IMPACT report - SANANIM Bratislava; October 17, 2011

1. IMPACT report - SANANIMBratislava; October 17, 2011 18.10.2011

2. Reporting until 31 August 2011 • 150 HIV screening test and 150 clinical screening symptoms on TB • 0 HIV reactive rapid tests • We referred 6 clients to the clinic testing because of positive TB symptoms • 3 clients underwent x-ray and other tests in the clinic centre – result nobody have TB

3. Information about the clients tested  SOCIO-DEMOGRAFIC DATA • 66% of tested clients are men (66% clients of contact centre are men) - men and women using testing and service equally • Average age is 29 years (same as average age of client of contact centre) • 95% tested clients were born in Czech Republic (same % in the group of all clients of contact centre) – just one client from Russia underwent testing, rests of foreigners were clients from Slovakia.

4. Information about the clients tested  SOCIO-DEMOGRAFIC DATA • Almost 40% live mostly in unstable accommodation in the last 12 months • 51% have primary level of education, nobody claimed - never went to school/ never completed primary school, one client refused to answer, and the rest have secondary level of education • 66% tested client are unemployed, 13,5% of responses daclare permanent employment • 32% tested clients were in the prison

5. Information about the clients tested so far  Mostly used Drugs • Combinations of drugs is very usual • drugs used in last four weeks • heroin – 14,4% • pervitin – 84% • subutex -51,8% • benzodiazepins – 22,3% • cannabis - 49,64 % • alcohol – 27,6%

6. Information about the clients tested so far  Injected used drugs in last four weeks: • heroin – 12,2% • subutex - 49,64% • pervitin - 74,10% • benzodiazepins – 1,44% 92,7 % clients have injected drugs in the last four weeks

7. Information about the clients tested so far  Risky behaviour: • 63,24% ever injected with a used syringe or needle from someone else - it is not corresponding to reality • 43,5% ever shared spoon, filter and other items for application • 6% tested clients had sex for money or drugs in the last 12 months.

8. Information about the clients tested so far Testing: • 21% were tested on HIV for the first time in IMPACT • 52,5 % have never been tested on TB; 21,5% don’t know

9. Project implementation • Start of project • The begging was chaotic due to many changes before final go were appeared, uncleare issues, low experience. • More version of final questionnaire, therefore it was difficult for us to create on-line database in appropriate time. • Delyed start of testing implementation • Testing obstacles • clients are in hurry; • usually don’t want to know the result of test, the lack of motivation to undergo the test, health is not sufficient motivation in many cases.

10. Project implementation Two goals conflict: • research (describe the target group and risky behaviour) and • work with clients … it is difficult for team members to mix two different activities – research and work with clients (pre and post test counselling and motivational discussion). Each activity requires a different way to interviewing. Most interviews are without problems. Sometimes clients are tired after long researcher's interview and have not enough energy for other discussion - risk behaviour etc... Several clients (5clients) are not able to undergo long interview. Therefore we tested this group as well, but out of the project. One client refuses the testing because of questionnaire

11. Project implementation Habit in target group • There is no will in the group of drug addicted people to undergo test regularly and voluntarily • Staff have to motivate them and sometimes push on clients to be tested. • Almost everybody have been already tested (just 20% of our clients haven’t been tested in their life). Almost 50% have been tested in last year (most of them were tested on entry to the treatment or prison or some other contacts with the doctor, for example – substitution etc.).

12. Questionnaire: • We expect that many respondents are lying in response to sexual behaviour (especially in questions like sex for money and money for sex). • Take a long time – sometimes clients are tired after interview • Low number of migrants - just 5% of our clients are migrants (in contact centre). Much more migrants use services in outreach program therefore we should focus on this group in street work programs. Many of them are careful and afraid to use the services. Difficult agenda for this group can be obstacle to undergo testing.

13. Monitoring sheet • The collection of data, information have significant influence on contact with clients. • Sometimes we offer to every clients testing and there is no more space for other issues. • Sometimes the collection of information is boring for clients and it can influence the atmosphere in contact

14. Organization of project in SANANIM • Project is run in 3 facilities. • Not every facility started in the time. • Missing regular coordination meetings of whole project IMPACT team • Only in one facility - one responsible person for doing IMPACT from the beginning. • Technical problems with our ambulance car.

15. Main strengths of the programme • there is one more workers who make just tests – so it increase number of tests • we started to cooperate with TB clinic and start to monitoring TB clinical symptoms • money as motivation for clients to undergo test • we started to use user friendly on-line questionnaire – it makes data collection easier

16. What should be changed • To give motivationreward (meal ticket) for client • More concentration on motivational conversation before test – to increase amount of tests • Focusing on migrants in outreach program • Project coordination in SANANIM • regular meeting on the level of facilites • regular meeting of all team together, control of project by management of organisation • regular financial reporting related to clear budget provision