Background
Despite multiple Harm Reduction (HR) programs worldwide, there are still an important number of people who use drugs (PWUD) who do not access those services. Their difficulties to obtain HR tools are due to their inability to reach such services (remoteness and/or limited customer service hours), costs, quantitative restrictions, fear of judgment, lack of confidentiality in pharmacy and unfamiliarity with HR programs. We tested an innovative approach using the power of remote online communication and the national postal distribution network to improve HR tools access and counselling.
Methods
Based on these observations, SAFE association created HaRePo in 2011, a free and confidential program designed for people who have difficulties accessing HR tools and counselling. PWUD can access the program by phone and/or email. An HR professional answers any questions, delivers HR counselling, and connects the PWUD to other HR services, medical, and social workers. HR tools are prepared and sent according to the person’s needs through the French postal service to users across Metropolitan France and overseas territories.
Results
Since 2011, 1920 PWUD have benefited from HaRePo: 10,450 parcels were sent accounting for more than 1.7 million syringes and 6 million HR related items. HaRePo receives positive feedback from PWUD who have improved their practices through remote but trusted communication. The percentage of people that, after joining the program, never reuse and/or share HR tools have significantly increased. On average 71.5% of beneficiaries never reuse syringes and 81% do not reuse needles. And they are 98.5% users who never share syringes and 99% needles any longer. Between 44% and 80% HaRePo beneficiaries have reported that their drug-related practices (injection, inhalation and snorting) are now safer. Finally, between 39% and 53% HaRePo users declared that their overall physical state has improved (e.g., venous condition, the appearance of point of injection, swelling of arms, legs, and hands).
Conclusion
HaRePo is an innovative HR program efficient for hard-to-reach PWUD. It shows evidence of a positive feedback loop for PWUD in improving their practices. Finally, HaRePo represents a clear benefit for health authorities in France, who decided to expand the program in 2016.