Good practice examples
GERMANY – Fixpunkt
(mobile)-drug-consumption-facilitites; paid-peer-and-community-workers; cultural-diversity; advocacy-at-local-and-national-level;
TEST; LINK; LTA; PWUD+; PEER; MULTI;
Where – Services provided:
low-threshold drug services and counseling; distribution of needles and syringes, drop-in centres; outreach street work; mobile units, including mobile drug consumption facilities.
Who – Target groups:
people who use drugs (PWUD) or inject drugs (PWID); men having-sex-with-men (MSM); (undocumented) migrants; people experiencing homelessness.
How – Team composition:
Social workers; nurses; (migrant) peer workers; volunteers.
Fixpunkt e.V. is a harm reduction service established 1989 in Berlin, Germany, which provides large scale harm reduction services including needle/syringe distribution, counselling, a drop-in centre, a drug consumption room (DCR) and outreach activities, including a mobile DCR, and other services. Fixpunkt e.V. is a shareholder in Fixpunkt GmbH which runs two drop-in centres with integrated DCRs, low threshold employment and training facilities as well as community-oriented outreach activities.
Staff of Fixpunkt e.V. include community workers (peers) from Zambia, Kenya, Pakistan and Syria and from Russian- and Arabic-speaking minorities who utilise their special expertise, such as their cultural sensitivity, language and background. Fixpunkt e.V. also has a specialised community worker in support of men-who-have-sex-with-men (MSM) engaged in chemsex practices.
At the beginning of the 1990’s, Fixpunkt e.V. started their hepatitis-related activities which were included in an HIV prevention programme.
Awareness & Prevention
Fixpunkt e.V. has direct, informative communication with their clients as well as using typical harm reduction handout materials and pre- and post-test counseling (following a specific protocol). Team members are specially trained to explain the precautionary measures and risk of HCV during the time a client is using other services, such receiving sterile syringes or the DCR. Discussions start about HCV and the client is informed of how to protect themselves against it, including how to use drugs safely and, if necessary, where to seek medical care.
Besides written materials and internal team meetings, Fixpunkt e.V. arranges annual mandatory trainings on basic HCV literacy for their staff and a short, yet intensive, drug counselling course for newcomers.
Each Fixpunkt site occasionally organises special events such as highlighting short interventions, special hepatitis related issues, poster presentations and information materials, giving incentives and promoting messages.
They have also implemented pre- and post-test counseling by a counselor, nurse or medical doctor as well as a hygiene protocol for their staff and clients to prevent the transmission of blood-borne viruses.
At Fixpunkt, a person can get HIV, STI, Hepatitis B and C testing and Hepatitis A and B vaccination, rapid HCV diagnostic tests, venipuncture, RNA and HCV core antigen assay by qualified staff and supervised by a doctor and, if required, laboratory testing. Fibroscan elastography can be accessed externally and completely anonymously.
Staff can also get tested on-site for Hepatitis B and C and vaccinated against Hepatitis A and B which is regularly offered by a specialised occupational physician.
Treatment & Care
Since treatment in community settings is not currently allowed in Germany, Fixpunkt refers clients to external medical doctors specialised in infection and drug dependence medicine, depending on the situation. They offer disease self-management support, such as alcohol consumption and diet, etc. They have a good, close partnership within their network, including health care specialists and institutions, organisations, local authorities and other political and administrative bodies.
Additional resources are needed in order to meet demand, such as the possibility to enable treatment within their facilities.
A further challenge has been clients without health insurance. Fixpunkt e.V. has begun offering services to such clients and is also advocating for their access to treatment.
The most important challenge facing Fixpunkt e.V. is to gain specific approval to provide on-site services. A further challenge is to hire, train and support qualified staff because whilst they have the sufficient means, the majority of medical professionals have a negative attitude towards the provision of services for people who use drugs (PWUD).
Advocacy, Sustainability and Transferability
Fixpunkt e.V. is highly involved in advocacy activities at every level; from local health authorities to government representatives, mainly in Berlin, a city with a fast-track HCV AIDS elimination initiative.
They operate under the strategy and goals of the mayor of Berlin and strictly adhere to WHO guidelines. Thus, they have sufficient political and financial support and direct contact with high-level politicians responsible for health issues and who follow the impact of harm reduction services. They have agreements and development plans and are also directly accountable for their actions.
According to Fixpunkt e.V., success comes through strong political and administrative support, a clear strategy and a political framework under which the organisation can operate and function well. The organisation is stable and has a developed network to identify relevant stakeholders and to create the required impact as a common force.
Finally, to be effective, an organisation such as Fixpunkt e.V. requires a dedicated and committed staff.
c/o De Regenboog Groep
European Harm Reduction
1013 GE Amsterdam
tel. +31 20 570 7829
fax.+31 20 420 3528
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