UNODC is cosponsor of the Joint United Nations Programme on HIV/AIDS - UNAIDS
RAS/H13: Training on Outreach Activities and Needle Syringe Program (28-30 April 2008) and Training on Positive Living and Services for Female IDUs and Female Regular Sexual Partners of Male Drug Users (2-4 May 2008) in Kathmandu, Nepal
Contributed by Lipi Chowdhury, Consultant, Project H13
To build capacity on the basics on Needle Syringe Program (NSP) and outreach activities under the Safer Practices, Peer Led Interventions (PLI) and gender strategy of the project.
To sensitize and build capacity of the staff from partner NGOs in the areas of positive living with a focus on women and services for female injecting drug users ( IDUs) and female regular sexual partners of male drug users.
Process of the trainings:
Participants understand PMCT with the help of the "But Why" tree
Inaugural: The first training session started on 28 April 2008, and included participants from the Drug Control Program (DCP), National Centre for AIDS and STD Control (NCASC), United Nations Development Programme (UNDP) and World Health Organisation (WHO).
Mr. Olivier Lermet,
HIV Advisor for UNODC in Nepal gave the opening address and emphasized the need to ensure that efforts of the various agencies are coordinated and contribute to the national response and strategy on HIV/AIDS. UNODC will contribute by leading the Joint UN Team on AIDS efforts as far as Injecting Drug Use, Prisons and Human Trafficking are concerned. He reminded the extreme level of expertise of the trainers and insisted on the synergies and linkages between this training and two new initiatives: The first is the NPLJ80 project on Female Injecting Drug Users, Female Prisoners and Female Partners of Drug Users, funded by Norway, tying up with the gender part of the training. The second initiative is the upcoming Technical Assistance and Advocacy Package to be delivered by UNODC in the second half of 2008 to all implementers of the comprehensive package for IDUs, funded by Department for International Development.
Female condom demonstration by Dr. Samiran Panda
Mr. Lermet also said that the gender training within the project was just the tip of the iceberg, part of the larger strategized gender approach of UNODC. He requested participants to give feedback in order to strengthen this approach and invited the government and the civil society organizations "to help UNODC support them."
Mr. Chandeshwar Acharya, Under Secretary, Ministry of Home Affairs (MOHA), in his address on
'DCP's strategy on drug abuse prevention', mentioned that drug use was a serious threat and directly related to human resource development as it affects the productivity in youth and human security. He emphasized that under the Government of Nepal, the new policy of the DCP makes it easier to work with civil society, donor agencies and other stake holders. In the past there has been focus on drug supply reduction but not enough focus on drug demand reduction, but that has changed now. Categorical changes in the policy include six intervention areas, of which one is, harm reduction that supports civil society through the UN systems and donor agencies. He mentioned that there are still gaps in coverage and that drug use prevention programs should also work on greater access to harm reduction services. He concluded by emphasizing that project H13 training programs would benefit and complement such program activities in Nepal and urged the participants to transfer the learnings to other colleagues in the field.
Dr. Mohammed S.A. Elgadir Programme Manager HIV/AIDS PMU, UNDP Nepal, in his address on
'UNDP's experiences on Needle Syringe Programmes in Nepal' emphasized that the UN family was a global initiative to align and support better the national initiatives on all aspects of social development towards achieving the millennium goals. He highlighted few points, firstly, that drug users are shifting to pharmaceuticals due to cheap and accessible drugs which has implications on size and kind of syringe. Secondly, creating an enabling environment was an issue. In Nepal, while the NGOs were doing good work and trying to learn, some NGOs did not adhere to safety measures of storage and disposal of needles which negated any efforts towards harm reduction .He said that work was discontinued with some NGOs not due to reluctance to support but due to lack of interest, adherence and coherence of the NGOs. He said, that everyone needs to learn and join together to have open policies, dialogue in order to improve storage of needles and syringes at drop in centres(DICs), distribution of needles and syringes to clients, the collection and disposal of used needles.
Demonstration on safer injecting practices by the Expert
Ms. Amaya Mawnaing, Medical Officer, WHO gave an address on
'Needle Syringe Programmes as an essential component of a comprehensive response' wherein she said that WHO, UNAIDS and UNODC were making joint efforts to develop a clear policy on comprehensive packages for harm reduction in drug use. She spoke of the nine components of prevention, care and treatment under the harm reduction approach in drug use, namely, NSP, Oral Substitution Therapy, Voluntary Counselling Testing Centre , Anti retroviral Therapy (ART), STI Prevention, Condom Promotion, Targeted Intervention-education and communication, Hepatitis A,B and C diagnosis, treatment and vaccination and Tuberculosis diagnosis and treatment She highlighted that, WHO has 20 years of research and evidence that NSP helps in control of HIV and blood borne disease. She said that the NSP is the responsibility of the service providers who must ensure the needles are sterile and there is no circulation of used needles and syringes and that there is safe disposal. The safe distribution and disposal of needles and syringes for the safety of drug users and their partners is a medical ethic. She concluded by saying that the service providers should remember that NSP alone is not enough and needs to be supplemented by risk reduction education and referrals to treatment and primary health care facilities.
Ms. Lipi Chowdhury, Consultant, Project H13 gave a briefing on regional progress of H13 till now, the Phase II activities in Nepal and the training objectives of the Project. She also clarified queries about the publications and the work plan of the Project in Nepal.
Dr. Padam Bahadur Chand, Director, NCASC spoke on
'IDU Interventions-the National Response', wherein he highlighted that so far there has been a consolidated response keeping in mind the national response for all sectors of health. He highlighted that, health is a package including needs of drug users who have multiple vulnerabilities and not just HIV/AIDS. Therefore, there is a need to have robust comprehensive packages of services for this vulnerable population.
Male condom demonstration by the participants under the supervision of the Trainer
Description of the training : The methodology used in both the trainings was participatory with role plays, simulation exercises, presentations, visits to ART service delivery and NSP sites and minimal use of power point presentation was done. The participants were from H13 partner NGOs who are implementing the NSP and PLI. The Project is providing support to further improve the quality of NSP programmes through the trainings to the above mentioned NGOs as was agreed in the workplan.
The trainings imparted information on harm reduction with emphasis on prevention, treatment and care related to drug use and drug use driven HIV. They included sessions on psychosocial aspects of service provision which was done to equip the partners to work in reducing stigma and discrimination and incorporate gender concerns in HIV interventions. The field visits for the NSP-Outreach training was organized at three sites. These were an addiction treatment center, DIC and an outreach activity site. For the ART visits, the participants were divided into three groups and went to different sites; ART centre at TEKU Hospital, SPARSHA - a centre for friends of and people living with HIV/AIDS and PRERNA-a crisis centre for women living or affected with HIV/AIDS. Overall, the field visits helped the participants to hone their existing hands on experience. Each group had to present their experience and be involved in group discussions which were facilitated by the trainers.
Participants with the Trainers and Project Consultant
The Project Consultant facilitated a session on initiating a tentative plan for trainings on positive living and services for female partners and drug users at the NGO and demo site level. These trainings would incorporate 16 sessions wherein one topic would be done with two support groups over 16 weeks for all the 13 NGOs. The NGOs will finalize their plans in the next two weeks and start with the trainings.
Conclusion : The trainings concluded with two participants doing a recap of the objectives and the process including content of both the trainings. They shared the new learnings and future plans of utilizing them. Mr. Lermet, expressed the importance of such training workshops especially given the need to have better service delivery provision. Mr. Chandeshwar Acharya, appreciated Project H13 for having these trainings and urged the participants to share their learnings with the rest of the staff and apply on the field. The Project Consultant concluded by thanking the DCP for their support, the experts and the participants for their keen involvement in the trainings.
"I have been able to understand that advocacy is a process that can bring in a change in the existing policy or in the way of doing things. And that advocacy plans can be revised and the way of advocacy can be modified in terms of intended change and impact."
Conclusively, all the 59 participants from partner agencies carrying out PLI and those carrying out NSP reported that the training on NSP-Outreach strengthened their existing learning on aspects of outreach work and ways to make it more effective. They also learnt that an important component of NSP is also an effective disposal program and reported clarity on process, output and outcome indicators in NSP. They revealed that the thematic areas of rights, sexual and reproductive health, ulcers and abscess management, ART and drug adherence, advocacy and networking in the training on positive living were new learnings for them. Most of them had never seen a female condom before and through demonstrations by the experts, learnt the correct way of condom usage (both male and female) and safer injecting practices. They reported the visible use and translation of these trainings in the field and were looking forward to more of such trainings in the future.