We define an integrated harm reduction service as a site or organisation that provides one or more ‘traditional’ harm reduction services
(such as opioid agonist therapy or a needle and syringe programme)
alongside other health and social services. In doing so, they ensure
that a wide range of services are available and accessible to their
Download the full briefing by clicking here.
Integrated services are better placed to treat people as people
clients as rounded individuals, rather than reducing them to ‘symptoms’
or ‘challenges’ encourages self-care and solidarity, and empowers them
to demand their rights.
- Collaboration in multidisciplinary teams can ensure that integrated services are complementary.
- Providing a space where people can simply exist in comfort and safety is just as important as formal health and social services.
- Holistic care and support can build self-worth, pride and solidarity, and combat the effects of stigma and discrimination.
Community leadership and involvement is transformational
leadership of peers eases the building of trusting relationships, and
ensures that people are treated as human beings not just patients.
in integrated services have a unique insight into the lives and
experiences of their clients, and can use that to provide compassionate
and non-judgemental services.
- Working closely with clients and community improves the range and quality of services you can offer.
a culturally safe environment for Indigenous communities makes services
more accessible and acceptable to people who may otherwise be
Integrating services makes them more accessible
- Service integration is about making services accessible and empowering people to use them, without pressure or obligation.
- Integrating services makes them easier for clients to navigate, and can support them to engage more effectively.
services understand the barriers their clients face when accessing
external services, and can ensure that clients are referred to the most
- Even complex services, like blood tests and
consultations, can be delivered in a way that places minimal burdens on
clients’ time and resources.
Integrated services can adapt to their environment
- Enabling political and legal environments support greater integration and accessibility.
services know their context and clients, and can make sure they have
access to the most relevant and safest commodities.
- Sometimes it
is necessary to recognise the limits of integration under one roof:
some services might be better delivered separately.
We looked at integrated harm reduction services in: Brazil, Australia, Nepal, Portugal, Kenya and Canada.
Peer treatment support workers from CAHMA feeding the community at an outreach site in Canberra. CAHMA peer treatment support workers engage with community in partnership with outreach primary health staff (doctor and nurse) from Directions Health Services to provide holistic care to our community where they live.
CAHMA Indigenous program The Connection provides pathways for Aboriginal community members to create art both as a means of community engagement and also to provide income from art exhibition and sales (100% income return to artists).
CAHMA and The Connection community members marching for the International Day for the Elimination of Violence Against Women 2020. This march closed CAHMA and The Connection’s 16 days of action to eliminate violence against women who use drugs funded by Women’s Harm Reduction International Network (WHIRN).
CAHMA and The Connection celebrating International Hepatitis Awareness Day in partnership with Hepatitis ACT. Community organisations coming together to provide the community a BBQ as well as art programs to increase awareness of viral hepatitis prevention and treatment.
Figure 1: Standing at the centre is MEWA’s addiction counsellor, supporting family psycho-education sessions for parents whose children are enrolled into methadone. This sessions are conducted on quarterly basis with family members as a pathway for family reunification and reintegration. Family provide the strongest pillar support for methadone maintenance program. Through this sessions parents and children have dialogues that have aid in healthy communication as a balance is strike on what is reality and what is ideal. The sessions are held outside Medically Assisted Therapy facility at King Fahad Hospital in Lamu County, Kenya. The cognitive mapping of the area helps family members to appreciate the process that their sibbling s go through with support from MEWA and health facility in dealing with opioid therapy treatment.
Fig 2: On the right is MEWA addiction counsellor engaging with a female drug users (FDUs) who is a sex worker within the street ‘alleys’ where sex work takes place. The addiction counsellor has decentralized risk reduction counselling and has one on one session with FDUs. Service decentralization as the street ‘alleys’ makes it possible for WWUDs to access health, harm reduction and rights services within their comfort zones. The decentralization model has enable MEWA to reach out to high volume clients with low threshold interventions.
Fig 4: The men with reflectors are paralegal, outreach worker and monitoring and evaluation officer visiting drug den to provide legal aid education to people who inject drugs (PWIDs). This site is one of the peddlers home where PWIDs converge to buy heroine and this is where PWIDs are easily reached. The monitoring and evaluation officer conduct field audit to verify the content shared and physical count of PWIDs.
You can also download the summary, the introduction or case studies separately by clicking on the links below.
HRI Integrated Services Briefing Summary
HRI Integrated Services Briefing Intro
Centro de Convivência É de Lei; São Paulo, Brazil
CAHMA (Canberra Alliance for Harm Minimisation and Advocacy; Canberra, Australia
SPARSHA Nepal (Society for Positive Atmosphere and Related Support to HIV and AIDS in Nepal); Lalitpur, Nepal
CRESCER, Lisbon, Portugal
Muslim Education and Welfare Associated (MEWA); Coast Province, Kenya
KONTAK, Montréal, Canada