Syringe Exchange Programs: Beyond a “Bridge” to Services

1. Syringe Exchange Programs: Beyond a “Bridge” to Services Harm Reduction Coalition, Technical Assistance Program HIV Education and Prevention Program of Alameda County (HEPPAC)/Casa Segura

2. Goals of Training • Learn about • Types of services IDUs need & • types of services SEPs can provide • Learn how to • Provide services at your SEP • Support and justify service expansion

3. CalSEP identified 10 preventive health services that most SEP clients need: • For clients not already known to be positive: • HIV testing, • Hepatitis B virus (HBV) testing, • Hepatitis C virus (HCV) testing, • TB testing • HBV vaccination • For clients who are sexually active: • Sexually transmitted infections (STIs) testing, • Safer sex counseling • For clients who are injecting drugs: • Drug counseling, • Safer injection use training, • Overdose prevention

4. Of the 10 possible preventive services, how many did SEP clients actually receive? • SEP clients needed on average 7 of the 10 possible preventive services. • But SEP clients received on average only 1 of the 7 services they needed (14%) in the past six months, therefore SEP clients fail to receive the preventive services they need. • Among SEP clients who did receive services, 76% of the services were received from the SEP. • In summary, SEPs are critical source of needed preventive services for clients, but clients still do not get all of the preventive services they need.

5. SEPs provided the majority of services received by SEP clients, particularly in the areas of counseling Percent of Eligible Clients Who Received Service

6. When SEPs offer HIV and HCV testing, SEP clients are significantly more likely to receive testing Percent of Eligible Clients Who Received Testing HIV Test p=0.002 HCV Test p=0.008

7. Engaging Clients • Salutation (greeting, supplies & syringes) • Conversation (listen/what they raise) • Drugs, cops, partner issues, housing, etc. • Observation (what they don’t raise) • Get permission to inquire • Find out their plan for dealing • Share possible outcomes/options • Education • Materials • Referrals • Follow-up, next time

8. Services obtained through SEPs • HIV Services • Hepatitis Services • Drug Treatment Referrals • Overdose Prevention • Wound Care

9. HIV Services - Options • HIV Screening & Testing • HIV Prevention & Education • HIV Treatment Referrals • HIV Case Management (including housing, basic needs, financial, etc.) • Psycho-Social Support

10. HIV Services - Implementation

11. Hepatitis Services - Options • HCV Screening • HCV Prevention & Education • Hepatitis A & B Vaccination • HCV Treatment Referrals • Psycho-Social Support

12. Hepatitis Services - Implementation

13. Drug Treatment Referrals • Referrals to CBOs • Methadone Clinics • Non-opiate drug treatment • 12 Step Meeting lists, etc. • Medical detox, “kick packs,” Buprenorphine, etc.

14. Overdose Prevention & Education - Options • Education – without Naloxone • Prevention • Recognition of (opiate) Overdose • Response • Education – with Naloxone • Education • Prescription

15. Overdose Prevention & Education - Implementation • Regulatory Issues • State Law & Policy – Challenges • State Law & Policy – Resources • Implementation Steps • Justifying Need • Exploring Models & Settings • Working with your Local Health Jurisdiction • Community Collaborations • Medical Involvement • Materials • Evaluation & Funding

16. Wound Care - Options • Supplies • Wound care kits • Written materials • “Education” not “Advice” • Referrals to medical treatment • On-site Medical Treatment • Prescribing medication • Cleaning, dressing, packing • Abscess surgery • Emergency Room

17. Wound Care - Implementation • Supplies • Wound care kits • Written materials • “Education” not “Advice” • Referrals to Medical Treatment • On-site Medical Treatment • Prescribing medication • Cleaning, dressing, packing • Abscess surgery • Emergency Room

18. Other Services & Assistance • Sexually Transmitted Infections • Safer Injection • Accessing Medical • Accessing Social Services • Referrals and Resources re. Legal issues

19. Resources, Evaluation & Justification • Look outside of harm reduction/SEP sources • Collaborate with others to provide services • Latino drug & alcohol (CBO w/gov’t $) • Traditional treatment programs • Government agencies & departments • Explore monies allocated to health issues • Measure A money (0.5 cent tax for Highland Hospital, 75/25 to CBOs) • Tobacco tax settlement money • Be able to do a cost analysis do demonstrate how much money you will save the County/Government!

20. What comes with the $$ • Collecting more Data • Maintaining Database(s) • Reporting on funded Outcome Objectives • Introduces additional Operational Expenses (e.g., government $$ leads to increased insurance, audits, • Certification and regulation (e.g., HIV C&T)

21. What you get for the Trade-off • (List: providing more services to people who need them)

22. Additional Resources • Hep C University www.hcvu.org • (etc.)

23. Thanks to… • Ricky Bluthenthal • Everyone who participates in CalSEP, especially SEP clients • All the SEPs