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Type of submission: Oral
Conference track: Research
Topics: Harm Reduction Services and Service Provision; Needle and Syringe Programmes
Presenting author: Susanna Ronconi
Background: The lack of political support and binding HR guidelines is the HR crucial problem in Italy. HR interventions have been provided since 1995, but in an intermittent, patchy and unstable manner. The lack of a clear political stance makes HR geography unequal. NSPs and HR interventions are not included in the list of health standard, guaranteed and free treatments (LEA), and are subjected to arbitrary local decisions. No political support means no routine monitoring, neither of outcomes, nor of investments.
Methods and Tools: the research has been carried out in the framework of HRI research “Harm Reduction Works!”, according to its design and methods. The HR services analyzed have been: OST, ART and NSPs. Because of the lack, fragmentation and low availability of data on national HR investments, data from different sources have been collected and compared, based on surveys and local HR services expenses, and estimates have been calculated.
Result: from 2010 to 2014, ART investments are (relatively) stable and clients coverage is high (86%), OST investments decreased but accordingly to people enrolled reduction (-32%), while pro capita expense increased (from 1.427 to 1.512 €) and coverage too (from 48% to 57%). On the contrary, HR services expense dramatically decreased: -20% of investments in 4 years, - 33% interventions/facilities, - 41% clients, coverage 15%.
Conclusion: it is necessary to promote innovation in two directions. 1) including HR services in LEA, becoming guarantee health performances all over the Country, besides regional different systems 2) appropriate financing: every Italian citizen spends 0,31 euros a year for NSP (2014), 18,69 euros for drug law enforcement, it would be enough to shift 1,76 euros from repression to health to reach a 100% NSP coverage