FILM DISCUSSION CARD 3

1. FILM DISCUSSION CARD 3

3. DROP-IN CENTRE

4. 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

5. 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’

6. LOCATION OF A DIC 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

7. 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

8. 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

9. 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

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

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

12. 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

13. 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

14. 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

15. EXAMINATION/TREATMENT/DRESSING 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

16. 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

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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. SERVICE PROVISION • Services at the DIC • NSEP • Condom distribution • Abscess management (treatment/dressing etc) • STI management (syndromic) • Counselling • Referrals • Group discussions • Recreation/ Rest facilities

25. 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)

26. 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

27. 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

28. 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

29. 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