STOP TELLING US NOT TO SHARE Participatory project design

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1 STOP TELLING US NOT TO SHARE Participatory project design Increasing access to clean injecting in Myitkyina township 3 Diseases Fund annual review 16 December 2010 Médecins du Monde In Myanmar French medical NGO created in 1980 Humanitarian medical organization mandated to provide medical care to high risk and vulnerable populations with extensive experience in Harm Reduction in France since 1987 (opening of the first free anonymous HIV testing center in France in 86; methadone bus started in 1987) since 1990 s in Russia, Serbia, China, Myanmar, Vietnam. 1996: HIV/AIDS prevention for high risk populations among general population, sex workers and I/DUs. 2002: Comprehensive medical care for I/DUs, FSWs and their partners 2006: Methadone Maintenance Therapy program Needle and Syringe Exchange Program Distribution of clean injecting Risk awareness (HIV, Hepatitis) Promotion of safer injection practices Collection and destruction of used needles In DIC and in outreach, mostly relying on peer educators 1

2 NSEP make good public health sense Effective (reduces transmission) Efficient (less costly than treating patients) Does not encourage drug use or discourage drug treatment Needles & syringes distributed (Myitkyina & Moegang, MDM only) 3,000,000 Quick maths IDU population in Myitkyina township only 2,500,000 2,000,000 1,500,000 1,000,000 4,000 5,600 persons X 3 injections / day X 361 days / year 500, = 4 to 6 millions syringes / year Coverage & gap (2010 in Myitkyina township only) Participatory project design with users and suppliers MDM HAARP+SARA Private sector or sharing / re-using to better understand the reality of injecting practices, in relation to the availability of new needles and syringes. 6 FGD with users and 6 FGD with private suppliers (pharmacy, shop keepers) From August to October

3 Key findings A clearly identified problem with inadequate responses We don t know the risks Awareness Awareness Availability Sharing Too expensive Price All mentioned HIV as the main risk of infection, but many also mentioned Hepatitis B and C and other blood borne diseases, skin infections etc. All prefer single use N&S, but all also have experience of cleaning material or sharing There is no available Social / legal risk Trouble with my family / with police Lack of information is not the main factor influencing at risk injecting practices. Availability Price Key role of private sector No specific preferences for brands / types Preference for Shooting Gallery settings= both drugs and N&S available Continuous and Consistent access is an issue Free in NSEP (and in most shooting galeries as supported by NSEP programs) 50 to 200 MMK / N&S in private sector, average 100 MMK Inexpensive compared to cost of drugs, however price can be an obstacle: if N&S cost is too high, users are encouraged to re-use and to share. 3

4 Social cost Aggravating factors Privacy / confidentiality a key factor for all users They don t want to be identified as IDU by families and neighbours Or by police Rural areas Less confidentiality, more social pressure Less developped private sector Less access to mainstream NSEP Withdrawal symptoms less rational choices Immediate availability key factor Current NSEP programmes But Knowledge is of very little help with the reality of drug use and its constraints. = health education is not enough «9 to 5» approach (week days only, sometimes not all days, not at night) NSEP very appreciated: Free Confidential and respect for anonymity Capilarity issue (geographical coverage limited by transportation and staff costs) Very limited geogr coverage so far Private sector fills the gap «Alternative» NSEP Longer opening hours Large geographical coverage But Price is an issue Legal framework unclear / inadapted Confidentiality not always ensured Building on private sector (shops, pharmacies) Very high level of subsidy / or free Through a «franchising approach» Backed with health education / awareness raising Starting soon 4

5 Thanks to 5

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