NL
 

The Netherlands

Strong connections between use of drugs and unsafe sex work

On the initiative of Mainline, Prostitutie & Gezondheidscentrum 292 / Prostitution & Health Centre 292, P&G292 carried out a survey of male and transgender sex workers between November 2013 and February 2014 in close cooperation with the Public Health Service of Amsterdam (GGD).

The goal was to gain more insight into the type and function of drug use during the sex work and the influence of drug use on sexual behaviour.

The results showed that the group targeted by the monitoring report uses drugs relatively frequently during their work. While under the influence of drugs they engage in riskier sexual behaviour. P&G292 finds the information provided by Mainline so relevant that they are carrying out an in-depth study among this group.


Relevance
Mainline and P&G292 see it as important that male and transgender sex workers who use drugs be informed about conscious use. Such information is expected both to have a positive effect on damage to health due to drug use (harm reduction) and to help to prevent sexually risky behaviour under the influence of drugs.


Most important signals from the monitoring report

• Twenty-five of the thirty respondents used drugs while working
The assortment of drugs used is broad. Poppers, sniffing cocaine, alcohol, Viagra/Kamagra, and cannabis were used most frequently. The frequency with which drugs are taken during sex work varies. More than half of the respondents indicated that they regularly, usually, or always used drugs while they were working.

• More than half of the respondents who use drugs engaged in riskier sexual behaviour when they were under the influence of drugs
It is striking that the group of seropositive men engages in riskier sexual behaviour and more often uses a variety of different drugs. Unprotected anal contact occurs frequently in this connection. Half of the respondents had experienced negative effects as a result of their drug use.

• Under the influence: Consistently safe or more risky
More than half of the respondents who use drugs said that they engaged in riskier sexual behaviour when they were under the influence of drugs. According to their own statements, the respondents are either very consistent with regard to practising safe sex during their work when they are under an influence or regularly take sexual risks.

• Unprotected oral contact more often seen as a given
The fact that this is the case could be interpreted as indicating that men do not see such contact as risky sexual behaviour, but no specific questions were asked in this regard.

• The reason for drug use during sex work is mainly commercial in nature

Use is frequently a tool for delivering ‘better sex’ (read: earning more money). For the most part, the sex workersdo not use drugs because they are dependent; rather, the quality and quantity of their work are both reasons for them to use drugs.

• Use of uppers (crack cocaine, sniffing cocaine, speed, crystal meth)
Strikingly often, the use of uppers is said to have the function of prolonging sex (which results in more money being earned). In this connection, there may be a risk that condoms can tear due to insufficient lubricant (for longer-lasting sex) or that mucous membranes can dry out, leading to the development of sores. In connection with unprotected anal contact there is a significantly greater risk of transmission of STDs, HIV, and hepatitis C.

• There is a need for nuanced information regarding drug use, specifically in relation to sex work
The provision of individualized information and the provision of information via a website for sex workers are highly desirable. The existing websites provide good information about the various drugs, but clear, nuanced information on combination use (which combinations are good and which are not) cannot be found online.

• New online information
In cooperation with Mainline, P&G292 has developed a new site for this specific target group (male sex workers) with clear information.

See www.info4escorts.nl


Contactperson: Renate van Bodegom

Our current projects


Understanding the needs of women who use drugs and their HIV+ children

Tanzania

Children Education Society (CHESO) in Tanzania has requested Mainline to assess the needs of women who use drugs and their (HIV positive) children. Between September and November two Mainline staff members will speak with women to ensure their needs for services will be taken up in the new national HIV and AIDS strategic plan. 

> Read more

Mainline - Technical Advice

Did Mainline become a supplier? Yes: a supplier of technical advice for the Global Fund. Harm reduction organisations and networks of people who use drugs across the world can now request a Mainline training or capacity building. Read more about how this works.

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Gender-based violence

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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 now.

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Women Who Use Drugs & Peer Workers

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?

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Chemsex

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. The best place to start? Our chemsex e-learning.  

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Stimulant Harm Reduction - Field Lab

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.

> Read more
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Love Alliance

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.

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Mindful Muscles

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.

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Young, Wild and... Free?

Kenya, South Africa

Young people use drugs - including minors. It's an inconvenient truth: societies usually seek to prevent young people from damaging their health and there is a big taboo on drug use among young kids. But are stigma, legislation or moral judgement keeping young people away from harm reduction services? This project aims to find and improve access to services.

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Size estimation and service mapping: introducing harm reduction

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, we drafted practical service guidelines. In doing so, Mainline hopes to have contributed to the introduction of harm reduction in Zambia.  

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Quality Harm Reduction

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.

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Prison Health

Indonesia

Prisons in Indonesia are often 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 feed important advocacy messages to improve the prison system in 2021.

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Train-the-trainer programme

In 2017, Mainline launched its first international train-the-trainer (ToT) programme. The objective of the programme is to develop the in-house training capacity of local partner organisations, making Mainlines capacity building efforts more sustainable in the long term.

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Our finished projects

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Reducing harms in the work environment

South Africa

Together with activists and peer- and outreach workers in South Africa, Mainline worked on a practical guide about involving peers in harm reduction work.

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Multi-country study on harm reduction and community involvement

Funded by Bridging the Gaps, this study aimed to understand how involvement of people who use drugs can influence the quality and availability of harm reduction services. The study took place in three countries - Indonesia, Kyrgyzstan and South Africa.

> Read more
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Hanoi field lab for stimulant harm reduction

Vietnam

October 2019 marked the start of a cutting edge new initiative. With the support of Open Society Foundation, Mainline and SCDI in Vietnam are building expertise to support people who use stimulant drugs. The core motivation to do so is the sharp rise in the use of crystal meth in the South Asian region and the lack of a coordinated harm reduction response.

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Harm reduction for stimulant users

A MAINLINE-GIZ STUDY

With the support of the Global Partnership on Drug Policies and Development (GPDPD), a project implemented by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, a team of three Mainline researchers conducted a study into effective harm reduction interventions for stimulant users. The study includes a review of the evidence for different harm reduction strategies for stimulants and a detailed description of seven good practices in different world regions.  

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Bridging the Gaps 2: 2016 - 2020

Indonesia, Kenya, Nepal, Pakistan, South Africa, Tanzania and Vietnam

The Bridging the Gaps programme started its second phase in January 2016 and continued until the end of 2020. The shared goal of the Bridging the Gaps alliance: to improve the health and rights of people who use drugs, sex workers and lesbian, gay, bisexual and transgender (LGBT) people.

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Tanzania

Heroin use has increased enormously in Tanzania and other East African countries in recent years. East Africa is situated along the heroin trafficking routes from Afghanistan to Western Europe, and this has also affected local consumption. It is estimated that there are 30,000 people who inject heroin in Tanzania wherein at least 10,000 of them live in the capital Dar es Salaam. People who use drugs in Tanzania are marginalised and cope with infectious diseases, overdose and police brutality. In 2019, Mainline partnered with Mukikute to build better health services for this vulnerable group of people.

> Read more
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