Responding to Injecting Drug Use and
the HIV Epidemic in Eastern Europe
Table of Contents
Annexes
The idea for this workshop arose at the workshop 'Responding to Injecting Drug Use and the HIV Epidemic in the Ukraine and Poland: a capacity building approach' organised by UNDP in the Ukraine in June 1996. This workshop included a basic introduction into a HIV prevention strategy among injecting dug users (IDU's) and relevant examples of methods to realise this strategy. During this workshop it became clear that organisations and services in the field of HIV prevention aiming at the IDU community in the Ukraine and Poland needed more support. Besides the general introduction offered in the Ukraine workshop a more indepth discussion of some elements of an effective HIV prevention strategy were suggested as relevant issues for possible followup workshops. Research and assessment techniques were particularly mentioned as important elements. One of the recommendations in the report on this workshop was "to support the organisation of an international workshop on qualitative research and rapid assessment techniques in relation to outreaching HIV prevention programmes for IDU and sex workers".1 A workshop on HIV and Injecting Drug Use in Belarus organised by WHO Europe in October 1996 in Svetlogorsk confirmed this need.2 There are good reasons for choosing socalled rapid assessment and, more specifically, a combination of rapid assessment and outreach work as the main issues of a followup workshop. Rapid assessment has proved to be an effective research approach combining qualitative and quantitative elements to gain insight in a problem area where extensive quantitative research is inappropriate and sometimes even impossible.3 In the case of an urgent problem requiring a quick response and in the case of a rapidly changing/developing situation, rapid assessment has proven to be particularly appropriate. The explosive development of (injecting) drug use and the HIV epidemic in IDU communities in some regions in Eastern Europe eg, in the Ukraine and Belarus make rapid assessment a more appropriate approach than extensive quantitative research for the following reasons:
Rapid assessment includes some basic elements of outreach work: eg, identifying key persons and developing a network of contacts. These contacts are valuable for collecting relevant information regarding injecting drug use and risk behaviour as well as for passing on relevant information regarding HIV prevention to the target group.4 Discussions between the Trimbosinstituut (the Netherlands Institute of Mental Health and Addiction), involved in planning and realising the Ukraine workshop, and UNDP in autumn 1996 led to a plan for a followup workshop focusing on these issues to be held in Warsaw in December 1996. As 'immediate objective' for this workshop was chosen: "To enhance national capacity in ethnographic mapping and rapid assessment of injecting drug use practices and their implications for the spread of HIV infection" (see annex 1). As a capacity building approach aiming at training local/regional facilitators had proved to be a suitable approach for the Ukraine workshop, the same approach was chosen for the Warsaw workshops (see annex 1). As in the Ukraine, this resulted in a plan for a programme entailing two workshops in the period from Wednesday December 4 till Friday December 13 (see annex 3). The focus of the first, a threeday facilitator training workshop for participants from government, the community sector and academia in Poland, the Ukraine and Belarus, was to enhance capacity in rapid assessment techniques, approaching outreach work, and designing and running a workshop on these issues. A programme for this workshop was developed by the international facilitators, Dave Burrows and Franz Trautmann (see annex 3). This workshop was followed by a fiveday regional workshop facilitated by the participants of the first workshop. The aim of this second workshop was to pass on the lessons learned about rapid assessment techniques and outreach work to a larger group of participants from the above countries, together with Russia. Although it was clear that the programme of the regional workshop would be finalised by the participants of the facilitator training workshop, an outline of the basics of its programme was designed by the international facilitators (see annex 3). The original idea was to have the facilitator training workshop on Wednesday, Thursday and Friday (December 4 till 6). The regional workshop would follow from Monday till Friday (December 9 till 13). However, due to the fact that the participants of the first workshop arrived Wednesday December 4 around noon and the participants of the second workshop were expected to arrive on Monday December 9 around the same time, the timetable had to be changed. Therefore, it was decided to start the first workshop on Wednesday afternoon but to also include Monday morning. Hence, the second workshop had to be reduced to a four and half days. Moreover, when selecting the participants for the facilitator training workshop it proved to be impossible to find participants who both met the selection criteria (see annex 2) and spoke fluent English. Arrangements were therefore made for an evidently second best option, a bilingual workshop. Due to the countries involved, the two languages to be spoken were English and Russian. Because simultaneous translation for financial reasons was impossible, subsequent translation was the only option. This of course meant a loss of time. Facilitator Training Workshop The introduction round at the beginning of the first session made it clear that most of the participants had an inaccurate picture of the objectives of the workshop. For instance three participants stated that they were very interested in learning something about how to prevent young people from getting into drugs. It seemed that the objectives as formulated by UNDP (see annex 1) had not been clearly communicated to the participants. The language problems turned out to be even more serious than expected. The selected participants from Poland stated that they would not be able to follow the workshop in English. This meant that the interpreter had to struggle with three languages, translating back and forth between Polish, Russian and English. This led to further loss of time. Differences in the stage of development of the HIV epidemics among IDU's and the mechanisms put in place to deal with these epidemics in the three countries meant that there was less exchange of practical information than had been planned. For example, Poland has been confronted with drug use and AIDS issues since the mid1980s, whereas in the Ukraine these problems become more prominent only in the past year and, in Belarus, within the last few months. The lack of time for extensive discussion necessitated by threeway translation added to this problem. The commitment of the participants generally was high, with the exception of one participant from Poland. Leaving the workshop several times a day (a mobile phone sometimes can have a very disruptive effect), regularly chatting with his colleague during the workshop and not attending on two mornings seemed to underline the lack of commitment. In addition, this participant did not facilitate a regional workshop due to sickness. As stated in the introduction, key issues in the programme of the facilitators workshop were assessment, outreach work and workshop facilitation. Specific needs of the participants caused some changes in the initial programme (see annex 3). These were not major changes but shifts in emphasis. Several participants pointed out that they would like to spend more time on how to facilitate a workshop. Another issue which required more time than originally planned was the design of the programme for the regional workshops. Therefore, the international facilitators decided to spend most of Friday's programme and Monday morning on allowing participants to develop this programme step by step in smaller subgroups, with reports to the full group on their plans. Furthermore, the participants from the Ukraine and Belarus spent a considerable amount of time in the weekend developing visual aids in Russian on the basis of the transparencies used by the international facilitators (in English) during the workshop. Other issues of special interest, which were not covered in the programme designed by the international facilitators, were the subject of short presentations on the Friday morning at the request of the participants. These issues were:
The final session of the facilitators workshop included an evaluation and a discussion of followup activities. The international facilitators tried to promote this by including exercises entailing the making of a concrete plan for assessment and outreach work. However, the preparation of the regional workshops was the major issue, and this precluded extensive work on participants' individual assessment and outreach work. The international facilitators also focused on making an appointment for a followup meeting of the participants. This will be of importance in building up a network of people trained in assessment, outreach and process facilitation in Eastern Europe. During the workshop the importance of a national/regional network people trained in these areas became clear. A regional network (encompassing national networks) could contribute to a more autonomous development of locally appropriate responses to HIV among IDU's in Eastern Europe: ie, less dependence on Western countries. Such a network could support the mutual exchange of expertise between different organisations and services in one country, and between neighbouring/nearby countries. Due to the differences between the countries and the languages spoken, it was decided that the regional workshop should be split into three subworkshops, one for the participants from Poland, one for the participants from the Ukraine and one from the participants from Belarus. Late in the planning of these workshops, four participants were invited from Russia. These participants joined the Belarus group. This decision was taken because there were no participants from Russia in the facilitators training workshop and the number of Belarussian participants for the regional workshop was relatively small (see annex 1). Adding the Russian participants to this group resulted in a fairly balanced number of participants in all three workshops. During the process of this workshop it became clear that a threeday programme is not sufficient to allow an appropriate discussion of the three key issues. Although the language problems mentioned above played an important role here, three days seems generally to be too short a period to treat the issues to a satisfying degree, especially as the participants were expected to be confident enough with the material to provide a workshop immediately afterwards. There was not enough time to treat some issues in more detail without having to cancel some parts of the initial programme. Moreover, the tight schedule did not allow enough time for a thorough (and more personal) introduction of the participants and practical exercises. Only a short introduction was possible. Therefore, it is advisable that a facilitators training workshop on these three issues should at least be four, and if possible, even five days. Regional Workshops The regional workshop began on Monday, 9 December at 2pm. Due to scheduling difficulties and time pressures, Franz Trautmann left Warsaw prior to the commencement of this workshop. After a short welcome by UNDP Poland representative Kasia Malinowska and a brief introduction by Dave Burrows, the workshop split into three groups in three separate rooms. A full participant list is provided in annex 4. The facilitators of the three groups were given complete control over the programme for their group. Four workshop sessions were held each day. The role of the international facilitator was to:
While reports will be submitted by the facilitators of the three workshops, it is important to note that there were several important deviations from the planned programme. These included:
The flexibility shown by facilitators in allowing such major changes to their programmes and their ability to redesign the programmes of their workshops to cover the major issues of rapid assessment and outreach work was extraordinary, given that most had not facilitated workshops of this type in the past. As the evaluation shows, these exchanges of information and ideas were among the most useful aspects of the workshop. If future regional workshops are held on topics related to HIV and injecting drug use, such exchanges should be included in their design. It is also important to stress the need for practical information from practitioners (eg of needle exchange) and the time, availability of translation (where needed) and encouragement of participants to ask specific questions of practitioners. It should be noted that this will only be possible if participants from at least one country (in this case, Poland) already have relevant experiences to share. It may also be important to leave some free time in such programmes to allow for developments to occur from the workshops themselves: eg, if particular participants have specialist knowledge, skills or experience that participants in other groups would like to hear about, time should be available in the programme to allow this to occur. While flexibility was the major feature of the workshop, it is important to note that there are limits to this approach. For example, due to tiredness of (all) the facilitators, scheduling difficulties and the logistics of the programme changes, daily informationsharing between group facilitators and the international facilitator were held sporadically and hastily. Future workshops of this type should schedule in at least halfhour meetings of the full group of facilitators and interpreters at a regular time each day (possibly at 9am as evening meetings were often postponed or cancelled due to changes in programming or tiredness). The need for two international facilitators also became apparent. Several times, each of the three groups asked that the international facilitator be present at their group at the same time (usually with good reason) and several comments were made by group facilitators that they desired (or needed) the international facilitator to spend more time with their group. Obviously a second international facilitator would not overcome this problem completely, but their presence would assist markedly in all of the roles described above, and in ensuring that meetings with group facilitators were held regularly and in greater depth. At the final plenary session, participants from each country gave a detailed presentation of the plan they had worked on during the previous four days, and comments and questions were invited on each plan. The participants from Russia planned a rapid assessment of the drug use and HIV situation in one district in Moscow, providing details of how each step would be taken within the specific area, the questionnaire (with 40 questions) they had designed in the workshop, use of the results to pressure local authorities to begin interventions, and ways to raise funds tocarry out the assessment The participants from Belarus planned an assessment and outreach project for a city near Svetlogorsk, including ways to attract drug users to the assessment process, use of volunteers as interviewers, main questions for a questionnaire, linking outreach to other forms of social support, payment of drug users for working with the project, establishment of needle exchange, and attempts to assess the impact of the intervention The participants from Poland agreed to establish a committee of NGOs working on HIV prevention among IDU's, including plans for establishment of a working group, formulation of incorporation documents and constitution, identification of potential member organisations; commitment was also made to keep in contact with organisations doing similar work in neighbouring countries and to provide training on rapid assessment and outreach work to Polish organisations not represented at the workshop The participants from Ukraine planned an assessment and intervention in a city in southern Ukraine, including details of the questionnaire to be used, dropin centre to be set up, recruitment and training of volunteers, outreach work plans, educational materials to be provided, needle exchange, organisational framework and coordination with the regional HIV/AIDS programme. An interesting feature of the regional workshop was the degree to which exchange of ideas and information was achieved between countries. Among the exchanges observed by the international facilitator or mentioned by participants were:
Facilitator Training Workshop For the evaluation of this workshop an evaluation form was designed in English (see annex 5). Due to time pressures and the inability of most participants to fill in the form in English, a selection of closedanswer questions were read to the participants in Russian with instructions about what the categories were. In this way, the five Russianspeaking participants were able to answer the selected questions. One Polishspeaking participant filled in the selected questions, using an Englishlanguage form, and the second Polish participant was absent during the evaluation session. Participants were also asked to write comments in Russian, English or Polish to two openended questions. Two participants responded to the openended questions and their answers were later translated by an interpreter. (In all, Questions 14, 68, 1314, 1718, 2122, 2728 were asked. See annex 5) Of the closedanswer questions (total 6 responses) all agreed that:
Five agreed that:
There was less agreement that:
The two responses on information lacking in this workshop were:
Other suggestions and/or remarks were:
Regional Workshops Evaluation of these workshops comprised observations by the international facilitator and a formal evaluation process on the final day. Observations were, of necessity, limited as there was one international facilitator attempting to visit three workshops. Observations:
An evaluation of the
regional workshop was carried out on the final day. Due
to the languages spoken and the fact that there were
three groups working largely on their own, this also
proved to be logistically difficult. The international
facilitator wrote a series of openended questions (see
annex 5) which were translated into Russian and Polish
and provided to group participants at the beginning of
the first session of the final day. Responses were
written in these two languages and collected after 30
minutes. Russian and Polish translators then summarised
these responses in English. The international facilitator
analysed the summaries and prepared the report below.
This report was provided verbally in English
(concentrating on the answers about future workshops) and
translated into Russian and Polish for participants in
the final plenary session.
The most common ways participants will apply the skills/knowledge learned in the workshop (in order of frequency) were:
The most useful aspects of the workshop (in order of frequency) were:
The least useful aspects of the workshop (in order of frequency) were:
The most commonly mentioned ways in which the workshop could be improved (in order of frequency) were:
If future workshops are held on HIV prevention among IDU's, the same countries should be invited. The majority of participants believed that the workshop should only include additional countries from Eastern and Central Europe, with the most mentioned countries being:
In addition, 8 participants called for involvement by countries with greater experience in effective HIV prevention among IDU's, specifically mentioning (in order of frequency):
Several participants also called for involvement from the Central Asian republics. There was almost unanimity on the question of what topic(s) should be covered by a future workshop. The workshop should provide concrete examples of effective HIV prevention among IDU's, especially from NGOs and especially focusing on working directly with drug users to outreach to and support other drug users. The workshop should allow participants to ask specific questions to people actually carrying out these programmes (rather than planners, managers or policy makers). The workshop should also include methods of assessing the effectiveness of HIV prevention programmes among drug users. A substantial minority also called for a workshop on HIV prevention among sex workers who inject drugs.
Recommendations regarding the process of a workshop This type of workshop (facilitator training followed by a regional workshop in the languages of the participants) clearly has benefits in providing training on complex topics such as rapid assessment and outreach to participants from several neighbouring or nearby countries over a short period. This type of workshop may have application in other parts of the world, notably in parts of Asia and South America which are experiencing regional HIV epidemics among IDU's. If this type of workshop is used again, the following changes should be made:
Recommendations regarding follow-up activities This region must continue to be the focus of extensive and ongoing training and networking activities as it has a group of HIV epidemics among IDU's which are rapidly growing and which will require substantial intervention if they are to be brought under control. The size and geographic spread of these epidemics suggests that UN agencies should not only be reactive to these epidemics, but provide workshops on topics of rapid assessment and outreach to other groups of countries in the region, notably the Baltic countries and the Central Asian republics. A meeting should be held of participants from the Warsaw facilitators training workshop in 34 months to enhance networking and to discuss future regional communications and training needs. Country UNDP representatives and the UNAIDS Intercountry Programme Adviser should attend the meeting to discuss UNDP/UNAIDS' role in assisting these processes. A workshop should be held in 68 months to follow up on the Warsaw workshops.
It should include a facilitators workshop and regional workshop with Russian and Englishspeaking participants and RussianEnglish translation for both workshops. Two participants from each country should attend the facilitators training workshop. If a Polish delegation is to attend, it may need to bring a Polish/English/Russian interpreter. The workshop should take into account all of the above mentioned recommendations regarding the process of a workshop. Consideration should be given to training one participant of the Warsaw facilitator training workshop as a regional consultant on HIV prevention among IDU's prior to the above workshop. This facilitator would assist the international facilitators at the above workshop with a view to becoming one of the international facilitators at future workshops, and to reducing dependence of countries in the region on facilitators outside the region. Regional and national networks should be enhanced to allow exchange of experience and ideas between people working in the countries represented at the Warsaw workshop. UNDP and UNAIDS offices should facilitate these networks by:
1 Jong, W. de, Responding to Injecting Drug Use and the HIV Epidemic in Ukraine and Poland: a capacity building approach'. Report of a consultational visit to the Ukraine on behalf of the UNDP, 5-14 June 1996. Utrecht (Trimbos-instituut) 1996. 2 Jong, W. de, HIV and Injecting Drug Use in Belarus. Svetlogorsk, 6-8 October 1996. Utrecht (Trimbos-instituut) 1996. 3 Vincent, N.C., Rapid Assessment Procedures: Informing the development of responses to hazardous and harmful amphetamine use. Paper presented at the 7th International Conference on the Reduction of Drug Related Harm, Hobart, Australia, March 3-7, 1996. 4 Trautmann, F., Barendregt, C., The European Peer Support Manual - peer support as a method for aids prevention in idu communities. Utrecht (NIAD) 1994. PROJECT PROPOSAL RESPONDING TO INJECTING DRUG USE AND THE HIV EPIDEMIC IN EASTERN EUROPE A Capacity
Building Approach BACKGROUND There is growing concern that the countries of Eastern Europe and the Commonwealth of Independent States (CIS) are facing an increase in the trafficking, production and distribution of injectable drugs. There is also concern that such an increase will hasten the spread and worsen the impact of the HIV epidemic in the region. Poland From 1985 to 31 July 1996 there were 4166 reported cases of HIV infection in Poland, at least 2802 of these were illicit drug users. Police statistics indicated that the number of drug trafficking offenses in the country rose from 1275 in 1990 to 5455 in 1994. A study of injecting drug users (IDU) attending two detoxification centres in Warsaw found 46% to be infected with HIV. Belarus Belarus has had a sharp increase in registered cases of HIV infection since June 1996, mostly among injecting drug users, particularly in Svetlogorsk. According to the police in Svetlogorsk, most young people below the age of 17 years have experimented with drug injecting. It is estimated that 4,000 -7,000 injecting drug users live in Svetlogorsk. Before June 1996 nearly all HIV test results from Svetlogorsk were negative. In June, 6 of 33 (18%) IDU tested HIV-positive. In July 173 of 333 (50%) tested HIV-positive. By October 482 cases of HIV infection were registered, mostly among IDU. These figures indicate an extremely rapid spread of HIV. ("HIV and Injecting Drug Use in Belarus" Svetlogorsk, 6-8 October 1996, Wouter de Jong, Netherlands Institute of Mental Health and Addiction). Ukraine There are estimated to be about 500,000 drug users in the Ukraine, 30,000 of these are thought to be in the Odessa region. New HIV infections are being detected in this region at the rate of about 500 per month, according to U.N. sources. COMMENTARY Although evidence from the region remains limited, experience from elsewhere in the world suggests that conditions for an increase in drug use and its associated sex work are ripe: social and economic dislocation, falling standards of living and rising unemployment, psychological stress and alienation especially among young people, inadequate health care and welfare services as well as changes in drug supply, including price and availability (linked to changing international patterns of drug production and trafficking, itself linked to the opening up of borders between Eastern and Western Europe). An increase in drug consumption does not necessarily imply an increase in drug injecting and, more significantly for the HIV epidemic, an increase in the sharing of injecting equipment. However, evidence from Eastern Europe and the CIS suggests that rising drug consumption is also manifesting itself as an increase in drug injecting and the sharing of injection equipment. Of additional concern is the increase in drug-related sex work, and the further spread of HIV infection that this may involve. Such a phenomenon is not unique to this region and, internationally, there exists a considerable body of literature about, and experience in, discussing and researching the link between the HIV epidemic and drug use, and developing appropriate policy and programming responses. One characteristic of such responses has been the pragmatic way in which different strategies have been combined. Thus, in conjunction with efforts to reduce the supply of and demand for illicit drugs there are, in many counties, also policies and programmes in place which attempt to decrease the adverse health, social and economic consequences of drug use. Such a combination has rarely been without controversy and has emerged from a process and a period, sometimes protracted, of intense debate, research and advocacy. The opening up of the countries of Eastern Europe and the CIS to the West offers opportunities for such countries to learn from and participate in the debates and research which have shaped drug policy making and programming in Western Europe, North America, Australia and, increasingly, parts of Asia. Equally importantly, there is hope to be gained from such international experience as it is commonly acknowledged that significant HIV epidemics among injecting drug users have been averted in cities as diverse as Glasgow, U.K. and Sydney, Australia through critical and timely decisions on appropriate policy and programme responses. Such decisions cannot merely be replicated in the countries of Eastern Europe and the CIS; that would be to ignore the particularities of history, culture and society as well as the characteristics of drug use and drug users in countries of the region. However, the process by which such decisions were made in Western Europe and elsewhere could be instructive for countries like Poland, the Ukraine and Belarus. The process may be broadly characterized as pluralistic, participatory and pragmatic in that it was driven by the actors and agencies of civil society as much as the state sector, and tends to be inclusive of a wide range of people and opinions, allowing for innovation and experimentation. Developments in democracy, governance and participation in Poland, the Ukraine and Belarus make such a process particularly appropriate and timely for those countries as it can build on existing efforts to increase institutional capacity, decentralize decision-making, democratize political systems and promote citizen and community participation. The conditions in which policy and programme responses to injecting drug use and the HIV epidemic may be discussed in a pluralistic, participatory and pragmatic manner can be located in the broader development framework of strengthening governance and participation. Such a development framework also allows the conceptual focus to widen beyond the individual to an understanding that HIV infection is as much to do with the social contexts as it is with an individual's behaviour. Work on injecting drug use and HIV must be placed in the contexts of poverty, gender, social disaffection and hypocrisy. For example, gender constructs patterns of sexual behaviour and injecting behaviour which heighten women's risk of HIV infection. Clearly, such social consequences are in flux in Eastern Europe and the CIS and there is a need to understand better how to influence such contexts through development decisions in ways which reduce impact of HIV infection. Specifically, the development framework helps policy makers and programmers address two sets of key issues with regard to drug use and HIV, namely:
PROPOSAL It is proposed to identify and train persons from government, community based organisations and academia in ethnographic mapping and rapid assessment of injecting drug use practices and their implications for the spread of HIV infection. In each participating country a critical mass of individuals would be created, who could then conduct further training at the national level to further enhance the national capacity to respond. Key institutions in each country would be identified and encouraged to forge regional links to further facilitate the exchange of information and expertise. Technical support will take the form of capacity building, and will proceed in two stages.
Both the facilitator training workshop and the intercountry workshop will be evaluated and documented, and the lessons learned distributed to national HIV/AIDS programmes, academic institutions and the community sector. The process facilitation methods developed by the Management Development Governance Division and the HIV and Development Programme will form the basis for the approach used throughout the facilitator training workshop and the intercountry workshop. PRIOR AND ONGOING ACTIVITIES Poland There have been a number of UNDP-funded HIV-related initiatives, including a publication series for health promotion and HIV, a project on local government and community training on HIV, and a project to facilitate post-graduate studies for the nursing profession. In March 1996, the UNDP sponsored a seminar on law, ethics and HIV in Warsaw, which was also attended by a representative of the National Anti-AIDS Committee of the Ukraine, and the National Professional Officer for HIV and Development of the UNDP office in Kiev. In mid-1996 a workshop was held in Warsaw on injecting drug use and HIV, sponsored by the Soros Foundation. The UNDP country office provided administrative and logistical support and the workshop was attended by the UNDP Programme Coordinator for HIV and Development in Poland. One important conclusion of this workshop was the need for further information about the specific nature of injecting drug use practices. The need to develop local capacity to conduct rapid appraisal techniques for outreach and mapping was stressed. Ukraine In 1995, two major consultancies were conducted to review the drug use problem in the Ukraine. In October 1995, the National Anti-AIDS Committee of the Ukraine held a meeting of non-governmental organisations and other potential partners on preventive activities in the context of injecting drug use and HIV infection. At the end of 1995, $40,000 was made available by WHO/GPA/EURO to support a review by the Ukrainian National Anti-AIDS Committee of existing HIV/AIDS legislation with a view to recommending legislative changes, where necessary. A training workshop on preventive activities in the context of injecting drug use and HIV infection took place in June 1996. The workshop was sponsored by UNDP, with technical support provided by the Netherlands Institute of Mental Health and Addiction, UNDP and UNAIDS. Participants for the workshop were selected by the National Anti-AIDS Committee. A participant from Poland also attended. The workshop was held in the context of a larger project proposal of the National Anti-AIDS Committee, supported by UNAIDS and funded by NORAD, entitled STD and HIV Prevention in the groups of Higher Risk (Injecting Drug Users and Female Sex Workers) (1995). Finally, Kiev has been identified as one site for a WHO drug injecting multi-city study which is expected to start in late 1996. The study is to be conducted by the School of Social Work in Kiev. UNAIDS has indicated an interest in collaborating on resources and methodology being developed for rapid assessments. Belarus In August 1996 a meeting was held in Svetlogorsk between national health authorities, local authorities and UNAIDS. A training workshop on HIV and STD prevention among IDU was held in Svetlogorsk from 4-14 October 1996, initiated by UNAIDS, UNDP and the National AIDS Centre of Belarus. About 30 representatives of governmental and non-governmental organisations participated. IMPLICATIONS FOR LOCAL AND REGIONAL INITIATIVES In Poland, the Ukraine and Belarus there is now a growing understanding amongst academics and policy makers of the implications of the emerging twin epidemics of injecting drug use and HIV infection. Experience in other parts of the world has demonstrated that injecting drug use practices are both locally specific and very diverse. Yet there remains both a lack of basic information regarding injecting drug use practices, and a need to develop local capacity to collect and analyse such data. Following the recent UNDP workshop in the Ukraine, Dr Tawil of UNAIDS observed: There is a need for basic information on the context in which drug injecting takes place. This includes such information as what are the social profiles of those involved, what is the nature of the sub-culture and norms surrounding drug injecting, where does injecting take place and what health or other services are accessible and trusted. In Poland, there is a growing awareness of the extent of injecting drug practices and the importance of a harm reduction approach. However, accurate data about the diversity and local specificity of such practices is necessary so that policies and programmes, such as needle and syringe exchange programmes, which respond to local and specific needs can be designed and implemented. The Netherlands Institute of Mental Health and Addiction, which worked with UNDP on the Ukraine capacity building workshop, identified the need for skills development in qualitative research and rapid assessment techniques. PROPOSED LOCATION Poland has been chosen for the site of this project following a request from the UNDP Country Office for technical assistance in rapid appraisal techniques for outreach and mapping, and based on the capacity of the UNDP to provide administrative and logistical support and follow up. IMMEDIATE OBJECTIVES To enhance national capacity in ethnographic mapping and rapid assessment of injecting drug use practices and their implications for the spread of HIV infection. Output 1 Participants from government, the community sector and academia in Poland, the Ukraine and Belarus will be have enhanced capacity in rapid appraisal techniques for outreach and mapping of injecting drug use practices and their implications for the spread of HIV infection, and to transfer these skills to others. Activities Appropriately qualified nationals from each country will be identified according to criteria developed in consultation the Netherlands Institute of Mental Health and Addiction, which has substantial experience in injecting drug use programmes, policy development and the community sector. This team will meet for three days to review rapid appraisal techniques for outreach and mapping in preparation for a intercountry workshop on the subject. The facilitator training workshop will also focus on developing the capacity of the team members to co-facilitate the intercountry workshop. An intercountry workshop will be held to train the participants in ethnographic mapping and rapid assessment techniques. Participants will be chosen from government, academia and the community sector in the participating countries. Output 2 The lessons learned from the facilitator training workshop and the intercountry workshop will be disseminated within the participating countries. Activities At the end of the workshop the participants will be invited to comment on substantive and other aspects of the workshop with a view to capturing the lessons learned. These comments will be included in a report which will be prepared in English by the international facilitators in conjunction with the national facilitators. The UNDP country offices will make this report available to government and relevant academic institutions and community based organisations. UNDP inputs UNDP will provide two international consultants to design and facilitate the facilitator training workshop and the intercountry workshop, in consultation with UNAIDS and WHO. UNDP will meet other costs of the meeting and workshop (translation and production of materials, interpretation, audio-visual, venue and associated costs.) UNAIDS inputs UNAIDS will sponsor the participation of national participants from Poland, the Ukraine, Belarus. UNAIDS will also sponsor four participants from Russia. PARTICIPATION Facilitator Training Workshop
Intercountry Workshop
TERMS OF REFERENCE: INTERNATIONAL FACILITATORS Facilitator Training
Workshop Convene a meeting of Polish, Ukrainian and Belarussian national facilitators on injecting drug use and HIV, in consultation with the UNDP HIV and Development Adviser, Poland, the National Professional Officer on HIV and Development, Ukraine, and the HIV and Development Specialist, Belarus. Through a capacity building approach using the techniques of process facilitation, train appropriately qualified nationals from each country in:
Assist the national facilitators to prepare to facilitate the intercountry workshop on HIV and injecting drug use to follow this meeting. Intercountry Workshop Support the national facilitators trained in the facilitator training workshop to facilitate an intercountry workshop on outreach and rapid appraisal techniques for ethnographic mapping and rapid assessment relating to injecting drug users. In consultation with the participants, prepare a report on the process and outcomes of the facilitator training workshop and the intercountry workshop, with reference to the lessons learned by both the participants and the international facilitators. Include recommendations for further initiatives as appropriate. PARTICIPANT DESCRIPTION Facilitator Training Workshop Two facilitators will be invited from Poland, Ukraine and Belarus. These facilitators will be responsible for facilitating the work of the intercountry workshop. The workshop will work in language-based small groups facilitated by two facilitators under the guidance of the international facilitators. The facilitator training workshop will include training in:
It will also finalize the approaches and programme of work for the intercountry workshop. Participants for this workshop should be selected on the basis of the following criteria: Ability to work in English. Experience in workshop facilitation and training; ability to work in a team. Either training or practical experience in rapid assessment and/or outreach techniques in community based work; and A familiarity with injecting drug use programmes, policy development and the community sector. Intercountry Workshop Participants will be chosen from government, academia and the community sector in Poland (nine participants), Ukraine (six participants) and Belarus (three participants). The participants will be identified by the respective UNDP country offices as follows. Each participating country is asked to identify a local institution or organization which would be interested in developing or strengthening a capacity to train in this area. One or two participants should be selected from this organization. Other participants should
be drawn primarily from programmes which work or have
expressed an appropriate interest in working with
injecting drug users, and employing users and ex-users,
in creating and strengthening self-support and prevention
programmes in these groups.
All participants need to be open to working in close collaboration with drug users and ex-users; to recognize the particular knowledge and experience that users and ex-users can bring to programme and policy design and implementation, and have the interpersonal and reflective skills required for assessment and outreach work. The workshop will be facilitated by the national facilitators identified above, with the support of the international facilitators. During the workshop the participants will be trained in outreach and rapid appraisal techniques for ethnographic mapping and rapid assessment relating to injecting drug users. At the end of the workshop, the participants will be invited to comment on the substantive and other aspects of the workshop with a view to capturing the lessons learned. These comments will be included in a report which will be prepared in English by the international facilitators in conjunction with the national facilitators. Each group of national participants will be asked to prepare a report. The UNDP country offices will make this report available to government and relevant academic institutions and community based organisations. INITIAL PROGRAMME FOR WORKSHOPS Facilitator Training Workshop day 1 afternoon part 1 part 2 afternoon day 2 afternoon day 3 afternoon Regional Workshops part 2 day 2 afternoon part 2 day 3 part 2 * exercise: working groups making a plan for the situation in the participants' regions: setting priorities, where to begin, which target group, why, etc. afternoon part 1 * the message: safer use safer sex part 2 *
counselling on the street (how to raise the subjects
HIV/AIDS, drug use and sex, how to discuss safer
behaviour, attitude and behaviour, practical rules, etc.)
day 4 outreach
work/assessment afternoon part 2 evaluation PARTICIPANTS OF THE WORKSHOPS Facilitators training workshop Lidya Andrushchak
Ukraine Regional workshop EVALUATION FORMS Facilitators Training
Workshop Regional Workshop
Authors:
|
