The Safe Works Access Program (SWAP)
Description of Program
What is the intervention/program/project?
The Safe Works Access Program (SWAP) is the needle distribution program offered by the AIDS Committee of Newfoundland & Labrador (ACNL). It is a health promotion and education service for persons who use drugs. SWAP offers harm reduction education and training for health and social service professionals.
What is the goal/objective of the intervention/program/project?
Working from a public health perspective, SWAP strives to reach people where they are at. The goal is to reduce the negative consequences of a particular behaviour, rather than requiring that the behaviour stop. This approach may result in the eventual reduction of the behaviour itself. Any positive change is considered harm reduction. It requires openness, honesty and a non-judgmental attitude.
Providing people with accurate information, compassion and support will enable them to make informed choices about their own health care. These aims are better achieved when people are directly involved in decisions that affect their lives, and in the planning and delivery of the services needed.
To assist clients in reducing the risks related to substance use, and to provide support, education and referrals required to enhance personal health.
Reduce harm related to substance use and other risky behaviour, including but not limited to:
- Harm related to HIV infection and transmission
- Harm related to Hepatitis B and C infection and transmission
- Harm related to wound infection.
Why was the intervention/program/project originally developed?
The decision to develop the program was made by the community and the Newfoundland government following a government study on the use of oxycodone. As a result of study, the government and the AIDS Committee of Newfoundland & Labrador collaborated to set up the first site in St. Johns, which was run as pilot from 2006 – 2009, when the program expanded to Corner Brook on the West Coast of the island. The program has dramatically expanded over the past two years, indicating an increase in drug use thus ACNL completed a provincial needs assessment and evaluation to determine future health strategies for controlling increases in STBBIs.
How was the intervention/program/project developed?
ACNL operated a small needle exchange since 1990. The present program resulted as a community/government response to increased drug use in the community based upon research. The program was developed through a study of needle exchanges in areas with populations similar to Newfoundland (eg. Mainline Needle Exchange in Nova Scotia, programs in small towns in Ontario, as well as programs in the West such as Edmonton). Different components of different programs were reviewed to determine what best suited the population(s) ACNL were trying to reach.
OrganizationAIDS Committee of Newfoundland & Labrador
- Harm reduction
- Harm reduction
- People who use drugs
- Service providers
Newfoundland & Labrador
The program is offered through two fixed locations, St. John’s and Corner Brook with office and mobile outreach to surrounding rural areas, and a mail-order distribution service.
Resources for Program
The program demands many resources. It is difficult to predict the budget from year to year due to fluctuations in the numbers accessing the service. Competent, well-trained staff are required to maintain program objectives and train volunteers and natural helpers.
Process monitoring or evaluation
- Number of clients.
- Number occasions services delivered, number unique individuals, age and gender breakdowns, needles distributed and returned, supplies purchased and people attending workshops.
Audience/client feedback and satisfaction
- Recently completed provincial needs assessment and evaluation of program over last 6 years
- Outcomes evaluation: Evaluation component of needs assessment includes interviews with people who use the service, government, community healthcare workers, community focus groups, RCMP and provincial police services. The objective is to evaluate what is and is not working and assess needs for additional program sites.
Evaluation TermsAudience/client feedback and satisfaction, Outcome evaluation, Output tracking, Process monitoring or evaluation
- Programs require a needs assessment, many community partners and government.
- Partnerships must be strong due to the vulnerability of the population the program is serving.
- Good partnerships with easily accessible doctors who are non-judgemental, drug rehabilitation facilities, programs and services must be in place to make sure that help is available without long waiting periods.
- In planning, it is easy to underestimate the number of people who require services when there is little understanding of the extent of needs within the community. With intravenous drug users, it is common to underestimate numbers. When the community becomes more aware of the availability of the service, numbers start tripling.
- It is important to be aware of trends in drug use and the broader community changes and dynamics that may contribute to increases.
- Stigma and discrimination are major challenges.
- Obtaining the support of the general public/electorate to ensure that the provincial government continues to providethe support necessary to implement an IDU health promotion program. No financial or moral/ethical support from the conservative federal government.