UNODC is cosponsor of the Joint United Nations Programme on HIV/AIDS - UNAIDS
RAS/H13: Training Workshop on Rapid Situation Response Assessment (RSRA) of Drug Use and HIV (11-13 February 2008) and Training Workshop on Basics of Drugs/HIV; Outreach and Community Involvement (15-17 February 2008) in Phuentsholing, Bhutan
Contributed by Lipi Chowdhury, Consultant, Project H13
To conduct training workshops on RSRA, to understand the basics of drugs and HIV, how to do outreach and involve the community for partner NGOs in Phuentsholing, Bhutan from 11 - 17 February 2008. The trainings were supported the Bhutan Narcotics Control Agency (BNCA) and Project H13, UNODC ROSA.
Participation from all the outreach staff from the partner NGOs in Phuentsholing and Thimpu (REWA and YDF).
Development of the RSRA plan with definite time lines and formation of the RSRA team (RSRA Coordinator, Peer Outreach/Field Coordinators - 1 male and 1 female, Peer Outreach/Field Workers- 2 males and 2 females; Peer Outreach/Field Volunteers) with role clarity and deliverables of each team member.
Outcomes of Training Workshops:
The trainings sought participation from officials from the Ministry of Health, Home and Education apart from peer counselors from the Recovering Alcoholic Network, school teachers, doctors and nurses based in Thimpu and Phuentsholing. The trainings were inaugurated by Mr. Kinley Dorji, Executive Director, BNCA, who emphasized the need to conduct a RSRA at the earliest to understand better, the drugs and HIV situation in Bhutan. He reiterated that the sooner we could get the assessment and status of the problem, the sooner we could come out with meaningful assessments. Also, Mr. Chaddor Wangdi, Chief Programme Officer, Demand Reduction Division (DRD), BNCA spoke on the placement of Project H13, UNODC ROSA's activities within the sphere of the Narcotics Drugs, Psychotropic Substances and Substance Abuse Act 2005, Bhutan.
The training program included methodologies such as role plays, simulation exercise, participant's presentations, brainstorming sessions and field visits to the target areas such as bars, cigarette shops, schools, health information centers in order get a preliminary understanding of problem of drug use. Through the active participation from all participants, a proposal and tentative plan for the RSRA and outreach in Phuentsholing was developed.
Dr. Roy gives guidelines on planning RSRA for group work session
Phuentsholing has been chosen for the RSRA study because of its vulnerability to the spread of HIV due to drug use. As Phuentsholing is located right next to the Indian town of Jaigon (Jalpaiguri), it is directly exposed to high risk commercial and amusement centers. Psychotropic substances such as Marijuana, Nitrosun, Proxyvon, Relipen, Cough syrups etc. are easily available in various outlets right across the border. Moreover, according to BNCA and the particpants, Jaigon and Puentsholing are home to a large amount of floating sex workers. It has also become a residential hub where youth as well as adults spend their vacations and use it as a transit point for trading purposes. Furthermore, it has also been understood from the discussions, that drug use in Bhutan does not exist in isolation and may certainly have a co-dependency with alcohol abuse (the latter is an a well established practice in Bhutan).
Keeping these facts in mind, the training and planning to carry out the baseline RSRA was aimed at developing effective interventions to prevent the transmission of HIV among drug users with a focus on preventing the switch from oral to injecting drug use in the Phuentsholing area.
Dr. Panda facilitates a brainstorming session
A. Findings from the trainings:
It was encouraging to find that the BNCA wanted to take lead and ownership of not only the RSRA but also the project H13 interventions.
Since drug use is in a nascent stage in Bhutan and there are very few existing NGOs in Bhutan, there are no services for drug users in Phuentsholing. Therefore, there was difficulty in involving relevant service providers such as NGO staff, Peer counselors/Outreach workers in the training. Given the existing social development structure and its machinery in Bhutan, participation was sought from schools, hospitals, health information service centres and recovering alcoholic networks.
The participants were from different backgrounds and the training on basics of HIV, drugs and outreach enabled them to better understand the issues, especially those related to carrying out assessments and working on creating an enabling environment.
The participants found the content and the participative training methodology very useful.
They expressed a need to conduct more such trainings specifically trainings on treatment and rehabilitation of drug users. A need for training the medical and counseling staff was also expressed. There was an expressed need to include study tours to established treatment and rehabilitation centres in India.
Trainees also felt that after the training, they were now in a position to carry out RSRA and proposed the RSRA team and roles within it.
Training experts, Mr. Chaddor and Mr. Dorji develop the RSRA plan
B. Recommendations for conducting RSRA-by mentor agency BNCA:
Based on various group discussions on the perceived problem of drug use and the existing sociological-cultural factors in Bhutan, the division of RSRA has been through two target groups:
1. School Settings
It has been found that the age of drug use in Bhutan has been as low as 8 years and thus it was understood that one would need to also conduct the RSRA amongst the children and young adults between the ages of 12-18. This target group could be easily accessed through the schools and thus it was decided that students from classes VI-XII of the following schools would be accessed to obtain relevant information for the survey.
Mr. Chaddor, Mr. Dorji and the participants share some light moments at the end of the training
Certain guidelines for accessing students in school settings were also identified. It was decided that a consult with the school administration staff would be undertaken to sensitize them on the issues of drugs and HIV, the relevance of RSRA and the sensitivities to be kept in mind while conducting research in school setting. Some of the guidelines were information from the students of the schools mentioned above will be obtained through Self Administered Questionnaires (SAQ). Confidentiality will be highly maintained in order to acquire genuine information. Students shall be clearly briefed that the questions are non academic and will not lead to negative consequences for them in any way. The briefing will be carried out by the RSRA team in the region.
2. Community Setting
Those above or equal to the age of 18 (legally adult in Bhutan), traders and female partners of drug users using drugs themselves would be accessed directly in the community setting. Certain guidelines would be kept in mind such as to include the floating population but it would exclude people from India using drugs in Bhutan.
Commemorative Group photograph at the end of the trainings
The time lines for RSRA are to be decided with the BNCA who will work on it based on the understanding that the RSRA needs to start within two weeks after the training. It will be done for six-eight weeks after which the analysis and report writing would be done within two weeks post data collection. Finally, the interventions would be planned and implemented based on the RSRA report.
Conclusion: The knowledge imparted and the methodology used for so during the trainings were reported to be useful and much needed. The plan for RSRA is yet to be finalized including establishment of the DIC and its staffing.