Hermez

Experiences in research, outreach and the role of NGOs: 

Experiences in research, outreach and the role of NGOs Joumana Hermez Lebanese National AIDS Control Programme

Background knowledge for implementing programs: 

Background knowledge for implementing programs The social context Drug use is strongly rejected as society is influenced by the religious and conservative social norms Drug users are well contained within their families but stigmatized by the whole society Quality of relationship between the drug users and their social relates involves conflicts and intolerance Communities tend to hide or deny the existence of drug users

Background knowledge for implementing programs… Cont’d: 

Background knowledge for implementing programs… Cont’d The legal context Drug use, or even possession of a drug, is a legal offence whose sentence is 3 months to 1 year of prison Drug users have the right for voluntary detoxification, but relapse is not allowed Police treatment at arrest is inappropriate Only approved treatment is detoxification, no substitution treatment is available, methadone is illegal Liberal purchase of syringe

Background knowledge for implementing programs… Cont’d: 

Background knowledge for implementing programs… Cont’d Drug use figures No estimates of the numbers of drug users in Lebanon According to professionals in the field of drug abuse, and to drug users, themselves IV mode of use is the least prevalent As noticed by professionals in the past few years, numbers are increasing and age of starting drug use is decreasing 6.3% of all reported HIV/AIDS cases are IDU, all males

Implications on implementation: 

Implications on implementation A hidden, hard to reach population An oppressed population who hardly has confidence in anyone Low self-esteem justifying self neglect A sense of helplessness, especially after repeated failures to abstain from drugs Deficient background information for designing and implementing the research and the outreach

Difficulties in implementation: 

Difficulties in implementation No specific site for intervention Hidden population, especially females Legal and social taboo DU mistrusting the rest of the population No social and health security coverage for most drug users

How we went about it: 

How we went about it Took the time for observation Established the appropriate partnerships Had chats with drug users and ex-drug users Had interviews with professionals in the field and people in contact with the target groups Had in-depth interviews with drug users and ex-drug users Explored the possibility for implicating drug users and ex-drug users in data collection and in outreach Designed the quantitative assessment tools (questionnaire) Recruited and trained interviewers and field workers Launched the field work

Relationship schemes: 

Relationship schemes

Key findings… IDU, access to clean needles/ syringes: 

Key findings… IDU, access to clean needles/ syringes

Reasons for needle sharing: 

Reasons for needle sharing 'syringe sharing is something unavoidable when one uses drugs by injection, because one becomes so urged to use that he doesn’t have 3 minutes to go to a pharmacy to buy the syringe. I usually try to use my own syringe as much as I can, especially that one must be careful of AIDS and other diseases, but there happen times when I don’t have one and I’m urged to avoid the pain'

Key findings… IDU, needle sharing: 

Key findings… IDU, needle sharing

Reasons for needle sharing: 

Reasons for needle sharing 'syringe sharing is something unavoidable when one uses drugs by injection, because one becomes so urged to use that he doesn’t have 3 minutes to go to a pharmacy to buy the syringe. I usually try to use my own syringe as much as I can, especially that one must be careful of AIDS and other diseases, but there happen times when I don’t have one and I’m urged to avoid the pain'

Reasons for needle sharing… IDU: 

Reasons for needle sharing… IDU 'sometimes I don’t have money to buy a syringe, in that case I’d take anybody’s syringe and inject myself' 'not all pharmacists sell us syringes, this is why I tend to limit the number of syringes I use'

Risky sexual practices… IDU: 

Risky sexual practices… IDU 'just like girls are offered money for sex, we too get offers from elder women, and we accept those offers to make money' 'Once I took my dose of heroin and met a man on the road, he looked like a girl, I came closer to him and discovered that he was a man. I had sex with him and drove him back to his place… I didn’t give him money but I gave him heroin. Since then, when I don’t have a girl, I meet with men and have no objection to having sex with them; of course I’d be under the effect of my drug; I tell myself I’m already living into sin, why mind this sin?'

Key findings… IDU, sex partners: 

Key findings… IDU, sex partners

Key findings… IDU, condom use: 

Key findings… IDU, condom use

Key findings… IDU, HIV/AIDS awareness: 

Key findings… IDU, HIV/AIDS awareness

Key findings… IDU, HIV testing and health seeking behavior: 

Key findings… IDU, HIV testing and health seeking behavior

Key findings… IDU, Risk perception and behavior change: 

Key findings… IDU, Risk perception and behavior change