2. Methods National Advisory Committee Harm Reduction Symposium

3. Methods Site Visits and Walkabouts in Selected Cities Whitehorse YT Victoria BC Edmonton AB Winnipeg MB Rouyn-Noranda QC Ottawa ON Québec QC Halifax NS St. Johns NL

4. Methods Site Visits and Walkabouts in Selected Cities Whitehorse YT Victoria BC Edmonton AB Winnipeg MB Rouyn-Noranda QC Ottawa ON Québec QC Halifax NS St. Johns NL

5. Methods Focus Groups

6. List of Visited Sites and Programs Whitehorse YTNo Fixed Address Outreach Van Blood Ties Four Directions Centre Victoria BCSociety Of Living Intravenous Drug Users (SOLID) Prostitutes Empowerment Education Resource Society (PEERS) Vancouver Island Compassion Society Edmonton ABAlbertas Non-Prescription Needle Use Initiative Boyle Street Community Services Streetworks Alberta Addicts Who Education and Advocate Responsibly (AAWEAR) Winnipeg MBSage House SOS Solvent Users Group Biidigen North End Schools Safer Corridors Project Kali Shiva AIDS Services – Sunshine House Nine Circles Community Health Centre

7. Rouyn-Noranda QC Abitibi-Temiscamingue HIV/AIDS Regional Clinic Arrimage Jeunesse Ottawa ONOasis Ottawa Public Healths Safer Crack Use Initiative Québec QCPoint de repères Prostitute Intervention Project of Quebec (PIPQ) Halifax NSMainline Needle Exchange Direction 180 Phoenix Youth Centre St. Johns NLTommy Sexton Centre Street Reach List of Visited Sites and Programs

8. Focus Group Results Whom we talked to: n = 50 men; 30 women ages 18 to 64: 30% 18-34 35% 35-44 31% 45+ 62.5% urban diverse ethnocultural identities 63.8% current users 26.2% on methadone 18.8% HIV; 53.5% HCV 33.7% often or always worried about food 23.8% homeless or hidden homeless

9. Treatment & Counselling I can get by just about everything… if Im low on food, if I need a crack pipe, or condoms or anything, clean clothes… I can find it. The only thing is, is if you want to straighten out or something, theres a problem there.

10. The Canadian National Coalition Pilot Addictions Treatment Model Specifically for Sex Workers We wanted to be in a centre that used a harm reduction approach, that didnt have the You have to have 30 days clean before you can get in; if youre caught using, youre kicked out.… They have the whole continuum on site, they have detox, they have 28 residential beds. They were very open and excited about piloting this model. -- Lauren Casey, Executive Officer, CNCEW We wanted to be in a centre that used a harm reduction approach, that didnt have the You have to have 30 days clean before you can get in; if youre caught using, youre kicked out.… They have the whole continuum on site, they have detox, they have 28 residential beds. They were very open and excited about piloting this model. -- Lauren Casey, Executive Officer, CNCEW

11. Methadone Maintenance I find that with the methadone the only thing that helped me because it put that much time, like three years now between me and the drug. Im not saying I've been clean the whole time, but 99% of the time I have been clean, and then I had counselling. I wish we had something for crack addicts like they do for people that do the opium, the methadone. I really think theres a need for that.

12. Direction 180 Low Threshold Methadone Maintenance Program Weve got people since day one that will use drugs til the day they die and they dont want to stop, so by keeping them engaged in the process, were keeping them alive, -- Cindy MacIsaac, Executive Director, Direction 180 Weve got people since day one that will use drugs til the day they die and they dont want to stop, so by keeping them engaged in the process, were keeping them alive, -- Cindy MacIsaac, Executive Director, Direction 180

13. Peer Involvement And its been really beneficial. Ive done a lot of public speaking in the last year since I really got involved with the user groups and started them off and… its really been good for the self-esteem and its given me a goal to shoot for. It was the main thing that got me straight, and I think thats great, and it was that people listen to me now. Yeah, if I can prevent even one kid [from going] through what I did for 30 years, then I am a success, right?

14. Needle Distribution If I had prompt access to free needle exchanges when I was actively using just prior to catching HIV… if I was given the knowledge early on and access to harm reduction strategies, there is a good chance that I would not be HIV positive.

15. Point de repères – Community-Based Needle Distribution – Street Guides Mario Gagnon, Executive Director at Point de repères, won the 2008 Kaiser Foundations National Award for Excellence in Reducing the Harm Associated with Addiction and Substance Abuse for his work in community programming.

16. Drop-In Centres and Shelters Socially, for me, having [a place] to hang out with every day… makes me feel part of a family. I dont have any direct family here… and having the drop-in centres… is really helpful for me. Every day I enjoy waking and look forward to go getting a coffee and talking with my friends at … drop-in centres around town.

17. Tommy Sexton Centre We seem to be getting more and more people who inject drugs and… wanting harm reduction because a lot of the other shelters are not able to handle that and support the residents as much when it comes to the harm reduction model. We are fine with it. As you can see, we have our needles, everything is laid out... We just want to make sure that they are safe and that they are doing it safely. -- Richard Baker, Housing Coordinator, Short Term Shelter We seem to be getting more and more people who inject drugs and… wanting harm reduction because a lot of the other shelters are not able to handle that and support the residents as much when it comes to the harm reduction model. We are fine with it. As you can see, we have our needles, everything is laid out... We just want to make sure that they are safe and that they are doing it safely. -- Richard Baker, Housing Coordinator, Short Term Shelter

18. Health Professionals & Service Providers And I got a really big sore on my leg. The last time I used, thats where I used. And like hes been saying to me, Go to the hospital, go to the hospital. But Id rather take a month for it to heal on its own, or let my leg fall off, than go to a doctor… because they, you know, you go in, they treat you like shit.

19. Award Winning Health Professionals in Abitibi-Temiscamingue Danielle Gélinas, Coordinating Nurse - Jill Sullivan Award for Excellence in Clinical Practice by the Canadian Association of Nurses in AIDS Care in 2007 Clinical Innovation Award - Quebec Order of Nurses: Danielle Gélinas, Suzanne Fiset and Pauline Clermont in 2006 for the Clinic project and its multidisciplinary approach Pauline Clermont, Suzanne Boucher-Veilleux and Isabelle Cornet in 2007 for the Pikatemps Program Clinical Innovation Award - Quebec Order of Nurses: Danielle Gélinas, Suzanne Fiset and Pauline Clermont in 2006 for the Clinic project and its multidisciplinary approach Pauline Clermont, Suzanne Boucher-Veilleux and Isabelle Cornet in 2007 for the Pikatemps Program

20. Information Dissemination More knowledge of consequences… If I knew back then what I know now, I wouldnt have suffered like I did half as much, about hep C, about AIDS, about sticking needles in my arm, about leaving scars in my arm.

21. Outreach Services Bring the services to them because a lot of people won't come. Female Respondent: I remember … I was scared to just to walk up to the needle van. Male Respondent: Theres a lot of shame.

22. No Fixed Address Outreach Van and Safer Crack Use Kit Program The safer crack use kit program has overtaken the needle exchange program with 62% of clients accessing the fixed site program at Blood Ties solely for safer crack use kits. -- Patricia Bacon, Executive Director, Blood Ties Four Directions Centre The safer crack use kit program has overtaken the needle exchange program with 62% of clients accessing the fixed site program at Blood Ties solely for safer crack use kits. -- Patricia Bacon, Executive Director, Blood Ties Four Directions Centre

23. Challenges and Lessons Learned

24. Contact Us: Walter Cavalieri The Canadian Harm Reduction Network Email: Telephone: +1.416.928.0279 Toll Free: +1.800.728.1293 www.canadianharmreduction.com/project Walter Cavalieri The Canadian Harm Reduction Network Email: Telephone: +1.416.928.0279 Toll Free: +1.800.728.1293 www.canadianharmreduction.com/project Lynne Belle-Isle Canadian AIDS Society Email: lynneb@cdnaids.calynneb@cdnaids.ca Telephone: +1.613.230.3580 ext 126 Toll Free: +1.800.499.1986 www.cdnaids.ca/learning_from_each_other Lynne Belle-Isle Canadian AIDS Society Email: lynneb@cdnaids.calynneb@cdnaids.ca Telephone: +1.613.230.3580 ext 126 Toll Free: +1.800.499.1986 www.cdnaids.ca/learning_from_each_other

25. Acknowledgements Members of the National Advisory Committee Patricia Bacon, Blood Ties Four Directions Centre, Whitehorse, YT Mario Gagnon, Point de repères, Québec, QC Cindy MacIsaac, Direction 180, Halifax, NS Gillian Maxwell, Keeping the Door Open: Dialogues on Drug Use, Vancouver, BC Marjorie McNeill, Play It Safer Network, Flin Flon, MB Chantale Perron, Liaison Officer, Méta dAme, Montréal, QC Ryta Peschka, Oasis, Ottawa, ON Carol Romanow, Society Of Living Intravenous Drug Users (SOLID), Victoria, BC Christopher Smith, Toronto, ON Marliss Taylor, Streetworks, Edmonton, AB Focus Group participants, everyone who helped with the site visits, walkabouts and written material, and the contractors. Members of the National Advisory Committee Patricia Bacon, Blood Ties Four Directions Centre, Whitehorse, YT Mario Gagnon, Point de repères, Québec, QC Cindy MacIsaac, Direction 180, Halifax, NS Gillian Maxwell, Keeping the Door Open: Dialogues on Drug Use, Vancouver, BC Marjorie McNeill, Play It Safer Network, Flin Flon, MB Chantale Perron, Liaison Officer, Méta dAme, Montréal, QC Ryta Peschka, Oasis, Ottawa, ON Carol Romanow, Society Of Living Intravenous Drug Users (SOLID), Victoria, BC Christopher Smith, Toronto, ON Marliss Taylor, Streetworks, Edmonton, AB Focus Group participants, everyone who helped with the site visits, walkabouts and written material, and the contractors.

26. Thanks to our Funders This project has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada. Support for the work of a photojournalist in association with this project was provided by the Ontario HIV Treatment Network and an anonymous donor. This project has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada. Support for the work of a photojournalist in association with this project was provided by the Ontario HIV Treatment Network and an anonymous donor.