AFEW: Annual Report 2001/2002 >> Harm reduction programmes

Annual Report 2001/2002

Harm reduction programmes

The spread of HIV among injecting drug users (IDUs) through the use of shared injecting equipment has been the main engine behind the rapidly increasing epidemic in the NIS. Currently, as many as 95% of all new registered HIV cases in the RF occur among this group. According to some Russian officials, there are between 3 million and 5 million drug users in the RF alone. It is expected that sexual transmission will become the most common route of transmission in the nearest future.

Realistic approach

Harm reduction (HR) policies, strategies and activities aim to limit or reduce drug-related harm, touching upon social, economic, legal and health issues. The HR approach is based on the realistic acknowledgement that there are no known interventions for completely eliminating drug use or drug-related problems in any city, community or country. International best practice examples have been used to initiate and implement HR activities throughout the NIS. These programmes include needle and syringe exchanges, together with counselling, outreach, peer education and support.

Outreach and peer support

In 1996, Mйdecins Sans Frontiиres - Holland (MSF-H) started the very first 'Harm Reduction, Outreach and Peer Support Programme', targeting IDUs in Moscow at street locations and in drug treatment centres. During the initial five years, the programme reached 15,000 young drug users primarily through the promotion of safer injecting behaviour practices. In 2001, this activity was handed over to the Russian NGO 'Return to Life'.

Harm reduction training

The first training programme on HIV/AIDS prevention strategies among IDUs started in 1997, and focussed on governmental and non-governmental regional structures such as AIDS centres, drug treatment centres, and local NGOs. Since this programme began, more than 200 health professionals from 61 cities have been trained, and the initial training programme has been handed over to the Russian Medical Academy of Post-Graduate Education in order to promote the HR philosophy among drug treatment specialists receiving continuing medical education.

Improving performance and effectiveness

A new advanced training cycle started in January 2000, and was designed to further improve the performance and effectiveness of existing HR programmes, allowing them to serve as models for future initiatives. At the beginning of 1998, there were only four HIV prevention interventions among IDUs in the RF. There are currently 43 programmes which focus on preventive health among IDUs. Roughly 75% of these programmes are funded by the British Department for International Development (DfID) and OSI. AFEW will continue its training activities until at least 2004. Applying the experience gained in the Russian context, AFEW developed similar training programmes for 21 Ukrainian and seven Republic of Moldovan HR projects.

Selected Outcomes from the Harm Reduction Training Projects in 2002:

• Training was provided for:
  • 42 HR projects in the RF;
  • 23 projects in Ukraine; and,
  • 8 projects in Republic of Moldova.
• Training sessions:
  • In Ukraine and Republic of Moldova, three joint training sessions were organised centrally and 12 on-site training sessions took place. A total of 379 participants were trained.
  • In the RF, 30 psychologists, 29 AIDS centre specialists, 35 project co-ordinators, and 42 project staff members participated in two training sessions.
  • Training topics included 'Motivational Interviewing', 'Pre- and Post-HIV Test Counselling', 'Project Evaluation', and 'Training for Trainers', as well as other topics.
• Site visits (54):
  • In the RF, 26 site visits were carried out.
  • In Ukraine, 21 site visits were carried out, and in Republic of Moldova, 7 site visits were completed.
  • During these visits, on-site training was provided for HR project staff on topics such as 'Basic Training for Outreach Workers', 'Working with Sex Workers', and
    'HR Principles and Activities for Medical Specialists'.
• In Republic of Moldova, 688,817 syringes and 50,000 condoms were distributed as part of the programme.
• In the RF, the HRT participated in the 'Public Health and Small Cities' project of the Open Society Institute.
  The HRT organised an initial training on 'Strategies of HIV prevention among injecting drug users in the RF: Rapid situation assessment and principles of harm reduction' for 17 representatives of local administrations and 38 medical specialists and social workers from 20 small cities. Representatives from 11 cities were selected to receive OSI funding to organise HR projects.
• The following information materials were developed, printed and distributed in 2002:
  • 4 issues of the Harm Reduction Information Digest – 600 copies each (Ukraine);
  • 4 issues of the 'HR in Russia Newsletter' – 3,000 copies per issue in Russian; 2,000 copies of an English-language compilation (RF);
  • 5 training manuals on 'Motivational Interviewing', 'Peer Support', 'Teaching Strategies of HIV Prevention', 'Rapid Assessment and Response on Injecting Drug Use
    and the Evaluation of Outreach Work', and a 'Manual for Outreach Practitioners' – 100 copies each (RF);
  • 4 HR booklets – 100,000 copies printed in Ukraine, and 46,000 printed in Republic of Moldova; and,
  • 5 information brochures – 3,000 copies each in the RF.