MARA

Project summary

The mission of Romanian Harm Reduction Network (RHRN) is to promote harm reduction services through increasing the communication between partner organizations and improving harm reduction services quality at national level. According to its mission, RHRN facilitates the implementation of effective policies and programs targeting drug users and other populations especially those exposed to HIV epidemic.

 

The goal of this project is to prevent and minimize the risk of HIV infection among adolescent boys and girls engaging in risk behavior (injecting drug use and sex work). The project is built on the previous advocacy initiatives developed at national and regional level by Romanian Harm Reduction Network (RHRN) with technical and financial support from UNICEF in 2004-2006.

 

The main activities will be developed under two components:

  • Enhancing protective environment policy and legal framework (advocacy);
  • Capacity building for governmental and nongovernmental service providers to initiate and scale-up evidence based harm reduction services

Target group:

  • Most at risk adolescent (MARA) boys and girls
  • Service providers working with MARA boys and girls that require capacity building
  • Decision-makers responsible for policy and legal environment

 

Project objectives

  • O1: Develop specific policies to provide protective environment for MARA boys and girls by end of 2007;
  • O2: Develop national standards, protocols and guidelines for targeted interventions for at risk populations with a special focus on adolescent boys and girls, by end of 2007;
  • O3: Increase the capacity of key government and NGOs to respond effectively to the needs of MARA, and design, implement and monitor evidence based and gender sensitive interventions for them and with their participation, by end of 2007;
  • O4: Strengthen the regional South Eastern Europe collaborative network (SEE-CN) on harm reduction and its role in advocating for harm reduction interventions for MARA throughout the sub region.

 

Geographical location:

The project activities are implemented in Romania –  four locations / hot spots: Bucharest, Timisoara, Iasi, Constanta – and two other Balkan countries: Montenegro and BiH, where two country missions are programmed.

 

 

Project goal

 

To prevent and minimize the risk of HIV infection among adolescent boys and girls engaging in risk behaviour (injecting drug use and sex work).

 

Project objectives

 

  • O1: Develop specific policies to provide protective environment for MARA boys and girls by end of 2007;
  • O2: Develop national standards, protocols and guidelines for targeted interventions for at risk populations with a special focus on adolescent boys and girls, by end of 2007;
  • O3: Increase the capacity of key government and NGOs to respond effectively to the needs of MARA, and design, implement and monitor evidence based and gender sensitive interventions for them and with their participation, by end of 2007;
  • O4: Strengthen the regional South Eastern Europe collaborative network (SEE-CN) on harm reduction and its role in advocating for harm reduction interventions for MARA throughout the sub region.

 

In order to achieve these objectives, the following activities were carried out during 1 May 2007– 30 June 2008:

 

The project activities will be developed under two main components:

 

1. Enhancing protective environment policy and legal framework (Advocacy).

 

1.1     Advocacy with central and local authorities, representatives of police, media   representatives and pharmacists for HIV/AIDS prevention intervention, harm reduction services and working with MARA in special locations (‘hot spots’).

 

8 advocacy meetings were organized by RHRN  in project locations during June-October 2007 (2 events per location). Each meeting gathered between 12-20 participants representing public authorities and NGOs. With the exception of Bucharest, all the meetings were hosted by state institutions. In Constanta and Iasi the meetings were opened by the prefect (Constanta, Iasi) and mayor (Iasi), which highlighted the need to develop services for at-risk population and expressed their official support towards projects and initiatives coming from civil society in this direction.

The meetings in Iasi, Constanta and Timisoara were organized with local support from an advocacy officer, which was payed from the project. Besides organizing the event, the advocacy officers contributed to writing the meeting reports and disseminated the information among participants in their locations. They were also involved in organizing local trainings with pharmacists (see activity  Training in harm reduction for pharmacists from new locations (‘hot spots’), in HIV/AIDS, drug use, harm reduction, working with MARA)

 

Participants in each meeting highlighted similar issues with regards to MARA and at-risk groups in general:

 

  • situation, characteristics and needs of MARA in Romania need to be documented before designing any specific intervention;
  • there is a need to inform the entire community and all decision makers (authorities’ officials) with respect to the current situation of teenagers faced with a high risk of HIV infection;
  • in this moment there are no specific services targeting MARA; existing services should be „friendly” enough to attract MARA;
  • teenagers with high infection risk are more visible than MARA in all ‘hot spots’; service providers need solutions for social integration of this adolescents and young persons (access to housing and work);
  • medical and social services can be accessed by all teenagers facing a high risk of infection should be created; a mapping of available services is recommended;
  • human resource in public institutions is lacking abilities to work with at-risk groups; training and monitoring should be performed;
  • VCTC is not functioning in several locations;
  • workers in this area, especially in the state sector, are under payed and therefore they have low motivation to perform a quality intervention;
  • MARA need to be included as specific group in the national strategy for child protection;
  • people without identification papers cannot access medical and social services; dimension of this population needs to be estimated in order to see if this is a social problem or just isolate cases;
  • working protocols with at-risk populations are missing;
  • a referral system should be implemented in order to insure the quality of services and to monitor the intervention;
  • a new strategy for approaching the counsellors within Municipal Council must be elaborated, starting from the city hall level, in view of obtaining their financial support for creating operative interventions for the teenagers facing a high risk of infection;
  • Mass-media must be involved in informing the community about injectable drugs users and sex work activities (launching aggressive media campaigns).

 

Indicators:

 

  • more than 120 policy makers, representatives of police, editors and journalists, pharmacists have knowledge about HIV prevention for MARA
  • 0 policy makers initiated intervention in regards with HIV prevention in MARA (reasons for this situation below

 

Challenges:

l  local action plans could not be developed; this is a long process which requires energy and resources for coordination and communication; the round tables provided the participants with the opportunity to identify the issues of HIV prevention among at-risk groups (MARA included) – a list of priorities was made but the time was not enough to develop specific action plans;

l  NGOs can develop services only if there are special funds or calls of proposals in a certain field; most of NGO resources are already invested in present activities;

l  state institutions, especially child protection departments and institutions did not noticed a special need to develop MARA oriented services; in case this would be a need, the process of opening a new service in difficult but not impossible to achieve;

l  local authorities are developing the sub-contracting process (local regulations and methodologies) to slow; budgets for services are either to small, either payed after the intervention was done.

 

 

2. Capacity building

 

2.1     Documenting and sharing good practices models

 

Three good practice models were elaborated, representing RHRN and UNICEF joined experience in:

l  working with pharmacists

l  advocacy and cooperation with local authorities

l  training in harm reduction for service providers

 

Each document includes standard information on general background and MARA, followed by the description of the intervention, lessons learned, concussions and recommendations for readers.

 

Indicators:

 

  • 3  examples of good practice models and lessons learned documented
  • 0 institutions initiating HIV prevention interventions for MARA based on existing good practice models

 

The case studies were finished in May 2008, and they will be printed and translated by UNICEF.

RHRN will disseminate the information via electronic communication (e-mail, website) and promote duplication of these initiatives.

 

 

2.2     Development of protocols, standards (mainstream services and outreach) and          guidelines for working with at risk populations; the guidelines will be gender    sensitive and will have special components/chapters on working with MARA.

 

Three experts were hired to elaborate standards and protocols for service providers. Writing and drafting the standards was a difficult process. Discussions about the objectives of these standards, the content and format, consultative process and additional technical issues lasted for more than 8 months. One month before project closure, the standards and protocol were prepared as final drafts, which need to be proposed for analyse to decision makers in key institutions. The final objective of this activity is to include the standards in the legislation.

 

Indicators

  • The experts developed three standards and protocols:

l  outreach services

l  drop-in centres (needle exchange programs)

l  day care centres for drug users

  • the standards and protocols are not accredited yet
  • 0 institutions initiating HIV prevention programmes for MARA

 

2.3.    Enlarging the RHRN in other cities of Romania (‘hot spots’), including IDUs self- groups and/or NGOs.

 

Training for new members

RHRN performed one training for new members – Close to You Foundation Romania (ADV) and Samusocial Romania. The training curricula included harm reduction principles, advocacy tools and techniques, introduction to the national system of services for the vulnerable and at-risk groups, specific legislation, IDU/MSM/SW profile, MARA terminology, HIV and risk reduction counselling. ARAS provided specialized trainers.

ADV and Samusocial are recent harm reduction service providers – outreach and needle exchange projects funded by UNODC. Cooperation between RHRN and the two NGOs started and increased during this project.

 

Website

www.rhrn.ro is the official web site of the Romanian Harm Reduction Network. The web site provides:

  • access to general population and organizations to information on drugs use and harm reduction philosophy, current international and national legislation/regulations (laws, strategies etc), standards and working protocols in harm reduction etc;
  • updated information on international and national studies/researches in HIV and drug use fields;
  • RHRN mission, activities (including advocacy initiatives) and services;
  • information on regional initiatives in the harm reduction field, as one of the partners in the SEE Collaborative network
  • a section for members
  • drug information, research and studies on drug use and risky behaviours
  • links to other relevant internet resources

 

The English page is still in construction.

 

In parallel, we developed www.rhrnnews.blogspot.com, which is an information resource on RHRN and members activities. The web log was designed to replace an electronic newsletter, making the information available in real time.

 

RHRN development

RHRN development involved efforts from all members and consultations took into consideration constituency, structural, and administrative issues.

Discussions about participation of state institutions in the network as members or as partners determined the PR orientation of the organization. RHRN signed partnership agreements with the National Anti-drug Agency (NAA) and the National Prison Administration. NAA expresses is intention to become a member in RHRN.

 

Currently, all NGOs providing needle exchange services are RHRN members.

 

RHRN has developed cooperation with harm reduction service providers and has become a brand which is well known in the field as training provider and information resource.

 

The RHRN website can be used by its members to post various documents (including press releases and position letters) regarding different issues related to the harm reduction field.

 

Press monitoring

A press officer monitored electronic editions of national newspapers in order to document cases of discrimination against MARA and drug users during May-December 2007. All information gathered can be the base for a research in a future project. Media monitoring reports were disseminated among RHRN members.

Cooperation with journalists was initiated. Two press articles and a radio report were produced.

RHRN supported the National Prison Administration needle exchange pilot project through a press release.

 

Indicators

  • 3 organizations have become RHRN members
  • 3 new members are managing harm reduction programs
  • RHRN website functional

 

2.4. Training of trainers for pharmacists (from Bucharest) to ensure the sustainability of harm reduction interventions developed through pharmacies.

 

RHRN elaborated a training curricula for pharmacists and provided four training session as it follows:

  • training for trainers
  • three local trainings for pharmacists in Constanta, Timisoara and Iasi, in cooperation with Romanian Pharmacists College local branches

 

TOT

The ToT was developed in cooperation with the Romanian Pharmacists College and the National Training Centre in Sanitary Field (CNPDS).

TOT consisted of two modules, a specialized 3 days harm reduction module, and a pedagogical module for 5 days.

Trainers were selected by human resource departments in each pharmaceutical chain targeted through this training.

The training was credited with learning points.

14 pharmacists and three RHRN members graduated the training and received trainer degree.

 

Only one pharmacist involved in local trainings organized by RHRN. Reasons for this situations are related to TOT trainees status in their pharmacies – most of them were pharmacy managers, with administrative responsibilities besides their role as pharmacists, which means a multitude of time consuming activities.

 

Indicators

  • 15 pharmacists were trained as trainers in harm reduction; 14 of them graduated the training
  • 1 training initiative developed by trainees
  • 33 pharmacists trained by trainers
  • we could not measure the number of pharmacists involved in harm reduction interventions after delivery of training; all pharmacists are promoting free needle and syringe selling in their pharmacies.

 

2.5. Training in harm reduction for pharmacists from new locations (‘hot spots’), in HIV/AIDS, drug use, harm reduction, working with MARA.

 

51 pharmacists from Constanta, Iasi and Timisoara were trained about harm reduction principles. Training focused on the central idea that improving access to sterile syringes has a legitimate medical purpose in preventing diseases.

During the training sessions, RHRN trainers took the opportunity to document drug users  situation from pharmacists perspective in the ‘hot spots’. In the same time, a micro-research based in short questionnaires was applied with support from the local advocacy officers. Results showed pharmacists in Constanta, Iasi and Timisoara are not encountering particular challenges in working with drug users. Sterile injection equipment is available without any restriction to everyone who is asking for it, compared with Bucharest, where most of pharmacies are selling injection equipment for medical purposes only.

 

The training curricula will included:

  • harm reduction principles
  • harm reduction services and management
  • vulnerable groups characteristics and their risk behaviours,
  • working with MARA
  • information on HIV/STIs prevention
  • networking
  • advocacy strategies and techniques
  • partnership development

A training manual was developed in order to be used by pharmacists. This manual was designed as a flexible tool that allowed the trainers to adapt the information and structure according to trainees’ needs and interests. The manual will be developed translated in English by UNICEF Romania and it will be promoted at regional level.

The Romanian Pharmacists College validated the training manual and ensured accreditation for the training (continuous pharmaceutical hours).

Local trainings for pharmacists was implemented in cooperation with the new RHRN members in each location and advocacy officers working in the project, as part of capacity building process.

This activity responds to the objective O3.

 

Indicators

  • 51 pharmacists were trained
  • 39 pharmacies selling injecting equipment after delivery of training

 

2.6. Strengthening the sub regional harm reduction network (South-Eastern European Human Rights and Treatment Collaborative Networking on HIV/AIDS and Drug Use).

 

Country missions and country reports

  • 2 country missions in Montenegro and Bosnia & Herzegovina were performed during July-October 2007; each country mission had as a final result a country report (using the model developed in 2006);
  • 1 multi-country report gathering brief descriptions and main conclusions and recommendations from all country reports was developed, generating a regional perspective of HIV prevention and MARA. The multi-country report is based on the findings from the field, when the country reports were done and needs to be updated.

 

Inter-country consultation

During December 3-4, 2007, RHRN and UNICEF organized a new inter-country consultation: „Counting Lives 2 – Regional focus on Substitution Treatment”. The meeting gathered 28 harm reduction professionals and OST experts from 8 SEE countries and three international experts representing IHRA and EHRN.

The meeting comprised a combination of presentations, debates, round table discussions, and workshops with the emphasis on delegates’ participation. Speakers, presenters and facilitators draw Balkans countries in order to provide delegates with view from governmental institution and civil society that works in the field of drugs and/or HIV prevention in the region. The goal of the conference was to provide to delegates the opportunity to share existing practices in OST from SE Europe and to provide them with arguments in advocating for OST continuity and quality, using the experiences, lesson learned and good practices from the region.

 

A snapshot survey regarding OST access in the region was made using methodology developed by EHRN.

 

Indicators

  • 28 participants in the regional consultation
  • 2 country mission reports developed and disseminated electronically
  • 1 multi-country report developed

 

Conclusions and recommendations

 

l  the amount of activities was bigger than organization capacity

l  more time in needed for similar projects

l  raising awareness activities among pharmacists need to be continued as a separate project

l  advocacy initiatives in ‘hot spots’ had a positive effect at local level and enforced the capacity and credibility of RHRN as communication facilitator among stakeholders

l  standards and protocols need to be incorporated into the legislation and a monitoring system has to be implemented

l  RHRN website can become the most important resource for drug information in Romania

l  international activities implemented by RHRN can continue with new country missions and a regional conference on harm reduction

 

The report was written by

Valentin Simionov (project manager)

 

29.06.2008

Bucharest