Vertige virtuel (Métis) (French Edition)

They made the decision not to target drug users coming to services, to stay away from the vicinity of services, and to refer drug users they arrested to those services. They began to adopt a public health role as well as a public order role and they were fully committed to the approach.

How successful was it? As far as behaviour change is concerned, there was a reduction in the sharing of needles and syringes and in the use of street drugs. Many more people were attracted into services who had never been before. Some people who had been injecting heroin for twenty-five years made their first appearance at a drug service. A range of physical problems related to intravenous drug use were found and dealt with.

The drug-using population of Mersey became healthier and more knowledgeable. In the late s, Liverpool was responsi-. An HIV epidemic did not occur among intravenous drug users in Mersey. By , twenty people had contracted the virus through injecting drugs, and some of these seem to have contracted the virus before moving to Liverpool. The development of harm reduction services in the late s led to many visitors from every part of the world visiting Mersey.

I was told by Dr. These visits played a key role in providing an impetus for the development of international activities and the launch of the annual International Conferences on the Reduction of Drug Related Harm. The international dimension was seen as an important part of the strategy of strengthening the credibility of the policy in Mersey, whose at-risk drug users were its prime target.

But of course, we believed that we were doing the right thing, and wanted to spread our message to internationalise the concept to convince others to follow suit. The First International Conference on the Reduction of Drug Related Harm took place in Liverpool in in response to the interest shown in what was happening in the region. Over the years, the conference has become a powerful instrument in exporting the concept of harm reduction.

It is now called Harm Reduction International and is a leading non-governmental organisation working to promote and expand support for harm reduction worldwide. Harm reduction is now mainstream in many parts of the world. It is accepted by almost all UN bodies the WHO has a member of staff who has global responsibility for harm reduction and one in each of its regional offices and by the International Red Cross.

The scientific evidence now supporting NSP and methadone maintenance treatment is overwhelming. This proves the efficacy, safety and cost effectiveness of the programmes. But other interventions are lacking, especially in drug law enforcement, and this is becoming increasingly apparent and remarked upon. There is an increasing acceptance of harm reduction in parts of the world that were extremely hostile twenty years ago. In the Middle East and North Africa, the ministers of health have accepted harm reduction as effective strategies for HIV prevention and care, and countries such as Iran, Lebanon and Morocco have included harm reduction in their national policies.

More countries around the world are willing to try modest reforms - prison needle syringe programmes, prison methadone maintenance treatment, medically supervised injecting centres, prescription heroin treatment, repeal of criminal penalties for personal possession of all illicit drugs, and vending machines for needles and syringes.

Harm reduction has spread to over seventy countries in twenty years, despite enormous cultural, political, and economic obstacles, which is a clear indicator of its merit. A striking exception is Russia, home to the biggest epidemic of HIV among people who inject drugs. Russia steadfastly refuses to accept the evidence for OST while the epidemic rages. Finally, and most importantly, the voices of people who use drugs are being heard.

We are people who have been marginalised and discriminated against; we have been killed, harmed unnecessarily, put in jail, depicted as evil, and stereotyped as dangerous and disposable. Now it is time to rise our voices as citizens, establish our rights and reclaim the right to be our own spokespersons striving for self-representation and self-empowerment.

For us professionals, however committed, harm reduction is our job. For those who use drugs and who are stigmatised, marginalised and denied the human right to health, it is their lives. Education, Prevention and Policy,vol. It was a place where marginalised drug users and those better integrated into society such as students would cross paths, all of them wanting to maintain complete anonymity in the process. At the time, distribution of needles on the street was prohibited. During this period, we lost count of the number of times team members were arrested and carted off for a few hours to the police station!

The need, in a sense, to train the police, by talking to them about harm reduction, seemed crucial, as they were ultimately the ones in contact with users too. In , the NEP team in Paris created the first health prevention kit for intravenous drug users. MdM continued, however, to improve the contents, adding a filter, a teaspoon and citric acid to avoid lemons being used. This enabled the number of both viral and bacterial infections to be reduced.

Nathalie Simonnot started life in Paris then moved to London among homeless people and drug users.

1. Pieces Of One?
2. Finance & Development, December 1998;
3. Hooch;
4. !
5. Product Range:.

She has been a volunteer with MdM on the programme to eliminate childhood lead poisoning and subsequently on the programmes to reduce harm among drug users and male and female sex workers. Aside from devising tools, the NEP also developed by recruiting the first salaried staff in , once government funding had been secured.

This was also the year that the programme acquired a mobile unit. During this time, the Paris NEP team was learning its trade and establishing its guiding principles. The first locations for the mobile unit were therefore decided on following discussion with users.

But the team ran into difficulties with partners and key players, namely with health pro-. In , the NEedle exchange Program team in Paris created the first health prevention kit for intravenous drug users. These difficulties did, however, have the considerable merit of raising the question of the place of public health in French drugs policy. Over and above outreach interventions undertaken to offer services to the most marginalised individuals, the fight moved into the political arena too.

The first public action in France relating to HR was organised on 30 November For the first time, drug users and ex-users spoke openly in public and were thus able to express what had long been withheld. A genuinely innovative alliance was formed between drug users and those combating AIDS, including health professionals. A joint platform was thus established and, from then on, no HR player operated as before. The first meeting of the HR group started badly: For them it was as obvious as providing cash machines to make it easier to withdraw money rather than going into a bank to face a teller.

The measure involving needles was the same: In the mid s, work in the field and in advocacy undertaken by civil society organisations, including MdM, began to bear fruit: But this success was potentially concealing a threat: Vigilance was therefore still required and the withdrawal of MdM from existing programmes, negotiated by those responsible for coordinating projects in France, led to two positive outcomes: On the other hand, these new circumstances enabled MdM activists to take HR into other areas. Launch of the Free Parties Programme aimed at synthetic drug users The programmes had scarcely been legalised, before MdM was once again shifting the focus with the start of health prevention activities aimed at free parties which were, for the most part, illegal.

So, in the spring of , the Free Parties Programme was created with the purpose of designing specific health-prevention tools and of offering appropriate healthcare support to users of synthetic drugs, such as ecstasy, at the locations where the parties were being held.

At the same time as organising health-prevention and healthcare activities at these electronic music events, the Free Parties Programme conducted research into harm reduction on the electronic music party scene. This research involved surveying the population concerned, the products consumed and the methods of consumption to determine exactly what the associated risks were in order to be able to adapt action taken in the field more effectively.

Those working in the party environment were thus the first to think that there was little point in offering needles to all-night partygoers and so MdM teams began, in secret, to hand out needle kits. Clinic , helped doctors navigate all the different ways in which the various products interacted and provided a guide based on expertise in the field. Similarly, testing and rapid analysis of products offered a sort of crystal ball, indicating whether or not a psychoactive substance was present in a sample. This intervention was officially banned in April , when the French government set out the regulatory framework for HR interventions.

MdM immediately began promoting a more complex analysis technique — thin layer chromatography TLC. This type of intervention, which still does not form part of a package of HR services either in France or within the United Nations reference framework, as well. TLC analysis gave rise to a new MdM programme — the XBT standing for bio-xenotropism — which focused, as a priority, on products observed by users as having unexpected side effects and which enabled a genuine counselling relationship to be established.

Lastly, interventions on the free party scene led MdM teams to begin informally helping minimise the risks of obtaining a fix. A protocol was drawn up for teams taking part in this type of activity. Counselling, testing and finally rapid testing were then extended to programmes across France, offering patients genuine added value. The methadone bus allowed marginalised users, who did not attend healthcare facilities, to have access to the drug substitute and required them to be part of the programme for a limited period of time only, namely the day they attended.

In contrast, the majority of methadone centres set users an obstacle course, which obliged them to meet with all the specialists on the team social worker, psychiatrist and doctor as the only way to gain entry. A second, similar MdM programme subsequently opened in Marseilles. So, from to the start of the s, MdM wrote a whole slice of the history of HR in France in the form of its eleven needle exchange programmes, four methadone centres, two methadone buses and eight Free Party Programmes.

Since the adoption in August of the public health bill, which officially made HR a government-funded and government-led part of public health policy, most of the programmes run directly by MdM have been transferred to service providers who are recognised by the government and, in most cases, set up by former teams from MdM needle exchanges and methadone centres and buses. In practical terms, this involves training sessions during which users inject their product in the presence of a two-person team of educators; each session provides a breakdown of the different stages of injecting and an opportunity to give advice.

This project is the forerunner to. However, the desire to extend the HR approach to those offering such sexual services and the creation of sex work programmes in Nantes, the island of Reunion and Paris between and emerged in a climate of tension within the organisation that was even greater than when the first drug user programmes were introduced. On the pretext of fighting for genIn , a needle exchange bus took up der equality — a cause, moreover, that is position in the city of Saint Petersburg in both just and as topical as ever — the most Russia.

Other projects were to follow: The latter three programmes place ing the sources. A sort of latent struggle particular emphasis on the social change ensued within the organisation. In spite of MdM is seeking by focusing on two everything, harm reduction players were aspects: In this way, the first harm reducother hand, the programmes concentrate tion programmes among people offering on being able to replicate the services sexual services for payment were able offered elsewhere by training profession- to overcome the constraints and MdM als and distributing tools.

In doing so, this activists succeeded in developing a global action aims to increase the acceptability approach to HR, incorporating sex work of HR in these countries. In addition to and drug use. This rich history has also helped create a pool of experienced activists for developing HR programmes internationally. Harm reduction among male and female sex workers But the history of HR at MdM is not solely about a public health response to drug use and the fight for human rights among and with drug users; it is also a history that engages with male and female sex workers.

It was the field teams involved in outreach programmes directed at drug users who first made the organisation aware of the need for action aimed at other marginalised people in our societies, namely those who offer sexual services in return for payment. The approach is in fact the same in both situations: Even more importantly, they are acknowledged as knowing better than those intervening what is or is not good for them and knowing when they want it.

Nor, it must be acknowledged, have there been any real forums in which this subject can be discussed and considered. There is still evidence of reluctance today and this is largely due to the comfortable stereotype of women as victims. Male prostitution is singularly absent from discussions. It is true that this aspect would open up an uncomfortable debate in terms of the prevailing discourse, begging the question of who is dominating whom.

And then things would start to get complicated. The way feminism has been hijacked is particularly painful for many of us. In the name of women, women are being crushed; they are no longer being listened to. People set themselves up as spokespersons, talking about realities they know nothing about. Some organisations, in similar vein, have arranged extremely high-powered lobbying of French MPs to assert how reliable their reductionist theories are — reductionist not in terms of risks but of rights.

And still today — but after all it is only. We were convinced that we were right and that the law needed changing. But this certainty must continue to be questioned and verified from the point of view of the interests of drug users and sex workers, and their interests alone. This was to avoid endangering the action we were in the process of putting together; the tented areas for supporting injecting at free parties are a good example.

To be sure of the validity of our proposals and our position papers, one thing needed to be guaranteed from the start of the thirty years of campaigning: This encapsulates the whole of the paradigm shift in care brought about by harm reduction: The preventive strategies put ent prevention choices made by the forward in the early leaflets were based populations encountered.

- شبكة سحاب للرد على أهل الضلال والأحزاب

From , progress in treatIt rapidly became apparent that dis- ment led to improvements in living contributing information and promoting ditions and life expectancy of seroposicondom use was an essential but inad- tive individuals. In addition, activists in equate prevention measure. On the one the fight against AIDS realised that the hand this was because the information epidemic was going to be a long-term did not resolve the issue of access to the phenomenon, involving a different way of means of prevention; on the other, it was thinking to that of an emergency context.

From the s, how can we envisage our long-term emothey put together a diverse range of pre- tional and sexual relationships, our interventive methods: He has been extensively involved in the fight ments were hard won and were under against AIDS since and has worked, in particular, on threat from securitarian policies. The at AIDES decided to broaden the scope of remit of the Direction of national programmes is to lead the the measures being used at the end of AIDES network, made up of 70 delegations spread across the s by formalising the Sexual Harm France, and to represent the organisation in dialogue with Reduction SHR discourse in writing and national stakeholders: A large proportion of the work centres on advocacy.

At the same time, the notion of Sexual Harm Reduction found its legitimacy in the double imperative of sexual health: In the context of HIV, managing sexual health can be a heavy burden. This effort at awareness-raising and informing, in which all those involved in combating AIDS shared, was essential and urgent in the context of an emerging epidemic and, to an extent, produced results. At the same time, in our outreach activities — in bars, at external meeting places and in saunas — we observed an emerging need for homosexuals to be supported in how they incorporated this information into their sexual practices and took responsibility for it, as a way of reducing the risk of being infected by or of transmitting HIV.

A method of individual and collective intervention, which we called Sexual Harm Reduction, gradually emerged from supporting homosexuals on a daily basis in their concern for prevention. The ethical question of prevention became crucial: Our objectives perceptibly altered to the extent that we developed an empathetic. In August , alongside the proceedImplementing this approach also allowed us to renew contact in the field ings of the International AIDS Conference with men who had problems with preven- in Mexico, the Swiss hammered home the tion and who avoided the arrival of the message: From then on, They compared estimated residual risks: The future of Sexual Harm Reduction also has a biomedical basis At the start of , a new preventive tool appeared to assist people — treatment as prevention TasP — and forced its way into France via sexual harm reduction.

The title was intentionally provocative: A flood of criticism ensued from researchers, doctors and health prevention workers, traditionally focused on the single, simple message: These statements identified three criteria for a risk to be estimated at below 1 in , For them there was: There was violent opposition and the speakers were reproached for promoting wide-scale abandoning of the condom and thus an increase in fresh cases of contamination. Hirschel has put his finger on it. It is the greatest source of distress suffered by people affected.

Can they contaminate others? Have they contaminated others? If this question becomes secondary then, yes, it does change their whole life. Since then, the surprise results of HPTN , a random trial involving 1, serodiscordant couples, published five years before the scheduled date because of the significance of the results, marked a new stage: In addition to public health interests, now broadly emphasised, what is also needed is full recognition of TasP as an individual HR tool which is as effective in every way as the condom.

Treatment partners, encouraging medical monitor- does indeed seem to be a new prevening and providing leverage for reducing tive tool which is finding its place among stigmatisation and discrimination sur- the combined range of preventive tools. But it is one thing to know that a tool is rounding people living with HIV. Thus, the main challenge faced by health prevention actors and people affected by or exposed to the risk of HIV, depending on where in the world they live, is to have access to treatments, syringes, substitution and even condoms; and to have the right to use them in complete safety.

Drug addicts exist who cannot or will not permanently give up taking drugs. In this chapter, Jean-Pierre Lhomme and Paul Bolo, two French general practitioners whose personal and professional experience has been enriched by harm reduction, discuss and question the link between healthcare worker and patient. This intimate and unique relationship has often been reported as difficult to establish between a patient who uses drugs and a healthcare professional. Jean-Pierre Lhomme and Paul Bolo demonstrate here that this link can be re-established, or never broken in the first place, provided each party demonstrates his or her desire to act and progress together.

The only reference point within the healthcare policy framework, which was itself shaped by morality and prohibition, was to discourage use; the only assistance provided was to help take people off drugs, dismissing those who could not, or did not want to, permanently give up their addiction.

The framework imposed in this way acted as an obstacle to any other form of help, leaving a good number of potential candidates attempting to attain this ideal by the wayside, and leaving them in a terrible physical and mental state. It was like asking someone over and over again, who had never done the high jump, to jump, immediately and repeatedly, with 1 metre 80 being the required and only height. This was the situation in which general practitioners found themselves: Something had to be done; What brought such an individual to you?

I did it and I still do it. I did it intuitively JPL: And then, it has to be said, general pracof the epidemic, drug users came to consult general practitioners, driven by an titioners were not considered experts, abscess that had worsened beyond tol- either in AIDS or drug addiction.

More usually, tor- term treatments. This contempt among mented by withdrawal, they came to try doctors had an impact on users and did to negotiate for some medication to calm not help smooth relations. Some treatment, of morphine-type medication users were thus able to benefit from suband Neo-Codion, of codeine in syrup form, stitution ahead of time. Providing this care in difficult condiwhich drug users took in large quantities! Another dialogue, I think. What that might have been. Nevertheless, the majority of general practitioners refused to treat these people who were making themselves ill.

How did the relationship between doctors and users develop during the s, the decade when AIDS appeared? Towards the end of the eighties, the HIV epidemic was setting in. Of course, the hepatitis B virus had been around for a long time and the hepatitis C virus had just been identified. And of course, faggots, druggies and whores had been around for a long time too.

The wholly inadequate preventative measures put forward in response to the risks being run by these populations began to show their harmful effects. These people were paying a heavy price in the face of the HIV epidemic. The healthcare reference frameworks were not functioning, in terms of public and individual health alike.

Faced with this situation, what was needed was to reinvent, to demonstrate pragmatism, to show the capacity to provide health prevention solutions that were both adapted to the health risk and worthy of the people concerned. The way of taking care of the community, taking care of the individual, had to be deconstructed and reconstructed. Many put every effort. The old story of access to healthcare for all, the old story made new in the face of an epidemic. The unexpected arrival of the AIDS pandemic was in the process of suddenly changing priorities and of imposing reducing the risk of infection as a primary objective among drug users.

Doctors had to recognise that they must take an interest in the users who could not or would not quit their addiction for good, had to acknowledge their essential role in helping users reduce the risks and harm at every stage of the course of their addiction. At the time, I spent a lot of time observing and looking at everything that was going on in the needle-exchange programmes.

HR enabled me to get involved and to put what I was doing into words. My involvement also enabled me to. But what is past is past and, at that time, not only did the professionals have to explain themselves to each other, they also, and more importantly, had to do something! A pragmatic approach was what was appropriate, without, however, each having to reject his or her own form of medicine. And some managed to take this on board. What had to be gered HR practices among drug users.

The health disaster was brewing. Along with attempting unofficially and precepts of HR applied to medicine? Secondly, there is tion. Of course, this had to be done first the extent to which the solutions proposed of all among colleagues who were sharing are compatible with the situation, the perthese practices. But it was not enough. It was a difficult step for these facil- The practitioner steps out of the picture ities to take to break away radically from for a time and reaches out to the other a healthcare policy on which they relied, person who then teaches the practitioner as was sharing medical knowledge with how to read him, without abandoning his patients — in other words giving up part knowledge and training.

It is the patient of their power. Sharing knowledge does who teaches the doctor how to care for not form part of medical training and, in him. Everyone is, to a certain extent, an the difficult task of managing the pro- expert on themselves and on the course fessional life of a doctor, certainties are their life has taken. Afterwards, everyone sometimes not a good place to look for must be able to question themselves and guidance, even if they do provide a source manage to avoid going too far.

I took the time to listen. I realised that you can only hear what you are ready to hear; that you can only see what you have the capacity to see. That seems self-evident, but in fact many doctors miss the point and feel themselves to be all-powerful. HR teaches listening skills and humility. Today, my listening is attentive and focused. This support is all the more necessary given the fact that various issues, insecurity and desocialisation are frequently intricately linked, and such problems are either clearly evident or sometimes masked. The medical, psychological and social JPL: The doctor puts forward his or tiated.

For me, taking care of a drug user, Of course, the doctor gives advice, but it is more than advice which often takes it goes beyond sharing knowledge. The the form of a one-way and thus illusory professional is there to support the indiexchange; he or she provides explana- vidual along what is sometimes a chaotic tions presented as advantages versus pathway. The framework of the consultation in my view makes it possible to reasdisadvantages, or benefits versus risks.

By adopting this attitude, or rather role, And when that moment of compatibilthe health professional also accords a place to the person consulting. The doc- ity arrives, does this time-out in a surtor combines his or her knowledge with gery, with a doctor, represent a special that of the individual, with the individu- moment?

This idea illustrates the form this medical knowledge. This blend of mutual knowl- son at a given moment. This involves adapting different variaedge — but blend here does not imply confusion — thus gives the care its coherence. Practising general medicine position at a given time. And so, while the qualof drug use clean shooting, shooting in ity of response needs to be worked on conditions and in places where it can in the relationship with the person and be clean, or adopting alternatives to in the preventative solutions and care shooting. To sum up, this is equivalent to mak- elsewhere than in the one-to-one context: This could be summed up in a phrase which most closely reflects what HR has contributed: Once this was achieved, it helped re-establish Lastly, is HR closely linked to medical a certain ease, calmness and comfortableness in the relationship with drug practice?

The hierarchical model for clas- users, but above all it brought about a sifying risk is in general fundamental to much better quality of medical provision our work in general medicine. Risk reduc- for these people. The involvement of general practition- ers would not have been altered to the ers, who are a significant majority, par- extent it has. For me, the main objective is to lead Jean-Pierre Lhomme is a general practitioner who, at people to, or back to, care. The essential the same time, has pursued work in hospital and as a volunteer with MdM. From to , his hospital work thing is to provide access to a medical was in specialist centres providing support for pregnancy centre and, thus, to be able to offer a terminations and then, from , in centres for addiction.

HR has ena- Joining MdM in , he did pioneer work to establish the bled me to practise what seemed to me first harm reduction programmes in France NEP from to be crucial from the outset of my career, followed by the methadone bus and, since , has played namely the humanising of healthcare and an active role in leading and encouraging debate on HR.

Paul Bolo is a general practitioner and divides his working life between a private practice and drug treatment and prevention centre in Nantes. He then helped establish a programme aimed at sex workers, known as the Funambus. Jude Byrne has worked as a drug user activist since the late s. She has worked in peer-based local and national drug user organisations while working towards the development of an international organisation. She is currently living in Canberra, Australia, and chair of INPUD which was established to ensure the most marginalised community members have a voice at the global level on issues that affect their lives.

Jude has written papers and presented at conferences on issues affecting the community of people who use drugs, she has been an intravenous drug user for nearly forty years and recently completed a successful hepatitis C treatment regime. While the communities of drug users have had some early and notable successes developing peerbased drug user organisations in individual countries such as France, Germany and Australia, the majority of countries were, and are still, unable or unwilling to support this pragmatic and humane public health policy.

Suffice to say, the drug injecting community is increasingly bearing the burden of this disease in an ever-increasing number of countries. The question of why our successes have been so hard won must be discussed. It is obvious to activists in the drug using community that it has often been external factors that have hindered our progress, not, as is so often said to be the case, that drug users are not a real community. We are a community in every sense of the word; we have our own culture, language and beliefs.

Most tellingly, we can come together across languages and cultural barriers and understand a universality of experiences, stigma, discrimination and, too often, shame. Current drug users were only dealt with in terms of recovery or incarceration, and as such were characterised as either sick or criminal. The homosexual community was well positioned to both lobby government and organise itself.

The new disease had clearly established a toehold in the intravenous drug using Testimonies. It was particularly clear in the US where the numbers of drug users and the circumstances of injecting, i. In our community, transmission was via shared contaminated injecting equipment. As I have said so often - and it is a really important point to remember when you look. Governments had no cachet with the drug using community; they were effectively at war with them.

So we had to follow the principles the gay community had instigated as best practices: It was blindingly obvious that the involvement of drug users in the response among their own community was absolutely essential.

The simultaneous change in atmosphere regarding drug users and the need to engage with them combined with the stability afforded by OST allowed activism among the community of people who injected to flourish. In countries where it was made possible, drug user activists rose to the challenge, and as a consequence, in countries where peer-based drug user organisations, NSP and OST were promoted, the HIV virus 56 People who injected drugs had wanted was stopped in its tracks. Germany, the 57 and needed new syringes for decades but Netherlands, France and Australia are all these were made as difficult to procure as examples of countries in which the rollout possible.

No person who injected wanted of peer-provided NSP and OST was rapid, to use old blunt needles - they hurt and and in all four the typical prevalence of they ruined your veins. The only people able to do that with available, supported and funded. Given what we know and our communities. Gay men ure to do so as genocidal. It is the moralism about the use of were not expected to stop having sex, sex workers were not expected to stop sex drugs that is fuelling this contempt for work. But there was an expectation from people who use drugs.

This is the fight some that former drug users were the only that INPUD has had to overcome, to get ones that government should work with. Along with NSP came Methadone a focus and the platform for the trainMaintenance Therapies MMT that ing of activists in the international comhad previously been extremely difficult munity of people who inject drugs, who to access.

Now MMT, or in some coun- were then ready to engage with the harm tries other opiate substitution therapies reduction movement as it emerged. OST , were opening up to stop, or at least limit, the chance of exposure to the virus by limiting the need or the frequency Drug user activists and the harm of injections. The availability of mainte- reduction movement nance therapies fortuitously provided a level of stability in the lives of people who The acceptance of drug users and, more injected on a daily basis that had previ- particularly, drug user activists in the harm ously been unreachable.

Chasing drugs is reduction movement, while providing our Jude byrne Nothing about us without us? While the philosophical underpinnings of harm reduction were a welcome change from the beliefs of an abstinence-based sector, we struggled with the notion of accepting harm as an inherent or inevitable part of drug use. Drug user activists argued that most of the harms that arise from using drugs were a direct result of prohibition and the panoply of harsh criminalising laws that come with it.

Many regions and countries resisted and fought this new philosophy, and many still do. The idea that drug users be educated and provided with the means to use their illegal drug was an anathema. However, Liverpool had some visionary individuals who, in the face of a potential human catastrophe, recognised the need to link the drug and alcohol sector to the HIV response.

Drug user activists utilised this burgeoning movement as a means of developing their own agenda. We had tasted full citizenship and we would not easily relinquish the experience. We wanted our entire community to have the same rights we were experiencing; watching our friends die unnecessarily from a disease gave us impetus and rage. So, international drug user activists began to meet at harm reduction Testimonies.

The 03 number range

It was stunning to meet people from other countries who felt as you did, and who would not accept the status quo anymore; it was liberating and inspiring. For many others, we were a nuisance demanding human rights and. Case study Australia Australia was one of the earliest countries to implement harm reduction strategies among the community of intravenous drug users. The combined partnership of government and community were so successful at controlling the HIV virus among our community that at one stage it looked like our funding was under threat.

However, the peerbased drug user movement was now so entrenched and the activists so passionate that they would not back down. We had discovered another virus had been decimating our community for decades, previously known as Non-A-Non-B, and so hepatitis C appeared in the late eighties. Our experience with HIV stood us in good stead, and the rhetoric about partnership and peer education was upheld.

The blood-borne virus section of the government continued to fund the Australian peer-based drug user movement and the priority was now hepatitis C prevention and later treatment. The national peer-based drug user group in Australia - AIVL - has never been funded by the drug and alcohol sector. They cannot see us as complete human beings, they want to do things to us to make us acceptable to the wider community - or kill us in the process, as it sometimes seems. Barcelona Conference was watershed where concerns about infrastructural and administrative issues were aired.

Later in BrugerForeningen the Danish Drug. Drug use is part of the human condition. It can be a response to life circumstances or happenstance, and it can just be because some of us derive pleasure from taking drugs. Our aim was to provide support to one another, exchange ideas and have our voices heard in the international arena, and push for heroin programmes and the end of discrimination against drug users.

We understood nonetheless that the legalisation of drugs was a long way down the road. Organising between meetings was problematic for some years, as fax and phone calls made it difficult to maintain contact. The arrival of the Internet provided us with enormous potential to communicate and support one another between the yearly meetings. International activism began to gain momentum. The facilities for people who used drugs were woefully inadequate. It was then thirteen years since we had first mooted an International Drug Users Movement and people were getting disheartened.

A grant was provided to assist the nascent international organisation to develop. This meeting resulted in the INPUD of today - a strong vibrant organisation that is a voice for the intravenous drug using community on the global stage. We have funding for a virtual secretariat of three positions: Filling these positions has been a challenge - most activists are employed in organisations in their own country and very few countries have supported the development of those peerbased drug user groups.

INPUD has a very small pool of people from which to find employees to work at the level our funding demands. Our funding will ensure that new opportunities for activists in other countries will open up; we can only hope. We are invited to speak globally on issues that affect our community. We work in concert with many other organisations in both the harm reduction and the blood-borne virus sector.

We have run peer education and self-advocacy programmes in Georgia and Afghanistan. All the above infections and co-infections and the resulting drug interactions have to be well understood. We need to work across the drug and alcohol sector, the mental health sector, as well as the criminal justice sector and human rights. All of these sectors and innumerable others impact on the day-to-day lives of our members and community.

It needs to be remembered that all of this funded activity is a public health response, and not a drug and alcohol led programme of activity. It seems highly unlikely that we would have been able to accomplish what we have if the drug and alcohol sector was responsible for our funding, even under the harm reduction rubric. While undefined harms remain a feature of the drug and alcohol sectors rhetoric, people who use drugs Testimonies.

We have been trying for over twenty years, and we are still struggling for the acceptance and the right to determine our own destinies. Too many other parties assume we have no right to self-determination while vigorously defending the rights of many other groups. There must be something deeply disturbing to the mainstream psyche about injecting drugs for pleasure, for there is no other explanation for the unremitting exclusion of our community in so many countries and on so many levels.

When the result of that exclusion is the transmission of preventable diseases, overdose, illness, and death, it illustrates a lack of empathy that is almost inhuman. Finally, it should not sordidness. It is an undeclared war, an and racism. We have somewhat forgotten asymetric war, led by the State against today the twilight, end-of-world atmos- its citizens, but described as such by the phere which served as a backdrop to highest authorities. Television images showed doctors transformed into astronauts, handling ill people weighing 40kg in sterile rooms.

He holds the ordinary public, paralysed by the a Masters in contemporary history and, for the past return of medieval hell-fires. The threat seventeen years, has worked hard in a professional of universal contamination peddled by capacity on harm reduction. In , he was the first fringe groups put the finishing touches president of the collective Limitez la casse, which to the apocalyptic scene.

An incurable promoted the policy of harm reduction in France. Since disease, transmitted by sperm and blood, , Fabrice Olivet has been a member of the National decimating first and foremost sodomites Commission on Addiction. In , he published La and junkies: Let us review the facts. A year later, France adopted legislation known as the Law, strongly influenced by this philosophy, and, the French government brought in a decree dated 13 March regulating the trade and importing of syringes, which in practice prohibited the sale of sterile equipment to heroin addicts.

It was this decree — now virtually forgotten — which was the origin of the AIDS epidemic and, subsequently, the spread of the hepatitis viruses among heroin addicts in France. More than collateral damage, the ban on obtaining syringes was the avatar of the war on drugs, a cursed offshoot of this policy in the form of apartheid, demanded by the State.

Unlike the ban on its own, which prohibited legal access to certain compounds, the war on drugs was directed against people. It was not a difference of degree but a change of perspective: It involved excluding a category of the population identified by its consumption of psychotropic drugs from ordinary law. By prohibiting the sale of syringes, the decree created an exclusion zone which served as a matrix for AIDS. The deadly trap which then closed on drug users soon revealed itself at the end of the s to be a threat to the whole population.

Born in the s, too late to be hippies and too early to be patients treated by addiction specialists, we were children of the crisis, busy looking for a vein to shoot up. We too enjoyed discoing at The Palace Parisian nightclub, but to come back down we discovered heroin. The story of this generation remains to be written. It paid a heavy price with overdoses, AIDS and violent deaths of every sort.

We were very familiar with the war. More than an excluded population, drug addicts were the dropouts, the majority of criminals in prison, swindlers of every sort, small-time gang leaders from the disreputable suburbs, professional armed robbers and burglars. Heroin required serious money. Before substitution, a heroin addict had to find something each day to tame the voracious beast, which, for the greediest, demanded the equivalent of to euros daily. It was impossible to find that on the streets or by begging. The life of an addict was therefore pushed beyond the sphere of what was legal; that was the aim of the war on drugs, a war essentially destined to transform drug users into terrorists or corpses.

Aside from dealing and stealing, all means were good for finding money, even paid work, which naturally did not mean dispensing with offering sex, getting in debt, defrauding the company, borrowing from family, in short engaging in a sort of permanent combat, very different from the experience of the clientele treated by the healthcare system today. It was something of an oxymoron: The politics of harm reduction: Since the end of the s, some voices had begun to be raised in France to create a breach in the war on drugs.

That breach had a name — harm reduction policy. Some European countries, like the Netherlands, out of pragmatism, or the United Kingdom, for reasons linked to legal and historical context, had already experimented with this new approach, which involved no longer passing moral judgement on the use of narcotics non-judgemental , but attempted to reduce the most harmful aspects. France had the highest rate of HIV contamination per inhabitant and intravenous drug users played a major role in the pandemic, particularly relating to contamination among homosexuals.

The nightmare of a society ravaged by HIV began to produce cracks in the frontline of the war on drugs. In , Limiter la casse Limit the Damage , a collective led by sociologist Anne Coppel, an iconoclastic figure in the drugs debate in France, brought together three groups: This was not a random tripartite grouping. This community movement led by associations provided real hope for all those wanting to change the drug policy.

HR policy had brought about a transformation in the intellectual frameworks at work in relation to drugs. Any rational analysis, if honestly conducted, necessarily leads to common-sense conclusions. HR, in contrast to the war on drugs, relies on the principles of reason, pragmatism and effectiveness. Between and , the number of heroin overdoses dropped by two-thirds, simply as a result of access to OST.

Drug addicts were the main players in a system that allowed them to take charge themselves of preventative action. In the mid s, an expert commission expressed doubts as to the willingness of heroin addicts to supply themselves with sterile equipment from pharmacies, even as a means of escaping AIDS.

The success of HR imposed a paradigm shift which. HR represented a genuine revolution for injecting heroin users, those vermin who, like the gay community, were threatened with extinction. It is because drug users represented an objective danger to the whole of society that the public authorities agreed to lift a small corner of the veil concealing the ineffectiveness of the measures inherited from the s. But one truth is still considered subversive: The notion of self-support emerged outside the French context.

Abdalla Toufik, a sociologist who regularly attended conferences of the International Harm Reduction Association, the principal organisation for HR promotion in the world, was the person who really conceived of ASUD.

Your UK 03 number

Returning to France, he took the initiative of bringing together a few crazies who were ready to defend the idea that Fabrice Olivet Drug user self-support: A journalist, Gilles Charpy, the now deceased son of a prominent Gaullist and a major heroin user, suggested firstly founding a newspaper which would talk about drugs and which would be by addicts and for addicts. In , the first edition of the ASUD newspaper put forward ten emergency measures.

What is striking today is how moderate this programme was and how twenty years later it is practically realised: But one demand — just one — has gone unheeded: Not only is it not on the agenda, but it remains a political topic rejected by virtually all political parties. Most of us, ex-dealers, robbers, burglars and hooligans of all persuasions, had but one objective: Decriminalisation legally refutes the idea of prosecuting an adult for freely consuming a substance in private.

Decriminalisation is essentially based on human rights which affirm that individual freedom should not impinge on the freedoms of others. At our first meetings, we did not believe at all that the association, created in one year after the newspaper, had any chance of a long-term future. This chain of solidarity was extremely gratifying on an emotional level. It enabled our groups, often subject to strong feelings of rejection in their own countries, to discover brilliant and enthusiastic counterparts from elsewhere, with little inclination for bemoaning their fate, while we tended to view ourselves as a peculiarly French phenomenon.

See part 2 of Chapter 7 written by her.

This annual event was devised as a forum for exchange for all stakeholders, users, healthcare professionals and ordinary citizens. Our idea of providing users with a platform remains linked to the fundamental notion that Drug addicts of all countries…unite! As Nicole Maestracci, cept imported from abroad. Charismatic drug tsar in France from to , leaders, now dead as a result of AIDS and rightly expressed it: Unfortunately, this founder of the German JES group, or brief improvement in matters was fought John Mordaunt, leader of the Mainliners against by an ill-assorted alliance of oppogroup in the United Kingdom, profoundly nents to HR policy and supporters of allinfluenced the first French self-support out medicalization, namely the historically associated twin cronies of the moral activists.

In , the Eighth International Harm order and the health regime. Reduction Conference was organised in Paris. Two hun- for changing how drugs are represented dred jokers proclaimed their drug use at but is not enough to achieve this. One of the tops of their voices at an official con- the political messages of Limiter la casse ference addressed by three former minis- and ASUD was to insist on bringing legal ters.

These shared moments created ties and illegal drugs closer together with that were strengthened through personal the aim of educating. Telecom operators adjust their bundled and all-inclusive call charges for calls made to 01, 02 and 03 numbers in order to compete with each other. The new OFCOM regulation has requested that all calls to 03 local rate numbers made from mobile phones and payphones have the same conditions as calls to normal landline numbers.

Having a number charged at local rate means that your company can have local presence, giving customers the impression you are on their doorstep. The great advantage of 03 local rate numbers is that they give companies national presence as well as giving small businesses the image of being much larger than they are. With an O3 Local Rate number a small business, working from home, can use a 03 number to protect its home number.

This number can then be changed at any time by just sending an email. Having a 03 local rate number means you have a number for life.

If you then relocate premises, all you need to do is just tell us your new destination number, and we will re-divert your 03 number for free, saving you advertising costs. With all Global Telecom 03 local rate numbers, you get the option of viewing your Call Stats on line, meaning you can monitor the ongoing success of your business marketing activities, and identify trends in the market. Revenue Sharing will be prohibited on 03 numbers.