HIV Prevention Knowledge Base
Combination Approaches: Harm Reduction for Injecting Drug Users
HIV in Prisons: Situation and Needs Assessment Toolkit
Aimed at national governments, particularly those of low- and middle-income countries, this toolkit first explains HIV in the prison context. It then provides the necessary tools to conduct the situation and needs assessments required before HIV intervention programs can be implemented. Although it focuses on HIV and tuberculosis-related HIV, it is also relevant to STIs and hepatitis. The toolkit recommends the establishment of a multidisciplinary steering committee and lays out a stepwise assessment process. Annexes include templates for consent forms and questionnaires, checklists, and information about sampling methodology.
Good Practice Guide: HIV and Drug Use: Community Responses to Injecting Drug Use and HIV
This comprehensive guide to HIV and drug use, written in clear, accessible language, aims to support community-based harm reduction and HIV programs, with a focus on developing and transitional countries. It thoroughly explains the issues of drug use, HIV, and health, and covers programs for special populations—women, children and young people, and prisoners—in a separate section. It spells out approaches to harm reduction, including community mobilization and gender-sensitive programming, and highlights the importance of involving all stakeholders, including people who use drugs, in programming. The guide describes in detail the HIV/AIDS Alliance good practice standards and spells out the key characteristics of effective programs.
Overdose Prevention and Response: A Guide for People Who Use Drugs and Harm Reduction Staff in Eastern Europe and Central Asia
Although this guide was produced with harm reduction staff and people who use drugs in Eastern Europe and Central Asia in mind, the information it contains is useful worldwide. The guide explains the basics of overdose, such as what happens to the body during overdose and the duration, potency, and overdose risk of different drugs. It describes the risk factors associated with overdose prevention and explains how to recognize an overdose. There is a section on responding step-by-step to an overdose, including a guide to rescue breathing and instructions for administering naloxone in the case of opioid overdose. A chapter for trainers on how to use the information provided completes the guide.
Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users
This guide explains the rationale for including nine different evidence-based interventions in a comprehensive package of HIV prevention, treatment, and care for IDUs. Recommended interventions include harm reduction measures, HIV testing, counseling and treatment, and prevention and treatment of STIs, viral hepatitis, and tuberculosis. Frameworks are given for each recommended intervention. A checklist offers guided assessment of the availability, coverage, and quality of each intervention.
Guide to Starting and Managing Needle and Syringe Programmes
This guide is designed to assist in expanding the response to HIV among IDUs. Many more NSPs will need to be established to meet the harm reduction needs of the growing IDU population. Sections I and II of this guide describe how to foster this process. Sections III and IV discuss how existing NSPs can expand the services that they offer and greatly increase their coverage. Scale-up of such programs must include establishing more NSPs in prisons and detention centers. Section V presents the particular needs of NSPs in such “closed settings.” The end of the guide provides a list of useful websites, publications, and networks.
Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs: A Treatment Improvement Protocol TIP 43
This highly detailed but easy to use document comprehensively explains the best practice guidelines for MAT of opioid addiction. There are chapters on the pharmacology and clinical pharmacotherapy of medication, the screening and assessment of potential candidates for treatment, and how to match patients with appropriate treatment options. The practicalities of providing MAT, from phases of treatment to maximizing patient retention, are covered. There are specific guidelines on the medical problems and co-occurring disorders typically seen in opioid addicted patients, as well as chapters on treating patients with multiple substance use and treating opioid addiction during pregnancy. The guide also covers administrative considerations such as staffing and program evaluation.
Advocacy Guide: HIV/AIDS Prevention among Injecting Drug Users
This guide provides a systematic approach to advocacy for HIV prevention and care among IDUs that can be replicated and adapted to various cultural, economic, and political settings. General principles of advocacy for HIV/AIDS prevention and care for IDUs are first presented. A step-by-step process is provided to establish advocacy groups with specific goals, undertake a situation analysis, develop a strategy, and implement the strategy. It also contains descriptions of many tools and methods for achieving advocacy goals and examples of their use in various country settings. Frequently used arguments related to HIV/AIDS prevention among IDUs are also included. Most methods in the guide can be used, after adaptation, at community, district, and national levels.
Training Guide for HIV Prevention Outreach to Injecting Drug Users: Workshop Manual
This training package is for workshops orienting and training public health policymakers, program developers, program managers, implementers, and field workers on IDU outreach for preventing HIV transmission. The training package has four workshop modules. Orientation to Outreach among IDUs provides evidence for the effectiveness of outreach programs and assists decision makers in introducing and developing such programs. Developing Outreach Programs for HIV Prevention among IDUs provides assistance to individuals interested or involved in developing outreach programs. Managing Outreach Programs among IDUs is for those who have never managed an outreach program, but can also be used as additional training for current managers and outreach field supervisors. Core Skills in Outreach among IDUs is designed for initial training of outreach workers or as a resource for ongoing training and revision among experienced outreach workers.
Manual for Reducing Drug Related Harm in Asia
This comprehensive manual grew out of the combined efforts of people in Asia to stop HIV. The first section presents background information on drug use and HIV vulnerability, the rationale for harm reduction, and balancing and integrating the approaches of supply, demand, and harm reduction. Briefing papers on critical issues, such as mapping drug use in Asia and care and support of IDUs with HIV, are included for use as advocacy tools in the region. The second section contains nine chapters on program design, implementation, and maintenance, including rapid assessments, voluntary counseling and testing, and addressing the needs of specific groups. The third section contains appendices with information on hepatitis A, B, and C; HIV; illicit drugs and their characteristics; and STIs.
Injecting Risk Questionnaire
This questionnaire measures the extent and nature of sharing needles, syringes, and other injecting equipment to assess levels of injecting risk behavior. It identifies different sharing practices and can be used for different types of IDUs. It can be used to assess need and target interventions. In the context of an appropriate research design, it can be used to help assess the impact of prevention services such as needle and syringe distribution schemes, publicity campaigns, peer education, and drug treatment programs. The questionnaire covers the direct sharing of needles and syringes, as well as sharing ancillary equipment (indirect sharing). It takes about five minutes to complete.
The Global HIV Epidemics among People Who Inject Drugs
Interventions targeting people who inject drugs (PWID) are not at sufficient levels to adequately reduce HIV transmission and acquisition rates, and without addressing the needs of this group overall success in countries will be challenging. The objectives of the study were to: 1) provide the economic evidence necessary to help advocate for increased services for PWID; 2) disseminate the results of the study to influence policy makers in making changes to their current HIV response to PWID; and 3) create a knowledge base for continual advocacy. Four key interventions for PWID were focused on in the analysis. These are needle and syringe programs, medically assisted therapy, HIV counseling and testing, and antiretroviral therapy (ART). Their level of effectiveness was determined by a review of the literature and used in four different modeling exercises depicting epidemiological data from Kenya, Ukraine, Pakistan, and Thailand. Each model explored how the expansion of coverage at the four intervention areas for PWID from 2012-15 would affect their HIV incidence rates and costs. The Goals mathematical model was utilized to measure no change in coverage, increase in coverage as is currently planned in national strategies, and increased scale-up. It was found across the four countries that reductions in HIV incidence were achieved when the four intervention areas were scaled up to achievable levels compared to the status quo scenario. It was also found that when a combination of the four intervention areas was scaled up, it was more effective and cost-effective compared to scaling up ART services alone. The findings indicate a need to drastically change the course of current HIV interventions targeting PWID.
The Global State of Harm Reduction 2012: Towards an Integrated Response
One in three HIV infections outside sub-Saharan Africa is caused by unsafe injecting practices, which fuel HIV and other blood-borne epidemics in many regions. This biennial report, the third in a series published by Harm Reduction International, tracks developments worldwide in adoption of harm reduction policies and program implementation since 2010. The report also explores critical issues for building a comprehensive harm reduction response, such as harm reduction programs designed for women, access to programs for young people, drug use by men who have sex with men, and global progress in decriminalizing drug use. This year’s report paints a bleak picture of current harm reduction activity internationally. About half of the 158 countries included in the report have no programming at all to prevent HIV transmission through injection drug use; even in countries that have programming, coverage is poor, and donor support is declining. For example, in Russia the number of needle exchange programs has dropped from 70 in 2010 to only 6 in 2012. According to the report, scale-downs of this kind are occurring worldwide, a trend made worse by insufficient government commitment to harm reduction and to the unwillingness of bilateral and multilateral donors to maintain funding levels for harm reduction. On the positive side, harm reduction networks continue to make important contributions, including advocacy and research, and civil society has become increasingly engaged in mobilizing international support for harm reduction.