SCOPE: Study Trip from Association Xenon (Georgia) to Gaïa-Paris Association (France)

My name is Tedo Bigvava and I have been working on a harm reduction program for several years. It has been almost a year since I joined the association Xenon as a social worker. Before that, I worked for the Equality Movement implementing a harm reduction program for LGBTQ+ people. Association Xenon implements a harm reduction program for people who use drugs and their sexual partners in Samegrelo-Zemo Svaneti region, Georgia. We offer various services, such as Voluntary testing for HIV, hepatitis B, C, and syphilis; Counseling and information on health and legal issues (STI, HIV/AIDS, safer sex, drug overdose, etc.); Provision of sterile injection equipment to people who use drugs to reduce the harm caused by injection drug use; Hepatitis C treatment; the case management; psychological support and more.

The European AIDS Treatment Group announced a scholarship for a study visit within the framework of the SCOPE project.  Its purpose was to visit an organisation chosen by the candidate for 2 days to get to know their activities and services, and then adapt the relevant service to their own organisation. Within this project, I spent 2 days at the Gaïa-Paris association, which is located in Paris, France (as you might have guessed from the name of the organisation). Since 2006, Gaïa-Paris has been managing two medico-social institutions approved and funded by the Regional Health Agency, a reception and prevention care center in addictology and a reception, support, and risk reduction center for people who use drugs. We chose Gaïa because they work with the same key population as we do, and their services could therefore best inform ours. Some of our employees had also visited the facility several years ago and their positive feedback led us to choose the organisation and learn about its developments.

On the first day, I visited the head office directly, where Ms. Elisabeth Avril introduced me to the general activities of the organisation. The next activity was to go on a mobile ambulance to different locations in Paris. The Gaïa methane bus is an addiction care program, it offers easy access to opioid substitution treatments and medical and social follow-up adapted to the request of those receiving the services. The objective is not to stop consumption but rather to monitor the medical, social, and psychological risks associated with drug use. In Paris, unlike in Georgia, methadone is brought to different locations by the mobile outpatient clinic, which is convenient for service users, while in the region where I work, people from different cities have to go to one specific location.

Later that day, I visited the most memorable place for me, which is called LaboFabrik. LaboFabrik is a professional integration scheme that offers revitalisation and production workshops with individualised support. This project engages people in the creation, exhibition and sales of objects made of recycled materials. Sales and exhibitions are organised regularly to create social ties and to rehabilitate the user in their social role, as a responsible eco-citizen in an economic and supportive environment.

On the second day of my stay in Paris, I accompanied Gaïa colleagues in their outreach in two different locations and offered the organisation’s services to the service users. Outreach is carried out by one or two people together. When I followed, the service users turned away because they thought we were policemen, considering that we were 3 people moving together, and in Paris, police officers move in threes.

I spent the second half of the day in the “Addiction Care” centre, a place where people who use drugs are welcome to go. It offers the possibility for people in precarious situation who use drugs to consume in safer conditions than in urban gatherings, called “consumption scenes”. The centre serves a dual purpose: public health, by reducing transmission of HIV, hepatitis C, as well as the risk of overdose and consumption on the open scene; public tranquility, by minimizing the nuisances associated with drug use in urban areas and by promoting better living together in the neighborhood. The place is organised into three distinct spaces: Reception (waiting and interviews for inclusion in the system, who then become customers and can access services); Consumption (with twelve stations for injection); Rest (interviews with professionals and break after consumption. Including social and medical consultation offices).

It is very important that all preventions are combined, because a person is not only a biological being, nor does a substance user have only the challenge of taking a substance. Some key learnings from my study trip:

1. I clearly saw and learned how important it is to provide other services in combination with safe substance use in the prevention process. Especially if it concerns personal hygiene and rest – meeting the basic needs that a person may have.
2. When a person’s primary needs are met, mental health is also important. One of the ways I saw there was art therapy, which has a lot of loads, besides psychotherapy. It shows a person that they are doing necessary and important work because someone might be interested in their work, someone might pay for it, etc.
3. When a person receives services in an environment where they are comfortable and do not have to go somewhere separate, which can carry the risk of additional marginalization, this is very important. For example, a methadone vehicle travels to different locations and serves patients on the spot.

Ultimately, we, Association Xenon Employees see and agree that people need services that are important to their well-being and improving their quality of life. We need to reduce the stigma by raising awareness and understanding that exclusion and turning a blind eye to the problem is never the solution.

The visit was really fruitful and informative, giving me perspectives on different types of services and new ideas for my own organisation. After the visit, I really wanted to include more combined prevention in the organizational policy. Namely, I was thinking about creating an art therapy group. However, during the last 6 months, we have not been able to implement some of the services we have visited at Gaïa because of financial reasons as well as because of the Georgian legal context. For example, injecting rooms or mobile methadone clinics would be illegal. Nevertheless, since the visit we have been trying to reach more young people who use drugs. We also want to train young people who, in turn, will be spreaders of information and knowledge in society.

I was given the opportunity to spend two days at Gaïa – Paris association where I learned about the services, they offer to people who use drugs. Harm reduction services are important to minimise the spread of various infections (HIV/AIDS, C, B hepatitis), integrate beneficiaries into society and improve quality of life.

Tedo Bigvava

Social Worker

EATG’s SCOPE project aims to strengthen the skills and knowledge of community health workers, advocates and researchers in the field of HIV combination prevention. It focuses on communities that are inadequately served by policies and programmes.

About the study trips

The SCOPE project provided two individual study trips for community health workers and advocates involved in HIV combination prevention service delivery in the WHO European region to carry out individual site visits to local community-based/led organisations.

Study trips provided the opportunity for community health workers and advocates in the area of HIV prevention to:

• Learn from peers about innovative, inclusive, and integrated HIV prevention services that can be adapted to their local setting
• Establish and/or strengthen partnerships with a host organisation(s).

The SCOPE project has been developed by the EATG and was made possible through a grant from ViiV Healthcare Europe Ltd.