2. Project description (background and justification)
The SAARC countries - Bangladesh, Bhutan, India, Maldives, Nepal, Sri Lanka, and Pakistan - are wedged between the world's two largest areas of illicit opiate production, commonly referred to as the Golden Crescent and the Golden Triangle. It is estimated that there are over 4 million drug abusers in this region. Chasing (inhaling the vaporized form) of heroin is popular in the region though transition to injecting has occurred and is rapidly diffusing. It is estimated that SAARC countries have about 400,000 IDUs. In certain locations in India, Nepal, Bangladesh and Pakistan, injecting drug use has been well established. Of concern is the escalation in the abuse of pharmaceutical drugs including synthetic opiates (like injectable buprenorphine), tranquillizers (diazepam), antihistamines and cocktails containing them. Among IDUs, sharing of injection equipment is common in India, Nepal and Bangladesh. Many IDUs in the region practice unsafe sexual behaviours.
HIV prevalence among drug users in the region indicates a differential epidemic characterized by unacceptably high levels in certain areas (Manipur with a reported HIV prevalence of 80%), escalating levels in certain regions (0% in 1994 and >50% HIV prevalence among IDUs of Nepal including Kathmandu in 2001), high prevalence rates (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. A 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. Majority of IDUs in the region exhibit high levels of injection as well as sex risk behavior. 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 problems in the region regarding injecting drug use and HIV are many. Drug users are a hidden population and are hard to reach. A relatively small number of drug users are benefiting from evidence-based interventions. The quality of interventions for injecting drug users to prevent HIV is often poor. Many agencies do not have the required technical ability to design and develop appropriate interventions or to properly implement and evaluate their own work. Stigma around injecting drug users and HIV positive people is also widespread.
In view of the above, the UN system together with the Inter-Country Team (ICT) of UNAIDS in the region, including Pakistan, initiated a regional planning process to prevent the spread of HIV/AIDS among vulnerable groups in the region. Four areas -young people, political advocacy, migration and injecting drug use- have been identified in meetings in Kathmandu (1999), Delhi (2000) and Colombo (2001) as crucial for interventions in the region.
UNDCP ROSA has been given the lead role for the issue of injecting drug use and HIV in the region. A situation assessment was compiled based on secondary data and national level focus group discussions with nodal agencies working in drug demand reduction, health ministries and civil society organizations. Based on the assessment a project idea was developed, which was discussed with the governments in the region during a regional consultation in New Delhi in June 2001. The consultations helped to crystallize and clarify the project idea and fostered partnership in the project development process. This project idea was then presented to UNAIDS co-sponsors, donors and the government of Pakistan at a meeting in July 2001 in Colombo. Feedback and inputs from the meeting clearly re-enforced the need for such a project, and also highlighted the need for quickly initiating quality scale up based on standardized protocols through a fast track approach.
This project proposal is closely interlinked with the UBW proposals for 2001 and 2002 (RAS/G23 and RAS/F90), on drugs and HIV related issues in the South Asian sub region. The focus of the UBW 2001 project titled "Mainstreaming of HIV concerns in ongoing drug demand reduction concerns in South Asia" is on development of a comprehensive database to monitor drug & HIV epidemics and responses for participating countries and gather evidence to formulate national strategies, policies and plans of action. Under this project protocol development will be initiated as tools for working among injecting drug users. The focus of UBW 2002 is on addressing vulnerabilities of young people in the South Asia region. Situation assessment of drug related HIV among young people; formation of GO-NGO networks for information and experience sharing; and carrying forward of national and regional policies related to facilitate the process of creating an enabling environment for initiating risk-reduction programmes, are the main components of this project.
3. Goal, Objective, Outputs & Activities
Goal
To reduce the spread of HIV among drug using populations in the SAARC countries
Overall objective
To foster regional cooperation for mainstreaming HIV /AIDS concerns in drug demand reduction programs of the SAARC countries.
FAST TRACK: 33 months
Immediate Objective
To strengthen capacities of national governments and civil society organizations to mount a comprehensive and effective response to prevent the spread of HIV/AIDS amongst injecting drug users in the SAARC region.
Preparatory PHASE Outputs and Activities
(6 Months)
Output I
Implementation and coordination arrangements for implementing the projects at the regional and national level are in place.
Activities:
- Establish a project office in UNODC ROSA and recruit Project Coordinator, Project Associate and general service support staff for project implementation.
- Identify focal points in the offices of the identified national competent authorities to carry forward the operational plans, facilitate inter-agency collaboration, monitor and supervise the project activities and deliverables and to report on the progress made.
- Organize a regional meeting of competent authorities from countries of the region, for finalizing the operational work plan and implementation arrangements including regional and national coordination mechanisms.
- Identify potential members for Virtual Technical Advisory Group (VTAG) for backstopping of the project, including representatives from international organizations, Asia Harm Reduction Network (AHRN), other existing organizational networks and research institutions working in the drug demand reduction and HIV/AIDS prevention sectors.
- Organize national stakeholder meetings in the seven countries of the region to ensure greater involvement and foster ownership at the national level.
Output II
A regional project management, monitoring and evaluation system is in place.
Activities:
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Establish a Project Advisory Committee (PAC) with representatives from law enforcement, nodal National AIDS Control Organizations, Drug Demand Reduction Organizations, UN Theme Group Chairs for HIV/AIDS or their representative, representation of AHRN, representatives from NGO, CBO, civil society organizations and ILWHA groups from the seven countries of the region.
- Organize bi-annual meetings of the PAC during project life.
- Develop annual costed work plans (to be developed by the project coordinator), which will be approved by the PAC for submission to UNODC for budget allocations for all five years of the project.
- Establish a Virtual Technical Advisory Group (VTAG) comprising of experts on drugs and HIV/AIDS for technical backstopping and monitoring of the project, inclusive of a net-based communication mechanism for providing technical expertise and advise to participating countries and sites.
- Organize two meetings and field missions of the VTAG in the first year of the project and annually thereafter.
- Establish mechanisms for initiating, facilitating and supporting the country level activities by the regional platform comprising PAC, VTAG, National Focal Points, UNODC ROSA, & UNAIDS.
Output III
Necessary mechanisms and instruments for developing regional and national strategic direction and for mounting responses planned under the project are in place.
Activities:
- Facilitate Documentation of good practices and lessons learnt in the region, based on a comprehensive review of existing programme interventions for preventing HIV among drug abusing populations especially injecting drug users.
- Support the competent authorities from the drug demand reduction, HIV /AIDS and drug law enforcement sectors to jointly review and within the overall framework of drug demand reduction, document the legal and political concerns related to IDU risk-reduction (consequences of injecting drug use).
- Disseminate and discuss the possible use of the "Common UN system position paper on prevention of HIV among drug users", "Guiding Principles of Drug Demand Reduction", the "UNGASS Political Declaration on Drug Control" and the "UNGASS Declaration of Commitment on HIV" as reference documents for developing comprehensive programmes and strategies.
- Commission a regional study on cross border networks of drug abusers especially injecting drug users.
- Commission a regional study to capture current capacities of NGOs and CBOs to undertake HIV risk-reduction interventions.
- Facilitate development of a regional database of resource persons, capacitated organizations, potential/current donors, ongoing risk-reduction interventions and current gaps in resources and services that need to be addressed in order to guide and capacitate a comprehensive regional response.
- Develop selection criteria for pilot sites to test protocols
- Develop a process for identifying public-private sector institutions and selected centres for piloting of protocols and undertaking efficacy trials
- Identify geographic areas of focus for initiating the pilots and for fostering country and regional ownership
- Establish regional mechanisms to evolve a comprehensive strategy and an appropriate response to reducing HIV related vulnerability among drug using populations in the SAARC region.
- Develop a Strategic Training plan for the project.
- Organise a regional 5-day workshop for thirty participants who are key stakeholders to revisit the log frame, undertake a "project risk analysis" and developing consensus on project monitoring and evaluation framework, indicators and management mechanisms.
- Develop and disseminate a gender strategy for the project.
PROGRAMME PHASE (24 months)
Immediate Objective:
To strengthen technical capacities of governments and civil society organizations for improving the quality of services provided and accelerating the pace of response to prevent the spread of HIV among drug users in the SAARC countries.
Output I
Critical elements in preventing the transmission of HIV among IDUs are identified and accepted for mounting an effective response by stakeholders in the region
Activities:
- Commission a draft working paper through a participatory process, identifying critical elements that prevent HIV transmission among IDUs and drug using populations
- Organize a 4-day regional consultation with representatives from NGOs and Government agencies working in the field of drug demand reduction and HIV/AIDS prevention in order to arrive at a consensus on a minimum package of HIV/STI risk-reduction interventions which will provide drug users an assured quality of services within the overall framework of drug demand reduction responses that include prevention, treatment, rehabilitation, after-care and social re-integration.
- Incorporate the suggestions from the above regional consultation into the working paper, and print/widely disseminate the same across to all influencers, policy makers and service providers in the region.
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Organize a 3-day regional consultation meeting with representatives from NGOs, ILWHA/PLWHA and competent authorities from Government in Drug Control and HIV prevention, to arrive at a consensus on critical factors and effective interventions.
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Incorporate the suggestions from the above regional consultation into the working paper, and widely disseminate the same across to all influencers, policy makers and service providers in the region.
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Organise a three-day regional sensitization workshop for key stakeholders on gender dimensions and strategy for the project.
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Identify, field missions and launch innovative campaigns with the help of high profile champions and advocates of change including Young Ambassadors, who could interact with those vulnerable, key influencers and planners in the region for creating an enabling environment for responses.
Output II
Feasibility studies utilizing standardized Protocols on Peer based Community Outreach, Low-cost Community-based Care and Support, NSEP and Oral substitution are completed and the experience gained is available for adoption and scale up by countries of the region.
Activities:
- Strengthen institutional capacities of selected agencies and organizations to provide field based learning opportunities through the identified demonstration sites for hands on skills enhancement for a variety of service providers in the region.
- Issue sub-contracts with specific Terms Of References (TORs) to the above institutions and demonstration sites to carry forward the activities.
- Organize consultation meetings and establish linkages for providing technical support and Quality Assurance between technical support persons from the Virtual Technical Advisory Group (VTAG) and the identified Institutions and Demonstration sites.
- Cost information on HIV prevention strategies for matching country setting with comparable programs, epidemiological and economic conditions is developed for use by national and regional policy makers.
Output III
Service providers are in the position to offer quality services for injecting drug users and "other drug" users in the region.
Activities:
- Develop an intervention tool-kit to serve as a road map for service-providers on the WHY & HOW of designing, setting up, implementing and evaluating the efficacy of above interventions, in a variety of settings and contexts.
- Identify a pool of researchers and resource persons and establish a regional network and mechanism for sharing information and skills for providing quality services.
- Organise 2 Training of Trainers (TOTs) programmes (for standardized protocols and intervention tool kits) at the regional level incorporating core skills building exercises and linked to study tours to the Demonstration Sites, to provide a pool of Master Trainers.
- Organize 10 in-country training programmes with the help of the Master Trainers to build capacities of service providers working in a wide range of settings.
- Organize study tours for key stakeholders and influencers to demonstration projects within the SAARC region.
- Enable the production of a regional journal on drug and HIV/AIDS for sharing scientific information to guide the practitioners for updating their information and knowledge.
Evaluation of Fast track (3 months)
Activities:
- Document the process, mechanisms adopted and the lessons learnt by the project
- Field a mission for evaluating fast track phase
- Organize a tri-partite review meeting to receive the findings of the evaluation team
- Organise a donor and key stakeholder meeting for mobilizing resources for the expanded program as well as incorporating lessons learnt into the national programs for sustainability and integration.
- Organise national level meetings for integration of the models adopted into the national programs especially for increasing support to the programs for prevention of HIV among injecting drug users
- Revise Track II work plans based on updated information and recommendations made by the end evaluation team
- Obtain approval for Track II workplan from Project Advisory Committee.
TRACK II: 27 months
Immediate Objective
To facilitate the scaling up process, in the countries of the region through mechanisms established in the "fast track".
PROGRAMME PHASE (24 months)
Output I
Best practices are documented and IEC material disseminated in the region for adaptation, replication and for developing a wide-scale response to the epidemic
Activities:
- Document best practices emerging out of the implementation of the protocols at the field level.
- Sub-contract GOs/NGOs for printing, participatory testing and dissemination of a good practices document, IEC material for advocacy and interventions.
Output II
Governments and other civil society organizations are further strengthened to carry forward an expanded response to the HIV epidemic among IDUs
Activities:
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Expand resource pool of trainers
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Assess additional training needs
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Carry out regional/national training courses/study tours/placements/workshops
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Identify additional organizations to take forward the interventions
- Strengthen institutional capacities (where necessary)
Output III
Facilitate the exchange of knowledge/information/skills within the region on HIV/AIDS risk reduction interventions among IDUs
Activities:
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Facilitate establishment of national/regional networks through provision of support to meetings, workshops, information dissemination and setting up of "e-fora" etc.
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Organize regional network meetings on a biennial basis.
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Identify mechanisms of co-ordination and facilitate secretarial support to the regional network by issuing a subcontract to an existing organization within the region.
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Provide support for publication and distribution of periodic newsletter and hosting of a regional web site.
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Establish a regional "clearing house" for collection, collation and dissemination of information within and outside the region.
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Identify and train through exposure tours and periodic technical updating, a core group from the above institution.
Output IV
A uniform Drug Abuse Monitoring System is in place in the 7 SAARC countries.
Activities:
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Review DAMS in India and other countries in the region. Possible linkages to Global Assessment Project will be explored.
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Organize a regional consultation for review of uniform DAMS tools, sources of data, indicators and outputs, and evolve a reporting mechanism for regional/national monitoring.
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Strengthen capacity of existing national monitoring systems and structures through provision of technical expertise, equipment, and software.
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Identify a regional institution to serve as a nodal agency for setting up a regional database for monitoring and reporting.
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Develop IT and other connectivity to the regional database centre and seven participating countries of the region.
Evaluation of TRACK II (3 months
)
- Field a mission for evaluating track II
- Organise a donor and key stakeholder meeting for mobilizing resources for the expanded program as well as incorporating lessons learnt into the national programs for sustainability and integration.
- Organise national level meetings for integration of the models adopted into the national programs especially for increasing support to the programs for prevention of HIV among injecting drug users
- Organize a tri-partite review meeting to receive the findings of the evaluation team
- Terminal report drafted
Document the experiences and processes initiated in Track II. |
