Drug Demand Reduction and Health Promotion in Central Asia
The Drug Demand Reduction Programme (DDRP) was a five-year USAID-funded initiative in Central Asia that sparked a response to the dramatic increase in drug use among vulnerable populations in three key countries of the region and the rapid rise in drug-related HIV infections. In 2002, HIV infection rates in the countries of Central Asia remained relatively low, but were beginning to accelerate very rapidly in line with the use of injecting drugs. The prison system was recognised as a critical link in the HIV/AIDS drug cycles, where wide availability of illegal drugs, unsanitary and crowded living quarters combined with a lack of basic HIV prevention practices and tools created hotbeds for drug dependency and the spread of HIV/AIDS.
By getting in early and launching a response at this stage, AFEW and its partners hoped to pre-empt national epidemics an epidemic that would spread within the prison system and beyond its walls, as had occurred in other countries of the region. The overall aim of the project was to build effective programmes for drug demand reduction, social services for vulnerable groups and providing less harmful alternatives to heroin/opiate use. On 10 pilot sites, AFEW and its partners introduced the four cornerstones of an effective prevention and treatment system:
- Health promotion and education for both inmates and staff;
- Wider provision of drug demand reduction services;
- Stronger capacity of local regions and communities to prevent and address heroin/opiate use;
- Better prison regulation policies in the area of drug demand and HIV/AIDS.
Over 3,700 inmates trained on drug demand reduction and HIV/AIDS prevention.
Over 66,500 informational and educational leaflets were distributed to inmates.
Over 440 medical and non-medical prison staff trained in drug demand reduction and infectious disease prevention.
Drug demand and health promotion courses incorporated in the official training for all prison staff of Kyrgyzstan, Tajikistan and Uzbekistan.
49 trainers were working in national teams to continue staff and inmate educational programmes as of the project end date.
560 representatives of NGOs, law enforcement agencies and other state service providers trained in drug demand reduction for sex workers.
Effective education and training models established for inmates in male, female and juvenile institutions. During the project, almost 4,000 inmates attended health and awareness courses on drug use, harm reduction and disease prevention. In addition, a series of informational brochures and radio broadcasts that provided health information and advice were developed and disseminated to prison inmates in the three project countries. Events held to mark campaigns such as International Day against Drug Abuse and Illicit Drug Trafficking and World AIDS Day augmented this work by involving inmates in creative awareness activities. All information and training was delivered in Russian and the local language (Uzbek, Kyrgyz or Tajik).
Education and training models for prison staff institutionalised. Raising the capacity of prison staff to educate inmates on health issues and ensure provision of vital services was a central aim of the project. AFEW’s training for medical staff focused on drug counselling, HIV/AIDS counselling and motivational interviewing. In order to ensure the continuance and expansion of good practice after the project ended, a national team of trainers was recruited and attended ToT (Training of Trainers) on harm and drug demand reduction in each of the three countries. Trainers were drawn from ex-inmates, prison staff, local NGOs and local healthcare systems. Altogether 49 trainers were working actively to implement staff and inmate training as of the project end date.
Changes to national policies on prison health. AFEW and its partners developed training modules on drug demand reduction and health promotion and a course ‘Health Promotion Issues in Prison’ that were officially endorsed by the governments of Kyrgyzstan, Tajikistan and Uzbekistan. These modules are now incorporated in the official training programmes for all prison staff in these countries. Importantly, all three governments have also made changes to the job descriptions of prison medical staff making it a key responsibility to conduct drug and HIV counselling for inmates. Three training modules (for inmates, medical and non-medical staff) were developed, printed and distributed among national partner organizations who continues implementing activities in prison facilities.
Long-term cooperation and dialogue on healthcare in prisons. The DDRP coalition also set up and coordinated a high-level working group on ‘Drug Demand Reduction and Health Promotion in the Penal System’ that brought together prison staff, directors and specialists of penal medical departments (i.e. drug treatment specialists, psychologists, infectious disease specialists and epidemiologists), staff from AIDS centres and AFEW country managers. This group eventually extended to include other national and international organisations and it continues to work to improve the legislative framework.
Another outstanding legacy of the project is the Central Asian Forum on Drug Use and Infectious Diseases in Prisons, which took place for the first time in Almaty in 2006 and for the second time in October 2008 (continued under AFEW’s ACCESS Project). This event brings together all stakeholders in prison healthcare – representatives of national ministries and institutes, prison staff and representatives of non-governmental and international organisations – in exchanging information, strengthening national awareness of drug-related issues and encouraging political ownership of these issues.
Additional capacity building for prevention work among sex workers. At the outset, AFEW was concerned to carry out additional work in addressing the crippling lack of drug demand reduction services and social support for sex workers. In-depth studies conducted among sex workers revealed a severe lack of access to medical services, needle exchange points and negative attitudes from medical and police staff that discouraged sex workers from seeking help.
In response, AFEW embarked on a region-wide programme of capacity training to engage local NGOs in helping sex workers with drug and other medical issues. Multi-sectoral working groups were formed in Tajikistan and Kyrgyzstan that succeeded in bringing governmental institutions and NGOs together on policy development on openly culturally sensitive issues related to sex work and drug use. Five Training modules were developed, printed and distributed. They were devoted to motivational interviewing, outreach work, lessons for law-enforcement bodies and best practice in organising services. Special attention was paid to work with the law-enforcement organs. In Kyrgyzstan, for example, a group of policemen who were particularly interested in the projectwas created that took part in regular training.