“From Margins to Mainstream” project

'From Margins to Mainstream' is an initiative of the Asian Harm Reduction Network (AHRN) implemented in collaboration with Mainline Foundation supported by the Dutch Ministry of Foreign Affairs. The 'From Margins to Mainstream' project is being implemented in Cambodia, India, Indonesia, Iran Malaysia, Nepal and Pakistan. The core premise of the project is that HIV/AIDS and drug use in Asia are largely driven by poverty. Therefore, the project seeks to address the root causes of HIV/AIDS and drug use - poverty - through employment schemes and income generation projects to facilitate the reintegration of recovering drug users based on the situation in each country. In just a short time, the project has demonstrated that people recovering from drug use can be productive citizens if they are provided with the necessary support and opportunities.

The 'From Margins to Mainstream' project represents a unique collaboration between AHRN, Thailand and Mainline Foundation, the Netherlands. For a number of years, AHRN has sought to bring the expertise and knowledge possessed by Mainline to the Asian region. In 2004, this was realised through a joint and collaborative bid to the Dutch Ministry of Foreign Affairs (MOFA) to finance an Asian regional programme. The programme concentrated on the triple nexus that exists between poverty, injecting drug use and HIV/AIDS. AHRN’s local experience was invaluable in generating a strategy to respond to the challenges in the region by developing replicable impact-based models of intervention which support the continuum of care for drug users.

In Iran (Teheran), Persepolis is developing its outreach support to drug users and enhancing its drop-in centre where pharmacotherapy support is administered.

In Pakistan (Islamabad), Nai Zindagi is developing a vineyard on 25 hectares of land which will employ up to 400 drug users (many of whom are PLWHAs).

In India (New Delhi), SHARAN is increasing their residential detoxification component and pioneering home-based detoxification; Sahara House is providing comprehensive health and social care services to transgender groups.

In Nepal (Kathmandu), Youth Vision has developed an outreach programme to current users in the Kathmandu valley.  As part of this programme it is hoped that pharmacotherapy using buprenorphine will be trialled in Nepal.

In Cambodia (Phnom Penh), Friends International and Mith Samlanh are providing technical assistance to government departments and other actors to enlarge the capacity of outreach to young people (street children) who are increasingly drawn into drug use.  In addition, a small business – Creative Design Studios – is focussed on teaching design concepts and unleashing the creative potential and entrepreneurial ability of young people completing rehabilitation.

In Malaysia (Terengganu), Pelangi is developing a hospice care model for homeless drug users living with HIV/AIDS and developing an organic dragon fruit business.

In Indonesia (East Kalimantan), LARAS is pioneering outreach services to drug users in Samarinda and health and social care services to sex workers in sex villages outside Samarinda and Bontang.

The first year of the programme concentrated on developing the specific design of projects, the project structure, establishing principles of how outcomes would be delivered and building the implementation network. All partners have signed contracts which include details of the objectives to be achieved under the project.

The partnership with the Dutch Ministry of Foreign Affairs (MOFA) in the Netherlands was established productively. MOFA has proved to be a flexible and supportive partner and demonstrates an excellent understanding of development dynamics and in particular is extremely supportive of measures aimed at improving the debilitating nexus of drug use, HIV/AIDS and poverty.

Regular updates of the programme will be published.

AHRN INDONESIA

FHI / ASA Project

Over the years, AHRN's support to harm reduction in Indonesia has focused on advocacy, networking, and capacity building. AHRN also invested in the development of a nationwide scale-up strategy. In close collaboration with senior government officials, AHRN submitted proposals for nationwide scale-up of harm reduction service delivery. As these proposals were not endorsed by central level authorities, AHRN's services could not be retained and have resulted in the official suspension and closure of AHRN activities at the Jakarta office as of October 2006.

AHRN remains committed to service delivery to marginalised communities in Indonesia and continues to support LARAS Foundation in East Kalimantan. LARAS is pioneering outreach services to drug users in Samarinda and health and social care services to sex workers in sex villages outside Samarinda and Bontang. For more information, contact A. M. Aslam, Executive Director, LARAS at idus_sellang@yahoo.com or Shanya Attasillekha at shanyaa@ahrn.net.

In September 2005, AHRN-Indonesia closed its Harm Reduction for Advocacy project with FHI under its Aksi Stop AIDS (ASA, Action to Stop AIDS) programme which began in October 2002 under Camille Lemouchoux, former AHRN Country Coordinator. This harm reduction project was operated with Aksi Stop AIDS (a programme funded by the Family Health International) and the Centre for Harm Reduction (CHR-Australia).

This programme has facilitated:
- the establishment and training of the Indonesian Harm Reduction Network (Jangkar), including a local language newsletter, a discussion group (in Bahasa Indonesia), a website and a clearinghouse;
- a series of training and advocacy workshops with law enforcement personnel and local NGOs; and
- harm reduction policy orientation to the Netherlands for high-level government, NGO and media representatives.

Programme Activities

1. Support the National Harm Reduction Network, JANGKAR (continued from previous Task Order);

2. Increase tolerance and coordination of law enforcement agencies (police, BNN, and BNP) towards harm reduction and harm reduction programmes.

Left to right: Sandy, Fredy, Ryan Fernandes (AHRN Training Officer), Irene Lorete (AHRN Indoensia Country Coordinator)  and Adit (translator for the training).

Main Outcomes

After the successful establishment of JANGKAR in 2002-2003, and the provision of cost-effective means for communication and advocacy, from 2004, AHRN gradually saw to the network’s transition into an independent self-governed body. The process began with its new organisational structure, a newly-elected governing body under the leadership of its secretariat, a larger contribution in the content of its egroup discussions and the Kabar Jangkar newsletter. Access to the Levi Strauss Grant Funding has provided JANGKAR's secretariat stability and sufficient leverage to pursue other funding options in order to continue providing the services established with AHRN's collaboration, and to mechanise the network’s work plan.

The success of the NGO workshop and training that AHRN recently organised for programme managers and field workers on behaviour change, ARV access and adherence for IDUs, respectively, are new programme niches that need to be filled in partnership with other donor agencies.

The development of the protocol for NGO-Police collaboration and the pursuit of a harm reduction training course for the police were turning points in AHRN’s advocacy startegy and helped steer an imminent transition from the BNN to the Indonesian National Police. Akin to this is developing a strategy that will consider the National Strategy for the Prevention and Control of HIV/AIDS and Drugs Abuse in Indonesian Correction and Detention Centres (2005-2009), which will address police engagements at the national, provincial and district levels.

JANGKAR, the BNN (National Narcotics Board), the criminal justice system, the KPA (National AIDS Committee) and other donor agencies have been AHRN’s key partners in the broader response to drug use and HIV/AIDS in Indonesia in the last three years.

The success of AHRN’s programmes with FHI-ASA lie in the continuing coordination it has fostered and the consequent respect for the niche it has created among different sectors and partners within the national response to the injecting drug use and HIV/AIDS epidemic. This is being reflected in AHRN’s plans to further and broaden technical assistance to Indonesia.

Levi's

In May 2005, AHRN, together with the Centre for Harm Reduction (MacFarlane Burnet Institute-Melbourne), secured a 12-month grant funding from Levi’s Strauss Foundation (15 June 2005 to 15 June 2006), covering these components:

1.  Technical assistance and capacity building to a local NGO at one site in Java, Indonesia to implement evidence based, harm reduction and HIV/AIDS programmes (under CHR’s technical management); and,

2.  Support to the ongoing development of the JANGKAR network of organisations specialising in HIV responses amongst IDU.

Because of its current relationship with JANGKAR from its inception, Component 2 was developed by AHRN in consultation with the network through its Secretary General, and considering its work plan that was ratified in February.

AHRN provided the Indonesian National Harm Reduction Network with technical support in office and fund management and administration for this Levi’s grant.

Indonesia HIV/AIDS Prevention and Care Project (IHPCP)

In October 2005, AHRN secured six months of funding from the Indonesia HIV/AIDS Prevention and Care Project (IHPCP, funded by AusAID) to provide capacity building and training in service delivery, and harm reduction for NGOs, community health centres and law enforcement agencies in Indonesia. Our activities included:

1. Training on prevention, care, support and treatment for HIV/AIDS among IDUs for field workers of new NGO and community health centres that IHPCP is supporting in six provinces;

2. Capacity building for implementing agencies on harm reduction for alcohol use for field workers of new implementing agency partners West Papua and West Timor;

3. Enabling environment for implementing agencies and IDUs through awareness and capacity building for narcotics and law enforcement agencies (strategic planning for national, provincial and district-level police collaboration, and organise a national workshop);

4. Training for field workers on needle and syringe programme (NSP) service delivery, and outreach.

For more information on programmes, projects and policies in Indonesia, downlaod the AHRN Country Fact Sheet - Indonesia: Harm Reduction Advocacy 2005 (336Kb).

AHRN MYANMAR

Fund for HIV/AIDS in Myanmar
Willy De Maere, Siddharth Singh, Thinzar Tun
Asian Harm Reduction Network - Myanmar

Background
The Fund for HIV/AIDS in Myanmar (FHAM) was established in January 2003 to support implementation of the Operational Plan for effective interventions aimed at reducing HIV infections from injecting drug use (IDU), under the Joint Programme for HIV/AIDS in Myanmar (2003-2006). AHRN-Myanmar is carrying out activities under three of the Programme’s components: Component #2 – Reduce individual risks of HIV among Injecting Drug Users, their sexual partners and their families; Component #3 – Increase awareness of HIV/AIDS among the general population, particularly young people; and Component #5 – Strengthening essential elements of enabling environments for an effective expanded and national response.

The Five Components of FHAM
- Reduce individual risks of sexual transmission of HIV/AIDS;
- Reduce individual risks of HIV among IDUs, their sexual partners and their families;
- Increase awareness of HIV/AIDS among the general population, particularly young people;
- Increase accessibility and quality of care, treatment and support for people living with HIV /AIDS;
- Strengthen essential elements of enabling environments for an effective expanded and national response.

AHRN-Myanmar
The AHRN Country Office in Myanmar was set up in July 2003 and became operational in August 2003 with a team of two expatriates and a Myanmar national. It operates through a MoU with the Central Committee of Drug Abuse Control (CCDAC), Ministry of Home Affairs, Union of Myanmar.

Design Workshop: Outreach Operational Plan, July 2003. With the objective to provide an overview of outreach services to injecting drug users (IDUs) so decision-makers can choose whether to implement such programmes in the country, in provinces or local areas, 25 participants from CCDAC, international NGOs (AMDA, ADRA, MSF, PSI, CARE, MDM), UNODC and local NGOs, MANA came to share their experiences. Facilitated by AHRN and Care-Bangladesh, an outreach operational plan was developed based on outreach services in three states: Northern Shan, Southern Shan and Kachin.

Study Tour to Nai Zindagi in Pakistan: Islamabad and Lahore, August 2003. Nine senior level delegates from the Ministry of Health (MoH), CCDAC, MDM, CARE, UNAIDS and MANA went to visit Nai Zindagi’s services that employs the comprehensive care and treatment model for people using drugs in Lahore and Islamabad.

Baseline Survey in Northern Shan State: Kutkai, Tanmoenge and Muse townships, November 2003. Aimed at developing an outreach implementation plan in the area, interviews were conducted with 10 public health professionals and law enforcement officials, and 15 people using drugs. Information on drug use behaviour, medical and sexual behaviour, and treatment history gave a significant sense of life circumstances of people using drugs’ (often socio-economically disadvantaged) and the difficulties they face.

Translation of Policy Documents into Myanmar language
- “Breaking the Link Between Injecting Drug Use & HIV Vulnerability in Asia and the Pacific” by UNODC-Regional Centre for East Asia and the Pacific, UNESCAP , UNAIDS-South East Asia Pacific Inter Country Team, WHO-Regional Office for South-East Asia and AHRN
- “The Guiding Principles on Community and National Responses to HIV/AIDS” – arising from the UNICEF Regional Seminar on “Buddhist Participation in Community and National HIV/AIDS Responses” Bangkok, August 25-29, 2004
- “A Review of the Evidence-Base for Harm Reduction Approaches to Drug Use” by Neil Hunt with contribution from Mike Ashton, Simon Lenton, Luke Mitcheson, Bill Nelles, and Gerry Stimson (2003);
- The Warsaw Declaration: “A Framework for Effective Action on HIV/AIDS and Injecting Drug Use”, 2nd International Policy Dialogue on HIV/AIDS held in Warsaw, Poland, 12-14 Nov, 2003
- “Preventing the Transmission of HIV among Drug Abusers”: A Position Paper of the United Nations System
- “Prison and AIDS: UNAIDS point of view”; UNAIDS Best Practice Collection, April 1997
- “Prison and Drugs 1998”: European Recommendations
- Dublin Declaration on HIV/AIDS in Prisons in Europe and Central Asia: “Prison Health is Public Health”, Dublin, Ireland, February 23, 2004

IEC & BCC Material developed
- Harm Reduction Strategies for Injecting Drug Users, Health Messenger Magazine Issue #22, Burmese Edition, December 2003
- Preventing Needle Stick Injuries (leaflet)
- Preventing HIV/AIDS among Injecting Drug Users (IDUs): safer injecting/bleach method (leaflet)

Advocacy meetings with Senior Level Health Officials in the Northern Shan State, November 2004. The AHRN Outreach Specialist (AHRN), a local NGO consultant and the TCU-UNODC Coordinator conducted two advocacy meetings on ‘Harm Reduction Based Service options in HIV/AIDS Responses in Myanmar’ with the Township Peace and Development Council Officers, health professionals and stakeholders from Kutkai and Tanmoenge Sub-Township Hospital.

Seminar: Buddhist Participation in HIV/AIDS Response in Myanmar, 17 December 2003

With over 150 participants – Sayadaws, lay buddhist groups, government agencies, international NGOs and UN organisations – the seminar gave a comprehensive overview of HIV, harm reduction and/or Buddhist responses in the region. Roundtable workshops focused on the Buddhist Guiding Principles in community and national HIV/AIDS responses that arose from the recent UNICEF Regional Seminar and on the needs of Buddhist Sayadaws, lay groups and NGOs on networking in tackling HIV.

Seminar: Drug Treatment in HIV/AIDS Responses in Myanmar, 23-24 March 2004 Sixty-six senior level policy makers (MoH & NAP, CCDAC), law-enforcement officers, health officials and service providers from the UN, and international/local NGOs, active in the field of HIV/AIDS and/or drug use in Myanmar came to listen to the broad range of substitution options – methadone, tincture opium and buprenorphine – as a comprehensive response to opiate dependence in the country. Dr. Sven Todts (Belgium), Dr. Jaroon Jittiwutikarn (Thailand) and Dr. Hem Raj (Pal-AIIMS India) facilitated key sessions while Dr. Tin Tin Phyu (DDTRU), Dr. Gyaw Htet Doe (UNODC-TCU) and Mr. Olivier Lermet (MdM) discussed drug treatment in Myanmar.

Training Workshop: Lashio Outreach Team (CARE, MDM, UNODC and MANA), March/April 2004. Organised with senior members of CARE-Myanmar and MDM, the event focused on IDUs, their families and their sexual partners with two broad objectives: 1) propagate knowledge and skills for effective outreach services applicable to drug use situations, and 2) establish a collaborative outreach service delivery model linked with a range of services. Fourteen outreach workers from CARE Mandalay Division and ten other participants (outreach workers, rehab centre staff, UNODC project staff and Lashio Outreach Project staff) came to this workshop in Lashio (Northern Shan State). In April, a follow-up workshop was held in Mandalay for a team of 24 Outreach Workers.

15th International Conference on the Reduction of Drug Related Harm: Melbourne, April 2004.
AHRN supported two senior officials from CCDAC and the Department of Medical Sciences, Institute of Medicine to attend the conference. Study Tour to SHARAN-SAHARA: New Delhi (India), May 2004. Delegates from CCDAC’s Department of International Relations (Ministry of Home Affairs), UNAIDS-Myanmar, MDM, Asia Regional HIV/AIDS Project (ARHP), CARE and MANA went to see SHARAN and SAHARA’s continuum of care service model which they emphasise in their programmes.

Seminar on Drug Users and Prisons as HIV/AIDS Responses in Myanmar, June 2004.
Besides enhancing knowledge on the topic and its health consequences on staff and inmates, the event intended to advocate for ‘safer prisons’ through staff/inmate training, assess regional responses in programmes for drug users and HIV/AIDS in prisons, share information between prison and health professionals on the topic, and facilitate local programmes in prisons. Thirty-five senior members of the Ministry of Justice, Department of Corrections, Ministry of Home Affairs, local and international NGOs, and representatives from the UN and WHO participated. Mr. Wayne Bazant, UNODC-EAPRO Regional Coordinator for drug use and HIV/AIDS was a key speaker.

Art Competition on Drug Use and HIV/AIDS in Myanmar, June 2004.
This nationwide art competition (art work, poster, cartoon), aiming to involve segments of civil society in HIV and AIDS responses in Myanmar, was organised in collaboration with CCDAC, the National Art Association of Myanmar and CDA (a local NGO). Besides choosing the best artworks, all entries were also exhibited during the Drug Use and Illicit Trafficking Day, 16 June.

Study Tour to Methadone Treatment Facilities in Hong Kong, 27-30 July
Eleven delegates from CCDAC Department of International Relations (Ministry of Home Affairs), Ministry of Health, UNODC, ARHP, WHO and UNODC visited the highly-acclaimed methadone maintenance clinics in Hong Kong.

For more information on programmes, projects and policies in Myanmar, downlaod the AHRN Country Profile - Myanmar: Service delivery, capacity building, and training in policy, advocacy and harm reduction 2005 (308Kb).

Contact:
Mr. Willy De Maere – Country CoordinatorAsian Harm Reduction Network - Myanmar Country Office - willy@ahrn.net.
1 (A), 5-1/2 Miles, Pyay Road, Hlaing Township, Yangon, 11051, Myanmar
Tel: + (95-1) 514402, 514404, 514405
Fax: + 95-1-514398