1. Working with SEPs: How do we expand Hepatitis Services ? Narelle Ellendon, RN HCV Director Harm Reduction Coalition, NYC ellendon@harmreduction.org ellendon@harmreduction.org www.harmreduction.org

2. Why work with SEPs?  Prevent the spread of any blood-borne infections, including HIV and Hep C  Make and maintain contact with active injectors outside of the health care system  Varied delivery, size, nature, populations, etc, etc, etc…

3. Why SEPs ???  It’s not just the Syringes, it’s not just the SEP.  Bridge to treatment and other services - HIV testing & counseling - Medical & Mental health services - Case Management - Housing - Food programs - Support groups

4. SEP Participants  Many IDUs not using SEPs  More then half acquire syringes from potential unsterile source  Nearly half report “sharing” syringes and other equipment  Generally participants of SEPs have been injecting for some time  Large number of IDUs already infected with HCV

5. HCV Prevention Attitudes  HCV infection is INEVITABLE  HCV infection is INCONSEQUENTIAL  HCV infection is INDETERMINATE

6. Limitations of SEPs to address HCV?  Lack of expertise & training  Competing Priorities  Lack of referral options for DU’s  Funding Limitations  Regulations on syringe provision  Police Harassment  Federal ban

7. Where to begin……  Assessment: - Participant - Staff - Program Evaluation not just for Data. Process of assessment needs to provide Education & Interventions.

8. Adding Hep C…. One size does NOT fit all…  Tailoring Program Strategic Plan to the SEP.  HCV Networking, (Motivation & Position)  Tailored Training, (SEP Staff, Other services)  Peer Education  Manuals & Curriculum  Materials

10. Awareness…

11. Adding Hep C….  Build on existing assessment tools  HCV Screening & Hep A/B Vaccs services  Linkages to care & treatment

12. Advocacy  Local & National forums to bring the focus on Hepatitis C & Drug  Coaching/Mentoring internal program advocacy  Community focus, African Americans & HCV  Pharmaceutical companies  Funding

13. IDUs more likely to not be infected with HIV or HCV if…..  Avoid situations that threaten safe injection: - withdrawal period - lack of syringes - high-risk contexts - institutionalization  Match equipment supply with drug supply  Maintain connection with community

14. Opportunities….  Validate & Share IDUs strategies to avoid HCV Infection.  Change syringe quotas  Tap into Social Networks, Peer Secondary Exchange  Police/Community Education  Address stigma of Drug Users using other services  Federal Ban on $ for SEP  Safer Injecting Facilities