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Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

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Page 1: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Outreach Programmes as a harm reduction

interventions in Cracow

Mr. Marek Zygadlo

Director of Monar Krakow, Poland

Page 2: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 3: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

MONAR Krakow Drugs Project was established in 1993

We have had:

1/ Out Patient Clinic for drug users and their families,

2/ Monar House – rehab center (therapeutic community model)

Page 4: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Out – Patient Clinic in Krakow

Page 5: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Monar House – 40 beds

Page 6: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 7: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 8: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Now we have

in Krakow also :

Page 9: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Detoxification Center – 15 beds

Page 10: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 11: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Shelter

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Page 13: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Hostel

Page 14: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

In 1995 Mr. Jean-Paul Grund –Director of IHRD - visited our project – with proposal of his support for the needles & syringes exchange (NEP) in Krakow

Page 15: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 16: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

In 1995 we sent two persons from our staff to Frankfurt for a site visit

Friends from „Drogen Hilfe” –Mr. Urban Veber & Mr. JoschStainmetz showed us their HR activities

Page 17: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 18: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

In 1996 we set up needle & syringes exchange program in Krakow „Planta Park”

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Before we started our work on the street we made:

1/ Training for street workers,

2/ Agreement with police

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Page 21: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

We made researches:

Really useful in our contacts with City Authorities

Page 22: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

“The needle & syringe life”

Page 23: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

The comparison of results the research

Q: Do you use somebody's needle or syringe ?

July 96

42%

58%sometimes

never

January '97

12%

88%

sometimes

never

Page 24: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

July '96

67%

33% More often

than once

Only once

January '97`

40%

60% More often

than once

Only once

Q: How many times you use the same needle?

Page 25: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

July '96

24%

76%

yes

no

January '97

9%

91%

yes

no

Q: Do another persons use from Your needle

and syringe ?

Page 26: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

July '96

P: Co robisz z brudna igla ?

97%

3% I throw out it

I keep to

exchangeJanuary '97

12%

88%

I throw out it

I keep to

exchange

Q: What do You do with dirty (used) needle?

Page 27: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Needles & Syringes Exchange

Programs

protect Local Community

Families

& IDU’s

before HIV and HCV infections

Page 28: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 29: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Mr. Dan Bigg from Chicago & Mr. Josch Steinmetz from Frankfurt made The Safer Injection GuideAnd Mr. Grzegorz Wodowski from Monar Krakow adopted it in to Polish context

Page 30: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Important question of the quality of life…

Slowly we understand – what HR is?

Page 31: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Work for people undergoing methadone treatment

Close to outreach work existingour Drop-in Center(it is a part of Krakow HR Center)We employing there Clients using methadone

Page 32: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

960Number of secondary exchanges

12.000Number of alcohol swabs handed out

7.500Number of injecting water handed out

2.600Number of condoms handed out

36.200 (59%)Number of collected used syringes

61.000Number of syringes handed out

48.500 (56%)Number of collected used needles

86.500 Number of needles handed out

17.000Number of contacts

800Number of clients

Methwork 2005-2006

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Page 34: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Any positive change makessense

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Page 36: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

HR principles

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Page 38: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

A Harm Reduction approach to the HIV epidemic threat or problem should include all activities among all target groups – undertaken with the aim of harm reduction or risk reduction for persons involved in risky behavior, their families and their community.

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Page 40: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

This is a philosophy and practical approach to problems, including HIV epidemics - for persons involved in risky behaviourand environments. It is based on several principles:

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Page 42: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

HR principles

1. Harm Reduction knows that abstention from risky behavior is not always the most important and most suitable manner of helping target groups.

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Page 44: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

HR principles

2. Harm Reduction helps in identifying situations in which the Client finds him or herself at present.

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Page 46: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

HR principles

3. Harm Reduction finds that

persons involved in risky

behavior can direct their own

behavior and can changethemselves as well.

Page 47: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 48: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

HR principles

4. Harm Reduction finds that some types of risky behavior are safer than others.

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Page 50: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

HR principles

5. Harm Reduction includes Clients in the creation of strategies and of methods of help for themselves.

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Page 52: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

HR principles

6. Harm Reduction takes into consideration the Client’s environment and circumstances, when planning the maximum benefit for the client, their family and community

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Page 54: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

HR in practice

Page 55: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 56: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

IV pillars of HR

Drug Education

Needle exchange (Outreach)

Substitution Treatment

HR Therapy

Page 57: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 58: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

HR Therapythis is new!

http://www.andrewtatarsky.com/publications/

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Page 60: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

outreach – work

Good space

to set up & keep

contact

with Clients

Page 61: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 62: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

IDU in any room = injection room

Page 63: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

INJECTION ROOM

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Equipment

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disinfections

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Service for Client

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Injection

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Cleaning

Page 84: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 85: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
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Page 91: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 92: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Before…

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Page 94: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Finally we see that:

If you do not know what to do ask to the Client,

If you are specialist –you will „Know – How”

Page 95: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland
Page 96: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Integrated approach

"The Integrated Approach ( IA)is the philosophy and practice of

help for drug addict persons,

which respect the patient’s rights

and needs, and admit that the patient and his therapist

Page 97: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

Integrated approach

- they decide together about range

and speed of a positive changes in

convictions, the attitudes and the

patient's behaviors.

The IA gives the same rights for Drug

Free and Harm Reduction solutions."

(Marek K. Zygadlo)

Page 98: Outreach Programmes as a harm reduction interventions in · Outreach Programmes as a harm reduction interventions in Cracow Mr. Marek Zygadlo Director of Monar Krakow, Poland

THANK YOU FOR YOUR KIND ATTENTION !


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