Across the great divide

Contemplating a landscape of change and fear, HIT Hot Topics speakers called for solidarity. DDN reports.

‘When we meet someone, we ask what music they listen to – it gives us a mirror we can understand. We start to apply labels “us and them” as soon as we start to talk that language.’ Talking at the recent Hit Hot Topics conference, epidemiologist Keith Sabin suggested that we being to categorise and stigmatise without even realising it.

Even the researchers were part of the problem. ‘We put people in a box and say “these people are higher risk”. It’s a dichotomy that doesn’t need to exist. We have to overcome this language, because language becomes a perception.’

With Donald Trump’s election victory newly sinking in, the threat of division and alienation felt raw to many of the speakers and delegates.

‘The war on drugs is an efficient and effective umbrella for genocide,’ said US activist Deborah Peterson Small. ‘The goal is to eliminate people, and what’s happening in the Philippines is the logical extension. It’s not just the actions of a mad man – it’s happening all over the world… if you think Duterte is an aberration, think again. Read your history – all the conditions before World War Two are in place now.’

Furthermore, she said, the media talked about ‘this stuff’ as if it was normal. ‘But Trump and his hostility to drugs and drug policy is no joke.’

So what do we do to stop this slide into the abyss? Neuroscientist Dr Carl Hart drew a positive from the shock election result.

‘The progressives fell asleep under the Obama administration… maybe now they’ll wake up!’ he said. ‘We claimed victories for things that weren’t victories. You know the score with Trump. It’s best to know the score than to hear pretty lies. Go to work!’

For many of the speakers, the challenges were very clear. Magdalena Harris, qualitative sociologist at the London School of Hygiene and Tropical Medicine, brought scrutiny to the complicated scenario of hepatitis C treatment.

For the 216,000 people living with chronic hepatitis C in the UK, the revolutionary new treatment was giving them the opportunity of a 90 to 100 per cent cure rate, without the former gruelling side effects. Being able to dispense the treatment in community drug treatment settings conjured up the vision of eliminating hepatitis C in a generation.

But restricted budgets, and a list price of around £35,000 per person per course (although the price to the NHS was confidential), meant that NHS England had limited treatment slots to 10,000 a year. The 22 local area networks had just 50 slots each a month, so were having to prioritise patients with the greatest clinical need, such as those with cirrhosis.

People who inject drugs came high up on the priority list – but only because they were seen as at risk of transmitting the virus, Harris explained. ‘They are being called transmitters and tracked like salmon. This language can be very alienating.’

While reducing mortality and onward transmission were clear criteria, Harris was also concerned that other life transforming benefits of treatment were not being acknowledged, such as the change to identity and the social benefits. It was easy to lose the full picture when looking at statistics and ranking greatest clinical need.

Faye McCrory, a recently retired consultant midwife, said we should cast the net wide for the full picture.

‘What has a midwife to do with drug services?’ she said, before answering ‘Drug misuse does not sit in isolation.’ Her challenge while working at a specialist midwifery service was to get staff to treat patients ‘as women, not as drug users and prostitutes’.

Many taboos had had an impact on these women – sexual abuse, child sexual exploitation, human trafficking, sharing information, safeguarding and child protection – and there were many ethical and moral dilemmas that meant health professionals should listen without prejudice.

Researcher Aaron Goodman also had an interesting view on challenging stereotypes, presenting his digital storytelling initiative, Story Turns ( Working with people who used heroin, he involved them in workshops to make a short video telling their personal story. Instead of the ‘dark, seedy, anonymous’ portrayal of drug users, the project resulted in ‘humanising’ stories and images – the message that (in the words of one participant) ‘there’s more to me than addiction’.

Psychologist Dr Suzi Gage shared another imaginative initiative, the ‘Say why to drugs?’ project, which uses podcasts to look at the harms and the potential benefits of drugs, with ‘no judgement, no spin and no hyperbole’. Her first series, in conversation with rapper Scroobius Pip, took the conversation to young people and aimed to take them into territory where they could ask questions and build up a full and fair picture of drugs and people who use them.

The theme of changing the narrative continued, from both a UK and international perspective. Michael Shiner from the London School of Economics focused on disproportionate policing, particularly stop and search, which had ‘engulfed policing since 1980’ and intensified since the Stephen Lawrence inquiry gave police ‘more power with less accountability’.

He explained that he was part of an organisation called Stop Watch, which was trying to change the narrative around stop and search, including tackling the ‘massive disproportionality in relation to drugs’.

Maria Phelan of Harm Reduction International (HRI) widened the view to the global state of harm reduction. While there had been progress on opioid substitution therapy (OST) in Monaco, Senegal and Kenya, funding cuts – and in some cases the lack of momentum to prioritise harm reduction – had scaled down progress in many countries.

Referring to HRI’s latest biennial report, she highlighted that harm reduction in prisons ‘lies far behind what’s available in the community’, with several programmes closing since the last report and Spain being ‘the only country that has anything up to scale’.

While Europe was seen as the ‘leader of a harm reduction approach’, there had been a decrease in needle and syringe programmes in the last two years, including in Portugal – the result of its financial crisis. Hepatitis C among injecting drug users remained a serious concern.

‘There has been growth, but not fast enough,’ she said. ‘The biggest question is how do we get countries to invest and sustain funding? It’s about protecting the gains we’ve made.’

In a talk about supervised injecting facilities, the Scottish Drugs Forum’s Kirsten Horsburgh suggested that doubts about their advantages tended to relate to lack of knowledge. When presented with clear benefits (from the results of 135 research projects) and ‘myth busting’ facts, most people were persuaded that providing a sterile environment was beneficial all round and did not perpetuate drug use.

Sharing this kind of research and information was of great benefit to drug users – the ‘popular scapegoats’, according to Mat Southwell of the European Network of People who use Drugs (EuroNPUD).

‘Drug user organising is no longer seen as separate, marginalised work,’ he said. ‘Europe has a strong network of drug user activists and we realised there was a need to get our act together and mobilise… We need to seize the opportunity to be active partners – we are high level advocates and technical providers.’

Looking at developing joint advocacy plans with other networks and running simultaneous campaigns would ‘help to create more noise’ and move towards meaningful representation with government and the EU.

But above all, the close working and information-sharing had the potential of much greater results – a key message from this year’s Hot Topics.‘We are committed to solidarity,’ he said. ‘Changes can’t happen in isolation.’

Picture credit: Nigel Brunsdon.
Pics in DDN magazine by Nigel Brunsdon and Craig Hardy.

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