RESUMO
Outreach interventions using ex-IDUs to inform and educate their peers about HIV/AIDS prevention measures have been found to be effective in the United States and other developed countries. While HIV/AIDS prevention programmes targeting IDUs have also been implemented in a number of developing countries, very little information is available on the process of implementation of these programmes. This paper attempts to document some of this knowledge by describing the implementation process of an outreach intervention targeting IDUs in a small town--Churachandpur--with high injection drug use and high HIV infection rates, in the north-eastern state of Manipur. The paper describes the barriers encountered in implementing the outreach and how these barriers were minimized. In conclusion, the paper makes the case for targeting outreach to the larger community before targeting the IDUs.
PIP: In the small town of Churanchandpur, Manipur, India, heroin injection began in the early 1980s. Over 80% of the injecting drug users (IDUs) in the state of Manipur are estimated to be HIV-positive. The implementation of an outreach intervention targeting IDUs is detailed. An advisory committee sought to create a supporting environment for the outreach by minimizing police harassment of IDUs. Church leaders were also provided information about the HIV/AIDS problem as were families of IDUs and the community. Outreach workers were recruited from the community and trained regarding HIV/AIDS epidemiology, prevention, antibody testing, and referral. The IDUs were approached in pairs by the outreach workers who delivered prevention messages: not to use drugs and injecting equipment; cleaning syringes with bleach; avoiding multiple sex partners; and using condoms. Within 1 year, 750 of the estimated 800 IDUs were reached and 3930 bleach kits and 4734 condoms were distributed. Referrals were made for medical problems (thrombophlebitis, abscess, and infections) to a team doctor or drop-in centers. Later, active IDUs were also recruited to help reach new IDUs. Dealers' homes were also visited to distribute risk reduction information and bleach kits. At the six drug treatment centers regular weekly visits were paid to provide prevention information. Weekly visits were made to the jail with a similar bid. A drug users' organization was formed which discussed health concerns faced by IDUs on a weekly basis. Two drop-in centers were also set up, where an average of 10-15 IDUs could come daily and discuss any problem with the field staff. Constraints on the outreach implementation included illegal drug use, low morale among the outreach workers, lack of understanding of the community and church, the cumbersome bureaucracy, the deteriorating political situation, no facilities for voluntary HIV testing and counseling, and the relapse of outreach workers into drug use.
