Harm Reduction Drug Project Uzbekistan - Contact Netz

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the old Soviet “everything is free” approach even among drug addicts, and this could have a positive impact on the good will of the general public. This option contains the possibility of sustainable development and greater autonomy from external donors. It would legalise the current, to some extent “illegal“, sale of syringes by volunteers. The latter would have a real income, and the project’s professionals could concentrate on the appropriate monitoring. The infrastructure and staff costs required for the implementation of a comprehensive strategy would fall greatly, and the costs of materials could be halved. There is a genuine chance of implementing this option. It could be turned into reality very fast. The difficulty of this option is that it is very likely that a change in the law would be needed. At present there are no plans in the Uzbek legislature to give NGOs the necessary tax exemption. Option 2: Enable syringes to be financed from the Global Fund and adapt the government Trust Points to the Contact Net model When Jakob Huber visited Uzbekistan in October 2004, it was agreed verbally with the Uzbek Ministry of Health as well as the relevant Uzbek officials responsible for the Global Fund, that the Trust Points should adopt our model. This strategy was confirmed at the Steering Committee. This creates an opportunity to implement this option. It has been planned that the Ministry of Health will organise a two-day workshop to be conducted by Jakob Huber and Victoria Ashirova in the spring of 2005. Some 70 Trust Point representatives are expected to attend. The objective is to adapt the 206 Trust Points so as to make them more attractive to injecting heroin users. Moreover, a “snowball” system using affected volunteers would be developed in line with our model. Contact Net will present a draft of this option to the MoH. It is intended that the Ministry should meet the costs out of the Global Fund. The lasting institutional changes would be achieved in a period of one year by Victoria Ashirova, and by Jakob Huber as and when necessary, through visits to the Trust Points and two follow-up seminars after six months. If the project in Uzbekistan succeeds, we will have achieved the second objective of our drug project: The experience from our model project would have been adopted by the Ministry of Health and integrated into its supply structures. It will then become clear whether our objectives were realistic and whether the institutional structures of the Trust Points are really adaptable. If they are not, it will be necessary to rely exclusively on NGOs in future. However, a positive outcome would also provide a useful example for the other countries of Central Asia. Option 3: Making Contact Centres more attractive so as to reach a greater number of drug addicts This option involves making the Contact Centres so attractive, either through offering methadone, an injection room, or a smoking room, that they would appeal to a much wider circle of drug addicts. This would lead to a massive increase in the number of syringes exchanged at the Centres. There is little likelihood of being able to implement this option in Uzbekistan. One possibility would be to launch a pilot project together with the person responsible for the AIDS Division and the Global Fund at the Ministry of Health. After attending a meeting, Jakob Huber felt that this might indeed be a possibility. Politically, however, such a project would need support at the highest level. 29 Weaknesses Need for a change in the law Financing through Global Fund Applying the model to Trust Points Importance of cultur and structur changes of Trust Points Improve attractiveness through more low-threshold approaches such as methadone programme of Contact Centres, or fixer rooms
The features that the three options have in common All three options have the objective of reaching 60-80% of injecting heroin users as quickly and cost-effectively as possible, either through new structures within the government healthcare system or through NGO distribution structures. The graphs below show the current relationships between the institutions, the supply of materials and access to drug addicts. The broken red lines in the first two graphs indicate the disproportionate relationship between overheads and actual effectiveness in the field in relation to HIV/AIDS and drug abuse. The third graph shows the ideal distribution system, in which the costs born by government and NGO structures are kept low while an optimum number of drug addicts are reached. This change is essential in the context of the options described above; without it the current system remains inefficient. 100% funding of projects HIV/AIDS/drug abuse harm reduction & prevention Costs of syringes and condoms State activities Wages, management, administration, evaluation, etc. 10% - 20% Syringes and condoms Funding for syringes and condoms Funding for institutions NGO activities Wages, management, administration, evaluation, etc. 20% - 40% Syringes and condoms NGO monitoring only Those concerned (incentives) parents, mahallas 70% - 80% Syringes and condoms Funding for organisation and materials 30 Objectives of three options Improve access to injecting heroin addicts Disproportionat e relationship between institutional costs and cost of syringes and condoms
Page 1 and 2: Harm Reduction Drug Project Uzbekis
Page 3 and 4: 8.2 NEED TO DEVELOP TREATMENT OPPOR
Page 5 and 6: 1. Abstract BACKGROUND The number o
Page 7 and 8: policy that is undifferentiated and
Page 9 and 10: find employment and accommodation,
Page 11 and 12: 3.2 Key project data Harm Reduction
Page 13 and 14: 3.5 Project costs The project’s b
Page 15 and 16: As can be seen from the organisatio
Page 17 and 18: 6. Project implementation 6.1 Phase
Page 19 and 20: Advantages and limitations of the
Page 21 and 22: The Uzbek partner outlined developm
Page 23 and 24: Table: Minimum number of syringes n
Page 25 and 26: 6.3.4 NGOs and their contribution t
Page 27 and 28: 7. Project development 7.1 The stre
Page 29: 8. Challenges to be faced for effic
Page 33 and 34: 8.2 Need to develop treatment oppor
Page 35 and 36: 10. Conclusions and new challenges
Page 37 and 38: 11. A learning experience In conclu
Page 39 and 40: In 2003, 15 million children were o
Page 41 and 42: C Bibliography Analyses of Internat

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