer and now offers special training on how to deal with erratic behaviour, double and triple diagnoses, the use of GHB in social services, the ins and outs of chemsex, making contact and overdose prevention. We have a completely new training page on our website. Here you can find our current offer. In 2021 we will also provide more training courses with open registrations. Keep an eye on our Linkedin-page to stay up to date.

Many of our training courses were moved online in 2020. And after we had overcome our resistance (Mainline likes contact), this went well beyond expectations. Many of our training courses could continue as planned in 2020, despite Corona. We worked on our first full-fledged chemsex e-learning and time that was ‘freed up’ by Corona gave us the opportunity to develop more long-term pathways for training.

Internationally, we trained many of our partners within the Bridging the Gaps programme, including on work with women who use drugs, working with peers, stimulants and mental health. Looking back on 2020, we are most proud of the candidates from our international train-the-trainer programme. They are now all fully-fledged harm reduction trainers and can be deployed as trainers in their own or a neighboring country. The trainers can all be found on our website. 

In addition to training, Mainliners can now also be "hired" as a consultant. It turns out that even as a consultant you can remain grounded, practical and down-to-earth. In 2021 our consultancy assignments will offer us a lot of new opportunities: to share our knowledge and to strengthen the international harm reduction field.

In 2020 Mainline made itself heard in all kinds of ways. We previously mentioned our interview in ‘de Volkskrant’ and the blogs we wrote about the misperceptions of drugs. An important campaign of ours was aimed at the Ministry of Foreign Affairs and Minister Kaag of Foreign Trade and Development Cooperation. This campaign focused on the Ministry's decision to end direct investment in harm reduction after 2020.

We drew up a petition together with 331 organisations from 95 countries across the world. We eventually offered this petition to Parliament and to Minister Kaag. We made the website www.harmreduction.nl, with an accompanying publication. Ultimately, we received support from a majority in Parliament, who voted in favour of a motion for continued Dutch support for harm reduction. 

Whether action will be taken in 2021 in response to this demand of Parliament is a big question mark. Especially in times of Corona and a looming economic crisis. Mainline has since found other ways to finance its international work. But the major shortages in the international harm reduction field are dire, as shown by a report by Aidsfonds and a recent publication by Harm Reduction International.

In 2020 we released four well-received Mainline magazines with the themes: confusion, love, pain and dreams. In addition, we published a special edition on drug use in Corona times: nine personal stories with beautiful photos of Mona van den Berg. 

Our "erratic behaviour" project resulted in training and a practical guide: "Understanding Misunderstood Behaviour: Dealing with Erratic Behaviour in Shelters". In addition, in 2020 we continued to focus the use of doping in the recreational sports. Amateur athletes often use in a "blast and cruise" rhythm - in which steroids courses follow each other non-stop. This is one of the health risks that appears in the report "Always Anabolic". In 2021 we will start a new project in the sports scene and we hope to put harm reduction for this group on the map once and for all. In an interview with Mainliner Tjeerd de Zeeuw you can read why this is important. Extensive harm reduction information for users of Performance and Image Enhancing Drugs is also available on our website.

Working with peers (people who actively use drugs) has always been a priority for Mainline. But many organisations struggle with drug use in the workplace. And conversely, peers often feel that they have not been seen or treated as fully-fledged staff members. Mainline published practical tools for working with peers based on a study in South Africa. We will translate this guide into training in 2021.

In addition to the Corona monitors, Mainline participated in various studies. An investigative report was published on the inhumane life-circumstances of women who use drugs in Kenya. A reality full of violence. In 2021, Mainline will go full steam ahead on this topic to bring about change for these women. In Indonesia the same applies to the work on prison health. A large part of the prison population in Indonesia uses drugs, but they have limited access to health care. It is an often forgotten group of people. Three studies were published on this topic in 2020. The aforementioned studies were made possible through ITPC and the Robert Carr Network Fund. 

Research within the Bridging the Gaps programme yielded three academic publications. A first publication is about the importance of working with peers. The findings from this study were also made available in a more accessible report. The Community Matters report was published in three languages and can be found on our website. The other two publications concerned research from Pakistan. A first study investigated the factors that increase adherence to anti-retroviral therapy. A second study examined HIV prevalence among the female partners of injecting drug users in Pakistan. Prevalence was found to be 8% (<1% in the general population). The research provides reason to recommend this group of women for PreP.

Mainline's sister Poppi Drugs Museum Amsterdam also achieved great success in 2020. The museum (in the making) organised its first longer pop-up exhibition: Dutch Drugs Stories. 

Poppi unveiled a unique photo archive for the general public during this exhibition. Photos by award-winning photographers showed the Dutch drug scene in a raw and moving way.

For a full month, the Vrij Paleis was devoted to Dutch drug history and in the evenings we organised debates, film screenings and theme evenings about drugs. Live tours were provided by people who experienced life on the street up close. And of course visitors could also take the Digital Drugs Tour. This tour, which takes you to the Amsterdam hard drug scene of the 1980s and 1990s, is now included in Poppi’s regular offer.

In 2021, Poppi hopes - if Corona cooperates - to be even more visible. Do you want to support our museum in its mission? You can now also buy shares in our company!