Nikolayev oblast, southern Ukraine: We stand by the little shop in the suburbs of the town, the wind almost blows us away and there is no place to hide from it. Outreach workers from a local NGO, supported by the Alliance Ukraine, hold on to a bag full of needles, syringes, condoms and informational materials to be provided to people who use drugs living in this area. We wait for one hour and it does not seem anybody will come at all; it is too cold and unpleasant to stay outside. An elderly man leaving the shop is interested in what we are doing here and is very surprised to hear from the outreach worker that “we help people who use drugs to stay healthy”. Suddenly a group of three men would come up to the outreach workers asking for a “boyan” (a slang word for a syringe). They exchange a couple of words, quickly take syringes for themselves and their friends and leave.
Mombasa, costal Kenya: The outreach takes place in the city centre, in a building partially destroyed by fire and there is a rubbish dump where the first floor used to be. There are representatives from different tribes and various parts of Kenya – both men and women, young and old. But people do not seem to notice the mess, they belong to this place, where they negotiate with each other, use drugs and sleep on the piles of smelly garbage. Outreach workers – partners of KANCO communicate with inhabitants of the area trying to explore their needs and to find out their attitude towards the needle exchange programme soon to be launched.
Kelantan State, northern Malaysia: Together with outreach workers from an organization supported by the Malaysian AIDS Council we go to a client’s house. This client is involved in secondary needle exchange and gets syringes from NGOs for himself and around ten of his friends. The host has a friend who came to inject together with him. His wife, children and neighbors are all happy to see the outreach workers. The wife says that in the beginning she was angry to see the outreach workers who would bring her husband syringes, because she thought they were supporting his drug use. But after she talked to the outreach workers and realised they want to protect her husband from getting an infection, she understood why they bring clean syringes and even calls them if her husband runs out of new ones.
These field notes are made in different settings at different times, but they illustrate the important role outreach workers play in harm reduction programmes. They are often the first to reach people who use drugs and they are the only ones who make a link between them and harm reduction services. Their role is important and responsible at the same time, but sadly in some of the organisations the outreach workers are considered to be “the lower grade staff” who do not receive enough support from the management. Of course, there are organisations that appreciate the outreach workers’ contribution and do their best to support them, build their capacity and reduce staff turnover.
In order to support outreach workers in their difficult job we have produced a new toolkit: Reaching drug users: A toolkit for outreach services. In the toolkit we share the experiences of organisations doing outreach work with people who use drugs in Ukraine, who have been pioneers in this field. It was developed in line with the International HIV/AIDS Alliance’s Good Practice Guide: HIV and Drug Use.