FILM DISCUSSION CARD 3 DROPIN CENTRE UNMET NEEDS

FILM DISCUSSION CARD 3

DROP-IN CENTRE

UNMET NEEDS OF IDUS � What are the needs of IDUs which cannot be provided for in outreach alone? • Additional Services: Abscess management, counselling, general health services and so on • Rest: IDUs need a place where they can be away from harassment • Interaction: IDUs need a place where they can interact with each other & staff freely

NEED FOR DIC � All the services for IDUs cannot be provided in the outreach alone � IDUs often need a place where they can rest peacefully without being harassed / discriminated � Service providers need a place to address their clients (IDUs & partners) as a group � IDUs need a place where they can come together and find a ‘common voice’ ‘ All these needs can be fulfilled by a DIC’

LOCATION OF A DIC should be located where: � IDUs reside � IDUs congregate � IDUs find it easy to access � IDUs do not face discrimination and/ or stigmatisation � IDUs can enter freely without any fear of the surroundings

ESTABLISHING A DIC � The following steps should be followed before choosing a location for DIC • Mapping of IDUs & hotspots • Mapping of Services and Referrals • Consideration of feasibility and budgetary issues • Opinion of the IDUs through group discussions • Opinion of the general community residing nearby

CONTD. � The final choice will depend upon: • Proximity of proposed site to: the hotspots, Services and Referrals • Acceptability of the site to the IDU and general community � Once a location is chosen on the basis of the above steps, the TI (NGO) should hold advocacy meetings with the general community residing around proposed site

CONTD. �Common concerns of general community are normally: • Increase of drug use in the community • Thefts in the area owing to IDUs frequenting the area • Initiation of drug use by their children through direct/ indirect influence of IDUs �All the above concerns should be addressed by the TI staff

REFERRAL PATHWAYS IDUs may reach DIC: • Directly DIC OUTREACH CONTACT • Via outreach contact • Via Referrals • Forcibly by family members REFERRAL SERVICE IDU

INFRASTRUCTURE AND STOCKS �A DIC should have adequate space for: • Recreation / Rest • Counselling • Treatment / Dressing • In addition o A room for examination of client / sexual partners o Basic amenities i. e. toilet & kitchen �Timings for the DIC should be decided in consultation with the IDUs

CONTD. � Following should be stocked: • Needles/syringes • Disposal bins • Condoms • Abscess prevention & treatment materials • IEC materials • Notice on rules and regulations prominently displayed • Confidentiality policy followed in the DIC displayed • Essential furniture • Social mapping should be displayed � The IDUs may be actively involved in the day-to-day maintenance of DIC

RECREATION / REST ROOM � This will be the Entry room with the largest space � Purpose: • For IDUs to spend time • For IDUs to rest • For conducting group activities & discussions � To attract IDUs, recreation materials such as carom board, chess, playing cards, television, video, etc. may be provided � For Documentation: • A daily attendance register should be placed at the entrance • Record of consumables bought & used • Record of other activities

COUNSELLING ROOM � Purpose • To provide one to one counselling to IDUs & family members • Referrals � Privacy should be maintained (both audio and video) � Counselling should include the following issues • HIV /STI prevention • Risk / Harm reduction • Pre-post test counselling • Psychosocial counselling • Other issues of the client

EXAMINATION/TREATMENT/DRES SING ROOM �Purpose • for doctor to examine, elicit history, treat general medical conditions, etc. • for nurse/doctor to treat abscesses and manage STI �If space is available, there can be a separate room for the doctor and nurse

CONTD. �Materials required in the room: • Table and chair for nurse and doctor • Stool for patient to sit • Stool for abscess management • Patient examination table • Sterilizer • Needle crusher • Gloves • Cupboard for PEP, OST & STI drugs and other material • Waste disposal container

WHO CAN ACCESS THE DIC? �IDUs �Spouses/Sexual Partners of IDUs �Family members of IDUs �General community may come to seek information

PROCESSES IN DIC � Upon arrival at DIC, the IDU may meet any of the staff members including ORW, PE, PM, Counsellor, etc � Usually if the client is referred from outreach, the concerned PE or ORW accompanies the client to the DIC � The first contact: • Staff at DIC discuss needs of IDU • Services are provided as per identified needs in active consultation with IDU

CONTD. � • The IDU is encouraged to visit DIC regularly • The dos and don'ts at the DIC are clearly explained to the IDU • Follow-up action is identified, e. g. referral to hospitals, ICTC, social support, etc. Follow-up • IDU should be made to feel a part of DIC • Efforts should be made to refer maximum number of IDUs to ICTC (HIV testing) with proper pre-test counselling

CONTD. • IDUs should be counselled on harm reduction concept and principles, safe injection, safe sex, importance of regular access to NSEP, safe disposal, abscess prevention, what is HIV, Hepatitis B & C & ways to prevent /acquiring them • IDUs should be involved in group discussions, where above mentioned topics can be discussed in a group

CONTD. � A basic medical history should be elicited by the counsellor/doctor/nurse • Enquire about type of drug and mode and patterns of use, abstinence attempts in the past, help/treatment sought earlier • Take history of exposure to contaminated blood and other risk behaviours • Glean knowledge and attitude towards diseases like TB, STIs, HIV/AIDS and Hepatitis B and C

CONTD. � Social well-being should be elicited by the counsellor including but not limited to: • Mental health problems • Family history of drug use and family support • Legal problems encountered • Sexual behaviour and practices � In addition, efforts should be made to involve general community in DIC through: • Advocacy at regular intervals

CONTD. • • Observance of important drug/HIV related days Social activities involving IDU � The PM should ensure that: • A directory of services is available for referrals • Liaison with hospital and emergency services to deal with any untoward medical incidents is established • Liaison with local police station officers for enabling environment is established

SERVICE PROVISION � Services at the DIC 1. NSEP 2. Condom distribution 3. Abscess management (treatment/dressing etc) 4. STI management (syndromic) 5. Counselling 6. Referrals 7. Group discussions 8. Recreation/ Rest facilities

HUMAN RESOURCES �Staff in DIC • Full time Project Manager, Nurse, ANM, Counsellor and ORW • Part time Doctor (min. 3 days per week) • ORWs will take turns to carry out DIC related work • One staff member (PM, Counsellor, or Nurse) must be designated as DIC In-Charge. (He/she will be responsible for the day-to-day functioning of DIC)

ROLE OF OUTREACH WORKER & PEER EDUCATORS �ORW and PEs play an important role in bridging the gap between IDU & TI staff �Role/Responsibilities: • Making the IDU comfortable in the DIC • Ensuring involvement of IDUs in DIC activities • Maintaining rules & regulations at DIC • Conducting group discussions • Encouraging the IDUs to visit DIC and access services

CONTD. • Facilitating formation of committees and self support groups in DIC • Ensuring concerns and the voice of the IDUs reach TI staff (project) • Ensuring a respectable environment for IDUs • Participating actively in the advocacy meetings with general community

BASIC RULES AT DIC � Some basic rules of DIC include • • • No drug use on the premises No drug dealing on the premises No violence or threats � Every effort should be made to help the IDU and partner feel valued and comfortable � Informed consent must be taken before testing and medication � Confidentiality must be emphasised � Listen to the whole story

CONCLUSION � DIC helps in meeting some of the needs of IDUs and their partners � Establishing & maintaining a DIC requires a number of steps to be followed � DIC service is complementary to outreach � A number of other services including NSEP can be offered in DIC, which require multi-disciplinary staff � DIC can also serve as a place for community mobilization