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Vietnam
Starting in late 2018, Mainline and Supporting Community Development Initiatives (SCDI) designed a response to the increased use of meth-amphetamine in Vietnam and its neighbouring countries. Our joint efforts led to the establishment of the Hanoi Field Lab for stimulant drugs (‘the Stimulant Field Lab’): a regional expertise and learning centre for stimulant harm reduction.
Several interventions for people who use meth-amphetamine are now in place in Hanoi and complement the existing harm reduction offer for people who inject heroin:
The Addiction Technology Transfer Centre of the Hanoi Medical University, evaluated the work on stimulant harm reduction in Hanoi and Ho Chi Minh City.
The centre concluded that the established interventions are rooted in, and contribute to, an international evidence-base. And that effective interventions to reduce the harms associated with frequent stimulant use are similar for different key populations: sex workers, MSM and young people who use meth.
The evaluation highlighted one important organisational challenge, namely the high staff turnover. This turnover was found to negatively impact the number of beneficiaries with access to stimulant harm reduction.
In terms of service delivery, beneficiaries indicated to have an even greater need for mental health support. This is in line with the concerns the outreach teams across Vietnam brought forward: they reported challenges around mental health screening and around the implementation of mental health interventions. Moreover, the shortage of available mental health services in the two cities made it difficult for outreach staff to refer clients to appropriate services.
The recommendation that are mentioned in the evaluation steer our work for 2021 and 2022.
In the coming months, we decided to prioritise the following activities:
The innovative approach in Hanoi attracted attention and a broad interest from CBOs across the region. The Field Lab fits a major need for a cost-efficient and humane response to the increased use of meth-amphetamines in Asia. Donors are also recognising this need. Service delivery for people who use stimulants across Vietnam can continue with thanks to Expertise France's 5% initiative. And recently, ViiV Healthcare decided to invest in a number of activities in the coming years:
Are you interested in this project and would you like to know more? Please contact Mac Busz via m.busz@mainline.nl. For those with interest in our training offer, you can contact Simon Williams via s.williams@mainline.nl.
Nepal
Mainline was asked to review the current harm reduction programmes in Nepal from the perspective of women who inject drugs. Based on interviews with women we formulated recommendations to improve service delivery.
Netherlands, Belgium, Spain, Greece, Germany, France
Several risk factors increase the vulnerability of (new) groups of migrants to engage in problematic drug use. These risk factors include traumatic experiences, disengagement with society, unemployment and poverty. Services and municipalities throughout the European Union are faced with the urgent challenge to address these migrants’ needs.
Burkina Faso, Burundi, Egypt, Kenya, Marocco, Mozambique, Nigeria, South Africa, Uganda, Zimbabwe
Mainline is a partner in the Love Alliance programme. The Love Alliance brings together organisations led by communities most affected by HIV and AIDS.
Vietnam
In 2021 and 2022, SCDI in Vietnam and Mainline can continue to strengthen and expand the available harm reduction offer for people who use meth-amphetamines. After establishing the regional field lab in 2019 and 2020 we now have the opportunity to push this innovative initiative to the next level. One important element: to improve and expand the community mental health response. Moreover, the skills that were built in Hanoi's field lab are ready to be further disseminated across the South East Asian Region.
United Kingdom, Finland, Greece, Estonia, Serbia, Portugal, the Netherlands
Harm reduction approaches are rarely applied in a recreational sports setting. And why would we - sport equals health, right? Not always. Research shows that the use of performance and image-enhancing drugs (PIEDs) is quite common in various recreational sport scenes. And for those people who use frequently and in high doses, harm reduction can make a big difference.
Brazil
Mainline is starting a two-year project in Recife, Brazil, together with LANPUD, and the Free School for Harm Reduction (ELRD). The project aims to expand harm reduction and HIV care and support for young people who use crack cocaine.
Global
The use of drugs during sex is a growing worldwide phenomenon among men who have sex with men (MSM). Mainline has built a unique track record while working in the frontline of the Dutch 'chemsex' scene. Now, we also apply this expertise in an international context.
Zimbabwe
Mainline have been asked to assess the drug scene in five provinces in Zimbabwe. A team of three researchers worked in close collaboration with the Zimbabwe Civil Liberties Drug Network throughout 2022. The goal: to gain an insight into which drugs are commonly used and to recommend health interventions.
Kenya
Women who use drugs in Kenya face violence every day: At home. On the streets. By the police. In their communities. A unique study - conducted in Mombasa, Kenya - sheds light on the tough realities these women encounter. Urgent action is needed.
Zambia
Harm reduction is new in Zambia. Mainline was asked to estimate how many people inject drugs in the country and to map the already existing harm reduction and HIV services for people who use drugs. Based on this information, we drafted practical service guidelines. In doing so, Mainline hopes to have contributed to the introduction of harm reduction in Zambia.
Indonesia
Prisons in Indonesia are overcrowded and health services are limited. Is quality prison health too expensive? Not according to findings from Atma Jaya University, who applied the method of 'economic modelling' to prison health services, including drug dependency programmes. The findings fed important advocacy messages to improve the prison system in 2021. Moreover, Atma Jaya - via a 2021 implementation study - succesfully introduced motivational interviewing into the prison setting: an evidence-based method to assist people who are dependent on drugs and would like to reduce or quit their drug use.
Iran
Iran is renowned for its harm reduction programme. It was one of the first countries in this geographical region to adopt a harm reduction approach. Government supports and funds the programme. But the drug scene in Iran has changed over the past 20 years. More people are using stimulant drugs and, due to economic circumstances, more people who use drugs have become homeless. Mainline sets out to see whether the current programme in Tehran still fits the needs of the local people who use drugs.
South Africa
Women Who Use Drugs face additional problems compared to their male counterparts. The harm reduction field far too often neglects the needs of women. To some extent, the same is true for peer workers: incredibly valuable staff in any impactful service. How can local services make sure that peer workers are valued, supported and living up to their full potential? And how can access for women who use drugs be improved?
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