Innovative practices in harm reduction outreach teams in the city of Lisbon

CRESCER Association have outreach teams since 2002, based in Harm Reduction philosophy, that privilege the relationship established with people who use psychoactive substances (PS). The goal is to accompany people who use PS and who are in extreme vulnerable situation.

The outreach teams work daily in the main neighborhoods of consumption and traffic of Lisbon, following 1400 people for year. The main activities are the exchange and distribution of prevention and aseptic material; collect syringes found on the ground; education for consumption and sexual practices with lower risks; social and psychological support; and medical and nursing evaluation and care.
Complementing the technical work, the outreach teams bet on peers integration, valuing their experience and knowledge, in order to promote their professionalization and enrich the multidisciplinary of the Teams. It is part of our philosophy to use the target population as stakeholders. To do this, we invite the peers to attend conferences and meetings, as well as be part of awareness raising actions or new projects, planning and implementing them. For example, to submit a proposal for a supervised drug consumption room, we asked the people who use PS, which services should be included, the best opening hours and the best location. To order the aseptic material, we ask what they prefer, and to contribute to the free time occupation, the peers start garrote construction made with reusable materials (tire chambers). The aim was promote belonging feelings to innovative projects.
When the team is not on the field, there are peers responsible for the exchange and distribution of aseptic consumption material, and this is a fundamental action on the promotion the individual and public health.
The teams begin to screenings hepatitis C virus, ensuring a comprehensive strategy by establishing partnerships with hospitals. After a reactive result, we go with the person to the hospital to do all the medical exams in the same day. When is necessary to take medication, the hospital gives it to our teams, so we can administrate it. As part of this activity, training was given to peers who are in the places of consumption on a daily basis, in order to plan and carry out on-the-spot tracing actions, involving a greater number of people who consume PS.
In order to improve the health and living conditions of consumers, the teams also do advocacy, in particular on matters related to: the availability of naloxone in the field; harm reduction alternative housing and health responses for people who use drugs and alcohol; and supervised drug consumption room.

For this, we used several qualitative and quantitative methodologies, such as meetings, interviews, questionnaires, focus group and observation.

In 2017 the outreach teams contacted 1400 people. We distributed 44737 syringes, 52721 condoms, 415 kits of pipes and 7422 aluminum foil. We performed 180 social referrals and 379 health referrals. We promoted 1728 information actions, awareness and education. We involve 50 pairs in intern and extern activities to the Association. We believe that in addition to the activities carried out by the Teams, the participation and inclusion of peers, the Advocacy done in themes related to innovative responses in harm reduction, have been an added value in improving the living conditions of consumers with health impact public and individual.