Shooting rooms: first encouraging results in France

In France, the first experiments with shooting rooms are giving encouraging results. This is indeed what emerges this Thursday from the ANRS AERLI study (Support and Education in Risks Related to Injection), carried out jointly by the AIDES association, Doctors of the World and Inserm U912 (Marseille). Unpublished results presented in oral communication at the 20th international conference on AIDS organized by the International Aids Society in Melbourne (Australia) from July 20 to 25, 2014.

Reduction of practices at risk of transmission of HIV and HCV
To achieve these results, these researchers proposed to drug users individual counseling and injection education sessions on risky injection-related practices. Delivered by trained peers and according to a standardized protocol, the sessions were based on an individualized educational intervention according to the practices of each consumer and the questions they ask themselves.
A total of 288 sessions were conducted with 113 consumers. These were recruited from 8 reception and support centers for reducing the risks for drug users (CAARUD). A control group of 127 users, comparable in terms of drug injection history, age and sex, was formed in 9 other centers. All participants were interviewed at the time of inclusion, and then 6 and 12 months later, about their injection practices at risk for HCV transmission and complications at the injection site. And after analyzing the data, the results are final, according to these scientists.
They show a significant benefit of the education sessions. Thus, it is found in the group “Intervention”, a 43% decrease in practices at risk of transmission of HCV and HIV (44% of consumers declaring at least one risky practice before the intervention compared to 25% 6 months after).

Fewer abscesses and infections
In addition, the team also noted a 41% decrease in 12 months in complications observed at the injection sites (abscess, infection, etc.). Thus, 66% of consumers declared complications before the operation against 39% 12 months after.
“In comparison with the control group, we observe a major effect of peer education on practices at risk of infectious transmission,” comments Inserm researcher Patrizia Carrieri who participated in the study. It is all the more interesting that a large part of these drug injectors remain on the fringes of the health care system, ”she added.

Low cost and easy to set up
In addition, the authors of this work emphasize that this type of intervention has two other advantages: its cost is low and it is easy to set up in the reception and care structures of intravenous drug users. All this team therefore pleads for a generalization of the device on the whole of the territory.
“In view of the observed benefits,” says Prof. Jean-François Delfraissy, director of ANRS, “it is now possible to implement community intervention on a larger scale and thus strengthen risk reduction among drug users.. This type of intervention could also be very useful in countries where the population of drug users is large and very concerned by the risk of contamination by HIV and hepatitis C, ”he continues.
Same story with AIDES: “we cannot afford to wait another 5 years to make this system accessible to users who need it most. It is estimated today that more than two-thirds of people who inject drugs are carriers of hepatitis C, many of whom are unaware of it. The time is not for procrastination or ideological considerations. We are in a context of health emergency, we must act, and act quickly ”explains Bruno Spire, president of AIDES.

Three shooting rooms in preparation in France
However, in fact, the establishment of the first shooting room in France is still stuck. The one announced in Paris in the Gare du Nord district (Xe) has in fact still not seen the light of day. In December 2012, the Paris Council gave the green light to such an installation scheduled for October-November 2013, before this authorization aroused numerous protests from local residents’ associations. Result, shortly before the opening, the Council of State had issued a negative opinion, requesting the adoption of a law before any implementation of such a device.
Except that in January 2014, during the presentation of the plan of the Interministerial Mission for the Fight against Drugs and Drug Addiction (MILDT), its director, Danièle Jourdain-Menninger, affirmed that such an installation, as a experimentation was on the agenda as part of the new plan to combat drugs and addictive behavior. The latter had even announced that two other shooting rooms were in preparation in other French cities.