Transcript Harm Reduction Program in Bangladesh: Progress, Opportunity and Challenges Presented By: Shamim Rabbani Team Leader IDU Intervention Padakhep, Bangladesh.

Harm Reduction Program in Bangladesh:
Progress, Opportunity and Challenges
Presented By:
Shamim Rabbani
Team Leader
IDU Intervention
Padakhep, Bangladesh
Presentation Outline
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Evolution of drug use in Bangladesh
HIV and drug use situation
Back ground of harm reduction program
Responses and essential service package
Major Achievements, Challenges and Call for further
actions
Evolution of Drug use in Bangladesh
Till 1970s: Cannabis smoking, opium ingestion and
drinking alcohol
Early 1980s: Codeine syrup ingestion and heroin
smoking
From 1990s: Injecting drug (Buprenorphine, other
pharmaceuticals and heroin)
Commonly Used Drugs In Bangladesh
Heroin
Cannabis
Tidigesic / TD
Sleeping pill
HIV and Drug Use Situation in
Bangladesh
• Official Estimates of IDUs in Bangladesh :
20,000 – 40,000
• HIV prevalence among IDUs has yet
remained low.
• But needle and Syringe sharing remained
significantly high and HIV prevalence has
been increasing in NEP intervention areas.
A Concentrated Epidemic in Bangladesh
8
7
7
7
6
4.9
5
%
4
4
4
3
2
2
1.7
1.8
1.4
1.1
1
0.8
1.7
1
0.8
0
0
1999-2000
2000-2001
IDU-Dhaka
IDU-Chandpur
IDU-Ishwardi
Combined male-Khulna
2002
0
2003-2004
0
2004-2005
0
2006
IDU-Narayanganj
IDU-Teknaf
Heroin smokers-Dhaka
Combined female-Dhaka, N.ganj and Tongi
Source: National HIV Serological Surveillance
1 0.9
0.8
0.6
0.3
0.2
2007
HIV risk & vulnerability who inject drugs
100
Percent
80
73.8
54.8
60
42.1
40
44.3
33.6
30.5
20.2
20
0
% with
comprehensive
correct HIV
knowledge
% of male reporting
% of female
% male reporting
use of condom in
reporting use of
use of condom in
last non-commercial condom in last non last commercial sex
sex
commercial sex
% of female
reporting use of
condom in last
commercial sex
% of male reporting
% of female
use of sterile
reporting use of
injecting equipment sterile injecting
the last time they equipment in last
injected
injection
Source: National BSS 2006-2007, NASP (unpublished), 4 Female IDU Cohort Study,
ICDDR,B, 2006 (unpublished)
Situation Assessment to Drug Use
• First Base line study Conducted in 1997 (CARE-B)
• National Assessment to Opiate/Opioid drug Use
Conducted in 2000- FHI
• Cohort study among IDU conducted in 2002 by
ICDDR.B
• Series of assessment done during 2004 to 2007 by
CARE-B & Padakhep
• RSRA Conducted in 55 districts in 2008 by Padakhep
and CARE-B, Supported by GFATM
Based on the findings - 3 generation harm reduction
program designed, developed and
Being implemented in Bangladesh
Responses
CARE – Bangladesh and PADAKHEP responding
HIV through IDUs intervention as the
implementing partner of National AIDS/STD
Program (NASP).
 Harm Reduction Intervention Started in 1998
 Estimated number of IDUs
:
20000 – 40000
 No. of DICs
:
93
 No. of IDU coverage
:
23,684
 % of IDU Coverage
:
59 (From highest estimate)
Geographical coverage of IDU Intervention
District covered through IDU intervention- 37
Evolution of Harm Reduction Program
1st Generation IDU Intervention (1998 – 2004):
 Considering the Vulnerability of IDUs – CARE-B conducted a Baseline survey on IDU
intervention on 1997
 IDU Intervention launched in May 1998 in Dhaka metropolitan city
 Intervention continued from May 1998 to June 2004 in 23 districts among 9400
populations
2nd Generation IDU Intervention (2004 – 2009):
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Government supported HIV/AIDS Prevention Program (HAPP) started in 2004
IDU Intervention expanded in 35 districts & coverage increases to 10415 IDUs
First inclusion of HSs in HR program, COHORT Started -2002
Started intervention for ILWHAs -2003
3rd Generation IDU Intervention (2008 – Ongoing):
 Global fund took decision to provide support for un-served IDUs
 Program expanded in the gap areas among un served population.
M
Year
9211
9566
7712
10415
23684
25000
20
08
20
07
20
06
5247
15000
20
05
20
04
4159
20000
20
03
4744
3703
3564
10000
20
02
20
01
20
00
1233
150
5000
19
99
19
98
98
ay
'
Number
Year wise IDU coverage
IDU coverage
0
Year wise expansion of DIC
100
93
90
DIC
80
70
Number
60
50
50
55
56
2005
2006
53
40
30
21
20
10
4
8
8
1999
2000
12
13
2001
2002
0
1998
2003
Year
2004
2007
2008
Essential Harm Reduction Packages in Bangladesh
At DIC :
 STI Management
 Abscess management
 General Health Care
 Counseling
 Awareness session ( Individual and
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Group)
Needle syringe exchange
Condom distribution
Recreational facilities ( Enjoy TV,
Reading Newspaper, Playing Carom,
Ludu, Chase)
Referral services for VCT, Drug
Treatment, Complicated STI/
Abscess/ TB
At Outreach:
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Needle/ Syringe Exchange
Condom Promotion
Education Session ( Individual and
Group)
Community Sensitization meeting
Referral and Follow up
Social reintegration activities
Drug treatment and Rehabilitation
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Community and Centre Based Drug
detoxification/treatment
Key Achievements
 Best Performance Award by the Honorable Prime Minister for
organizing community based drug detoxification Program
 Outreach Model of Dhaka has been selected as a best practice in
‘Preventing HIV/AIDS among drug users Case studies from Asia’
published by UNAIDS
 ‘National Harm Reduction Strategy developed and published by
Government
 National HIV/AIDS strategy document (2004-2010)’- developed and
endorsed by Government
 Regular national HIV sero-surveillance conducted
 Scale up NEP
Impact on IDU Intervention
Without Intervention
With Intervention
Source: Presentation of Anna Foss, 14th International HR conference
Challenges
 Gap in funding
 Lack of variation in programs over the country-need contextual study
 Violence against target Communities affecting IDUs (Eviction of shooting
gallery, beating, extortion) program.
 Revise existing policies and Law to provide comprehensive harm reduction
service delivery
 Mobility of IDU hampers regular reach/contact
 Partner Management of STI and referral for necessary services
 Lack of Job placement/social reintegration and poverty
 Pilot and rapidly scale up Oral Substitution Treatment (OST) and expand
coverage of needle & syringe program to reach critical coverage of both
men & women who inject drug.
 Stigma & discrimination related with drug use and ILWHA
Challenges
Challenges
Challenges
Challenges
Acknowledgement
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National AIDS/STD Programme ( NASP)
CARE-Bangladesh
Family Health International (FHI)
Save the Children-USA
ICDDR,B
PADAKHEP
3 key Secrets(!) behind the scene of effective Harm
Reduction Program in Bangladesh:
 Early Intervention
 Wide Coverage
 Quality of the Program
Thank You