2. Project Description (Background & Justification)
The quality and the quantum of information available from South Asian countries on the issue of drug abuse and HIV/AIDS vulnerabilities and responses vary considerably from country to country and also among various regions inside each country. While large-scale national-level studies examining the issue of drug abuse and HIV/AIDS have been recently conducted in some countries such as India (2002), Bangladesh (2002) and Maldives (2003), such studies are required to be conducted in Nepal and Sri Lanka. There is a lack of precise qualitative and quantitative data related to the magnitude of drug use in prisons and services available for them in prisons as well as vulnerability of street children to drug use and HIV in South Asia.
Since a large number of the prison population (both under trial and in remand) is incarcerated for drug or drug-related crimes, it is critical that the information base to capture the profile is developed and appropriate drug and HIV risk reduction strategy and interventions are developed.
Street children use a number of substances including solvents such as glue and petrol sniffing, apart from heroin, cannabis, psychotropic substances and sedatives to cope with social stresses of living on the street. Sexual abuse is extremely common. They are also sexually active at a younger age and often indulge in multi-partner sex with older boys and girls who promise security on the streets. In most countries the governments and civil society partners have initiated health care and non-formal education programmes for these children with help of street educators. The skills to address substance use and sex and sexuality related issues of the service providers are limited and as a result the drugs and HIV seldom feature on their agenda. Therefore, any programme that is designed would need to build on the special skills of street educators by building their capacities to address the twin issues of risk behaviour in this sub population. Street children when sent to services for older people often do not benefit from the services as drug use patterns are different and treatment facilities are not geared towards addressing their concerns.
There is a wide gap between the treatment demand and service provision as well as the treatment expectation and quality of services offered especially for vulnerable groups drug users in prison and street children. Interventions like community outreach, peer driven interventions and maintenance treatment are operational in some places in the region but it is likely that these interventions are not driven by standardised protocols. Protocols that facilitate proper implementation and evaluation of large-scale programming need to be developed.
Interventions, even when available, are often not directed specifically at vulnerable population groups such as prison inmates, young people and street children. There is a lack of cohesive, coordinated response from drug demand reduction and HIV/AIDS prevention agencies in some countries. The region lacks a comprehensive intervention toolkit that primarily focuses on community management for risk-reduction amongst these high-risk groups. This toolkit needs to be culturally adapted to the local settings of use. One gap identified in rapid situation assessments is an intervention that accesses networks of current drug users and motivates them to get into the treatment net of interventions for HIV prevention.
Both the UBW projects (RAS/F90 and RAS/G23) strive towards attaining the objective of prevention of HIV/AIDS in drug users. However, efforts and approaches such a peer led interventions initiated under these two projects could be adapted and adopted for vulnerable groups of drug users in high risk settings. Specifically, there is a need to direct project activities towards vulnerable groups such as street children and prison inmates, and continue to support selected peer-led intervention sites developed under RAS/G23 after an evaluation of these sites. Both the afore-mentioned projects also address the issue of formulation of national policies and strategic plans. There is a need to carry these activities forward and base the national strategic plans for addressing concerns of street children and incarcerated drug users on the information available from resource and vulnerability mapping.
The project aims to intensify efforts to reduce drug related HIV/AIDS amongst vulnerable high-risk groups in South Asia. By strengthening the capacities of existing governmental and non-governmental organisations engaged in the prevention of drug abuse related HIV/AIDS on the one hand, and targeting vulnerable high-risk populations on the other hand, it aims to address existing gaps identified through a participatory process. Intervention programmes for certain vulnerable high-risk groups like incarcerated drug users, young people, especially street children, and those affected and afflicted by drug abuse and HIV/AIDS will be developed and scaled up for an expanded response to prevention of drug use related HIV/AIDS in this region.
3. Immediate Objectives, Related Outputs & Activities
Immediate objective
To enhance institutional and technical capacities of relevant ministries and civil society partners to mount effective intervention programmes to reduce the risk of substance-related transmission of HIV among selected high-risk groups.
Output 1
Implementation, coordination monitoring and evaluation arrangements for implementing the project at the regional and national level are in place.
Activities
- Establish a project office in UNODC, ROSA and recruit project staff for project implementation.
- Establish a Project Advisory Committee (PAC) with representatives from nodal National AIDS Control organisations, Drug Demand Reduction organisations, and organisations/ministries dealing with issues related to street children and prisons (in countries hosting interventions), UNODC ROSA, UN Regional theme group chair for HIV/AIDS and UNAIDS SAICT.
- 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.
- Recruit a short-term consultant for revisiting the logical framework analysis and monitoring and evaluation framework
[1]
and organising a regional meeting for agreement on logical framework, monitoring and evaluation framework and costed work plan.
- Organize a regional meeting of competent authorities from countries of the region, for revisiting the logical framework analysis of the project, finalizing the operational work plan and implementation arrangements including regional and national coordination mechanisms, and the monitoring and evaluation framework for the project.
- Continue efforts to secure full funding for the project.
- Develop annual costed work plans
- Organise annual meetings of the PAC during project life.
- Organise regional meetings within the framework of network for resource and information sharing established by RAS/G23 in South Asia Region.
Output 2
Service providers working with drug using vulnerable groups are in a position to serve their clients in selected high-risk settings and reduce the risk of HIV.
Activities
- Assess training needs of service providers working with drug using vulnerable groups.
- Conduct a resource assessment of trainers and training agencies in the region to address ongoing training needs of countries in the region.
- Develop training toolkits for use by service providers working with drug using vulnerable population
- Organise 3 regional training-of-trainers programmes for training a cadre of 60 master trainers from across the region that could train service providers working with drug using vulnerable groups.
- Organise 20 national training programmes for 500 service providers for developing skills to undertake interventions for reducing substance use related HIV vulnerabilities among vulnerable groups.
- Develop mechanisms for monitoring the process and outcome indicators of training programmes
Output 3
Twelve pilot prison-based programmes in HIV prevention among incarcerated drug users in place.
Activities
- Develop a tool for monitoring the profile of drug use amongst prison population and commission a study to capture the current profile.
- Develop a protocol for prison-based programmes in HIV prevention among incarcerated drug users
- Initiate and support twelve prison-based programmes in HIV prevention among incarcerated drug users in countries of the region
- Disseminate lessons learnt in national and regional meetings organised by the projects in UNODC ROSA and advocate strategic direction and response.
Output 4
Twelve pilot initiatives among street children are established and best practice areas are identified.
Activities
- Develop a tool for monitoring the profile of drug use amongst street children and commission a study to capture the current profile.
- Develop a protocol for drug abuse related HIV/STI prevention among street children and young people.
- Support twelve pilot initiatives for drug abuse related HIV/STI prevention among street children and young people.
- Document activities carried out under this output of the project and disseminate lessons learned in national and regional meetings organised by the projects in UNODC ROSA.
Output 5
Ten care and support pilot initiatives for HIV prevention among IDUs in referral, relapse prevention, self-help groups for income generation/alternative activity, HIV/STI prevention and counselling, IDU risk reduction, and counselling on psychosocial issues, are established.
Activities
- Develop a protocol for pilot initiatives in the above mentioned activities modifying the protocol prepared by RAS/F90
- Identify NGOs and community based organizations to carry out activities
- Document activities carried out under this output of the project and disseminate them.
- Disseminate lessons learnt and advocate strategic direction and response in national and regional meetings organized by the projects in UNODC ROSA
Output 6
Sixteen peer-led interventions initiated by Project RAS/G23 for reduction of risk-taking behaviour amongst young people are supported.
Activities
- Evaluate peer-led interventions initiated by Project RAS/G23
Select sixteen peer-led interventions sites for continued support.
[1] Short-term consultant(s) will be recruited for revisiting log frame analysis and developing monitoring and evaluation framework.
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