From the Mountaintops-2011-Portugal-proof3.indd - Global Initiative ...

teams of social workers who work in the streets and in centers that provide methadone forpeople dependent on heroin and night shelters for homeless drug users.Ninety percent of these projects are carried out by NGOs funded by the state after winninga tender announced by the IDT. According to one IDT staff member, this solution waschosen because NGOs are more flexible than government agencies and have better accessto people in the streets. NGOs have also been found to be better than state agencies at establishingmutual trust between service providers and users. Although the state does not aimto punish users, a person still has to appear before a Dissuasion Commission and/or facea sanction. Therefore, government agencies, although they try to help drug users as muchas they can, can nevertheless arouse mistrust or at least hesitation among some drug users.This reality was verified during the daily rounds of social workers in places aroundLisbon where drug users gather. The social workers are well known to the drug users andtrusted by them, but on an occasion when they were accompanied by a researcher, therewas clearly a measure of distrust. Although the users agreed to talk to the researcher, theyexpressed concern to the social workers that the researcher may have been a plainclothespolice officer.The role of a street worker team, one of the most important activities of harm reduction,consists of a daily tour of places where drug users gather. A team of two or threepeople—one of whom has to have a professional background in psychology—gives out smallkits to drug users. The most important components in these kits are clean syringes andneedles for heroin-injecting users. The kit also contains hygiene agents, such as distilledwater, gauze, and a condom.In order to get a new kit, users have to give back used syringes and needles, whichthey tend to do. By prompting the return of used syringes and needles, the kit plays anadditional, vital public health function by helping prevent the spread of HIV and otherbloodborne diseases (such as hepatitis C) through injection drug use. 29Other important street outreach worker functions are to talk with drug users abouttheir history of dependence and inform them about treatment possibilities; mediate withtreatment centers; and, help engage the professional psychological and medical help neededto address the problems that have prompted the drug use. Heroin users are also informed29. Needle exchange is a well-documented intervention and is supported by major healthinstitutions, such as the World Health Organization and the National Institutes for Health(United States). In a recent review of needle exchange in Australia between 2000 and 2009, itwas estimated that around 27–31 million needles were given out, avoiding an estimated 32,050HIV infections. For every dollar spent, the government saved four dollars in short-term healthcare costs. See: National Centre in HIV Epidemiology and Clinical Research, Evaluating the CostEffectiveness of Needle and Syringe Programs in Australia, 2009.DRUG POLICY IN PORTUGAL 29