2. Project description (background and justification)
[NOTE: The following details were written at the commencement of this project in 1999 when the situation, as described, prevailed.]
The project aims to mainstream HIV/AIDS concerns in ongoing Drug Demand Reduction programmes in south Asia.
It hopes to create an enabling environment for addressing the consequences of HIV/AIDS among drug abusers and to develop effective national policies and responses in Sri Lanka, India, Nepal and Bangladesh, develop protocols for undertaking risk reduction measures including drug substitution, needle syringe exchange interventions and low-cost community based care and support programmes for drug and HIV related issues. It will also facilitate regional sharing of information and resources for a concerted and convergent response to Drug and HIV issues through setting up of a National and Regional database.
HIV prevalence among drug users in the region indicates a differential epidemic. High levels in certain areas e.g. Manipur, characterize it, with a reported HIV prevalence of 80%. There are escalating levels in certain regions (e.g., 0% in 1994 and >50% HIV prevalence among IDUs of Nepal including Katmandu in 2001). There is high prevalence rate (above 5%) in many cities of India with 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), and 1.4% HIV sero-prevalence in Bangladesh (2000). There are also regions like Sri Lanka, where HIV is yet to be demonstrated among drug using population. Rapid escalation of HIV infection has occurred within 6-12 months from 0% to above 50% HIV sero-prevalence among IDUs in certain locations of the region. A majority of IDUs in the region exhibit high levels of injection as well as sex risk behaviour. In some regions, the population segments at risk for drug use and high-risk sex overlap. In high prevalent IDU-HIV areas like Manipur, transmission of HIV virus from injecting drug users to their spouses has been established and a study found 45% of the wives of the HIV infected IDUs to be HIV positive.
The specific drug control field is demand reduction, more specifically, preventing the spread of HIV/AIDS among drug users in the South Asian countries. The project will focus on facilitating setting up of a regional database, establishing national and regional policies/strategies for Drug and HIV risk reduction and initiating protocols for drug substitution, low cost care and outreach services.
Risk behavior that includes sharing of drug injection equipment is highly prevalent among populations of people using illicit drugs, presenting an environment in which an explosive spread of HIV and other blood borne diseases is inevitable. Governments in the region endeavor to take measures against the threat of drug abuse and HIV in their countries. Awareness is increasing and efforts are under way to address the needs and concerns of high-risk groups such as sex workers, injecting drug users, truckers, etc. The majority of the countries have developed national strategies and programmes on HIV issues.
Despite the ongoing efforts, governments and NGOs working in this area are still facing a series of problems:
- Information on drugs and HIV is still scattered and the linkage between the two areas is still weak. Additionally, drug abuse monitoring systems are in place only in India and Sri Lanka but not in the other countries of the region.
- Quality of interventions in the different countries is low.
- National strategies and policies are generally weak on how to prevent the spread of HIV among drug users.
In view of the above, it is critical that a regional project on drugs and HIV/AIDS is developed for creating an enabling environment and a framework for regional co-operation and sharing of technical resources, common concerns and lessons learnt.
The project will concentrate in four of the six countries of the South Asia sub-region namely, India, Bangladesh, Nepal and Sri Lanka, in view of the evidence of spread of HIV/AIDS among injecting drug abusers in the country.
The target group will be policy makers, planners, academicians and NGO service providers working in the field of drugs and HIV/AIDS. The indirect target group will be those drug abusers who are at risk of HIV infection and those who are infected and affected. Maldives and Bhutan will be also benefit from the protocols developed and the database.
This project will be part of the UNODC ROSA's strategy for the sub-region, that is, to strengthen national drug demand reduction and HIV measures. In line with government priorities and plans this project will contribute to:
Strengthening capacities of NGOs, community based organizations and governments by developing protocols for mounting an effective response to the consequences of HIV and drug use
Developing policies, strategies and workplan.
The mechanisms comprise developing a regional database to monitor drug and HIV epidemics and responses; developing mechanisms for co-ordination and co-operation in 6 countries of the region for drug and HIV/AIDS issues. This is to create an enabling policy environment; and developing necessary protocols for quality assurance for undertaking risk-reduction measures such as drug substitution, needle exchange, and low cost community based care and support. Critical to this project is quality assurance through technical assistance and developing capacity for programme implementation. The project will also facilitate the process of mainstreaming drug concerns in the national policies and strategies for HIV/AIDS prevention and control through the intensive interactions with the working groups formulated to develop the national policies on drugs and HIV/AIDS.
At the end of the project, it is expected that this project will assist national programmes in
- Developing policies, strategies and plans to address HIV risk reduction issues,
- Improving the quality of interventions through the development of protocols, and
- Developing, strengthening and linking up drug abuse monitoring systems with HIV information systems.
Drug control objective
To create an enabling environment for countries in the region to undertake HIV-AIDS prevention work amongst drug users.
3. Immediate objective, outputs and activities
- To develop national policies, strategies and plans of action for addressing HIV-AIDS risk reduction issues.
- To appraise and develop standardized protocols for reducing risk behaviour associated with drugs and HIV.
A comprehensive regional database to monitor the drug and HIV epidemic and responses is established.
- Identify relevant institutions with the help of competent national. Selection criteria will include country commitment and institutional ability to sustain the activity beyond the project period.
- Identify and recruit 1 technical consultant to facilitate the process and co-ordinate and provide technical backstopping.
- Document and disseminate significant findings from the region.
Four of the six countries in the Region (India, Bangladesh, Nepal, Sri Lanka) develop national policies, strategies and plans of action.
- Establish a working group in India, Bangladesh, Nepal and Sri Lanka with representatives from nodal agencies in Drug Demand Reduction, Law enforcement agencies, National AIDS Control agencies, UN theme groups and civil society representatives as appropriate for policy formulation, strategic planning.
- Recruit national consultants to co-ordinate, facilitate and provide technical backstopping to the working group.
- To organise two three-day workshops in each of the 4 countries as identified above, to assess review and plan the framework for an effective response.
Protocols for drug substitutions, needle and syringe exchange, and low-cost community based care and support are developed.
- Subcontract the review and development of protocols for the above.
- Organise regional consultation for reviewing and identifying appropriate protocols.
- Identify sites for field-testing the protocols in the 4 identified countries of the region.
- Establish a mechanism for periodic review, evaluation and scale up.
Database is evaluated, national strategies are developed and standardized protocols are available for scale up.
- Recruit one international consultant for a period of one work month for a thorough evaluation of database, national strategies and scientific protocols developed under the project.
- Organize a two day meeting with representatives from UNAIDS, UNODC ROSA and National Competent Authorities for dissemination of the findings and for securing their commitment for sustainability of the database, scaling up of the protocols and adoption of national policies.
4. Implementation arrangements
The executing agency for the project will be UNODC Regional Office for South Asia. UNODC ROSA will work closely with the drug demand reduction and HIV institutions in the countries. The implementation partners would include the National AIDS Control Organizations and the Country Programme Advisers of UNAIDS as well as the Theme Group Chairs in the region and relevant competent authorities responsible for Drug Demand Reduction.