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Any web outreach worker, including me, is sleeping at 4 AM. What you do is just explain [that you were unavailable] and, of course, provide services according to the request. Another challenge arises when clients record voice messages instead of sending text messages.
In such instances, web outreach workers may not have an opportunity to listen to voice messages promptly, thus the provided services are unlikely to be as immediate as the clients expect. Web outreach workers described that under such circumstances they asked clients if they could send a text message instead.
Depending on their reply, counseling was offered after their text message was received or when the worker had an opportunity to listen to the voice message. If not, they have to wait. Such occurrences happened when clients did not formulate their requests clearly. In these cases, the workers either tried to clarify the request by asking additional questions or suggested discussing the request by phone. Web outreach workers noted that some clients trusted them enough to discuss their requests on the phone, while other clients refused to continue their communication with a phone call and agreed to only text-form communication, as giving their phone number would compromise their anonymity.
One informant reported that some clients stopped messaging her completely after a phone call was proposed:. Several web outreach workers mentioned phone calls as the next step in communication between them and some of their clients. Web outreach workers described this stage as being crucial to their work, as it helps them to verify whether the services that they provided were of use for their clients and whether the clients knew whom to contact if they required help in the future.
One worker narrated that it was very important for her to end communication with clients by leaving her contact information:. In this section of the paper, we explore the first two stages of the process of web outreach work in terms of needs of PWUD and services provided to them. We identified two major themes in regard to whether the needs can fully be met or that the needs can only partially be met via online platforms. We distinguished several sub-themes under each theme based on common requests of PWUD and matched the sub-themes with services provided by web outreach workers.
The first major theme is composed of needs for harm reduction services, which can be provided to PWUD entirely online. The following sub-themes were included in this theme: minor injection drug use complications; information regarding harm reduction, HIV and HCV; information regarding at-home detoxification; information regarding the COVID pandemic; general psychological support. The most common sub-theme was treatment of minor injection complications.
Such complications included collapsed veins, blown veins, venous ulcers, varicose veins, and rashes. PWID who requested help in such instances were offered advice from web outreach workers on how PWID could treat and prevent their injuries. Medical professionals verified the advice before web outreach workers sent it to clients.
In cases where web outreach workers felt that more skilled assistance was needed, they provided PWID with contact information of doctors who work at the NGO. The doctors then would provide medical advice via Telegram. The clients were provided with verified information on the topics, as well as with the contact information of other NGO workers, whom they could connect with should they have more specific questions.
A less common, yet still important, sub-theme was requesting information about at-home detoxification. Only five clients conveyed an interest in this topic. Web outreach workers articulated to such clients the potential risks of at-home detox, provided them with general information about medically assisted detox and shared contact information of workers, whom the clients could message regarding such issues.
As in the previous cases, web outreach workers provided their clients with relevant and verified information in accordance with their requests. PWUD contacted web outreach workers to receive general psychological support concerning a number of personal issues. Common examples of requests included having difficulties in combatting drug addiction; expressing anxiety about repercussions of quarantine measures taken during the COVID pandemic e.
As the clients did not request help from a certified psychologist, web outreach workers provided them with advice based on their personal experience and contact information of the NGO staff whom they could message if they required additional help. This theme is represented with the following sub-themes of needs: getting medical, psychological, social, and legal services; severe injection drug use complications; getting harm reduction services; and drug overdoses.
The most common sub-theme was getting medical, psychological, social, and legal services. Such complications included severe cases of blown veins and venous ulcers, as well as edemas and skin abscesses. In such instances, web outreach workers referred PWID to doctors at the NGO as the workers themselves were not qualified enough to provide necessary help to their clients. The doctors contacted the clients online and after consulting them invited the PWID to the NGO mobile unit to receive treatment offline or encouraged them to go to a clinic to get necessary treatment.
Web outreach workers could not address such needs via online platforms, thus they provided PWUD with instructions regarding how they could obtain such services offline at the NGO or affiliated clinics in the cases of PrEP medication. Overdoses OD were the least common sub-theme; only four cases of OD were mentioned in the work reports. This bot, a built-in Telegram application created by the NGO, serves as an automated service, which provides Telegram users with information on symptoms of OD, cardiopulmonary resuscitation CPR techniques, and medications to treat an OD.
It also provides them with contact information of a doctor, whom the PWUD can contact in order to get help online. Therefore, instead of web outreach workers manually searching and sending information to PWUD, they share a link with the PWUD, who then find the necessary information themselves using the bot. In each instance, web outreach workers provided their clients with a link to the bot.
Thus, in addition to sending the link to the bot, the web outreach workers continued their communication with the clients until an ambulance arrived. Web outreach work to PWUD has only recently been implemented in Russia, a place that continues to struggle with meeting the need for harm reduction services. We described the stages of the web outreach process, needs of PWUD, who request help via online platforms, and services that are provided to them by web outreach workers.
Our research demonstrates that a number of harm reduction-related needs among PWUD can be met entirely through web outreach work, while some can only be partially met online. These findings are in line with the existing literature on online platforms bringing new opportunities to harm reduction services provision [ 18 , 19 , 20 ]. They also contribute to the growing amount of literature regarding the processes of web outreach work [ 22 , 23 ] and bring new evidence on how various needs of PWUD are addressed by web outreach services.
We identified a three-stage process of web outreach work. The process illustrates the benefits that PWUD gain from online harm reduction services provision without face-to-face contact with web outreach workers. An absence of requirement for physical presence of PWUD at a harm reduction organization facilitates greater level of anonymity in comparison with offline harm reduction services provision.
In addition, the use of text messages brings greater convenience to PWUD, who do not feel comfortable with discussing drug use-related issues in person. These factors indicate that web outreach work helps to encourage harm reduction behaviors among PWUD who, otherwise, might not seek or have access to brick-and-mortar harm reduction services.
Our analysis of the needs of PWUD and services provided to them demonstrates two major functions performed by web outreach workers: 1. They can provide certain services completely online, and 2. They navigate clients within the organization in order to match the needs of the PWUD with a person who can address them. Our research on web outreach work indicates an increasing level of efficiency that comes from online provision of harm reduction services.
Instead of traveling to a harm reduction facility, PWUD can contact the organization via an online platform. Furthermore, harm reduction services provided entirely online gain particular relevance amidst the COVID pandemic when offline harm reduction organizations experienced new challenges to providing in-person outreach services. Our findings suggest that online harm reduction services provision can be improved in terms of accessibility and efficiency.
A challenge for web outreach work, as described by informants, was the inability of workers to communicate with PWUD after hours. One possible solution is to automatize some processes with Telegram bots, as it was done with the cases of OD. Currently, web outreach workers manually send information to PWUD. If automatized, then PWUD themselves could use a bot to get necessary information at any time of the day.
This is especially important in emergency situations, such as OD. Another way to develop provision of online harm reduction services is to increase their presence on darknet forums. Another obstacle in increasing accessibility of online harm reduction services was that some clients refused to continue communication with web outreach workers via the phone.
More research is needed to explore the needs that PWUD have in such cases, identify the reasons why certain PWUD refuse to communicate via the phone, and explore how web outreach work can be provided in such instances. Our research has several limitations worth noting.
First, as anonymity of their clients is a priority for the NGO, all communications in direct messages are deleted a short time after work with them is completed. In some instances, workers filled their work reports after direct messages were deleted, which meant that they had to fill the reports based on memory.
This implies a potential recall problem in descriptions of needs and services. Second, given that informants were asked to review their month-long work experience, another recall problem arises as a limitation of the study. For example, informants may have forgotten to mention more challenges of their web outreach work and cases of negative feedback.
Third, web outreach work of the NGO in darknet forums was not included in the research due to its limited volume at the time of the study. Nonetheless, our findings provide rich descriptions of the novel web outreach work being done in Russia today.
Our timely and descriptive findings can serve as the foundation and a reference point for further research into online harm reduction services as well as provide important information for existing organizations that seek to expand their harm reduction services to meet the needs of PWUD who may best be reached via online platforms. The findings from our research suggest that web outreach work is an approach that harm reduction organizations should consider implementing.
Web outreach work may make provision of their services quicker, help to access hard-to-reach populations of PWUD and guarantee that services can be provided when offline provision cannot. However, web outreach work requires further research in order to explore its benefits for PWUD and harm reduction organizations. It is vital to examine which harm reduction services can be delivered entirely online rather than offline by estimating the net benefit for PWUD and harm reduction organizations.
Such aspects as total anonymity and convenience of online platforms as well as potential loss in quality of services provision caused by online platforms should be considered. The positive net benefit would indicate that harm reduction organizations are to incorporate online harm reduction services provision into their activities or increase them.
The web outreach work may be an important approach to help address challenges in reaching the younger generations of PWUD and also to ensure continuity of services during the COVID pandemic and social distancing measures in place. Stigma and human rights abuses against people who inject drugs in Russia: a qualitative investigation to inform policy and public health strategies.
Policing drug users in Russia: risk, fear, and structural violence. Subst Use Misuse. Med Baltim. Heimer R, White E. Estimation of the number of injection drug users in St. Petersburg, Russia. Drug Alcohol Depend. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review.
Lancet Glob Health. Federal scientific and methodological center for prevention and control of AIDS Central research Institute Central research Institute of epidemiology of Health-care regulation system. HIV infection in Russia in the first half of [Internet]. Coffin P. Overdose: a major cause of preventable death in central and eastern Europe and central Asia. Logan D, Marlatt G.
Harm reduction therapy: a practice-friendly review of research. J Clin Psychol. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. J Infect Dis. Potential impact of implementing and scaling up harm reduction and antiretroviral therapy on HIV prevalence and mortality and overdose deaths among people who inject drugs in two Russian cities: a modelling study.
Lancet HIV. Hoskins R. Foreign Policy [Internet]. A new generation of drug users in St. Petersburg, Russia? AIDS Behav. Power M. Vorobyev N. A new breed of drug dealer has turned buying drugs into a treasure hunt. Vice [Internet]. Monitoring new psychoactive substances: exploring the contribution of an online discussion forum.
Int J Drug Policy. Hout M, Bingham T. J Ment Health. Rolando S, Beccaria F. Drugs Alcohol Today. Masson K, Bancroft A. Detecting illicit opioid content on Twitter. Drug Alcohol Rev. Netreach work in Europe: responses to developments on the dark web and the use of new psychoactive substances. In: Wouters M, Fountain J, editors. Between street and screen: traditions and innovations in the drugs field. Lengerich: Pabst Publishers; Google Scholar.
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