Drop-In Centre

FILM DISCUSSION CARD 3

DROP-IN CENTREUNMET NEEDS OF IDUSWhat 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 freelyNEED FOR DICAll 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 voiceAll these needs can be fulfilled by a DICLOCATION OF A DICA 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 surroundingsESTABLISHING A DICThe 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 nearbyCONTD.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 siteCONTD.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 staffREFERRAL PATHWAYS DICIDUs may reach DIC:DirectlyVia outreach contactVia Referrals Forcibly by family membersOUTREACH CONTACTIDUREFERRALSERVICEINFRASTRUCTURE AND STOCKSA DIC should have adequate space for:Recreation / Rest CounsellingTreatment / DressingIn addition A room for examination of client / sexual partnersBasic amenities i.e. toilet & kitchen

Timings for the DIC should be decided in consultation with the IDUsCONTD.Following should be stocked:Needles/syringesDisposal binsCondomsAbscess prevention & treatment materialsIEC materialsNotice on rules and regulations prominently displayedConfidentiality policy followed in the DIC displayedEssential furnitureSocial mapping should be displayed

The IDUs may be actively involved in the day-to-day maintenance of DICRECREATION / REST ROOMThis will be the Entry room with the largest space

Purpose:For IDUs to spend timeFor IDUs to restFor 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 entranceRecord of consumables bought & usedRecord of other activitiesCOUNSELLING ROOMPurposeTo provide one to one counselling to IDUs & family membersReferrals

Privacy should be maintained (both audio and video)

Counselling should include the following issuesHIV /STI preventionRisk / Harm reductionPre-post test counsellingPsychosocial counsellingOther issues of the clientEXAMINATION/TREATMENT/DRESSING ROOMPurposefor 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

CONTD.Materials required in the room:Table and chair for nurse and doctorStool for patient to sitStool for abscess managementPatient examination tableSterilizerNeedle crusherGlovesCupboard for PEP, OST & STI drugs and other materialWaste disposal container

WHO CAN ACCESS THE DIC?IDUs

Spouses/Sexual Partners of IDUs

Family members of IDUs

General community may come to seek information

PROCESSES IN DICUpon 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 IDUCONTD.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-upIDU 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 counsellingCONTD.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 groupCONTD.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 CCONTD.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 intervalsCONTD.Observance of important drug/HIV related daysSocial activities involving IDU

The PM should ensure that:A directory of services is available for referralsLiaison with hospital and emergency services to deal with any untoward medical incidents is establishedLiaison with local police station officers for enabling environment is establishedSERVICE PROVISIONServices at the DICNSEPCondom distributionAbscess management (treatment/dressing etc)STI management (syndromic)CounsellingReferralsGroup discussionsRecreation/ Rest facilitiesHUMAN RESOURCESStaff in DICFull 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)ROLE OF OUTREACH WORKER & PEER EDUCATORSORW 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 servicesCONTD.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 communityBASIC RULES AT DICSome basic rules of DIC includeNo drug use on the premisesNo drug dealing on the premisesNo 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 storyCONCLUSION 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