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Vietnam
October 2019 marked the start of a cutting edge new initiative. With the support of Open Society Foundation, Mainline and SCDI in Vietnam are building expertise to support people who use stimulant drugs. The core motivation to do so is the sharp rise in the use of crystal meth in the South Asian region and the lack of a coordinated harm reduction response.
Our shared ambition is to create a ‘field lab’: a learning hub where organisations from the region can experience in practice which interventions work for people who use ice.
Building blocks
In the past two years, Mainline and SCDI have already seriously invested in setting a basis for a regional learning hub. Mainline trained CBOs in Ho Chi Minh City in 2018 and in Hanoi in 2019 to design a harm reduction response focused on meth users.The work is inspired by Mainline’s work in Indonesia and seeks to include the best practices that we described in our 2018 Speed Limits research. Part of this exercise is also to ‘learn-by-doing’: the field of stimulant harm reduction is still a largely unexplored territory and particularly difficult in a context where there is no mental health system in place.
Concentrated training
To reach new depths in the stimulant harm reduction work, Open Society supports a concentrated training effort in Vietnam. Mainliner’s Nick and Simon work very closely with SCDI and local community-based organisations during the months of October and November 2019. During this time, an intense training course focuses on various interventions that can support meth users. They range from motivational interviewing to working on targeted IEC materials and from deciding on which commodities to provide to finding ways of attracting new people to services.
One of the interventions, described in the Speed Limit study, is the start of a ‘contemplation group’. Mainline’s South African partner Shaun Shelly will join the Mainline trainers for a week to set up such a group.
Community mental health response
Central to the training is mental health. People who use stimulants may encounter mental health problems, such as anxiety and panic attacks, depression, hallucinations as well as paranoia and psychosis. As there are very few psychologists and psychiatrists in Vietnam, the ambition is to enable field workers to provide an adequate first response. A set of very easy to implement interventions can help people with acute mental health problems.
Fieldworkers learn to distinguish between acute and more chronic mental health problems. For those service users who suffer from serious, chronic mental health symptoms, we are working on a referral system with the few psychiatrists and doctors in Hanoi who are working with meth users. We aim to lower the threshold for people to seek support as we slowly diminish the stigma associated with mental health issues.
Train-the-trainer
Train-the-trainer candidates Adam and Hien play a special role during the concentrated training. They assist in almost every training and help with role playing and translations. Their role is key, as we aim to start inviting groups from other cities and even other countries over to see the services first-hand in the first quarter of 2020. They would ideally have access to a unique training programme to ensure visitors can apply the Vietnamese experience in their hometown.
Check out the aftermovie of the program in Vietnam:
Evaluation
This project was evaluated at the end of 2020 by the Centre for Training and Research on Substance Use and HIV of the Hanoi Medical University. Please read more about this and find the evaluation here.
More information
Would you like to learn more about the stimulant field lab in Vietnam? Or are you interested in the trainings that underly this work?
Please reach out to our trainer Simon Williams at s.williams@mainline.nl.
Nepal
Mainline was asked to review the current harm reduction programmes in Nepal from the perspective of women who inject drugs. Based on interviews with women we formulated recommendations to improve service delivery.
Netherlands, Belgium, Spain, Greece, Germany, France
Several risk factors increase the vulnerability of (new) groups of migrants to engage in problematic drug use. These risk factors include traumatic experiences, disengagement with society, unemployment and poverty. Services and municipalities throughout the European Union are faced with the urgent challenge to address these migrants’ needs.
Burkina Faso, Burundi, Egypt, Kenya, Marocco, Mozambique, Nigeria, South Africa, Uganda, Zimbabwe
Mainline is a partner in the Love Alliance programme. The Love Alliance brings together organisations led by communities most affected by HIV and AIDS.
Vietnam
In 2021 and 2022, SCDI in Vietnam and Mainline can continue to strengthen and expand the available harm reduction offer for people who use meth-amphetamines. After establishing the regional field lab in 2019 and 2020 we now have the opportunity to push this innovative initiative to the next level. One important element: to improve and expand the community mental health response. Moreover, the skills that were built in Hanoi's field lab are ready to be further disseminated across the South East Asian Region.
United Kingdom, Finland, Greece, Estonia, Serbia, Portugal, the Netherlands
Harm reduction approaches are rarely applied in a recreational sports setting. And why would we - sport equals health, right? Not always. Research shows that the use of performance and image-enhancing drugs (PIEDs) is quite common in various recreational sport scenes. And for those people who use frequently and in high doses, harm reduction can make a big difference.
Brazil
Mainline is starting a two-year project in Recife, Brazil, together with LANPUD, and the Free School for Harm Reduction (ELRD). The project aims to expand harm reduction and HIV care and support for young people who use crack cocaine.
Global
The use of drugs during sex is a growing worldwide phenomenon among men who have sex with men (MSM). Mainline has built a unique track record while working in the frontline of the Dutch 'chemsex' scene. Now, we also apply this expertise in an international context.
Zimbabwe
Mainline have been asked to assess the drug scene in five provinces in Zimbabwe. A team of three researchers worked in close collaboration with the Zimbabwe Civil Liberties Drug Network throughout 2022. The goal: to gain an insight into which drugs are commonly used and to recommend health interventions.
Kenya
Women who use drugs in Kenya face violence every day: At home. On the streets. By the police. In their communities. A unique study - conducted in Mombasa, Kenya - sheds light on the tough realities these women encounter. Urgent action is needed.
Zambia
Harm reduction is new in Zambia. Mainline was asked to estimate how many people inject drugs in the country and to map the already existing harm reduction and HIV services for people who use drugs. Based on this information, we drafted practical service guidelines. In doing so, Mainline hopes to have contributed to the introduction of harm reduction in Zambia.
Indonesia
Prisons in Indonesia are overcrowded and health services are limited. Is quality prison health too expensive? Not according to findings from Atma Jaya University, who applied the method of 'economic modelling' to prison health services, including drug dependency programmes. The findings fed important advocacy messages to improve the prison system in 2021. Moreover, Atma Jaya - via a 2021 implementation study - succesfully introduced motivational interviewing into the prison setting: an evidence-based method to assist people who are dependent on drugs and would like to reduce or quit their drug use.
Iran
Iran is renowned for its harm reduction programme. It was one of the first countries in this geographical region to adopt a harm reduction approach. Government supports and funds the programme. But the drug scene in Iran has changed over the past 20 years. More people are using stimulant drugs and, due to economic circumstances, more people who use drugs have become homeless. Mainline sets out to see whether the current programme in Tehran still fits the needs of the local people who use drugs.
South Africa
Women Who Use Drugs face additional problems compared to their male counterparts. The harm reduction field far too often neglects the needs of women. To some extent, the same is true for peer workers: incredibly valuable staff in any impactful service. How can local services make sure that peer workers are valued, supported and living up to their full potential? And how can access for women who use drugs be improved?
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