Alberta Harm Reduction Alberta Harm Reduction ConferenceConference

Keep Doing the Work: Just Keep Doing the Work: Just don’t call it Harm Reductiondon’t call it Harm Reduction

Greg Riehl RNJune 1st, 2011

Key MessagesKey Messages

Hopefully my journey and story will Hopefully my journey and story will give you an idea or two on how to give you an idea or two on how to

work with organizations who do not work with organizations who do not support Harm Reductionsupport Harm Reduction

Know what not to doKnow what not to do

• Conflict of InterestConflict of Interest• Gregory Andrew?Gregory Andrew?• Policy what policy?Policy what policy?• Exit Interviews – don’t go to high!!!Exit Interviews – don’t go to high!!!

• Those who oppose harm reduction are unlikely Those who oppose harm reduction are unlikely to change their views until they feel their fears to change their views until they feel their fears have been taken seriouslyhave been taken seriously

• False Evidence Appearing Real = FEARFalse Evidence Appearing Real = FEAR• Know which audience you are talking to Know which audience you are talking to

The journey beginsThe journey begins

Nursing Career -Nursing Career -

• 1991 – Student Nurse Infectious Diseases1991 – Student Nurse Infectious Diseases• 1994-2000 – First Nations on-reserve1994-2000 – First Nations on-reserve• 2004 Public Health Sexual Health Street Health2004 Public Health Sexual Health Street Health• ID ClinicID Clinic

• THE RELATIONSHIP BETWEEN HEPATITIS C VIRUS AND THE RELATIONSHIP BETWEEN HEPATITIS C VIRUS AND INJECTION DRUG USE IN SASKATOON STREET YOUTHINJECTION DRUG USE IN SASKATOON STREET YOUTH

• Egadz youth CentreEgadz youth Centre• The vanThe van

• HIV NurseHIV Nurse• HIV BBP STI TB CoordinatorHIV BBP STI TB Coordinator

Working for the Federal Working for the Federal GovernmentGovernment

Public Health Agency of Canadawww.publichealth.gc.ca

Summary of NACHA meeting October 2 and 3, 2005Regina, Saskatchewan

“Tanya reported that the Populations Section of the HIV/AIDS Division was looking for members of NACHA to provide comments on their draft Policy Framework on Harm Reduction and Drug Use. NACHA identified members to participate in the process.”

Nurses at the Forefront of Nurses at the Forefront of HIV/AIDS: Prevention, Care and HIV/AIDS: Prevention, Care and

TreatmentTreatment

• 2006 International AIDS Conference2006 International AIDS Conference

• Share your visionShare your vision

• Work with people with similar philosophiesWork with people with similar philosophies

• Don’t assume people have the same Don’t assume people have the same values.values.

Community Health Community Health NursingNursing

• Nurses are often the first point of contact in Nurses are often the first point of contact in caring for those who use illicit drugs and are caring for those who use illicit drugs and are at risk for contracting HIV/AIDSat risk for contracting HIV/AIDS

• Nurses have a Nurses have a duty duty to provide safe, to provide safe, competent, ethical carecompetent, ethical care

• Protect dignity and choiceProtect dignity and choice

• Enact social justiceEnact social justice CNA, 2007

CNACNA

• 20072007

CNA ResolutionCNA Resolution

CANACCANAC

SRNA Position Statement

• Promoting Equity through Harm Reduction In Nursing Practice

• February 2008

• Keep doing the work

Right to PlayRight to Play

• Need to be innovativeNeed to be innovative• Meet the needs of the population Meet the needs of the population

that you work withthat you work with• Give and takeGive and take• Find solutionsFind solutions• Need to find projects and action to Need to find projects and action to

keep moving forwardkeep moving forward

CANACCANAC

• 16th Annual CANAC 16th Annual CANAC ConferenceConference

• The Power if HIV Nursing: Context The Power if HIV Nursing: Context and Connectionsand Connections

• April 19 – 22, 2008, Ottawa, ON at April 19 – 22, 2008, Ottawa, ON at the Lord Elgin Hotelthe Lord Elgin Hotel

April 22, 2008 10:30 ETCanadian AIDS Care Nurses Voice Support for Harm Reduction

Harm reduction is part of Harm reduction is part of professional and ethical nursing professional and ethical nursing

standardsstandards

• OTTAWA, ONTARIO--(Marketwire - April 22, 2008) - Nurses caring for people with HIV/AIDS OTTAWA, ONTARIO--(Marketwire - April 22, 2008) - Nurses caring for people with HIV/AIDS have a professional obligation to promote the health and well-being of their patients, which have a professional obligation to promote the health and well-being of their patients, which includes supporting strategies that reduce harm to patients dealing with addictions, says includes supporting strategies that reduce harm to patients dealing with addictions, says the Canadian Association for Nurses in AIDS Care (CANAC).the Canadian Association for Nurses in AIDS Care (CANAC).

At the close of CANAC's eighth annual conference, held April 21 - 22 in Ottawa, the At the close of CANAC's eighth annual conference, held April 21 - 22 in Ottawa, the association is calling on municipal, provincial and federal governments to immediately association is calling on municipal, provincial and federal governments to immediately implement evidence-based harm reduction programs throughout the country and to implement evidence-based harm reduction programs throughout the country and to continue supporting those already operating.continue supporting those already operating.

"Nurses are concerned about the lack of support for essential harm reduction programs in "Nurses are concerned about the lack of support for essential harm reduction programs in Canada," says CANAC President Greg Riehl. "Harm reduction has been dropped from the Canada," says CANAC President Greg Riehl. "Harm reduction has been dropped from the current government's new 'Anti-drug Strategy', and many vital programs are being current government's new 'Anti-drug Strategy', and many vital programs are being threatened, including needle exchanges, the safer crack kit program in Ottawa, and the threatened, including needle exchanges, the safer crack kit program in Ottawa, and the supervised injection site (Insite) in Vancouver, despite research showing that these supervised injection site (Insite) in Vancouver, despite research showing that these programs work."programs work."

The City of Ottawa recently withdrew support for the city's safer crack kit program and is The City of Ottawa recently withdrew support for the city's safer crack kit program and is now considering imposing a restrictive one-for-one needle exchange policy.now considering imposing a restrictive one-for-one needle exchange policy.

"These actions represent a major step backwards," Riehl continues. "We need maximum - "These actions represent a major step backwards," Riehl continues. "We need maximum - not restricted - access to programs that prevent disease and suffering."not restricted - access to programs that prevent disease and suffering."

Put focus on addicts: Put focus on addicts: NursesNurses

• ““(Critics) should be taking two steps back and focusing on (Critics) should be taking two steps back and focusing on the homeless people trying to deal with their pain so the homeless people trying to deal with their pain so they’re using injection drugs,” said Greg Riehl, president of they’re using injection drugs,” said Greg Riehl, president of the Canadian Association for Nurses in AIDS Care (CANAC)the Canadian Association for Nurses in AIDS Care (CANAC)

• ““The needles are a symptom of what’s happening in The needles are a symptom of what’s happening in society.”society.”

• The association, closing its annual conference here, held a The association, closing its annual conference here, held a press conference yesterday in which it called on all levels of press conference yesterday in which it called on all levels of government — and for every day Canadians — to support government — and for every day Canadians — to support “harm reduction programs” that have come under fire “harm reduction programs” that have come under fire recently for dispensing free drug paraphernalia to addicts.recently for dispensing free drug paraphernalia to addicts.

Harper urged to extend Harper urged to extend drug injection site drug injection site

agreementagreement

• ““People who use drugs need to be People who use drugs need to be given options and those options given options and those options include harm reduction, and they also include harm reduction, and they also include treatment,” said Greg Riehl, include treatment,” said Greg Riehl, CANAC president.CANAC president.

• ““If we don’t have harm reduction, if If we don’t have harm reduction, if we don’t have Insite, those people will we don’t have Insite, those people will be dead. Dead people cannot enter be dead. Dead people cannot enter into treatment.”into treatment.”

HARM REDUCTION: A FIRST NATIONS APPROACH

Désirée 4th year NEPS StudentFirst Nations and Inuit Health

Health Canada – July 2008

Share knowledge, be a mentor, support learning

2008 International AIDS Conference2008 International AIDS Conference

Represent whenever and wherever you can

International Nurses'International Nurses'ForumForum

• Dedication and Action at the Dedication and Action at the Forefront of HIV/AIDS;Forefront of HIV/AIDS;

• Advances and Improved Advances and Improved Practices in HIV/AIDS Care: Practices in HIV/AIDS Care: CANAC‘s experience.CANAC‘s experience.

• August 2August 2ndnd, 2008, 2008Mentoring, partnership and Collaboration:Respect for Human Rights:Diversity:Participation and Empowerment:Integration:Accountability:Advocacy and leadership:

“There is nothing either good or bad butthinking makes it so”. (William Shakespeare)

SRNA - SRNA - The SRNA Podcast FeedThe SRNA Podcast FeedOOPS!!!!!OOPS!!!!!

• The Saskatchewan Registered Nurses' Association The Saskatchewan Registered Nurses' Association delivers timely information about the nursing delivers timely information about the nursing industry through regular video podcasts.industry through regular video podcasts.

• Harm Reduction Greg Riehl is the President Harm Reduction Greg Riehl is the President Canadian Association of Nurses involved in AIDS Canadian Association of Nurses involved in AIDS Care. Care.

• He is currently working with Health Canada as the He is currently working with Health Canada as the HIV/AIDS/Bloodborne Pathogens/Sexually HIV/AIDS/Bloodborne Pathogens/Sexually Transmitted Transmitted Infections Regional Coordinator Infections Regional Coordinator for Health Canada First Nations and Inuit Health for Health Canada First Nations and Inuit Health Programs Saskatchewan. Media files Programs Saskatchewan. Media files 2008_mar_19.mp4 (Movie Clip)2008_mar_19.mp4 (Movie Clip)

Back to Nursing for Back to Nursing for supportsupport

• Harm Reduction asks us to look at ourselves and how we offer services. As nurses, are we really Harm Reduction asks us to look at ourselves and how we offer services. As nurses, are we really open and accessible to those we want to reach? open and accessible to those we want to reach? The intention of Harm Reduction is to help people The intention of Harm Reduction is to help people make informed decisions and empower our clients to reduce the risk of HIV infection. make informed decisions and empower our clients to reduce the risk of HIV infection.

• The Code supports visionary nurses and the art of nursing is enhanced through ethical practice. We The Code supports visionary nurses and the art of nursing is enhanced through ethical practice. We need to focus on advocacy for our clients and staff and be able to use Harm Reduction models to need to focus on advocacy for our clients and staff and be able to use Harm Reduction models to guide our nursing practice. guide our nursing practice. Holistic approaches are required to address issues and factors that affect Holistic approaches are required to address issues and factors that affect HIV/AIDS programming, targeting not just the disease, but also the social determinants of health HIV/AIDS programming, targeting not just the disease, but also the social determinants of health and economic circumstances. Goodand economic circumstances. Good Harm Reduction programs strongly support the participation of Harm Reduction programs strongly support the participation of those living with HIV/AIDS in the process. those living with HIV/AIDS in the process.

• The Canadian Nurses Association’s The Canadian Nurses Association’s Code of Ethics for Registered NursesCode of Ethics for Registered Nurses is a statement of the is a statement of the ethical values of nurses and of nurses’ commitments to persons with health-care needs and persons ethical values of nurses and of nurses’ commitments to persons with health-care needs and persons receiving care. It is intended for nurses in all contexts and domains of nursing practice and at all receiving care. It is intended for nurses in all contexts and domains of nursing practice and at all levels of decision-making. It is for nurses by nurses. The Code assists nurses in practicing ethically levels of decision-making. It is for nurses by nurses. The Code assists nurses in practicing ethically and working through ethical challenges that arise in their practice with individuals, families, and working through ethical challenges that arise in their practice with individuals, families, communities and public health systems. Harm Reduction and the Code meet people where they are communities and public health systems. Harm Reduction and the Code meet people where they are at, improving the quality of people’s lives, especially the disadvantaged or vulnerable. at, improving the quality of people’s lives, especially the disadvantaged or vulnerable.

• Advocating for our clients is ethical nursing. Advocating for our clients is ethical nursing.

• http://www.cna-aiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdfhttp://www.cna-aiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdf

Restoring Balance through Harm Reduction

Sex, Health, Wellness and HIV

Monday November 24Monday November 24thth, 2008, 2008The Norwood HotelThe Norwood Hotel

Greg RiehlGreg RiehlCanadian Association of Nurses in Canadian Association of Nurses in AIDS CareAIDS Care

“Our lives begin to end the day we become

silent about the things that matter”

MLK

Get feedback from those in you Inner Circle

• Conflict of Interest - it does not help to speak publicly against your employer

• Policy? What Policy?

Hero, Victim, Villain?Hero, Victim, Villain?

Hero

VillainVictim

I am obviously not a CowboyI am obviously not a Cowboy

Who are you accountable Who are you accountable to? to? And who do you work for?And who do you work for?

It isn’t about the person.. . It isn’t about the person.. . ..

“Harm Addition”

Working from the inside

• Sometimes you are more effective working on the outside

• And by working on the outside keep your connections on the inside

• Keep current• Be an expert (or at least play an

expert on…)• Use the media

Educate yourself

• Harm Reduction can take many faces

• I researched a lot

• From HR philosophy, to religion, to policy, to science

• Get feedback from your people - Do you really want an ‘official policy’? Maybe not . . .

Morals can help Morale?

• Empirical Science Meets Moral Panic:• An Analysis of the Politics of Needle

Exchange• DAVID BUCHANAN, SUSAN SHAW, AMY FORD, and MERRILL

SINGER

• We need to speak with one voice, but this is difficult because we don’t speak with one voice

You need to be heard, or at least listened to.

• We need to speak with one voice, but this is difficult because we don’t speak with one voice

• Social media can be your friend, and it can be the friend of people opposed to Harm Reduction• Don’t stop

• Focusing strictly on empirical evidence has not worked so far.

• Don’t get caught in the trap of trying to prove Don’t get caught in the trap of trying to prove your point (over, & over & over, & over & over…)your point (over, & over & over, & over & over…)

The Duty to Provide Care

Perspectives of:

•The individual nurse•The employer•The nursing regulatory body

•And the state

I you can’t beat them – join I you can’t beat them – join them?them?

• Saskatchewan Ministry of Health Saskatchewan Ministry of Health 20092009• One more lesson to learn . . .One more lesson to learn . . .

• Harm Reduction Working Group – Harm Reduction Working Group – Building Capacity, Enhancing Building Capacity, Enhancing Capability, Engaging CommunityCapability, Engaging Community

• HIV work strengthens health HIV work strengthens health systemssystems

• A 6 month termA 6 month term

Leading Together CAS March 2010

Every 48 Hours: Every 48 Hours: Addressing Prairie Addressing Prairie

SyndemicsSyndemics

• Why is everyone talking about Why is everyone talking about Saskatchewan and what is so unique Saskatchewan and what is so unique about the epidemiology of this about the epidemiology of this province? province?

• Hear from an RN in Saskatchewan Hear from an RN in Saskatchewan how these numbers can help or hinder how these numbers can help or hinder communities, agencies and, most communities, agencies and, most importantly, people in the Prairies importantly, people in the Prairies living with HIV.living with HIV.

Keep your friends Keep your friends informedinformed

• http://news.nationalpost.com/2011/05/14/http://news.nationalpost.com/2011/05/14/the-expert-patient-who-knows-best-the-the-expert-patient-who-knows-best-the-doctor-or-the-patient/ doctor-or-the-patient/

• http://www.xtra.ca/public/Vancouver/http://www.xtra.ca/public/Vancouver/Activists_aim_to_rekindle_vigil_in_2012-Activists_aim_to_rekindle_vigil_in_2012-10144.aspx 10144.aspx

Saskatchewan Public Health Saskatchewan Public Health AssociationAssociation

Keep doing the work

• PHAC National Advisory Committee• U of T Male Call Canada• CPHA NPT Balkans• SPHA• AB HR Conference

• Find your passion

SummarySummary

• As a Registered Nurse, I care about my As a Registered Nurse, I care about my professionprofession

• As a citizen I care about peopleAs a citizen I care about people• We must support culturally competent care to We must support culturally competent care to

all people. all people. • Western culture tends to blame the victim.Western culture tends to blame the victim.• Harm reduction can improve the quality of Harm reduction can improve the quality of

people’s lives.people’s lives.• We are all faced with several risk factors, at We are all faced with several risk factors, at

one time or another, that puts us at risk for ... one time or another, that puts us at risk for ...

U 2 should try and be a rock star

Thank you

• gregriehl@sasktel.net

Thank you for your time

• Greg Riehl• gregriehl@sasktel.net

• I will post this presentation on www.slideshare.net

• Thanks again…