Reducing injecting drug use and its harmful consequences in The Union of Myanmar (AD/MYA/03/G54)

Introduction

The G54 project is implemented in partnership between UNODC, Médecins du Monde (MDM) and CARE International. UNODC assumes responsibility for the project's overall coordination and monitoring. The project aims to reduce injecting drug use and its harmful consequences among injecting drug users and their families and communities. In particular, it focuses on reducing the transmission of HIV/AIDS among injecting drug users (IDUs) and their families and communities, through increased access to information and services for drug users. The target groups are drug users and IDUs, their sexual partners, families and communities; local decision-makers and service providers; outreach workers and peer educators. The activities ascertained under the G54 project include the establishment and expansion of adequate services to drug users in institutional and non-institutional settings; training and capacity building to decision makers, service providers and outreach workers; behaviour change communication (BCC) to IDUs; community-based counselling, and care and support to people with HIV/AIDS. The project conducts community-based activities in 3 townships in Kachin State (Myitkyina, Moegaung and Moehyin/Hopin) and in selected townships in Yangon, Mandalay and Lashio municipality in Northern Shan State.

The G54 project commenced in January 2003 and was initially intended to run until January 2006. By means of a No Cost Extension, the project will continue its operations until 10 November 2006 upon which a phase II will be introduced so as to continue providing services for another 20 months.[ top]

Objective

Main Objective: To reduce injecting drug use and its harmful consequences especially HIV/AIDS transmission among injecting drug users (IDUs) and their families and communities through increased access to information and services for drug users.

Specific Objectives:

• To create an enabling environment for drug use and HIV/AIDS prevention activities at a community-based level.
• To increase the availability and the quality of drug treatment and rehabilitation services.
• To attend to the immediate needs of the drug users for effective behaviour change towards less HIV-related risks.
• To make counselling care and support (CCS) services available to drug users and their families.[ top]

Strategy

The G54 project focuses on building the capacity of existing personnel and structures engaged in drug treatment and rehabilitation as well as members of the community. Training programmes for capacity development will focus on:

• Training of Working Group members on project formulation and programme management, and social assessments.
• Training of drug users on HIV/AIDS and practice of safer drug use and safer sex.
• Training of families and friends on HIV/AIDS care and support and dealing with drug problems.
• Training of health personnel on counselling, care and the implementation of strategies to reduce the harmful consequences of drug use.
• Training of outreach workers and peer educators on behaviour change communication methodology and skills, counselling, and referral.

Training of trainer workshops will be undertaken to cover all project interventions. Health workers and Working Group members will participate in training of trainer sessions provided by key Health Department staff, project staff, and consultants. Non-medical workers, such as project facilitators and project staff will also participate in training of trainers and will subsequently provide training to outreach workers/volunteers and peer educators. Peer educators include members of the communities sharing similar socio-cultural background and language. Some peer educators will be ex-drug users or current drug users.

The project will take a participatory approach and seek active involvement of working groups in the situation assessment, planning and implementation of activities. Likewise, participation of target communities in core activities is a key element of the project strategy. The project will work through a Revolving Loan Fund (RLF) to ensure that relevant lead initiatives that demonstrate broad participation can be supported in a timely manner, both to increase project impact and coverage, and to provide experience-based learning opportunities.

Working through international NGOs, the project will introduce innovative approaches in line with international best practices in the field of HIV prevention among drug users. This way, the project has better chances to demonstrate success through quality interventions.

Broad participation of communities and authorities will ensure sustainability of the project outputs in terms of enabling environment, reduced stigmatization and changes in peer norms among target beneficiaries. Successful involvement of existing services and personnel will increase significantly the coverage and cost effectiveness of the response.[ top]

Project Components

Component 1: Provision for the immediate needs of drug users for behaviour change.

Activities

• Train project staff, local outreach volunteers, and Working Group members in relevant research methodologies and undertake assessment on environmental and behavioural risk among drug users.
• Develop, test and evaluate appropriate sets of specific BCC material for HIV/AIDS prevention.
• Training of Trainers workshops for Drugs and HIV awareness raising and provision of participatory educational sessions and materials on less harmful drug use behaviours.
• Implement activities on awareness and prevention of HIV/AIDS and drug use to the general population in the communities.
• Educate and provide a comprehensive package of services for drug users, their families and the community.

Component 2: An enabling environment for prevention activities for drug use and HIV/AIDS.

Activities

• Establish and strengthen HIV/AIDS and Drug Use Working Groups at township level.
• Undertake orientation training for township level Working Group members in HIV/AIDS, safer drug use and harm reduction strategies.
• Formulate detailed site-specific action plans for lead initiatives.
• Establish and monitor a Revolving Loan Fund (RLF) for drug use and HIV prevention lead initiatives.

Component 3: Achieving an increase in the availability and the quality of drug treatment, detoxification, maintenance, counselling, support and rehabilitation services to IDUs.

Activities

• Offer referral service to detoxification or other services when required.
• Establish drug use treatment and rehabilitation facilities in the criminal justice system.
• Support delivery of specialised drug treatment services and rehabilitation within the existing health care delivery system.
• Development of manual and training module on Counselling, Care and Support to the specific needs of drug users and their families.
• Train staff in institutional settings on HIV/AIDS prevention, safer drug use, drug treatment options, and harm reduction for IDUs, prevention of opportunistic infections and care of people living with HIV/AIDS (PLHA).
• Establish a Mobile Team capable of delivering drug treatment services in remote areas.
• Establish drop in centres staffed by trained volunteers and outreach workers.
• Support the provision of ongoing and follow up counselling and support services to the ex-users and families in the communities.[ top]

Background

The launch of the G54 project in 2003 and its subsequent extension in 2006 reflects an attempt to address the problem of continuing increase in multiple drug use and especially injecting drug use in Myanmar. According to government figures, there are presently approximately 70,000 registered drug users within Myanmar, and the vast majority of newly registered addicts are heroin injectors. The prevalence of HIV/AIDS among Injecting Drug Users stands at an estimated 35%. In some areas, HIV rates among IDUs have reached over 80%. Given the prevalence of injecting drug practices, existing treatment and rehabilitation services are significantly inadequate in terms of range of services available.

With the extremely high HIV prevalence rates among drug user, the number of IDUs infected by the virus is continually growing. Because of their status and backgrounds, the stigma, the access to primary health care and specific care is often limited or non-existent. Specific interventions are required to extend Counselling Care and Support Services to drug users and their families.

The project will improve the capacity of the township level government departments in the areas of project design and management, research methodologies, behaviour change communication, drug use treatment and HIV/AIDS prevention. Through trainings organized by the project, targeted groups such as general practitioners, family members of drug users, outreach workers and volunteers will acquire new technical skills in the fields of drug use treatment, drug counselling, risk minimization etc. and will put these skills into practice with direct project support.

Capacity building of the existing drug treatment centre staffs and providing more option for detoxification programme to the injecting drug users, simultaneously with community based activities through partner NGO will give opportunities for drug users to choose between institutional based or non-institutional based for their detoxification as well as more knowledge for safer practices.[ top]