Working with SEPs: Working with SEPs: How do we expand How do we expand Hepatitis ServicesHepatitis Services ??

Narelle Ellendon, RNNarelle Ellendon, RNHCV DirectorHCV DirectorHarm Reduction Coalition, NYC Harm Reduction Coalition, NYC ellendon@harmreduction.orgellendon@harmreduction.orgwww.harmreduction.orgwww.harmreduction.org

Why work with SEPs?Why work with SEPs?

Prevent the spread of any blood-borne Prevent the spread of any blood-borne infections, including HIV and Hep Cinfections, including HIV and Hep C

Make and maintain contact with active Make and maintain contact with active injectors outside of the health care injectors outside of the health care systemsystem

Varied delivery, size, nature, populations, Varied delivery, size, nature, populations, etc, etc, etc…etc, etc, etc…

Why SEPs ???Why SEPs ???

It’s not just the Syringes, it’s not just the SEP.It’s not just the Syringes, it’s not just the SEP. Bridge to treatment and other servicesBridge to treatment and other services

- HIV testing & counseling- HIV testing & counseling

- Medical & Mental health services- Medical & Mental health services

- Case Management- Case Management

- Housing- Housing

- Food programs- Food programs

- Support groups- Support groups

SEP ParticipantsSEP Participants Many IDUs not using SEPsMany IDUs not using SEPs More then half acquire syringes from More then half acquire syringes from

potential unsterile sourcepotential unsterile source Nearly half report “sharing” syringes and Nearly half report “sharing” syringes and

other equipmentother equipment Generally participants of SEPs have been Generally participants of SEPs have been

injecting for some timeinjecting for some time Large number of IDUs already infected with Large number of IDUs already infected with

HCVHCV

HCV Prevention HCV Prevention AttitudesAttitudes

HCV infection is INEVITABLEHCV infection is INEVITABLE

HCV infection is HCV infection is INCONSEQUENTIALINCONSEQUENTIAL

HCV infection is HCV infection is INDETERMINATEINDETERMINATE

Limitations of SEPs to Limitations of SEPs to address HCV?address HCV?

Lack of expertise & trainingLack of expertise & training Competing PrioritiesCompeting Priorities Lack of referral options for DU’sLack of referral options for DU’s Funding LimitationsFunding Limitations Regulations on syringe provisionRegulations on syringe provision Police HarassmentPolice Harassment Federal banFederal ban

Where to begin……Where to begin……

Assessment:Assessment:- Participant- Participant- Staff- Staff- Program- Program

Evaluation not just for Data.Evaluation not just for Data.Process of assessment needs to provide Process of assessment needs to provide

Education & Interventions.Education & Interventions.

Adding Hep C….Adding Hep C….One size does NOT fit One size does NOT fit all…all…

Tailoring Program Strategic Plan to the Tailoring Program Strategic Plan to the SEP.SEP.

HCV Networking, (Motivation & Position)HCV Networking, (Motivation & Position) Tailored Training, (SEP Staff, Other Tailored Training, (SEP Staff, Other

services)services) Peer EducationPeer Education Manuals & CurriculumManuals & Curriculum MaterialsMaterials

Awareness…Awareness…

Adding Hep C….Adding Hep C….

Build on existing assessment toolsBuild on existing assessment tools HCV Screening & Hep A/B Vaccs HCV Screening & Hep A/B Vaccs

servicesservices Linkages to care & treatmentLinkages to care & treatment

AdvocacyAdvocacy

Local & National forums to bring the Local & National forums to bring the focus on Hepatitis C & Drug focus on Hepatitis C & Drug

Coaching/Mentoring internal program Coaching/Mentoring internal program advocacyadvocacy

Community focus, African Americans & Community focus, African Americans & HCVHCV

Pharmaceutical companiesPharmaceutical companies FundingFunding

IDUs more likely to not IDUs more likely to not be infected with HIV or be infected with HIV or HCV if…..HCV if…..

Avoid situations that threaten safe Avoid situations that threaten safe injection:injection:

- withdrawal period- withdrawal period- lack of syringes- lack of syringes- high-risk contexts- high-risk contexts- institutionalization- institutionalization

Match equipment supply with drug supplyMatch equipment supply with drug supply Maintain connection with communityMaintain connection with community

Opportunities…. Validate & Share IDUs strategies to avoid HCV Infection.Validate & Share IDUs strategies to avoid HCV Infection.

Change syringe quotasChange syringe quotas

Tap into Social Networks, Peer Secondary ExchangeTap into Social Networks, Peer Secondary Exchange

Police/Community EducationPolice/Community Education

Address stigma of Drug Users Address stigma of Drug Users using other servicesusing other services

Federal Ban on $ for SEPFederal Ban on $ for SEP

Safer Injecting FacilitiesSafer Injecting Facilities