 Well, well worth 35 hour of travel for those 12 minutes. Thank you, Dr. Born So I have a couple of questions My da so this morning when when we were speaking Before we got started you mentioned that some people have told you that your work isn't necessarily Harm reduction. What's your response to that? I Don't know how and maybe I don't know if I have to answer this question, but It's a second time I come to a harm reduction conference And I always feel like very marginalized because everyone is talking about like injected drugs Safe space to injection needle exchange programs, and I have no aid so I don't have like any expertise on this But I think harm reduction has to be taught in context and in the Brazilian context. We do not have a massive problem with injected drug and So we can maybe say that we don't have to do harm reduction in Brazil, but For me like personally and for my organization it was a shock when so I've been working a long time with human rights And my organization is working for more than 20 years with human rights And when we understood that we didn't look to people who use drugs for so many years It was like how could we so how? And it was possible to defend a positive agenda for human rights without looking for people who use drugs, so And I don't know if everyone is familiar with the Brazilian context, but we are like in very different situation We have like a very conservative Government right now It would be impossible to have a representative from the Health Minister in a harm reduction conference in Brazil nowadays And we have a really strong church Conservative church power political power that don't that is clearly against harm reduction so And we have been having a hard time to even speak about human rights in Brazil, so I think so we are in the step where we have to Defend an agenda for human right and really trying to every To put people who use drug in the agenda of every Organization that works with human rights in Brazil, so we are like in a really different moment and Different context. I think I do harm reduction So Adam You know you talked a lot about The data that shows the prevalence of drug use among LGBT populations, and I'm curious if you could Dig down or drill down a little deeper about why there is such a high prevalence of drug use Sure The easy answer is there's no easy answer There are kind of three or four main hypotheses that are put forward each have their own flaws So I'm not going to advocate strongly for any one of them The first is a it's kind of what's often referred to as a social geographies hypothesis it's the kind of idea that LGBT people through the the fact that they're often Marginalized through the fact that they're a minority population They have to gather in physical spaces where they feel safe like they congregate in particular social Geographical areas and typically that's been the gay scene. It's been the gay bars and clubs In various towns and cities and those are bars and clubs that serve alcohol and where and drugs are often commonly available and that is the reality of a lot of social interaction for LGBT people in a way that it isn't Necessarily for heterosexual people and you can meet It's very easy to meet another straight person on the bus in work in the elevator in everyday life LGBT people are two or three percent of the population. It's a very different environment So we're kind of not forced to but we congregate in settings which Tend to you to where alcohol is served and I say where drugs are often present kind of one explanation the second is that Drugs are more normalized within the population of LGBT people. So the kind of normalization hypothesis and It's a little bit complicated because the same could be true of any different and all sorts of different geographical areas or Populations that may the there are varying degrees of norms around drug use and Toby Lee and if Toby's here Also from one of my colleagues from Australia is giving a talk in the next session the key population sessions that challenges Some of that normalization hypothesis And the third is the what's called the minority stress theory Which is applied to multiple populations minority populations In relation to where they experience health inequality and it essentially says that You know people who are of a minority group they experience stress from a variety of different ways in their everyday life They experience stigma and discrimination from their families their communities that kind of broader social systems That may be very acute But it may be more low level that kind of chips away at you every day and as a consequence of that you look for Kind of support or coping within with substances to kind of mitigate and manage Your reaction to those everyday stresses each of those none of those is perfect But I think there's still it's only been in the last few years We've really started to understand better that difference in prevalence and now we're really starting to drill down into More detail why that might be occurring but thus far those are the kind of three main arguments Thank you So we want to open the floor to the audience There I'm assuming folks have microphones. Do folks have microphones? Do any of the volunteers have perfect so anyone in the audience have a question if for the panel They answered everything. Oh Dr. Small Right over here right over here in the front Wonderful presentation My question is for Marie. I got a chance to visit one of the Crack-a-landias the one in Sao Paulo and It was amazing to me to see that kind of harm reduction in action It was so different than the sort of Pseudo portrayal that we saw on TV in the wire of what it would look like to create a space for it. It was completely Affirming of people and when I asked the service workers if how they dealt with Any incidents of violence or anger among the population? They told me that they had never had any of that happen that when people were upset they didn't come to the space and I just want to one Thank you for providing an opportunity for those of us in places like the US to see a Possibility of real harm reduction for a population that doesn't get served well in our country at all and to Affirm that you are doing harm reduction in the best way and in a way that affirms human rights and to tell you how sorry I am about the political changes in your country that have resulted in the decimation of so many of those programs and To also lift up the role of racism Because I think that it's important to note that the majority of the people that you serve and that are being Marginalized and attacked also happen to be black and that they don't represent You know the majority of drug users of Brazil. It's the marginalized drug users. So I just want to thank you so much for what you do The other questions I'm here at the mic. I don't know if you can see me. Thank you. Yes. Thank you I have a question for Adam and It's where are the stories? I haven't seen it at this conference at all the stories of gay and lesbian women and bisexual women and the analysis of both drug use but generally substance use either in the data Which you've articulated is potentially missing, but where are their stories? That's a tremendously good question One thing I didn't say in the opening Section was that I was reliant really in making this presentation and drawing Pretty exclusively on data relating to gay men because that is pretty much the only data source that exists There are a handful of community surveys that talk about Substance use among lesbian and bisexual women But they have been marginalized at a global level in this kind of in research and If I would to be cynical I would say that's because I mean most of the research that exists on gay men exists because of HIV as I said and Because lesbian and bisexual women aren't affected by HIV in quite the same way They haven't received that kind of attention relating to their drug use because we have been so fixated in Seeing all aspects of LGBT through a prism of HIV. I think lesbian and bisexual women have then kind of been sidelined I think that needs to change There are a kind of growing number of surveys that are documenting those differences and it's great to see more Countries desegregating their data it prompts more social researchers to ask those Qualitative questions about how their drug use is occurring settings the spaces it's occurring in and their particular Harm reduction needs but right now. It's just really not there in quite the same way, so I Completely agree with you. Thank you Other questions Hi My name is Morgan Shalifu. I just wanted to start off by saying you it was all wonderful to all the speakers But my question is and just my comment is for the fellow at the end there. I'm from Edmonton, Alberta I work for a program called healthy empowered resilience and With our program we work with pregnant women that use substances or just have falling through the cracks a lot of our moms are Indigenous and so for us, I guess my question and I guess maybe if I could just connect with you afterwards I'd love to ask just a few more questions, but What are some of the have you encountered a lot of pregnant women throughout your Education and throughout your experiences going through these communities and what worked best with connecting with them? Thank you for the question I Do have the all right used to have the advantage of traveling around and visiting different aid service organizations and getting to getting First-hand experience from the women like they're telling me how these programs are working for them Yes Most of the women that I've met are not pregnant at the time that I meet them But many of them have children and many of them I hear you know have children after I've met them So, you know, it's a process. It's only nine months while they're pregnant But so yes, those women are Some of them do use through pregnancy. Some of them don't they take breaks, you know how it is It's everyone's different, but there are models like there's from the BC Center of Disease Control They have a program called Chima Muck and maybe you've heard of it But they they'd make a lot of resources for indigenous people and they have one called around the kitchen table And it's it's for women to talk about HIV talk about drug use talk about Risk-taking and just in a women's environment where it's it's women supporting women So there's and it's been shown to have very very good results. That that's one example another another example I could use is a visioning health study where It's led by an indigenous researcher and a non-indigenous researcher and a partnership and what they do is they they give women living with with HIV in this case Cameras and they go out and take photographs and produce the photographs and then they describe Their experience living with HIV or being at risk for HIV through the photograph and the kind of data that we're getting is so robust And so much more full because they're able to be creative and and and they don't have to fit into somebody else's model And here's here's how you do it first you sign your name and then you you can go talk to that person And then you can tell your story and do an intake sheet. It's not not like that Here's a camera go make some art make something beautiful and tell us what's coming from your heart and and the kind of data That we're receiving is is is is usable in order to change policy and programming So those are two examples, but I look forward to talking to you after the after the panel Thank you so much. That was awesome. Hi Mike comment Question is also for Trevor as well. I am a mental health and addictions worker in Sioux look at Ontario So I work with 33 of the northern communities And I just was wondering might be a silly question. What kind of advice you would have for Advocating for harm reduction with some of the bound councils that some are really really receptive to it And some aren't so receptive to it. So if you have any advice, that would be great Are you from the Sioux Sioux lookout Tribal Council? No, I work in the Maniawan Hospital Okay, because a Sioux lookout actually that they are doing incredible work with harm reduction and for for our first nations for on reserve They are leaders. I can tell you they are leaders in in the country That the kind of work they're doing should be used should be adapted into other tribal councils and into other You know because that's where it has to go first into Chief and council our governance structures They're the ones that have to get on board to change, you know make a band council resolution or a policy That supports the people that a lot of our people want to do the work But they we don't have those policies in place and that's why community Mobilization is so important where you get someone from a lack from someone who's elected from governance someone from the education sector Some of our health workers and maybe professional doctors coaches Community people so that we have community mobilization as the whole community because the pieces of the community these different sectors have different information They and when they get together they go really people are turning in safer crack use kits at the nursing station The teacher didn't know that the chief and council didn't know that so the model that they have I would say you're in the right place I would I would really follow their example and encourage them To come to conferences like this and share their models because they are really You're very lucky to be that close to where they are Thank you Thank you before we move on to the next question. I have one for Yati and now to this morning you you mentioned that Malaysia is actually The the lead of the Philippines what is happening in the Philippines under Duterte's Presidency, how is that playing out in your country? These are very good questions Let me answer the question honestly from my heart as a drug user if ever there's a Malaysian delegates here Reports me to the policemen in Malaysia. I'll be sentenced to compulsory rehab center for two years and Then two years in probation With urine test and if I was found Positive any of the drugs I'll be sentenced again to jail for three years I'm I must be lucky because I'm a woman, but if I'm a man I Will get three Slash three lashes of King in the prison just because I use drugs I Believe that the Asian Summit war on drug declaration is Influencing all the neighborhood country Where recently the our national anti-drug agency is implementing the hashtag war on drug until it finished That is their hashtags and the police were doing the hashtag Holy war on drugs. I Personally think that it's not working, but Now it's not the time for us to blame and shame each other We need to work together. They must understand us as a drug user how we can be productive as a drug user and we can also entertain them with Referring the clients to ART or OST by removing the fear toward the national anti-drug agency We have time for one more question I saw here. Yeah This is addressing the question of lesbian Drug use and infection risk You know, there's a real shortage of such work in places saying like Malaysia for sure but in some of the wealthier Countries and the you know the English speaking countries There's actually been maybe more research than people think some of it may be old but for example, we had an Institute of medicine lesbian health report in the late 90s that Gave some of these kinds of data the other thing is that a lot of the studies that look at drug users in the United States and some other countries Including Australia have on occasion asked about Either a lesbian identity or women who have sex with women and They have found greater drug use on a wide range of drug uses There's a number of them have found enormously higher HIV risk comparable only to those of gay men and Scattered evidence on a wide range of STIs and Hepatitis B and we're about to come out with an article soon when we get it written showing that among young opioid users in New York who Have been injecting drugs. They're more likely to be infected with hepatitis C and we will be analyzing the Overdose experience of people who survived overdose with this set of things in addition You know, it can be done with the data on a lot of us who are researchers here have Collected if you thought to ask that question and you might and it's important that people do so I think Thank you, Sam So I wanted to end the plenary I'm reading this book Emergent strategy it's by Adrienne Marie Brown who is a Really wonderful healer. She's also a former staff member of the harm reduction coalition and I've been working with her in a few different ways And as I was thinking about the conference and the conference theme right at the heart of the response there were Some things that Adrienne wrote some observations. She made that I thought were particularly relevant So if you would indulge me One thing she says she's observed is that when we are engaged in acts of love We humans are at our best and most resilient The love and romance that makes us want to be better people The love of children that makes us change our whole lives to meet their needs The love of family that makes us drop everything to take care of them and the love of community that makes us work tirelessly with broken hearts If love were the central practice of a new generation of organizers and spiritual leaders It would have a massive impact on what was considered organizing If the goal was to increase love rather than winning or dominating a constant opponent I think we could actually imagine liberation from constant oppression When we would suddenly see be seeing everything we do Everyone we meet not through the tactical eyes of war, but through eyes of love We would see that there's no such thing as a blank canvas or an empty land or a new idea But everywhere there is complex ancient and Fertile ground full of potential We would organize with the perspective that there is wisdom and experience an amazing story in the communities We love and instead of starting up new ideas and new new organizations all the time We would want to listen support collaborate merge and grow through fusion not competition and Lastly we would understand that the strength of our movement is in the strength of relationships Which could only be measured by their depth Scaling up mean would mean going deeper being more vulnerable and more empathetic and on that note I'll leave you To enjoy the rest of the conference. Thanks everyone