Sustainable Livelihoods: A Broader Vision

1. Sustainable Livelihoods: A Broader Vision

2. Alternative Development – General Approach and Activities Six countries of intervention: Afghanistan, Bolivia, Colombia, Lao PDR, Myanmar, Peru Alternative Development Afghanistan, Bolivia, Colombia, Lao PDR, Myanmar, Peru

3. INCB Report 2005 (E/INCB/2005/1) “Poverty, despair and lack of prospects are some of the reasons why people have become involved in drug abuse and other drug-related activity.” “In addition, there is increasing recognition that the focus of alternative development, as it has generally been practiced, needs to be broadened, paying greater attention to the needs of marginalized and neglected populations in both rural and urban areas.” “Governments, international organizations and the other parties concerned need to ensure that the relevant communities - not just communities growing illicit drug crops but all communities affected by the illicit drug economy are provided with legitimate livelihoods that are both viable and sustainable in the long term.”

4. UNAIDS/PCB(27)/10.26 (15 November 2010) Interventions to support livelihoods include those that promote income generating activities and micro-finance (which is a loan, not a transfer) can also mitigate the impact of the epidemic and strengthen food security. These types of interventions often provide households with the means of purchasing food as well as cater to other needs such as health and education. These programmes are usually not (and should not) be exclusive to PLHIV. Stigma can arise when PLHIV are singled out for preferential treatment while their equally poor neighbours whose HIV status may be negative or unknown do not qualify.

5. Alternative Development / Alternative Livelihoods: drug supply reduction Target Group: farmers and their families at grassroots level, depending on income derived from illicit drug crop cultivation, living in remote rural areas

6. Sustainable Livelihoods: drug demand reduction Target Group: drug dependent individuals and prisoners vulnerable to HIV infection or living with AIDS, in urban areas

7. Both concepts are participatory development approaches for groups of people whose access to traditional development is restrained Common points: custom-made activities for individual target groups stages of impact (short, medium, long-term) → inclusion of marginalized groups into society as productive members of the community

10. Target Group: drug dependent individuals and prisoners low and middle income countries living in urban areas vulnerable to infection with HIV or living with AIDS

11. Vulnerabilities: Vicious Circle

12. Target group Treatment and Rehabilitation Interventions HIV and AIDS Prevention and Treatment Interventions Sustainable livelihoods interventions – three-step-model

13. Sustainable Livelihoods FOOD SHELTER CLEAN CLOTHING VOUCHERS, FOOD TEMPORARY JOB OPPORTUNITIES (CONDITIONAL EMPLOYMENT) PROTECTED JOBS SUPPORT TO RENT A HOUSE/ROOM From help on the street to treatment seeking…

14. Medium-term interventions First-line socio-economic assistance Three-phase-model: psychological counselling, health training, vocational education, micro-credit, employment Long-term livelihoods assistance Months / years needs-based regular medical assistance, steady shelter, protected income-generation Several weeks / few months food, shelter, hygienic measures, urgent medical treatment Same day to few weeks

15. Interventions • 3 Phase model applicable to: • Drug dependence prevention • Drug dependence treatment • Crime and prison populations • Health and HIV/AIDS

16. attract more drug users and vulnerable groups • in order to establish contact between • them and outreach units • create a more stable relationship between • the outreach units workers / clinicians and • drug dependent individuals • - contribute to improving the target group’s health • - decrease rate of new HIV infections among vulnerable groups • improve general health condition of former • drug users and prisoners living with • HIV/AIDS • Result: Restoration of human dignity, decreasing of health and social risks • Outcome: higher chances for treatment, rehabilitation and reinsertion into society

17. Project: Response to the Social and Livelihood Needs for HIV/AIDS Prevention in East Africa Countries: Ethiopia, Kenya, Tanzania, Uganda, Zambia →

18. Target groups: marginalized drug users vulnerable to HIV infection or living with Aids prisoners or persons recently released from prison Interventions: Low-threshold Based on most urgent needs and exiting services in respective country

19. Detoxification naltrexone Methadone maintenance Buprenorphine maintenance Counselling Pharmacotherapy for stimulants users Mental health care Health care Measures to prevent HIV and Hepatitis Dentist One stop shop Psychotherapy CBT Antiretroviral therapy Social assistance Family therapy Vocational skills and reintegration Outreach and home visiting Self-help groups AA - NA Overdose prevention Follow up in prison