Harm Reduction Program for Injecting Drug Users

Though HIV prevalence is still low in Bangladesh (<1%), however HIV infection rate is increasing among most-at-risk-population (MARP) particularly among People Who Inject Drugs   and Given the current scenario of needle sharing, unprotected sex and overlapping risk behaviors, sex work and injecting drug use, prevalence among people who inject drugs is bound to increase unless comprehensive measures are taken to reduce HIV risk among this population Reduce and control HIV epidemic among the Injecting Drug users, Package-907 propose the proposal to promote safer behavior (Safe injecting and safer sex practices) following harm reduction strategies to addressing the present need and reducing the vulnerability among the drug users.

The Drug users are very much stigmatized in the society. They are treated as anti-social, criminal. The drug user population is also highly vulnerable due to their high rate of risk behaviors. Several studies have reported needle/syringe-sharing habits and unsafe sexual behavior among drug users. The essential harm reduction services such as Syringe Needle Exchange, Condom promotion, STD/ Abscess/General health support provision, Counseling service, Awareness through health education, resting, bathing and recreational facilities for the Injecting Drug users need to be provided through DIC and out reach for those are still un-served.

Drug users are dependent on specific substances and it treated as sickness. The dependency may reduce following specific standardized drug detoxification/treatment and rehabilitation protocol. It is important to run a comprehensive intervention includes Advocacy, identify un-served IDUs, developing training materials, plan and conduct training of trainers, peer educator, outreach supervisors and drop in center in-charges for capacity building, establishing and operating Drop in Centers (DIC) and outreach activities for delivery the essential harm reduction services, Provision of detoxification support and vocational training, promote self-help group aiming social reintegration for PWIDs and creating enabling environment.

Till now the harm reduction approaches is not well accepted in the community. The existing law does not support the harm reduction program. Many types of harassment exist for the drug users. So, addressing the above issues it is important to design necessary advocacy activity at local and national level. It is also important to extend support them to shifting from margin to mainstream of the society.

Since 2009, Save the Children, with the support from GFATM has been facilitating focused interventions, addressing to Most at Risk Population (MARPs) with full range of services – People Who Inject Drugs (PWID), Female Sex Workers (FSW) and their clients, building linkages with all existing and future response for accelerating national response through collaboration with NGOs, civil societies, private sectors, professional bodies and institutions.

Along with the harm reduction services for the PWIDs, advocacy with different stakeholder and community gatekeepers at different level is one of the significant events of the GFATM project. The aim is to create an enabling environment for smooth implementation of harm reduction program through sensitizing the community people, local level GOB officials, NGOs, law enforcing agencies and other stakeholders.

Rational:

Harm reduction services for the PWIDs, advocacy with different stakeholder and community gatekeepers at different level is one of the significant events of the GFATM project. The aim is to create an enabling environment for smooth implementation of harm reduction program through sensitizing the community people, local level GOB officials, NGOs, law enforcing agencies and other stakeholders. National Level Policy Makers, Government Health and Family Welfare Department, Leaders, Law Enforcement Agencies, Media and different Stakeholders play significant role in the implementation of any development program. Taking this into account the advocacy activities of HIV prevention program has been designed aiming at creating enabling environment for smooth operation of the program activities. The advocacy activities also aim at getting support in favor of harm reduction services for PWIDs, the most vulnerable population of the society from the key public and private stakeholders. Provision of Essential Harm Reduction Services for Injecting Drug Users is an especial kind of program because of its target population- the PWIDs. The PWIDs, are neglected, stigmatized and hidden group in the society and, it is difficult to reach them with the essential health services. Therefore, it is important to involve the secondary target group to get the PWIDs, for providing essential services in an integrated manner. The advocacy activities can help to get support from the community.

Cox’s Bazar is a vital and risky zone from the perspective of HIV epidemic in Bangladesh due to a number of reasons such as borader with Myanmar, seaport, migrant worker, major tourist attraction etc.  Samaj Kalyan O Unnayan Shangstha (SKUS) is a national NGO, implementing SR of “Expanding provision of essential harm reduction services for IDUs, GF-907” project for interim period. SKUS along with other organizations has been implementing harm reduction program at Chittagong division under Global funding different projects.  As a part of continued advocacy efforts, an advocacy workshop has been planned at Cox’s Bazar district with a view to share the activities, the progresses and challenges with concern authority, officials and other stakeholders to smooth implementation of the harm reduction services at the Chittagong district.

2. Objective of the workshop:

Title of the Workshop: “District level Advocacy and sensitization meeting with relevant departments and stakeholders on Harm reduction program”

The overall objective of the Advocacy Workshop is to create enabling environment, develop understanding, get support and commitment of the policy makers, Officials of different key Ministries, Law enforcing agencies and other stakeholders for ensuring Essential Harm Reduction Services for Injecting Drug Users.

Specific objectives:

• Create enabling environment at National to Local Level
• Share GFATM Project overview

Share basic overview of Package # 907

• Share updated Global and National situation of HIV/AIDS with particular focus on People Who Inject Drugs  (PWID) & progress update of the  Harm Reduction Program for PWIDs
• Role of the participants for program implementation
• Share the challenges of Harm Reduction Program
• Enhance the collaboration and cooperation with police authority, drug and narcotics control department, local and national government/non government organizations, civil society, private/voluntary organizations, community and religious leaders for harm reduction program for PWIDs
• Create an enabling environment for further initiatives on Harm Reduction Program for PWIDs in Chittagong in particular

3. Participants category:

4. Workshop Methodology and Material used:: While conducting workshop SKUS follows interactive and participatory methods to make the workshop successful. SKUS use visual presentation, question answer, panel discussion etc as workshop methods.

AIDS tottoy, multimedia and presentation. Participants have given pen, pad, folders etc.

5. Workshop information: Workshop was held on 21 June 2012 at 11 am to 1:15 pm at Civil Surgeon Office of Cox’s Bazar.Inaugural Session: From SKUS Mr. Md. Salah Uddin, Assistant Director and program and M&E coordinator of for GF-907 welcome all the participants of the workshop. He shared the overall objective of the project. He also shared what SKUS is doing and in what context HIV prevention among the IDUs is very important.

Mr. Uddin told the participants to consider most vulnerability of IDUs as they do inject and share it with others. They are marginalized and their right have ignored. So, we all should take opportunity to work for IDUs.

Working session:

At the beginning of workshop, moderator requested participants to introduce them selves by pronouncing name and where they came from. After the intro

Presentation and Open discussion:

Comment s of participants:

• Dr…….Member District AIDS Committee (DAC)- We have a strong and active DAC in Cox’s Bazar district since 2008. We operate monitoring and supervision of all HIV/AIDS project at Cox’s bazaar. We have some limitation here like-no budget. We have a MIS committee, Vigilance Committee headed by DD Social welfare. We require a monthly report from each NGOs who are working here at Civil Surgeon.

• Mr. Kamal SI, Cox’s Bazar Model Thana- We have to create a social movement. Police also work for drugs control. All we are present here have to work for in hail the bad effect of drugs and create hype on it.  In his comments he given tress upon the creation of area committee. It can be also disseminate from the mosque. For more recovery we can ensure drugs treatment centers. He also we can go for school and college for more awareness.

Speech from Special guest:

• Dr. Dipak Talukder, DD Family Planning: We have to work on dissemination of right information on HIV and AIDS to the target people as well as all general people. He asked about people regarding prevention of HIV. Then he told the participants that there is no such vaccine yet to prevent HIV Virus but if you follow the ABC then it can be prevented easily. He told A mean Abstain for drug and sex, B mean be faithful to your partners and C mean use constantly only condom. He requested all to teach moral and ethical education to the children and ensure to say no to drugs from early life.  He told that especially those who are injecting drug users are more vulnerable but they are not out of our family. They are involve with a risk behavior cycle, they used to go sex workers and some time donate blood for money.

So, we have to work both way for demand reduction as they are dependent on drugs, supply reduction. We have to think why people take drugs, he also told about drugs dependency.   We have worked for return them from drugs. He told he will extend his cooperation who works with IDUs and other MARPs. He will visit DICs. He focuses internal cooperation of working packages.

•  Journalist: He asked about the number of infected in this district
• Sadhon Barua: Bangladesh consider as a triangle of drug transit. On the other hand we have a strong relation with bordering country. Due to this relation we have inviting knowledge as well as diseases, AIDS is such diseases. We need to establish a total network to ensure a comprehensive prevention effort. We will support drugs and HIV prevention effort. He remind that who are the consumer of all drugs? Our young generation and they will ruin if we cannot stop them. We have to ensure family education.
• Mr. Rashed, ED-Nongor: He thanked SKUS to organize this important meeting in right time. Harm reduction service has worked for prevention of HIV/AIDS and STIs, but Demand reduction need to be ensured side by side. IDUs are vulnerable due to their double risk, cox’s bazaar have a present scenario, we have HIV positive IDUs, this effort have to continue and un-interrupted. He also shared that new drugs are coming like weave from Myanmar, which may create crime and HIV.
• Inspector DNC: Young people are victims of drugs, we need to raise awareness. DNC will support harm reduction activities within their limit.
• Dr. Professor Mezbah – Cox’s BazarMedicalCollege: He argue that no one should not raise question regarding data as it follows international standard and protocol. HIV and other data have collected following those. He mentions that HIV prevalence rate among the IDUs has gone down due to some successful effort by NGOs and government. HIV rate has decrease from 7 to 5 percentages. He mentioned that in every country IDUs get emphasis on programming of HIV/AIDS prevention.

He shared a behavior network among the MRAPs and reminder participants that no one is safe from HIV as it has shown its face to human kind. He told sharing is key problem among the IDUs population and need to educate them on it. He shared his experiences from Thailand and India and told that condom can be effective tools. He tress on alternative drugs to minimize the harm among the IDUs and call on legalize some drugs to battle with it.

Speech from Chief Guest:

Civil Surgeon Dr. Kajal Kanti Barua: Though SKUS is new here, I know their activities; they are doing well in HIV sectors. He told, Cox’s Bazar is vulnerable due to available drugs, bordering with neighbor country.

He point out the following-

1. Sensitization of all actors in Cox’s bazar to success the program
2. We have to have a sympathy for IDUs as they are human being
3. For HIV prevention we have a coordinated effort
4. Family education is essential for IDUs and need family support for those who have taken detoxification. So that they avoid relapse.
5.  Everyone have to think how one can get rid of poverty.  Due to poverty many become victimize and involving in crime.
6. We all should support government initiatives
7. Though we have many limitation we will support your effort to make it successful

Chairperson:  From the organization Md. Salah Uddin chaired the workshop. He summarizes the open discussion and shared with participants about the common issues of the workshop. Every one of the workshop was agreed about risk of HIV infection for general population through the injecting drugs Users. No one is safe. So, he thanked all and call for work together for HIV/AIDS prevention.

Recommendation:

From the workshop we have get some recommendation which are as follows-

• We should work in prevent drugs from the society
• Young people need more consideration
• More detox for drug users
• Create social movement in the local community
• Use mosque and other religious institution for disseminate message
• Involve all sectors in drug prevention

Conclusion:

In Bangladesh Cox’s Bazar is one of most attractive tourist spot for many people. Due to this reason many people come and visit here. It is also a vital and risky zone from the perspective of HIV epidemic in Bangladesh due to a number of reasons such as boarder with Myanmar, seaport, migrant worker, major tourist attraction etc.  Samaj Kalyan O Unnayan Shangstha (SKUS) is implementing SR of “Expanding provision of essential harm reduction services for IDUs, GF-907” SKUS has been implementing harm reduction program at Chittagong division under Global funding different projects.

As a part of continued advocacy efforts, an advocacy workshop has organized and conducted with relevant stakeholders at the civil surgeon office to create an enabling environment for implement the harm reduction program activities in Cox’s Bazar district. In the workshop we have shared our program view and  share the activities, the progresses and challenges with concern authority, officials and other stakeholders to smooth implementation of the harm reduction services.

Participants are very keen to help the program. They demand uninterrupted support for IDUs here in Cox’s Bazar. They also request to implement their recommendation.