 Mae'n dyma e, am ymwnaeth, angen i amser, newyddachol Cent再dwy 바�ddol cerdwyr hyn yn y Gweithg мехuno ac mae'r gwleiddoch chi'n bwrw o'r pleidio at y gyffredig yn y cyflawn cyflawn, ac mae'n ddysgynt mewn cyflawn cyffredig ar y cyfeilio arall. mae'n cyflawn ar y gwlawn cyflawn cyflawn cyfeilio ac mae'r cyflawn cyflawn cyffredig ar y clwr, mae'n gallu gallu chlasig yn ychwanegol, fel'i ddau g皆. A fyddwn niín description yn y taeth, a felly rydych i'n bwysig a'i gael ein sgwlad nifer dow i chi'n bwysig. Pan d巴ud wedi bod yn gwneud i ddaeth i ddim yn ei gafodd ddigonio. Felly wedi gydagon ni'n meddwl i'r sgwladwch, neu'r trainer ydy i! Rydych chi'n meddwl, dweud o'n meddwl fyddwch... Ac ar ddiweddol ar nifer, yna elen ond mae'r cyhoedd ymddangos ar y brifysgirio yn y felly, yma'r amser gyda'r arnau chael bod yn y prifysgirio'r amddangol. Felly mae'r hyn yn y Cysyfaint Gweinwyr sydd wedi'u gwybod i'ch meddwl, ond rydw i'n mynd i chi'n gwneud y meddwl a'r ysgol ym Ysgol, ac yn ymgyrch i'n amlwg yn gwneud i'n meddwl y British person, ond mae'n gwneud i'n meddwl i'r USA, ond yna'r ysgol i'n meddwl mewn gwirionedd ac yn adnodigu yno ar gyfer eu gweinwyr. Mae'n tynnu yng Nghylch Gweinwyr a'r ysgol o'r hwnnw a'r wneud i'r hwnnw. felly iawn i'r maen nhw'n meddwl yma'r Gweithdoedd amser yn Srinjaxxus yng Nghymru. Mae'r ddweud bod all yr oedau wedi'i ddod o'r ddweud. Mae'n ddweud yn y ddiddordeb. Mae'n ddweud o'r ddweud o'r ddweud, ond mae'n ddweud. A dyna gweithio ar y cwm yma, mae'n cael ei fod yn eich holl o'i sgol, mae wedi ddweud o'r ddweud. Mae'n ddweud ar y ddweud, 2013, January of 2015, we got the news from Austin, Indiana that they'd had a HIV outbreak. Now this was not surprising to many of us because you've already heard this morning that across the US we've seen massive increases in hepatitis C, massive increases in the rates of overdose and on the back of that because this is connected to an increase in injection drug use there's this concern and this worry that we're going to see more HIV outbreaks and it happened in Indiana. Austin is a really small community in a rural area there's only four and a half thousand people and to date they've seen over 200 people develop HIV as a result of this outbreak. That's a massive challenge for this very poverty stricken area we went to work there, it's always really interesting to me in America they call it the city of Austin it has one stoplight I'm like how do they get to call it a city it's like a village to me 200 people in that vicinity of four and a half thousand and it's in the Scott County which the county only has 24,000 people and we know that Indiana is one of the states in America has the lowest public health spending per head of population as well so there's very little resources to even provide treatment and support for people in these areas so they've been hit by this epidemic. So this news began to hit the headlines and we'd already been doing some capacity building work in Indiana and then what happened is we began to be inundated at the harm addiction coalition with people coming from the in and around those states Kentucky was very quick off the mark, Ohio was been in contact with us West Virginia got in contact with us, we are seeing the same conditions there and we think we could be on the verge of a HIV outbreak too so they came to us and said you know we really need some capacity building one of the really good things about working at the harm addiction coalition as well is that we have a really great policy and advocacy team headed up by Daniel Raymond, deputy director of policy and planning who for years have been doing policy and advocacy work in and around these areas and we were able to then complement that by bringing capacity building and training and technical assistance to help people to then begin to act on that policy and advocacy so some of the lessons we learnt that I want to share with you from doing this work I think really go to the core of who we are as harm reductionists so we're going into communities that feel very stigmatized people in Indiana have received a lot of press attention there's Austin itself, at one point some bright spark decided they should put stop signs at the beginning and the entrance of the town to say HIV here which then people quickly realise how stigmatized that was and they shouldn't do that so when we're going into communities to provide capacity building that we're recognizing that especially as outsiders that we're coming in with that sensitivity and that harm reduction love where we say we're going to meet you where you are and we're not going to necessarily tell you how you shouldn't be doing this we're going to give you the information about how people do it elsewhere and we're going to help you build it to meet the unique needs of your community and your area so being very sensitive to that when we go into those communities and also recognising that when we go into these communities people in these communities have never had a chance to learn about harm reduction you hear this saying you don't know what you don't know so we were going into communities where this was brand new stuff to people people say really messed up shit in meetings and as harm reductionist you have to kind of hold that sometimes and be ready to kind of meet them with some I call it the hug slap hug method so like you hug them in there like because it comes out of anxiety I've sat in community meetings where I've had community members that are like this is ridiculous it goes against the grain of common sense all the classic stuff we hear as harm reductionist you're enabling people but they've never had a chance to learn about actually what it is we are enabling that we're enabling people to be safer we're enabling people to help be healthier and we're enabling people to have the tools to keep themselves alive so that they have a chance to get to recovery so again as a harm reductionist it's going into these communities and being ready for that and being ready to help people understand what we're really about so we did a lot of work I even had staff sitting in training that have been told by their manager oh you're going to start doing syringe exchange and they knew nothing about it you know I had one lady in Louisville her only job in public health was to go and test the water in swimming pools to see if it was safe or not suddenly she'd been told oh you're going to do syringe exchange so we have to be very by providing this capacity to help people kind of reassure them and gain the confidence that what they're doing is not enabling because that's what I was told 20 years ago and I didn't have the vocabulary to explain why it felt right luckily now 21 years ago 21 years on I can so so what we were often doing in past part that is helping people to build their case because local people who felt like they needed to do this or they wanted to do it or they were coming to harm reduction for the first time they needed a lot of support to build their case so providing them with the data and the tools and there is this conflict we feel like why the heck should we be spending more money on research and stuff that's already been researched and we've proved that it works but some of the challenges that people face are very conservative areas that they have legislators that were like well that research is from 2002 we want to see more up to date research so there is a place I think for continuing to provide some updated research to support people in these areas to show that it is still working and it is still evidence based helping them to learn that I said to them you need this data in your back pocket when you're speaking to people in the community it's been amazing to see some of the transformations I've seen people in community meetings do 180s or even 360s we were a community meeting in Kentucky where by providing this education and this information at a very grassroots community level in a local church I saw a pastor that was completely against harm reduction decide that by the end of the meeting he wanted the syringe exchange van to come and park in his parking lot I saw a community member that was totally against it and by the end of the meeting he was getting a sharps container to go and pick up the needles that he'd seen in the back of his behind his house that he was really worried about he was almost like a volunteer for the syringe exchange so by being able to provide this information we can help people make really come to harm reduction truly understanding dispelling some of the myths a lot of people think that we have the opposite of abstinence helping people to understand that abstinence is a huge part of our spectrum but we offer many different goals for people in recovery we're not just hinged on that some of the other things that are really important to our work we're also helping the staff to understand especially in health departments the impact of stigma so we're seeing a lot more health departments coming to harm reduction now and the staff there especially those that are new to harm reduction really understanding that you can't just necessarily open up the doors of a building without understanding the stigma that gets in the way of people walking through the doors so helping people to understand what that means or people thinking that people will just roll their sleeves up and show me their track marks understanding that the shame and the stigma that prevents people from doing that and what it takes to create the engagement and the relationships that you need to get people into your services is a really fundamental part and a lot of the health departments that we've worked with most recently we were in Nevada in Utah they were like the stigma piece was really key for us to really understand this stuff so really helping people to understand that when we're doing this capacity building is important and I think the other thing that for us as harm reductionists is really important when we're doing this work is helping people to understand the history when I'm sat in a room of health department folks who are new to this helping them to understand that this did not come out of public health this came from people who use drugs for people who use drugs and that's the history of our movement it's the history of our work so helping them to understand that so helping them to then understand why it's really important that as you develop these programs wherever you are that you include the voice of people who use drugs that their expertise should be at the forefront of your planning and development and also helping them to understand the communities that have been disproportionately affected we've heard a lot about that communities of color that for years have been struggling with this they've developed their own harm reduction because nobody else was willing to provide it for them and when I'm sat in a room I was sat in West Virginia with a group of folks all white folks and I'm like how are you going to connect with the communities of color where you are who have been experiencing this for years personally because middle class white kids are dying you want to do something about it how are you going to address that with those communities too who are you going to connect with and create partnerships and alliances with to help you reach those folks too similarly we were in Florida recently they've just opened their first syringe exchange in Miami and they know they're struggling they're actually in a community of color and they're seeing more white people even though they know that there's people in that community that need them because there's a huge distrust amongst those communities because of the way that they've been historically treated so helping people to understand that in terms of their program development and then the other important part is especially when we're seeing a lot more health departments and public health folks coming to harm reduction that we help them to understand that it's still really important that they partner with community-based organizations and grassroots organizations in terms of delivering this work because often the community-based organizations are the ones that may already have the pre-existing relationships with folks that are using drugs because they may be accessing them for other services so that as health departments it's key that you include and partner with them we've also seen situations for example in Indiana where you've got really small health departments working in these counties that sometimes they have one and a half staff and suddenly they're tasked with a public health emergency so it's imperative that they partner with other organizations so for example in Bloomington Indiana the health departments there decided you know what we're not going to do this they often hold the power of getting it approved so they'll have that power to get it approved but they decided to partner with a local community-based organization that's actually now covering three counties because they are better placed to do it and in a time when resources at the state and the federal level may even be getting less that's becoming more important because sometimes community-based organizations do not only have the relationships but the resources to be able to do this and then also helping people to understand because a lot of harm reduction and the work that we've done has come out of urban areas and we're seeing a lot more rural areas that are being impacted for the first time so helping them to explore the unique ways that they need to deliver syringe exchange and harm reduction services so helping them to understand that you know you might be able to open a store front that you really need to think about mobile provision and secondary provision by having peer based distribution and one of the other things is one of the key things and I heard this through some of our other speakers actually you know thinking about Morocco where they have the regional training center one of the things we've really focused on is creating training of trainer opportunities because we can go in and we can provide this capacity building but we want people to be able to do it for themselves so really by being able to train people in those local areas who can become those harm reduction trainers there that gives them more capacity to sustain what they're doing I want to just say I hope what I've shared with you in light of all the challenges that we're facing and even in America right now where we have Bonkersville at the national level that by doing capacity building with people on the ground at a local and state level we can still foster the resistance that Deborah spoke about this morning there is hope out there there are people that are committed to doing this on the ground and so if we continue to support them to do it we can hopefully mitigate some of the challenges that we're seeing on a more national level in terms of conservative government so thank you