2. Project Description (Background & Justification)
India is wedged between the world's two largest areas of illicit opium production, the Golden Crescent and the Golden Triangle. This has rendered India both a destination and a transit route for opiates produced in these regions. In addition, risks arise from the possibility of diversion from the licit opium crop and the conversion of the same into heroin, the illicit cultivation of opium poppy and cannabis, the clandestine manufacture of methaqualone and mandrax, the trafficking of cannabis and hashish from Nepal as well as the diversion of precursors from both domestic and international trade. A new factor is the trafficking of ATS from Myanmar into India. The most significant recent shift in drug use patterns in India is the move from smoking or chasing to injecting drug use. Heroin, buprenorphine (Tidigesic®/Tamgesic®) and dextropropoxyphene (Spasmo-proxyvon®)
[1]
are the commonly injected drugs in India.
HIV prevalence among drug users in India is displaying a differential epidemic characterized by high levels in certain areas (Manipur with a reported HIV prevalence of 80%), high prevalence rates (above 5%) in many cities of India within a concentrated IDU population (Chennai, Mumbai, New Delhi), low-level prevalence in certain areas like Calcutta (<2% HIV sero-prevalence for the past seven years). A majority of IDUs in India exhibit high levels of injection as well as sex-risk behaviour. In some areas of India, the population segments at risk of drug use and high-risk sex overlap. In high-prevalence IDU-HIV areas like Manipur, transmission of HIV from injecting drug users to their spouses has also been established and one study found 45% of the wives of the HIV-infected IDUs to be HIV-positive.
UNODC ROSA and the Ministry of Social Justice and Empowerment, Government of India have, in the past year, initiated several research initiatives to study the nature extent and pattern of drug use and abuse as well as its consequences. The Drug Abuse Monitoring Systems (DAMS) captured the profile of treatment seekers. A Rapid Survey Assessment (RSA) in 14 cities of drug users collected and collated street based information on drug use and drug related HIV. In-depth thematic studies of drug use in the border areas, women drug users, drug use in rural areas and pattern of drug use in prison populations were also launched. A National Household Survey having a sample size of over 40000 males in the age group 12-60 years documenting the extent, patterns and trends of drug use in India was a major part of the research collaboration. Preliminary findings of the above studies indicate multiple drug use in opiate abusers with a significant proportion of pharmaceutical drug use. All studies reported IDUs with users injecting heroin, buprenorphine and propoxyphene. DAMS reported ever injectors at 14% and current IDUs (within the last month) at 9.4%. Needle-sharing was reported by 7.7%. RSAs conducted in Jamshedpur, Hyderabad, Bangalore, Shillong, Dimapur, Thiruvanthapuram, Goa, Ahmedabad, Imphal, Chennai, Mumbai, Delhi and Kolkata indicate ever injectors at 43% of clients interviewed. Needle sharing was reported by 53-85% of the injectors. Non-cleaning of needles/syringes was common and knowledge of modes of HIV/AIDS transmission was limited. Consequently risk-perception of HIV was low. Significantly, women drug users also reported injecting drug use. Clearly there is a need to extend interventions and prevention activities into areas other than the northeastern states, particularly the metropolitan cities of India where injecting drug use is an emerging or well established issue with over 100,000 estimated injecting drug users in India other than the northeast.
Drug abuse treatment is not chosen by all drug abusers at risk for HIV infection, or may not be attractive to drug abusers early in their injecting career. In addition, recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. Relapse to drug abuse and risk behaviour can occur during or after successful treatment episodes. Various outreach activities have been designed to access, motivate and support drug abusers who are not in treatment to change their behaviour. Findings from research indicate that such outreach activities taking place outside conventional health and social care environments reach out-of-treatment drug injectors, increase drug treatment referrals, and may reduce illicit drug use risk behaviours and sexual risk behaviours as well as HIV incidence.
3. Immediate Objectives, Related Outputs & Activities
Immediate Objectives
To strengthen the outreach and knowledge of service providers in the northeastern states of India and metropolitan cities such as Calcutta, Chennai, Delhi and Pune/ Mumbai.
Outputs and related activities
Output 1
Capacity of 8 Regional Resource and Training Centers (RRTCs) is strengthened to reach out and respond to vulnerable populations in a concerted and convergent manner.
Activities:
- Specific training courses for RRTCs and other NGOs are designed and carried out in coordination with MSJE and NACO
- Identify Master trainers as facilitators in the RRTCs
- Identify peer educators in the project areas
- 8 training programmes for peer educators organized
- Organize meetings in the project areas with stakeholders to review peer driven initiatives as a national priority for providing cost-effective quality coverage of IDU populations.
Ouputs 2
Innovative peer-led interventions in 10 sites identified by the 8 RRTCs are piloted within their areas of intervention.
Activities:
- NGOs launch community-based peer led interventions, targeting vulnerable populations, especially young people, IDUs, and women
- Interventions involve recovering drug addicts and positive people trained to lead peer driven initiatives, in creating sustainable impact in a community owned and managed process
- Create and support peer networks at the project sites
Output 3
Guidelines for addressing stigma and discrimination related to substance abuse and HIV/AIDS are available for service providers.
Activities:
- Formulate the guidelines for service providers
- Review guidelines with all stakeholders
- Make available the guidelines to all service providers, government etc.
Output 4
The project progress, process and findings are well documented and distributed to the Theme
Group and the Government.
Activities:
- Document the project process and progress
- Document best practices in the project
- Distribute documentation to main stake holders
[1] Note: the trade names under which these drugs are sold in the market are not intended to imply a pejorative sense.
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