“The reality is that the HIV outbreak and drug-related deaths haven’t gone away just because we have declared a coronavirus pandemic in Scotland,” says Jennifer Goff.

Jennifer is the communications and engagement officer at Waverley Care, a Scottish organisation created over 20 years ago in response to the HIV outbreak in Edinburgh during the late 1980s.

Scotland is currently the country with the highest rate of drug-related deaths in Europe, with Glasgow sitting well above the country’s average number of cases.

This, together with a recent spike in HIV infections amongst injectable drug users, has put the city of Glasgow in the centre of national efforts to tackle this public health crisis.

“Ultimately, we are worried that the lockdown might induce unsafe injecting practices and decrease testing, increasing the risk of HIV transmission”, says Jennifer.

The Glasgow City Alcohol and Drug Partnership (ADP) estimates that there are around 500 people injecting and living on the streets in the city centre, making ends meet by begging, resorting to prostitution or petty crime.

“These are very vulnerable people, subject to stigma and discrimination on a daily basis, and due to the lockdown, their support network has been disrupted. They have lost their main source of income as there is nobody on the streets, and shops are closed, and it seems that the availability and quality of drugs on the street has diminished,” explains Austin Smith, policy and practice officer at the Scottish Drugs Forum (SDF).

“We fear that this might have a negative impact on the current drug crisis”.

Since the lockdown was officially declared across the UK on 23 March, Glasgow’s city centre has become a ghost town.  Most businesses across the heart of the city’s commercial centre are now closed; only a few grocery and convenient stores remain open.

Making ends meet

I met Jaimie outside a Poundland store on Argyle street. “This is one of the few shops that are still open. It’s all shut because of the virus. You can stand here, and sometimes folk give you a bottle of Irn-Bru from a multipack, sometimes a piece [sandwich], but there’s not many people around anymore.”

I find him wrestling with the back cover of an old Nokia phone, trying to insert a SIM card. “There is not much to do since this all started. It is hard to get your mind occupied.”

He is 41 years old and has been homeless for nearly a decade. “I just came out of jail in January, and I didn’t want to be released. I was getting three meals a day, and I knew what I was coming out to.”

He has been in and out of jail for petty crime and drug-related charges over the years. “I used to inject. I am on methadone now, but see now, almost all the folk that use [heroin] are [HIV] positive. It is frightening. I got hepatitis, but there is a cure, you know…I am clear that way, but I feel it’s taken ten years off my life.”

Jaimie is clearly distressed. His anxiety strengthens the notion that for these communities there is comfort in crowds. We are the only people standing outside on the street. It is mid-afternoon, and you can clearly see that Jaimie is uncomfortable, vigilant, almost out of place.

“See this phone.” He shows me the old Nokia. “How am I supposed to do anything with this? I am due £350 from the council but I can’t get it because the circumstances won’t allow it. You need to fill in all these forms online. Before this [lockdown] if I needed to go online, I used to go to the library or the community hub, but now, it’s all shut. You are on the streets, but they still want you to go online.”

Since the coronavirus struck, the benefits system has undergone an unprecedented level of strain. According to the Department of Work and Pensions, 1.8 million people across the UK applied for universal credit from mid-March to the end of April.

With all face-to-face support cancelled, and telephone assistance overwhelmed by the volume of requests, the lockdown has put these communities, already hindered by low technological-literacy and a lack of digital access, in immediate risk of being excluded from the welfare system.

Facing lockdown with nowhere to go

David, a long-term heroin user, has been homeless for the past eight months after being released from Barlinnie prison in Glasgow following a short sentence. “There is nobody on the streets so it’s hard to make any money… Jobs are out of the question for us… You are waking up in an alleyway and you need to get to work at nine o’clock. It doesn’t work like that… I have nowhere to stay for free. See all the shelters are closed because of the virus.”

Most homeless night shelters are open only during the winter months and close in March. Shelters in Glasgow closed early this year after cases of coronavirus were confirmed and in light of the social distancing guidance, as guests were accommodated in a single room.

The Glasgow City Council confirmed in late March that would be providing hotel accommodation in the city centre so those in need could self-isolate where necessary.

I asked David about the availability of the accommodation. “I keep trying, and I keep trying, and they keep telling me there is a waiting list… waiting list, waiting list. There is a constant battle for a waiting list. It’s just…it’s ridiculous. There are lots of people like me, just waiting.”

Others that have secured accommodation complain of the conditions. “Somebody died of an overdose yesterday in my hotel… It is hard, it is very busy, there is no hot water at the moment, and nothing to do. They expect us to stay in the hotel all day, but how can we stay in if there is nothing to do.”

I met Jade outside the Simon Community hub, one of the local charities supporting homeless people with finding emergency accommodation. “See today, I have been stopped eight times already on the way here by the police – what are you doing out? where are you going? go straight back to your hotel. They don’t stop anybody else, only us.”

Adding to the pressure to find accommodation, all more long term re-housing efforts for homeless people have been put on hold due to the lockdown. Gavin Dunbar, general manager of the Glasgow-based charity Starter Packs, supporting homeless people during their first tenancy, confirms.

“We were incredibly busy just before the lockdown as Housing Associations were trying to get people into new tenancies before the lockdown happened, and we ended up delivering more starter packs [re-housing assistance] in March than we have ever done before,” he says.

“We are aware how many folks are struggling in our community, and it doesn’t feel great to be closed at this time.”

A daily reality

I met Laura, the founder of Kindness, a Glasgow charity running an outdoor soup kitchen, currently one of the only places in the city centre providing free meals for those in need.

“We used to be here once a fortnight and we are now out every night serving over one hundred people a night,” she explains.

The soup kitchen has five different stalls and is located under a railway bridge. Besides food, each stall provides different essential items – shoes, clothing and toiletries mostly.

One hour into the food distribution, one of the guys queuing, leaning against the wall of a nearby pub, loses his footing, stumbles and collapses on the ground. The organisation immediately intervenes, calls for support and 20 minutes later an ambulance rushes in ready to assist.

Right next to him, a guy holds his bicycle and a carrier bag dropped during the fall.

“He is my best pal. He is not doing very well,” he says.

“He is on heroin and has taken some benzos [benzodiazepines] and a few cans. Another one of my pals died a couple of days ago. It’s not easy as it is, but now with all of this, it is harder to get help.”

Losing the safety net

Reports from various sources point to a decrease in the availability and quality of heroin due to the current situation, whilst prices on the streets have increased. As a result, users have more regularly resorted to combining benzodiazepines and alcohol, increasing their doses of heroin and using methadone.

This is the case for Craig, who has been struggling with the heroin supply since the lockdown started. “I have to go and see the doctor, but I only managed to get an appointment a week from now. They are telling me that they are just too busy, that everybody is phoning, and that their lines are all jammed.”

“I am not on methadone right now, I am still using, but it [heroin] is hard to get, and as there is none coming in, they are mixing it with all sorts of rubbish. That’s how the doctors are so busy, because people cannot get their heroin, and they are trying to get a script [prescription of methadone].”

This is backed up by Jenny Jamieson, a coordinator with Waverley Care’s HIV street support project.

She says: “The reports we are getting of low-quality heroin on the streets are very concerning. If the heroin they are getting has been badly cut, they will use more to hold them, and their tolerance level will be lower as a result. When they use again, if they get a higher quality batch, the chances of an overdose will be much higher.”

Waverley Care has been supporting these communities for many years, offering psycho-social support, clean injecting equipment and HIV testing.

“Also, we all carry naloxone, [an opioid inhibitor that can rapidly reverse an overdose]. Now, due to social distancing and the lockdown, all our street-level activities have been dramatically reduced.”

The availability of life-saving naloxone has been limited to a mobile needle exchange van – operated by NHS Greater Glasgow and Clyde in partnership with social care provider, Turning Point Scotland – meaning less emergency treatment for those who overdose.

It is still too early to evaluate the full scope and impact the coronavirus lockdown is having on these communities, but one of the biggest concerns is over the needle exchange services, found in pharmacies.

David Liddell, chief executive officer at Scottish Drugs Forum, says: “Keeping pharmacies safe and social distancing rules mean that there have been long queues for all customers at pharmacies.

“People with drugs in their pocket and in withdrawal are not going to stand and wait in a half-hour queue. The fear is that people are re-using and sharing injecting equipment.”

This is compounded by the reduced capacity of other on-street services such as rapid HIV testing. “There is a question over the impact this situation will have on the HIV transmissions in the area, particularly now that the testing has been put on hold,” concludes Jenny Jamieson from Waverley Care.

Supporting communities through change

Many local and national organisations are working to understand and help to moderate the effects that the lockdown could have on these communities.

Turning Point Scotland, one of the few organisations still accepting walk-ins and admissions to their drug harm reduction services, has seen a dramatic increase in people seeking support.

Claire Gallagher, service manager of the group’s Glasgow drugs crisis and homelessness services, says more people are using their services during the lockdown.

“We have started to see people use the service that we haven’t seen before…[Particularly] we have seen more sex workers present at our services as due to the Covid-19 pandemic and a clear heightened police presence there is little demand for their services, and they cannot fund their drug use.”

Turning Point Scotland has been exploring how to best support these communities when faced with severe service restrictions. “We have been offering people one week’s worth needle supply, and the needle exchange van now visits different locations to reach a wider population of drug users,” says Gallagher.

Alongside this measure, the Scottish Drugs Forum has put together a brochure describing best practices on how to clean needles after use. There has been a lot of government resistance to this previously because it is viewed as poor practice and may encourage the reuse of equipment. But under the current circumstances, the forum believes it can prove vital.

Faced with the possibility that the pandemic may result in many more drug-related deaths, Turning Point’s Glasgow Drug Crisis Centre has increased the distribution of naloxone by making it available as take-home doses, and training people in its use.

Current systems of support are trying to adapt to users needs as lockdown continues, and the number of coronavirus cases continues to rise in Scotland. But the crisis has caused inequalities to deepen, and increased the risk to already vulnerable communities.

Photos all thanks to Francesc Galban.

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