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ID: 814

Type of submission: Oral

Conference track: Practice

Topics: Peer-Driven Treatment, Care and Harm Reduction

Presenting author: Evert Wisse

Presenting author biography:

Ernst learned Harm Reduction at field level in a Mobile MMT clinic in Paris. Since 2009 he has been working as a project manager or consultant for HR projects in Afghanistan, Iran, Vietnam, Libanon, Myanmar and France with organisations like Médecins du Monde and Doctors Without Borders.

Home-based peer-system to ensure basic Harm Reduction services in a context of armed conflict

Evert Wisse, Mélanie Quétier, Niklas Luhmann


In Kachin, northern state of Myanmar, an ongoing armed conflict is regularly blocking main access roads to certain areas. Security concerns regularly completely cut off areas where the international organization Médecins du Monde (MdM) is implementing outreach interventions.


Myanmar is the second producer of opium worldwide. Kachin has one of the highest burden of problematic drug use and related HIV prevalence among PWID records up to 47% (IBBS 2014). Within MdM’s cohort, HCV prevalence among PWID reaches up to 71.9% (2015).
Kachin hosts one of the longest ongoing conflicts worldwide. Since 1961, regular clashes disrupt daily life and since 2011, 100.000 people have been displaced due to the conflict.


MdM is providing Harm Reduction services in Kachin since 1996 and has currently 4 Drop-in-Centers and 4 methadone centers. One of the main components is the outreach activity that reaches yearly about 7.000 clients. This activity is far-reaching and certain areas require a night-over to access, particularly the conflict area.
In order to ensure access to essential Harm Reduction services like clean needle and syringes, MdM adapted its outreach with a home-based peer system. Selected peers are living in these affected areas and are self-governing their outreach activities. One-month supplies of clean syringes are kept in decentralized stocks, like in the peer private houses or local stores.

Discussion and outcomes

Despite regular communication and field visits, supervision and monitoring remains very challenging. In addition, without being clearly identified as an NGO worker, these peers are exposed to risk of misunderstanding of their activities by the local community and police.

During the previous armed clashes, two areas where unreachable for 2 months. MdM managed to continue basic syringe provision and an estimated 30.000 syringes where provided to more than 100 clients.