essential package of targeted interventions for mara romania experience
TRANSCRIPT
![Page 1: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/1.jpg)
Essential package of targeted interventions for MARARomania Experience
![Page 2: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/2.jpg)
UNICEF
Romania specific profile
• General population = 21.5 mill
• People living with HIV = 9 540
• Low HIV prevalence – less than 0.1% - first HIV case: 1985
• Aprox. 7 500 young people aged 15-19 years, infected during 1988-1991 via transfussions with infected blood;
• Efficient governmental and NGOs response (ARV treatment is covered from the National Program funds; National AIDS Commission, national strategy, social protection for PLHIV);
![Page 3: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/3.jpg)
UNICEF
Estimation of drug users/sex workers in Romania in relation with HIV/HCV/HVB
IDU/SW estimation number: • 2004 - Bucharest (aprox 2,5 mill. population): 24.000 IDUs (National Anti-drug Agency
report);• 2008 - Bucharest: 16 800 IDUs - (National Anti-drug Agency report);• No statistics available (prostitution is criminalized)
HIV cases among IDUs:• 1985 – 2008: 3 HIV cases among IDUs (HIV M&E Department);• 2008: 3 new HIV cases among IDUs (Public Heath Authority – study among 380 IDUs)
HIV/HCV prevalence among IDU accessing Needle Exchange Programs andOpiate Substitution programs (National Antidrug Agency, 2008 – 327 IDUs questioned):
• 18-24 y. o. = 42%• 1.5% HIV prevalence; • 61.5% HCV prevalence;
![Page 4: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/4.jpg)
UNICEF
Project: Essential package of targeted interventions for MARA
Goal:
To prevent HIV/hepatitis/STIs and to reduce the related harm associated to risk behaviors among MARPs, including MARA
Activities:
Evaluation study of MARA risk behaviors
Harm reduction (IEC, needle exchange, codom distribution, VCT)
Referrals to medical and social services
Develop and pilot a referral system on voucher basis;
Capacity building for local and national counterparts;
Networking among counterparts (regular consultation meetings & communication);
![Page 5: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/5.jpg)
UNICEF
Project: Essential package of targeted interventions for MARA (cont.)
Key results achieved so far:
• 7 ongoing projects targeting MARA (IDU, SW) operating in 4 cities;
• Research finalized;
• More than 300 MARA reached out of 3 000 IDU and SW involved in harm reduction services (needle exchange programs, medical care, voluntary testing).
![Page 6: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/6.jpg)
UNICEF
Partners
• 7 NGOs providing harm reduction services (RHRN members):– Needle exchange (outreach and drop-in centers): ALIAT, ARAS, Integration, PARADA,
Sastipen, Samu Social; – Opiate substitution treatment (ARAS – National Infectious Diseases Institute
partnership);– HIV/HCV/HBV counseling and testing (Public Health Authorities and ARAS).
• Local partners: Child Protection Authorities; Medical Units (National Infectious Diseases Institute; hospitals, clinics, etc).
• National partners: • National Antidrug Agency (NAA); • MoH (National Commission against AIDS); • Ministry of Labor, Social Protection and Family; • National Authority for Child Rights Protection; • Romanian Angel Appeal Foundation – GFATM PR for Round II;
• UNODC (technical and financial assistance – training on MARA and M&E; prevention equipment – condoms, lubricants, injection kit)
• UNAIDS (technical assistance)
![Page 7: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/7.jpg)
UNICEF
![Page 8: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/8.jpg)
UNICEF
Programme data collection sources
• National AIDS Authority statistics;
• MARA data base (data collected at NGOs implementing MARA projects);
• Voucher collection and analysis;
• Project records;
• Service providers interviews;
• Meeting with partners;
• Site visits;
• Routine quality monitoring (supplies, facilities check lists, code system in use).
![Page 9: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/9.jpg)
UNICEF
Policy, legal barriers and advocacy efforts
– voucher system –
• Medical staff working in NGOs offers the voucher to clients depending on the health problem;
• The clients access the medical service on voucher basis and informal partnership with ARAS;
• The vouchers are collected and data interpreted by ARAS coordinator;
• Preliminary aspects:– Clients, especially FSW, accessed the medical service (HIV, HVB,
HCV tests, STI) in an increased number in relation with other vulnerable groups (IDUs);
– Increased number of clients accessing medical services, including HIV/HCV, HBV counseling and testing;
![Page 10: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/10.jpg)
UNICEF
Policy, legal barriers and advocacy efforts – health services –
Barriers in accessing health services for MARPs:
• health insurance;• ID papers;• parental or child protection consent
for under-aged clients;• ethical bias of medical staff;• limited knowledge in toxicology.
Advocacy efforts:• Increasing access to medical and social care:
– partnerships with medical units (the voucher system pilot);
– cooperation with Population Registration Service – the right to identity;
– cooperation with child protection services.
![Page 11: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/11.jpg)
UNICEF
![Page 12: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/12.jpg)
UNICEF
Policy, legal barriers and advocacy efforts (cont.)- social protection and ethical concerns -
Policy and legal barriers
Limited specialized child protection services and professionals (outreach units/detoxification services/low threshold clinics accessible to MARA aged 16 – 25 years old);
Parents consent for treatment;
Confidentiality.
Advocacy efforts
Conduct capacity assessment exercise in order to evaluate specific needs of medical care units and child protection departments;
Advocate towards local authorities in order to put on their agenda the issue of MARA; Include the MARA problem on National Authority for Child Rights Protection agenda (specialize existing services for MARA under 18 years old)
![Page 13: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/13.jpg)
Other challenges due to emerging situations • Financial crisis:
• Cuts in governamental expenditures;
• Reorganization of central and local authorities:• National Antidrug Agency was restructured and reorganized
under the Police Inspectorate – its current situation is uncertain;
• NAA OST services should be taken over by MoH
UNICEF
![Page 14: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/14.jpg)
UNICEF
Next steps - governmental sector
Meetings with MoH – put on MoH agenda the issue of IDU and SW, including MARA;
Adopt a minimum medical - social package for uninsured clients;
Specialize child protection services for working with MARA under 18 years old;
Increase the capacity of local public authorities to work with IDUs and SWs, including MARA through trainings and establishing networks;
Conduct impact research on pharmacies and level of syringes access for IDUs.
![Page 15: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/15.jpg)
UNICEF
Next steps - NGO sector
• Conduct a capacity assessment of service providers in order to evaluate their needs and develop strategic plans to work with MARA;
• Increase the capacity of harm reduction NGOs to work with MARA (trainings, standards and protocols of working with MARA);
• Identify possible solutions for unifying the code system data base on MARA from implementing NGOs in order to avoid overlapping in intervention and have a common data base available at the level of RHRN.
• RHRN coordination meetings
![Page 16: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/16.jpg)
UNICEF
Next steps - NGO sector
• Continue NGOs MARA interventions for 18 months;
• Conduct internal evaluation of the projects;
• Conduct MARA study at the end of the project to document changes of risk behaviours due to project implementation or due to other emegeing situation (unemployment rate, poverty, financial crisis).
![Page 17: Essential package of targeted interventions for MARA Romania Experience](https://reader036.vdocument.in/reader036/viewer/2022062517/56649eb75503460f94bc156e/html5/thumbnails/17.jpg)
UNICEF
Thank you for your attention!
Questions or comments?
www.rhrn.ro