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Counselling in Targeted Intervention for Injecting Drug Users – a Resource Guide

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Counselling in Targeted Intervention for Injecting Drug Users – a Resource Guide COUNSELLING IN TARGETED INTERVENTION FOR INJECTING DRUG USERS – a resource guide COUNSELLING IN TARGETED INTERVENTION FOR INJECTING DRUG USERS – A Resource Guide Year of Publication: 2011 A publication of United Nations Office on Drugs and Crime, Regional Office for South Asia AND Tata Institute of Social Sciences, Mumbai Authors The publication was authored by Atul Ambekar*, Ravindra Rao$, Debashis Mukherjee$ and Swati Kedia* * National Drug Dependence Treatment Centre, AIIMS, New Delhi $ UNODC, ROSA © UNODC & TISS All rights reserved. The text of this publication may be freely quoted or reprinted with proper acknowledgment. Disclaimer The opinions expressed in this document do not necessarily represent the official policy of the United Nations Office on Drugs and Crime. The designations used do not imply the expression of any opinion whatsoever on the United Nations concerning the legal status of any country, territory or area of its authorities, frontiers and boundaries. Designer and Printer Macro Graphics Pvt. Ltd. www.macrographics.com Contents Abbreviations iv Preface v Acknowledgments vii About the module… ix Targeted interventions for IDUs – an overview 1 Understanding drugs & drug use disorders: the basics 7 Understanding HIV/AIDS & STIs: the basics 15 Approaches to address drug use problems 23 Understanding injecting drug use 29 Assessment and diagnosis in drug use disorders 33 Counselling: basic issues, skills & techniques 39 Counselling IDUs: Injection-related risk-reduction 47 Counselling IDUs: Safer sexual practices 57 Counselling IDUs: HIV-related issues 71 Motivation enhancement 83 Counselling IDUs: drug-use related issues 89 Co-morbidity among IDUs 101 Crisis management 113 Family counselling 119 Addressing burnout issues in counsellors 129 Glossary 135 Further Reading Materials 139 Annexure 1: High risk behaviour scale 141 Annexure 2: Individual risk assessment activity worksheet 143 Annexure 3: Depression anxiety stress scale – 21 items 145 Abbreviations AVE Abstinence Violation Effect BCC Behaviour Change Communication DASS Depression Anxiety Stress Scale DIC Drop-in-Centre DOTS Daily Observed Treatment Strategy GFATM Global fund to fi ght AIDS, Tuberculosis and Malaria Hep C Hepatitis C HRG High Risk Groups ICTC Integrated Counselling and Testing Centre IDU Injecting Drug User MARP Most at-risk Population NACO National AIDS Control Organisation NACP National AIDS Control Programme NDPS Act Narcotic Drugs and Psychotropic Substances Act NGO Non Governmental Organisation ORW Outreach Worker OI Opportunistic Infection OST Opioid Substitution Therapy PE Peer Educator PM Programme Manager RPT Relapse Prevention Therapy SACS State AIDS Control Societies STI Sexually Transmitted Infections SUD Substance Use Disorder TB Tuberculosis TI Targeted Intervention TISS Tata Institute of Social Sciences UNODC ROSA United Nations Offi ce on Drugs and Crime, Regional Offi ce for South Asia WHO World Health Organisation Preface The practice of injecting drug use which was reported since the early 1980s has been steadily spreading to different parts of India. Associated with this spread has been an increase in HIV prevalence rates among injecting drug users (IDUs). IDUs engage in both unsafe injection and sexual practices that increase the risk for HIV transmission. Among various population sub-groups, HIV prevalence is the highest among the IDU population in India, as evident from recent reports of the National AIDS Control Organisation (NACO). In response to the increasing HIV prevalence among IDUs, NACO has responded by setting up a number of Targeted Interventions (TIs) for IDUs. Key to the national response is services such as needle syringe programmes and opioid substitution therapy, counselling and behaviour change communication. With enhancing numbers of interventions in the country, the gap in training and capacity-building of service providers is being acutely felt. Saksham is the GFATM’s (The Global Fund to Fight AIDS, Tuberculosis and Malaria) Round 7, HIV/AIDS counselling component in India. As the principal recipient of this component, Tata Institute of Social Sciences (TISS), is responsible for providing strategic leadership and direction to the programme. Saksham aims at enhancing capacities of institutions of higher learning that conduct HIV/AIDS counselling training programmes in India, and thus contribute towards responding to the needs of the national programme. The module ‘Counselling in Targeted Intervention for IDUs’ is prepared by UNODC in partnership with TISS, as a fulfi lment of one of the important activities in Saksham, i.e. to develop a training resources in counselling for IDU TIs. United Nations Offi ce on Drugs and Crime (UNODC) is the lead UN agency mandated to assist the Government and civil society on HIV prevention and care among injecting drug users. UNODC has adopted a comprehensive package approach which includes a wide variety of measures, ranging from drug dependence treatment, including drug substitution treatment to outreach services providing IDUs with information on risk-reduction, referral to services, clean needles and syringes, condoms, voluntary counselling and testing, treatment of sexually transmitted infections, and antiretroviral (ART) therapy. UNODC has been working closely with the Government of India in developing a comprehensive and sustainable National AIDS Programme for the drug-using population. The module is for use by trainers who would train the counsellors working in IDU TI. The module is a package consisting of three separate documents and prepared by a group of experts with experience in drug-related counselling as well as harm- reduction. It is hoped that this module will serve as a valuable tool in building the capacity of the counsellors working in IDU TI and aid in providing quality services to the IDU population. Brinelle D’Souza Cristina Albertin National Programme Director Representative Sakshan-GFATM R7, HIV/AIDS United Nations Offi ce on Drugs and Counselling Programme Crime, Offi ce for South Asia Faculty Member, School of Social Work, TISS vi | Counselling in Targeted Intervention for Injecting Drug Users – A Resource Guide Acknowledgments The authors wish to acknowledge the contribution of the all the organisations and individuals who have helped in developing this training module. First and foremost, thanks are due to the National AIDS Control Organisation (NACO) for providing this opportunity for developing this module. Thanks are also due to the leadership role provided by the UNODC ROSA and TISS. The authors have relied upon a variety of resource materials to develop this manual. Important among these are: Counselling for Drug Addiction Individual, Family and Group – A fi eld guide for trainers and service providers, MSJE and UNDCP, 2002. Substitution Therapy with Buprenorphine for Opioid Injecting Drug Users, NACO, 2008. A Manual for Working with IDUs (Harm Reduction/Outreach Training Module), NACO, 2009. National Guidelines on Prevention, Management and Control of Reproductive Tract Infections including Sexually Transmitted Infections, NACO, 2010. HIV Counselling Training Modules for VCT, PPTCT and ART Counsellors, NACO, 2010. The resource material developed and used by the authors for providing harm-reduction and OST training to various TI NGOs working with NACO. Other training manuals developed by the authors (Reaching Out to Female partners of IDUs – being developed for UNODC and NACO; Substance Use Disorders: A Manual for Paramedical Personnel – developed for WHO [India] and Ministry of Health and Family Welfare, Government of India; Training on implementing OST, being developed for DFID TAST and NACO). This draft manual has undergone peer review by eminent experts in the fi eld as well as by NACO. The authors are extremely thankful to these experts who have provided their valuable feedback, which has helped in polishing and refi ning this module. Atul Ambekar Ravindra Rao Debashis Mukherjee Swati Kedia about the module… The goal of the third phase of National AIDS Control Programme is to halt and reverse the epidemic of HIV in India by 2012. One of the important components to realise this goal is to provide interventions to those at highest risk of HIV through targeted interventions. Injecting drug use is recognised as an important behaviour which contributes to the continuing spread of HIV infection in India. To prevent this, NACO has signifi cantly scaled-up targeted interventions specifi cally for IDUs throughout the country. The focus now is on improving the quality of interventions provided by these TIs. To improve the knowledge and skills of the staff working in TI, they have to be constantly trained and their capacity has to be built. One of the important outputs of the TI is to provide counselling and by doing so, change their behaviour from high-risk to low-risk. In case of IDU TIs, the counselling staff, not only has to provide HIV-related counselling, but also has to support the IDU during periods of his drug use as well as during his attempts to stop drug use. In this regard, the counselling staff has to play the role of HIV counsellor as well as drug counsellor. Currently, there are no training materials specifi cally targeted towards counselling for injecting drug users. Tata Institute of Social Sciences (TISS) is charged with building the capacity of all the counsellors in programmes funded by NACO, especially those working in Integrated Counselling and Testing Centres (ICTC) as well as those working in the
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