1 / 28

Scaling up an Essential Harm Reduction Package: overcoming the barriers in South Asia

Scaling up an Essential Harm Reduction Package: overcoming the barriers in South Asia. World Bank Inter-Country Consultation on Prevention of HIV among IDUs Scaling Up: From Evidence to Action 9–13 April, 2007, Kolkata, India Dr. Alex Wodak, St. Vincent's Hospital, Sydney, Australia

zoie
Download Presentation

Scaling up an Essential Harm Reduction Package: overcoming the barriers in South Asia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Scaling up an Essential Harm Reduction Package: overcoming the barriers in South Asia World Bank Inter-Country Consultation on Prevention of HIV among IDUs Scaling Up: From Evidence to Action 9–13 April, 2007, Kolkata, India Dr. Alex Wodak, St. Vincent's Hospital, Sydney, Australia awodak@stvincents.com.au

  2. Outline: • Recognising national HIV problem • Recognising need for harm reduction • Planning implementation • Ensuring sustainability

  3. 1 RecognisingHIV/IDUs problem: • Will, or is, HIV a problem in my country? • Will, or is, HIV/IDUs a problem in my country? • Power of national immunity myths • Power of denial • Can HIV/IDUs be controlled? • Pervasive nihilism about drugs • Nothing works, nothing effective or acceptable

  4. Recognition HIV/IDUs problem: • Why bother trying to save IDUs? • ‘AIDS and drugs are problems that will solve each other’ • Does my country have to adopt harm reduction? • What is harm reduction? • Is harm reduction acceptable politically, legally? • Entrenched support drug law enforcement major obstacle to harm reduction

  5. Overcoming barriers: 1 Assessment of risk: • Is HIV a problem in my country? • Is HIV/IDUs a problem in my country? • Isn’t my country immune? • Surveys HIV/IDUs: power of local data • Rapid assessment • Modelling health, social, economic impact • Comparing costs action vs. costs inaction • Reviews of international experience

  6. Overcoming barriers: 2 2 Assessment of response: • Can HIV/IDUs be controlled? • Reviews of international experience • Harm reduction is effective, safe, cost-effective • Why bother trying to save IDUs? • Altruistic arguments • ‘It’s the right thing to do’ • Self-interest arguments • ‘What if it was your own son/daughter?’ • ‘You will go down in history’ • ‘You might not like them but the general population will suffer’

  7. Overcoming barriers: 3 • Does my country have to adopt harm reduction? • Review of options • What is harm reduction? • Explaining harm reduction • Primary focus on harm • Includes promotion abstinence • Use of same approach in other policies

  8. Overcoming barriers: 4 • Is harm reduction acceptable politically, legally? • Documentation support in UN system • WHO, UNAIDS, UNODC • Acceptance by other countries • Legal status UNODC report • Relationship to drug law reform? • Indulgence? • Essential?

  9. Overcoming barriers: 5 • Critical importance political leadership • HIV control only achieved where strong leadership e.g. Thailand, Uganda, Australia • What’s popular doesn’t work • What works, isn’t popular • Need highest level leadership • Raise, maintain high level awareness • Belief efficacy, safety of prevention • Mobilise funding

  10. 2 Accepting harm reduction: • Is harm reduction accepted nationally? • Will harm reduction be implemented by all government departments? • Is harm reduction morally acceptable?

  11. Overcoming barriers: • Is harm reduction accepted nationally? • Arranging demonstration of national acceptance • Will harm reduction be implemented by all government departments? • Developing partnerships: • Religious leaders • Government officials • Law enforcement • Guidelines, training, international collaboration • Injecting drug users • Researchers, clinicians

  12. Overcoming barriers: 2 • Is harm reduction morally acceptable? • Contrast with morality condemning unborn generations HIV despite known effective prevention

  13. 3 Planning implementation: • How many IDUs are there? • What kinds of interventions needed? • How much each intervention is needed? • Goals and targets? • Should prisons be included? • Vulnerable and bridge populations? • Should ‘pre-IDUs’ be included?

  14. Planning implementation: 2 • How many, what kind staff needed? • Buildings? • Materials procured? • Vehicles, computers? • Training? • Administration? • Funding? • Research?

  15. Overcoming barriers: • How many IDUs are there? • Capture-recapture • Multiplier • Triangulation • Back calculation, modelling • What kinds of interventions needed? • Reviews international experience • Education, NSPs, drug treatment, community development • Manuals

  16. Overcoming barriers: 2 • How much each intervention is needed? • UNAIDS guidelines • Modelling • Current reviews • Goals and targets? • History + x%? • 5 year plan?

  17. Overcoming barriers: 3 • Should prisons be included? • Community first, then prisons? • Important but too difficult? • Vulnerable and bridge populations • Ethnic minorities • Severely disadvantaged groups • MSM IDUs • CSW IDUs • Certain drugs e.g. amphetamine, cocaine

  18. Overcoming barriers: 4 • Should ‘pre-IDUs’ be included? • High risk youth • Non injecting drug users • How many, what kind staff? • Doctors • Other healthcare • Administration • Researchers

  19. Overcoming barriers: 5 • Buildings? • Needle syringe programme outlets • Drop In Centres • Drug treatment clinics • Materials? • Methadone, buprenorphine • Needles, syringes • Environmental policies

  20. Overcoming barriers: 6 • Vehicles, computers? • Coordination • Generating, compiling data • Training? • Manuals • Train the trainer • National centre?

  21. Overcoming barriers: 7 • Administration? • Central control? • Devolve states/provinces? • National guidelines? • Funding? • Are national resources available? • If not now, when? • Can GFATM resources secured? • Other • Multilateral • Bilateral

  22. Overcoming barriers: 8 • Research? • Hasn’t there been enough research? • Local data much more powerful • Local researchers • Understand language, culture, history • Always there, critical advocacy role • How to train? • Help defend sensitive programmes

  23. 4 Ensuring sustainability: • How monitor, evaluate? • Defending ‘controversial programmes for unpopular populations’

  24. Overcoming barriers: • How monitor, evaluate? • Simple • Timely • Inexpensive • Un-intrusive • Meaningful • Benefits of small, frequent vs. large, infrequent

  25. Overcoming barriers: • Defending controversial programmes for unpopular populations • Strategic, creative, national • Monitor opposition carefully • Commission research • Attend promptly to problems of prevention

  26. Conclusions: • Raise, maintain high level awareness of HIV • Promote effectiveness, safety, cost effectiveness of harm reduction • Explain, maintain advocacy harm reduction • Importance high level political leadership

  27. Conclusions: 2 • Entrenched support drug law enforcement major obstacle to harm reduction • Counter moral arguments against harm reduction by appeal to protection unborn generations • Develop structures encourage partnerships

  28. Conclusions: 3 • Plan strategy implementation • Which strategies? • How much? • Goals, targets? • Estimate staff, materials, support, training, funding • Ensuring sustainability • Monitoring, evaluation • Supporting valuable, vulnerable programs

More Related