2. Project Description (Background & Justification)
[NOTE: The following details were written at the commencement of this project in 1999 when the situation, as described, prevailed.]
Cannabis use has been traditional and is a common drug of abuse in many countries of South Asia. Alcohol is a significant public health problem in countries like India, Nepal and Sri Lanka. Heroin was introduced in the region in Nepal and North East India and subsequently in other parts of India, Sri Lanka and Bangladesh. Chasing (inhaling the vaporized form) of heroin is popular in the region and transition to injecting has occurred and is rapidly diffusing in the region. In certain geographical locations in India, Nepal and Bangladesh injecting drug use has been well established. Of concern is the escalation in the abuse of pharmaceutical drugs including synthetic opiates (like injectable buprenorphine), tranquilizers (diazepam), antihistamines and cocktails containing them.
Heroin, buprenorphine (Tidigesic®/Tamgesic®), diazepam (Calmpose®)
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, promethazine (Phenargan®), chlorpheneramine maleate (Avil®), other synthetic opiates (pethidine, pentazocine and morphine) and dextropropoxyphene (Spasmoproxyvon®) are the commonly injected drugs in the region. Buprenorphine injecting is common in Nepal, Bangladesh and many parts of India excluding North East India. Heroin and dextropropoxyphene are the preferred drugs for injecting in North East India.
The switch to injecting has occurred in the region and is well established in North East India, certain metropolitan cities (Chennai, New Delhi, Calcutta and Mumbai) of India, many towns and cities in India, Nepal and Bangladesh. Injecting is relatively less common in Sri Lanka where a majority of heroin users inhale or snort the drug.
Reports and surveys point to a sharp increase in injecting drug use, particularly among young people. Much of injecting drug use is carried out by sharing unsterilized needles and syringes and this is fuelling the rapid spread of HIV in Nepal and in some parts of India. In Nepal, HIV prevalence shot up among injecting drug users from 2.2% in 1995 to nearly 50% by 1998. Half the country's 50,000 drug users, including non-injecting drug users, are in the age group of 16-25. In Churachandpur (Manipur state) within a span of four years, HIV prevalence rose from 24% in 1994 to 67.6% in 1998. In Bangladesh, the epidemic is concentrated mainly among injecting drug users - a prevalence rate of 2.5% among the estimated 25,000 IDUs.
This illustrates a worrying trend for countries in the region, where injecting behaviour was virtually unknown. Studies have also found drug-injecting behaviour among sex workers. Drug injecting may also contribute to an increased incidence of HIV infection through HIV transmission to the children of drug injecting mothers, and through sexual contacts between drug injectors and non-injectors. HIV risk among drug abusers does not arise only through injecting. Many types of psychoactive substances, whether injected or not (including alcohol) are risky to the extent that they affect the individual's ability to make decisions about safe sexual behaviour.
As in other parts of the world, youth in South Asia (Bangladesh, Bhutan, India, Maldives, Nepal and Sri Lanka) are disproportionately affected by HIV/AIDS. A majority of the drug users in the region are in the age group 15-35 years. This has major implications for a region where 55% of the population is below the age of 25 years and is vulnerable to risk taking behavior. Infection patterns already show this disturbing trend of infections in young people below the age of 25. Of the estimated 5 million people
(IMPORTANT: footnote on revision of estimates in July 2007) living with HIV/AIDS in the region, more than one third are young people below the age of 25. This trend in infections means that large numbers of young people could become affected with devastating human and economic consequences.
The South Asian sub-region contains over 400 NGOs and Community Based Organizations (CBO) working on drug demand reduction issues. While most service providers offer de-addiction, counseling and aftercare based on the abstinence model, treatment options targeting drug users that include community outreach, peer support, Needle Syringe Exchange Programs (NSEPs) and drug substitution are limited. There is a wide gap between treatment demand and service provision as well as treatment expectations and quality of services offered.
Specifically service providers, governments and CBOs do not exchange enough information and knowledge on prevention, treatment and rehabilitation efforts in the countries. Additionally, the existing networks hampered by the lack of strategic visions and funds are not able to provide a holistic approach on drug abuse and HIV/AIDS and assist the governments in developing comprehensive policies in this area. Furthermore, the evidence of drug abuse and HIV is often not available and does not allow civil society organizations, service providers and young people to carry out advocacy measures.
In view of the above, it is critical that the project facilitates:
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An extraordinary response in reducing HIV related risk among young drug users through fostering regional and national alliances and development of partnerships between CBOs, NGOs and governments,
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Information sharing between countries and,
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Evidence-based advocacy in the region.
3. Immediate Objectives, Related Outputs & Activities
Immediate Objectives
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To foster alliances and strengthen regional networks for information and expertise sharing, and capacitating them to create an evidenced based policy and program environment thereby facilitating GO-NGO and other appropriate institutions to mount an extra-ordinary response to address HIV/AIDS risk in young drug using populations in South Asia.
- To increase the capacity of CBO- NGO and GO structures and systems to undertake effective and evidence based interventions through sharing information, resources and skills in order to break the chain of HIV transmission among young drug using populations.
Outputs and related activities
Output 1:
An assessment of the situation and strategic information related to spread of HIV/AIDS amongst young drug abusing populations and for mounting evidence-based responses is available in South Asia.
Activities
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Identify and appoint a Research Coordinator and a Research Associate at the research cell in UNODC to lead and facilitate activities necessary for achieving output
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Identify and place national focal points in at least four countries of the region for providing technical support to the national counterparts and facilitating activities such as rapid situation assessments, setting up of database on youth vulnerability and possible resources to respond, identifying resource persons for carrying out training needs assessment and capacity building of Youth Ambassadors, Peer Educators and other relevant stakeholders, and helping national competent authorities in undertaking programme and policy formulation and review.
- Develop, print and disseminate a comprehensive report on HIV/AIDS risk reduction opportunities amongst young drug abusers in South Asia and use it to advocate for national level policy and program review.
- Develop capacities within countries of the region to monitor and manage drug related HIV in young people.
- Develop, print and disseminate a comprehensive report on HIV/AIDS risk reduction opportunities amongst young drug abusers in South Asia and use it to advocate for national level policy and program review.
- Develop capacities within countries of the region to monitor and manage drug related HIV in young people.
Output 2:
A South Asia network consisting of NGOs, CBOs, representatives of academic, bilateral and multi-lateral agencies, development media organizations and private sector foundations are established and facilitated for undertaking drug and HIV/AIDS risk reduction activities among young people.
Activities
- Identify and appoint a short-term consultant to facilitate network formation and work closely with focal points and national counterparts, Key Influencers, NGOs and CBOs
- Focal Points to facilitate/establish contact with national level federation of NGOs working on drugs and HIV/AIDS and initiate a dialogue for mainstreaming drug and HIV/AIDS concerns in ongoing activities.
- Organise 2 three-day meetings with 60 participants from the region to facilitate establishment of a regional network and forum with clear TOR and MOU.
- Focal Points identify key influencers amongst NGOs, CBOs, multi-lateral and bi-lateral agencies who could meet to develop a regional advocacy, strategic planning, implementation and review forum on drugs and HIV/AIDS prevention among young people in South Asia.
- Focal Points organise 4 National level advocacy meetings to mainstream HIV/AIDS concerns in ongoing Drug Demand Reduction programs and Drug Demand Reduction concerns in ongoing HIV/AIDS programs.
Output 3:
Experience and information is shared, advocating effective approaches to prevent HIV/AIDS amongst young drug users.
Activities
- Identify, record and publish a compendium of existing good practices of preventing HIV risk among young drug users.
- Disseminate data from research and best practices in the region.
- Produce and disseminate a quarterly regional newsletter.
- Organise 6 five-day training programmes for NGOs, CBOs, peer educators, medical, law enforcement etc on drugs and HIV/AIDS prevention issues.
- Support regional study tours/on the job placements for representatives of NGOs and CBOs for developing a South Asian response to HIV/AIDS prevention amongst drug abusers.
- Identify and support 60 young people from the region (youth ambassadors, positive persons-PLWAs, recovering drug users) to serve as Peer Counsellors.
Support small research initiatives in behaviour change in South Asia, which will baseline existing behaviour among vulnerable youth and use peer led intervention mechanisms based on behaviour change communication and other skills to address risk-reduction . |
