A Manual On Working With Injecting Drug Users - A Trainers Manual

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A Manual on Working with

Injecting Drug Users - a Trainers Manual
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TABLE OF CONTENTS
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Title Pg. No.
Acknowledgement 04-05
Introduction 06-09
DAY 1 : Session One: Welcome, Introductions and Sharing Expectations 10-19

Session Two: The IDU Programme Under NACP III
Session Three: Basics of Drugs
Session Four: Drug-Related Harms
Session Five: Harm Reduction
DAY 2 : Session One: Principles of Outreach 20-30

Session Two: Planning Outreach for IDUs
Session Three: Conducting Outreach for IDUs
Session Four: Roles and Responsibilities of Peer Educators
and Outreach Workers
DAY 3 : Session One: Importance of Trust and Confidentiality 31-39

Session Two: Behaviour Change Communication
Session Three: Needle and Syringe Exchange Programmes
Session Four: Condoms - Understanding their Importance and Correct Usage
DAY 4 : Session One: Drop-In-Centres 40-52

Session Two: Referral and Networking
Session Three: Abscess Prevention and Management
DAY 5 : Session One: Advocacy 53-60

Session Two: Community Mobilisation
Session Three: Oral Substitution Therapy (OST)
Glossary 61
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ACKNOWLEDGEMENTS
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This training module has been prepared with extensive inputs from a number of individuals with rich
programme experience as well as experts in the field of Injecting Drug Use (IDU).
An initial outline of sessions was drawn up by the IDU team at the National AIDS Control Organization
(NACO) along with officers from the North East Regional Office of NACO. A workshop was conducted
in June 2008 co-ordinated by Emmanuel Hospital Association (EHA), and the identified contributors
were invited to discuss the contents along with the expected outcomes of the training. Additional
contributions were subsequently invited in the form of presentations on topics which were considered
important to the training. The contributors are listed below:
Agarwal Alok, Senior Resident, National Drug Dependence Treatment Centre, All India Institute of
Medical Sciences, New Delhi
Ambekar Atul, Assistant Professor, National Drug Dependence Treatment Centre, All India Institute
of Medical Sciences, New Delhi
Arun MC, Manipur University, Imphal, Manipur
Asem Jiten, Project ORCHID, Avahan, Guwahati, Assam
Beddoe Simon, Consultant, Kolkata, West Bengal
Humstoe Chenithang, North East India Harm Reduction Network,
Humtsoe Chumben, Project ORCHID, Avahan, Guwahati, Assam
Khumukcham Sophia, Technical Officer IDU, NACO, New Delhi
Kipgen Richard, SHALOM, Churachandpur, Manipur
Lenin RK, Associate Professor, Regional Institute of Medical Sciences, Imphal, Manipur
Nathan Mahesh, Team Leader Technical Support Unit, Kolkata, West Bengal
Phalguni Kh., Dedicated People’s Union, Bishnupur, Manipur
Rao Ravindra, Programme Officer- IDU, NACO, New Delhi
Sanghlun, Presbyterian Hospital, Aizawl, Mizoram
Senti, Project ORCHID, Avahan
Sharma Charanjit, Regional Programme Officer-IDU, NACO North East Regional Office, Guwahati,
Assam
Sinate, Rebecca, Regional Programme Associate-TI, NACO North East Regional Office, Guwahati,
Assam
Singh Upendra, Team Leader Targeted Intervention, Technical Support Unit, Lucknow, Uttar
Pradesh
Touthang , Project ORCHID, Avahan, Imphal, Manipur
Waikhom Ronnie, CARE, Imphal, Manipur
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ACKNOWLEDGEMENTS
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Subsequent to receiving the contributions, two teams were formed to further develop the module. The
first team (Dr. Atul Ambekar and Dr. Alok Agarwal) made changes in the content to provide continuity
to the day-one sessions. The second team (comprising of Dr. Ravindra Rao, Sophia Khumukcham,
Charanjit Sharma, Simon Beddoe and Chumben Humtsoe) reviewed the rest of the sessions for
correctness and relevance of the content. The slides were then edited from a language perspective by Mr.
Ravindra Raj through EHA. The contents were finally handed over as a set of power point presentations
to The Communication Hub (TCH) for developing the same into a comprehensive training package.
The package thus developed contains a training manual supplemented with training aids including an
animation film, as also participant take-away materials.
The pre test of this package was carried out by The Communication Hub at Dimapur, Nagaland.
Participants were drawn from the State Training Resource Centre, Nagaland, Targeted Intervention staff
from Avahan-supported and Nagaland State AIDS Control Society supported NGOs, and experts in the
field.
In addition to contributions made by all the above, acknowledgements are due to the Society for
Promotion of Youth and Masses (SPYM) for their permission to use a film developed by them during
the training.
Finally, acknowledgments are due to Dr. B Langkham, Emmanuel Hospital Association (EHA), Public
Health Foundation of India (PHFI) and Avahan (the Bill and Melinda Gates Foundation) who have
supported and funded the development of the module.
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Day 1
INTRODUCTION
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The prevention of new infections in High Risk Behaviour (HRB) groups and in the general population
is a major thrust in the National AIDS Control Programme (NACP) III. The most effective means of
reducing HIV spread is through the implementation of Targeted Intervention (TI) amongst persons
most vulnerable to HIV/AIDS, such as Female Sex Workers (FSW), truck drivers, migrants, Men
who have Sex with Men (MSM) and Injecting Drug Users (IDU). Both National AIDS Control
Organization (NACO) and the states place a high priority on full coverage of High Risk Groups by
TI projects.
Under NACP III, the TI approach encourages peer-led interventions by community based organisations
or NGOs both in the rural and urban areas and focuses on clients of sex workers, partners of MSM and
IDUs. All TIs are designed to work towards empowering the communities, by following a rights-based
approach that recognises the fundamental right of every individual to information and services that seek
to reduce his/her vulnerability to HIV/AIDS and provide the necessary care, treatment and support. The
prevention strategies are thus linked to care and treatment, and seek to empower the community against
stigma and discrimination.
As part of targeted interventions, under NACP III, the following specific interventions are provided to
IDUs to reduce their vulnerability:
Needle and Syringe Exchange Programmes (NSEP)

Abscess management and other health services
Detoxification/de-addiction and rehabilitation
Oral Substitution Therapy (OST)

The period from 2008 – 09 has seen a major expansion in the number of TI Projects for IDUs. This
expansion has been foremost in those states where there were no pre-existing IDU TIs. Hence, the
capacity or experience to implement and monitor the functioning of such projects was found to be
relatively limited. The need for a module for use by trainers was felt acutely.
This 5 day training module has been developed in response to the need felt to provide a comprehensive
curriculum for training on Injecting Drug Use under the NACP III TI projects. It covers a broad
spectrum of content ranging from a theoretical understanding of the basics of drugs and drug-related
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INTRODUCTION
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harms, to a comprehensive exposure to the system of outreach for IDUs as is envisaged and being
implemented under the NACP III programme. The curriculum covers an exhaustive set of topics
including both information-based and skills-based learning, touching on subjects such as NSEP, OST,
abscess management, Behaviour Change Communications (BCC), and also providing participants the
opportunity to reflect upon issues pertaining to ethics, confidentiality, and the myriad other challenges
of working with the community of IDUs. It also provides insights on the dynamics of the Outreach
Worker (ORW) and Peer Educator (PE) relationship in the context of IDU project.
Design of the Module

This module has been designed to develop and broaden the perspective of the participants on their role
while working with Targeted Intervention Projects for IDUs. The greater focus of this training lies on
building the knowledge and skills of staff in understanding the need to work with IDUs, the issues
therein and the strategies to be adopted for effective implementation of the project.
Scheduling
The module has been designed for a five day training workshop. It is preferable that participants devote
this time at a stretch in the training workshop.
Every session has been planned with time for open discussion and sharing of experiences of the
participants. Interactive methods such as group work, brainstorming, games and such like have been
introduced at key places in the training package to make for better recall of core learning and to
enliven the training process itself. The participants are expected to develop a basic understanding about
the sessions in advance by going through the supplementary manual provided to them. This manual
contains the presentations that they will be exposed to as also additional reading material to broaden
their understanding of the subjects.
The package also contains an animation film ‘Every Step Counts – A Film on Working With Injecting
Drug Users’ that the facilitator can use to summarize key learnings of the workshop. The package
contains a booklet that elaborates on key issues addressed in the animation film. The booklet acts
a workshop take away for participants who can use it as a ready reckoner to refresh their learning
on key issues pertaining to IDU projects. The package also contains a film made by SPYM, Delhi
which elaborates on issues like abscess prevention and management, overdose management and oral
substitution therapy.
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How to Facilitate
The workshop trainers or facilitators should be familiar with experiential and participatory forms of
learning. They should have the ability to ask exploratory open-ended questions and should be sensitive
towards involving all the participants especially given that the group is likely to be that of a varied
profile.
The facilitators should be technically competent to answer various intervention related questions.
Adaptations of the various topics may be made in order to suit local needs and priorities.
While a range of devices such as energizers, brainstorming, games and such like have been provided in
the manual itself, facilitators could also go beyond these and include others such as debates and quizzes
related to the session topics. It would be helpful to review the feedback forms on a daily basis so as to be
able to respond to any significant issues such as lack of comprehension of important content or perceived
lack of applicability, if any, on the topics and issues.
It will be important at all stages for participants to correlate their class room teachings with field level
learning and vice versa.
How to Use the Module

Each session provides the following information:
Objective: What the facilitator hopes to achieve by the end of the session.
Expected Outcome: The outcomes anticipated as a consequence of the session.
Duration: Approximate time each session will take.
Suggested Teaching Method: Teaching methodology and techniques that will be used.
Materials/Preparation required: Materials that are required to carry out the session, may include flip
charts, marker pens, handouts, etc. and any preparation that is required.
Process: The step-by-step instructions on how to implement the activities and run the sessions.
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Key Learnings: The core learning content that the facilitator will explain with the help of the Power
Point presentation for the session. It is the main points participants should learn and take back from the
session. The facilitator must ensure that these key learnings are understood well by the participant by
encouraging a recap of the session that will elicit these points.
Evaluation of the workshop: Formats for daily evaluation of the sessions are provided in the
supplementary manual.
Workshop Take-aways: Participants will take away soft copies of all the Power Point presentations, and
also the booklet summarizing key learnings from the animation film.
Key things to remember as Facilitator:
Dos
- Read the Operational Guidelines and training module completely before the workshop
- Be flexible. Scheduling may have to change depending on the need of the participants
- Use different teaching methods to enhance participation and retain interest
- Ensure all teaching materials like handouts, charts etc are available
- Respect participants’ local knowledge
- Encourage peers to participate and make presentations
- After the training, ensure that a follow-up plan is developed
- Remember, this is a participatory workshop and your role is to FACILITATE!
Don’ts
- Let any one person dominate the discussion
- Speak more than the participants – let the participants brainstorm and discuss
- Allow distractions like mobile phones and chatting between participants
- Make the training a boring experience – intersperse the sessions with energizers
- Read out from the Power Point presentations – prepare yourself well and use the presentation slides
as cue cards to elaborate on the relevant points
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Day 1
DAY 1
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Context Setting: Outreach
Session One
Welcome, Introductions and Sharing Expectations 9:30am - 11:00 am 1.5 Hours
Introductions/Ice-Breaker 15 Minutes
Sharing Expectations 45 Minutes
Workshop Agenda/Discussion 30 Minutes
Tea/Coffee Break 11:00am - 11:15am 15 Minutes
Session Two
The IDU Programme Under NACP III 11:15am - 12:15pm 1 Hour
Introduction to NACP III and TIs with IDU 45 Minutes
Discussion 15 Minutes
Session Three
Basics of Drugs 12:15pm - 1:15pm 1 Hour
Group Brainstorming Session 15 Minutes
Group Work and Group Presentations 30 Minutes
Presentation on Drug Use and Effects of Drugs 15 Minutes
Lunch Break 1 Hour
Session Four
Drug-Related Harms 2:15pm - 3:45pm 1.5 Hours
Group Brainstorming 15 Minutes
Role Play Exercise 45 Minutes
Group Discussion 15 Minutes
Discussion on ‘Hierarchy of Harms’ 15 Minutes
Tea/Coffee Break 3:45pm - 4:00pm 15 Minutes
Session Five
Harm Reduction 4:00pm - 5:30pm 1.5 Hours
Recap about Drug-Related Harms 15 Minutes
Brainstorming 15 Minutes
Introduction to Harm Reduction Framework 30 Minutes
Discussion and Interactive Session 30 Minutes
Wrap Up & Evaluation of Day One 5:30pm - 5:45pm 15 Minutes
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Day 1
WELCOME, INTRODUCTIONS AND
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SESSION 1:
SHARING EXPECTATIONS
Objective Expectations from the Workshop

To welcome the participants, get introduced to each
other and share expectations from the workshop. Each participant is requested to jot down 2
Expected Outcome expectations from the workshop on a slip of
Participants get to know each other paper; the papers are then collected. The
Participants share their expectations from the workshop facilitator requests 2 participants to come up;
Facilitator shares the agenda and overview of the while one reads out the expectations, the other
workshop writes them on a flip chart. The facilitator
Duration groups the expectations according to
1.5 hours ‘knowledge sought’/ ‘skills sought’. The
Suggested Teaching Method facilitator then discusses the workshop agenda
Games, discussion and writing on board already provided to the participants and walks
Materials/Preparation required them through the logic of the flow and content.
Flip chart, marker pens, and workshop agenda
Ice-breakers/Introductions
Process
Participants are welcomed to the workshop and the The facilitator can choose from any of these or
facilitator selects one of the ice-breakers given devise a game of his/her own depending upon
below to get them to introduce themselves and to the time available.
know each other better.
Option 1: Juggling Ball Game
Each participant is requested to jot down 2
expectations from the workshop on a slip of paper Everyone stands in a close circle. (If the group
(the choice of putting their names on the paper is is very large, it may be necessary to split the
theirs); the papers are then collected. group into two circles.) The facilitator starts
by throwing the ball to someone in the circle,
The participants’ expectations are collated on a flip saying their name as they throw it. (Each person
chart as per the steps given below and the facilitator must remember who they receive the ball from,
sums up the discussion. and who they have thrown it to.) Continue
catching and throwing the ball to the same
The workshop agenda is shared and discussed with person – establishing a pattern for the group.
the group.
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Day 1
WELCOME, INTRODUCTIONS AND
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SESSION 1:
SHARING EXPECTATIONS
Once everyone has received the ball and a pattern is established, introduce one or two more balls, so
that there are always several balls being thrown at the same time.
Option 2: Space on My Right
Participants are seated in a circle. The facilitator arranges for the space on their right to remain empty.
They then ask a member of the group to come and sit in the empty space; for example, “I would like
Rajesh to come and sit on my right”. Rajesh moves and there is now a space on the right of another
participant. The participant who is sitting next to the empty space calls the name of someone different
to sit on his or her right. Continue until the entire group has moved once.
Option 3: The Sun is Shining On…
Participants sit or stand in a tight circle with one person in the middle. The person in the middle shouts
out “the sun shines on...” and names a colour or articles of clothing that some in the group possess. For
example, “the sun shines on all those wearing blue” or “the sun shines on all those wearing socks” or
“the sun shines on all those with brown eyes”. All the participants who have that attribute must change
places with one another. The person in the middle tries to take one of their places as they move, so that
there is another person left in the middle without a place. The new person in the middle shouts out “the
sun shines on...” and names a different colour or type of clothing.
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Day 1
THE IDU PROGRAMME UNDER NACP III
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SESSION 2:
Objective Key Learning

To help participants understand the operation of the The facilitator uses the Power Point presentation
IDU programme under NACP III. given in the supplementary manual to emphasise
Expected Outcome the following key learning points.
Participants are oriented to the evolution of the na- The first case of AIDS was identified in
tional programme and NACP III’s approach to Tar- 1986; the Ministry of Health and Family
geted Interventions (TI) among IDU. Welfare formed the National Health
Duration Committee. NACO came into being in
1 hour 1992.
Suggested Teaching Method
Presentation and discussion The main objective of NACP I
Materials/Preparation required (1992-99) was to develop infrastructure
Power Point presentation, flip charts, marker pens. for the treatment of sexually transmitted
The facilitator should be familiar with the NACP III diseases in district hospitals and medical
Operational Guidelines for IDU Targeted Interven- colleges, expansion of blood banks, and
tions (TI). (Refer to NACP III TI Guidelines) to initiate the HIV sentinel surveillance
system.
Process
The facilitator explains the HIV situation in India NACP II (1999-2006) was launched with
and the evolution of the National AIDS Control the objective of strengthening India’s
Programme (NACP) with the help of the Power capacity to respond to HIV/AIDS on a
Point presentation. long-term basis.
The Power Point is used to walk participants NACP III (2007-2012) aims to halt and
through a detailed understanding of the various reverse the epidemic in India over the next
components of TI. five years.
The facilitator highlights the approach to IDU In India, HIV is a concentrated epidemic,
interventions in NACP III. which affects specific High-Risk Groups
(HRG) like FSW, MSM, IDU and Bridge
Participants are encouraged to discuss and seek Population (truckers and migrants).
clarification.
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Day 1
THE IDU PROGRAMME UNDER NACP III
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SESSION 2:
Targeted Interventions (TI) are needed in order to actively control the spread of HIV among HRGs.
IDU is a critical category of HRG since HIV is highly transmissible through the sharing of needles.
High HIV prevalence highlights the importance of urgently addressing the IDU community, e.g., 7
out of every 100 IDU are HIV-positive.
Under NACP III, the harm reduction approach is adopted as the key strategy for TIs among IDUs and
their sexual partners, especially to reduce the risk of acquiring and transmitting HIV.
Under the harm reduction approach, services are delivered through a needle and syringe exchange
programme (NSEP) and oral substitution therapy (OST) to bring about behaviour change (e.g., from
sharing of contaminated injection equipment to safer injecting; and from injecting to oral
substitution).
Treatment to stop drug use, (e.g. detoxification and rehabilitation) is provided through linkages with
drug de-addiction centres/ detoxification centres.
Under this strategy, condoms are promoted and outreach to sexual partners of IDUs is also
established.
Self-care and life skill development among women who have male partners injecting drugs constitute
an important element of the harm reduction intervention approach.
Harm reduction services are delivered under TI to IDU through a 3 tiered approach. Tier 1 involves
outreach by NGOs. Tier 2 involves Oral Substitution Therapy (OST). Tier 3 involves referral/linkage
services and advocacy for an enabling environment. While NACP II focused primarily on Tiers 1 and
3, NACP III also focuses on Tier 2 – oral substitution therapy (OST) (refer to Power Point
presentation).
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Day 1
BASICS OF DRUGS
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SESSION 3:
these drugs are referred to, including

Objective colloquial names and ‘code language’ if
To provide participants with important knowledge any, used by IDUs for these drugs.
related to drugs.
Expected Outcome Each group makes a presentation of its
Participants have increased knowledge about drugs and work to the larger audience and a
drug use. discussion is generated.
Duration
1 hour Finally, the facilitator walks the
Suggested Teaching Method participants through a presentation on the
Presentation, brainstorming and discussion stages of drug use and the effects of drugs.
Materials/Preparation required
Power Point presentation, flip charts, marker pens, Key Learning
Drug Matrix. The facilitator uses the Power Point presentation
given in the supplementary manual to
emphasise the following key learning points.
There are three main categories of drugs:

stimulants, depressants and hallucinogens.
Process
Participants are asked to brainstorm on the different Drugs can be classified as legal or illegal
types of drugs that come to their mind and these are (depending upon the drug).
listed on the flip chart.
There are several modes of drug use, e.g.,
The facilitator then uses the Power Point drinking, swallowing, chewing, injecting,
presentation to explain the three main categories of inhaling, snorting and smoking.
drugs, i.e., stimulants, depressants and
hallucinogens. Drug use takes place along a continuum
from experimental use to occasional use to
Participants are divided into four groups and each regular use to dependent use. This is also
group is given a matrix (please see attached format). called “the usual drug-use career”.
They fill the matrix by recalling the presentation they
were exposed to, and indicating the classification,
mode of use of the drug and category of drug; they
are also asked to generate the local term(s) by which
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Day 1
BASICS OF DRUGS
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SESSION 3:
Effects of drugs depend on a number of factors: drug itself (e.g. properties of the drug, its dose,
duration of use and mode of administration), the individual using the drug (e.g., her/his mental and
physical health) and the environment within which it is used.
Drug use may result in a number of problems, including health, social, occupation, financial,
familial and legal (among others).
Drug intoxication can also lead to risky sexual behaviour, thus increasing the possibility of HIV
transmission.
Drug Matrix
S. No. Drug Local/Colloquial Modes of Use Classification Category of Drug
name of Drug (i.e. legal/illegal) (i.e, stimulants,
depressants and
hallucinogens)
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Day 1
DRUG-RELATED HARMS
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SESSION 4:
The different card papers are arranged on

Objective
the board accordingly.
To provide participants with an overview of the harms
associated with drug use.
The Power Point presentation is used to
Expected Outcome
describe the ‘Hierarchy of Harms’ and the
Participants have increased knowledge about drug-re-
need for harm reduction programmes to
lated harms, interaction between harms, the concept of
focus on harms which form public health
hierarchy of harms and priorities of harm reduction.
priorities.
Duration
1.5 hours Key Learning
Suggested Teaching Method The facilitator uses the Power Point presentation
Presentation, brainstorming, small group work and given in the supplementary manual to
discussion emphasise the following key learning points.
Power Point presentation, flip charts, marker pens. The harms associated with drug use, broadly
include physical, occupational, financial,
familial, social, psychosocial and legal harms.
Process
Harms caused in various spheres of drug
Role play exercise: Participants are asked to divide users’ lives are closely inter-related.
themselves into groups and develop a role play
about the life of a drug user. The groups return and The inter-relationship between drug-related
present their role plays. harms forms a vicious circle.
The role play exercise is followed by a Harms may be added or aggravated due to
brainstorming session within the larger group about simultaneous use of other substances.
the harms associated with drug use and how these
harms interact with other harms in the life of the The ‘Hierarchy of Harms’ highlights that
drug user. harms differ in their severity.
As participants brainstorm, the harms are listed Although harms may differ in their severity,
on card papers and are pinned up on a board. The a harm reduction programme must focus on
group collectively brainstorms on ranking these harms that form public health priorities.
harms from least severe to most severe.
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HARM REDUCTION
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SESSION 5:
Objective emphasis of the harm reduction approach

To provide participants with an understanding of the on short-term pragmatic goals over
key concepts of harm reduction, components of a harm long-term idealistic ones.
reduction package and the role of harm reduction in
the prevention of HIV. The facilitator uses the “Interactive
Expected Outcome Session” slides to sum up the day’s
Participants have a clear understanding of what harm learning about drug-related harms and the
reduction is and the benefits of harm reduction vis-a- need for harm reduction.
vis other strategies.
Key Learning
Duration
The facilitator uses the Power Point presentation
1.5 hours
given in the supplementary manual to
emphasise the following key learning points.
Presentation, brainstorming and discussion
Materials/Preparation required Harm reduction is a framework in which
Power Point presentation, flip charts, marker pens. The effective HIV prevention can be carried out
facilitator should be familiar with the harm among IDUs and their sexual partners.
reduction framework under NACP III (refer to
NACP III TI Guidelines). The focus of harm reduction interventions
remains on immediate and easily
Process
preventable harms rather than on setting
The facilitator recaps the drug-related harms discussed unrealistic goals such as complete
earlier. abstinence.
The Power Point is used to walk the participants Harm reduction aims to prevent the
through drug abuse management strategies. Partici- transmission of HIV by reducing the harm
pants brainstorm about the pros and cons of the vari- associated with high risk behaviours such
ous strategies. as sharing needles, syringes and other
equipment for preparing and injecting
The facilitator uses the Power Point presentation to drugs, and unsafe sexual behaviours.
highlight the harm reduction framework, including its
key concepts, principles and strategies. There are three tiers of harm reduction.
Tier 1 includes Needle and Syringe
Participants are encouraged to discuss the
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HARM REDUCTION
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SESSION 5:
Exchange Programmes (NSEP) and outreach. Tier 2 focuses on Oral Substitution Therapy (OST).
Together, tiers 1 and 2 bring about behaviour change from sharing of contaminated injection
equipment to safer injecting and from injecting to oral substitution. Tier 3 focuses on referrals and
linkages with other services and advocacy for an enabling environment.
Needle and Syringe Exchange Programme (NSEP) and Oral Substitution Therapy (OST) are integral
parts of the spectrum of the harm reduction package. While NACP II focused primarily on Tiers 1
and 3, NACP III also focuses on Tier 2 – Oral Substitution Therapy (OST).
A combination of strategies and individualisation of interventions are important aspects of the harm
reduction approach.
Harm reduction provides a practical and flexible approach to reducing immediate drug-associated
harms.
Do ensure that participants complete the feedback form for the day!
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Day 2
DAY 2
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Outreach: Principles and Concepts
Session Plan
Recap of Key Learning of Day One 9:30am - 9:45am 15 Minutes
Session One
Principles of Outreach 9:45am - 10:15am 0.5 Hours
Energizer 10 Minutes
Introduction to Outreach, its Roles and Objectives 20 Minutes
Session Two
Planning Outreach for IDUs 10:30am - 1:00pm 2.5 Hours
Introduction to Rationale and Objectives
of Outreach Planning 30 Minutes
Small Group Work 60 Minutes
Group Presentations and Discussion 60 Minutes
Lunch Break 1 Hour
Session Three
Conducting Outreach for IDUs 2:00pm - 3:30pm 2 Hours
Group Work - Role Play 1 Hour
Presentation and Discussion 1 Hour
Session Four
Roles and Responsibilities of
Peer Educators and Outreach Workers 3:45pm - 5:15pm 1.5 Hours
Introduction to Qualities of a PE and ORW 15 Minutes
Brainstorming and Discussion 15 Minutes
Situation Card Exercise and Discussion 60 Minutes
Wrap Up & Evaluation of Day Two 5:15pm - 5:30pm 15 Minutes
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Day 2
PRINCIPLES OF OUTREACH
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SESSION 1:
Objective
To provide participants with an understanding of outreach, its rationale and the critical objectives of
outreach.
Expected Outcome
Participants have increased knowledge of specific characteristics of outreach and principles of outreach
for HIV prevention among IDUs.
Duration
1/2 hour
Energizer, presentation and discussion
Power Point presentation, flip charts, marker pens.
“Outreach is a systematic approach to

delivering HIV prevention services to people
injecting drugs in their environments. ”
Process
The facilitator uses the Power Point presentation to The facilitator highlights the importance of
walk participants through the definition of outreach planning in outreach.
and to discuss its rationale and objectives.
Participants are asked to brainstorm about the critical

components of outreach work and its principles.
Participants discuss the importance of outreach in

preventing the transmission of HIV among IDU and
their sexual partners.
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Day 2
PRINCIPLES OF OUTREACH
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SESSION 1:
Energizer:
Who are you?
Ask for a volunteer to leave the room. While the volunteer is away, the rest of the participants decide on
an occupation for him/her, such as a doctor, or a counsellor. When the volunteer returns, the rest of the
participants mime activities. The volunteer must guess the occupation that has been chosen for him/her
from the activities that are mimed.
Key Learning
The facilitator uses the Power Point presentation should also be consistent and adequate to
given in the supplementary manual to emphasise be effective.
the following key learning points.
The approach to outreach is that women
Outreach is an approach for contacting drug users
outreach workers and peers should reach
in their local neighbourhoods and providing them
out to female IDUs and the female sexual
with education, advice, information (risk reduction
partners of male IDUs, and male outreach
counselling), testing and counselling and the means
workers to male IDUs.
(skills and/or products such as needles, syringes,
condoms, sexually transmitted infections treatment)
Outreach to IDUs and their regular sexual
to change their risk behaviours related to injecting
partners is done with the prime objective
drug use and sex.
of preventing the transmission of HIV and
other blood-borne viruses by reducing
Drug users are often hidden and stigmatised, and
needle sharing and sexual risk behaviours.
therefore, difficult to reach. Outreach services are
usually more successful in finding and contacting
Outreach work must involve detailed
IDUs at places where they live, work, buy, sell and
outreach planning to be effective (see next
use drugs.
session).
Outreach is commonly linked to (or part of) other

programmes such as NSEPs, OST and other forms
of drug treatment, and health and social services.
Outreach work involves building rapport with IDUs,

so as to ensure their full participation. Outreach
22
Day 2
PLANNING OUTREACH FOR IDUs
N AC O
SESSION 2:
Objective Key Learning

To provide participants with practical knowledge of The facilitator uses the Power Point presentation
planning outreach in IDUs. given in the supplementary manual to emphasise
Expected Outcome the following key learning points.
Participants have increased knowledge about planning
outreach for HIV prevention among IDUs. Planning is vital to effective outreach
Duration programmes.
2.5 hours
Suggested Teaching Method Outreach planning is the process of using
Presentation, small group work and discussion various tools to facilitate individual-level
Materials/Preparation required planning and follow up of service uptake,
Power Point presentation, flip charts, marker pens. based on individual risk and vulnerability
profiles of IDUs.
Process
The facilitator uses the Power Point presentation to Outreach planning helps to understand the
walk participants through the rationale and reach of general and programme services (if
objectives of outreach planning. started) for IDUs and to identify and monitor
the relevant product and service gaps.
The six basic steps in the outreach planning process
are explained to participants. Outreach planning is useful to identify and
track service access and behaviour
Participants are divided into smaller groups and modification.
asked to undertake an outreach planning process
(following the basic steps in outreach planning, i.e., An effective outreach planning process also
social mapping, spot analysis, contact mapping, enhances participation of IDUs in
risk/vulnerability assessment, work planning and programmes.
individual-level tracking or monitoring).
The outreach planning process involves six
Participants return to the larger group and make key steps, including 1) social mapping, 2)
their presentations. Each group presents its plan spot analysis, 3) contact mapping, 4) risk/
and outlines the steps it considered in the outreach vulnerability assessment, 5) work planning
planning process.
23
Day 2
PLANNING OUTREACH FOR
N AC O
SESSION 2:
IDUs
and 6) individual- level tracking or monitoring.
Social mapping is conducted to establish a dynamic understanding of IDUs for complete coverage
through outreach in a project site, and also various other facilities available nearby.
Spot analysis helps compile information gathered through a situation and needs assessment related to
each high risk spot within the project site.
Contact mapping is used to map contacts with IDUs and their sexual partners in each spot and plan
for outreach based on these contacts.
A risk or vulnerability assessment gathers information along specific risk/ vulnerability parameters
(e.g., types of drugs, frequency of injection, sharing N/S and other equipments, sexual behaviour) of
each IDU in the site.
Using information from the social mapping and risk/vulnerability assessment of IDU, outreach teams
develop week-by-week targets for outreach to IDU in each site. Weekly plans should vary from week
to week depending on the service uptake and outreach patterns. Weekly plans should also tie into
other activities designed to increase IDU engagement as well as service utilisation.
Individual-level tracking and monitoring formats are used to update individual outreach tracking on a
weekly basis. This is useful to identify strategies for outreach/uptake of service delivery that worked
or that still need to be developed.
24
Day 2
CONDUCTING OUTREACH
N AC O
SESSION 3:
FOR IDUs
The facilitator uses the Power Point
Objective
presentation to walk participants through
To provide participants with an understanding of how
the importance of effective outreach in a
to conduct effective outreach in IDUs.
TI programme and some critical steps in
Expected Outcome
conducting outreach.
Participants have increased knowledge of the steps
in conducting effective outreach for TI programmes Key Learning
among IDUs. The facilitator uses the Power Point presentation
Duration given in the supplementary manual to emphasise
2 hours the following key learning points.
Suggested Teaching Method Outreach is the most important activity of
Presentation, small group work, role play and a TI programme.
discussion
Materials/Preparation required The quality of outreach determines the
Power Point presentation, flip charts, marker pens. outcome of the programme.
Process
Constant monitoring and re-planning (of
Participants are asked to divide into three groups. outreach) is required to reflect and address
the changing patterns and needs of IDU.
Participants in group 1 are asked to imagine that
they are managing an outreach programme; A conducive environment is essential for
participants in group 2 are asked to imagine that effective delivery of services and to assist
they are the IDU community and participants in IDUs to access available services without
group 3 are asked to imagine that they are the fear of stigma.
general community.
Building trust within the IDU and general
Each of the groups brainstorms about the barriers community is essential for effective
to outreach. One representative from each of the outreach.
groups comes forward to role play. The team
managing the outreach programme is confronted Some components of outreach services
with opposition from members of groups 2 and 3. include IPC, BCC, Needle and Syringe
Types of barriers and potential solutions are Exchange Programmes (NSEP) and refer-
discussed.
25
Day 2
CONDUCTING OUTREACH
N AC O
SESSION 3:
for IDUs
rals (please refer to relevant sessions of this curriculum for more information)
An analysis of the barriers to conducting outreach and steps to strengthen service uptake must
be conducted with peers.
Regular, weekly documentation and analysis of outreach should focus on whether all IDUs are
being covered and if they are being covered regularly.
26
Day 2
ROLES AND RESPONSIBILITIES OF PEER
N AC O
SESSION 4:
EDUCATORS AND OUTREACH WORKERS
Objective
To provide participants with an understanding of the qualities and characteristics of a Peer Educator
(PE) and Outreach Worker (ORW).
Expected Outcome
Participants have increased knowledge of the roles and responsibilities of PEs and ORWs and the
process of managing a PE.
Duration
1.5 hours
Presentation, situation card and discussion
Power Point presentation, situation card, flip charts, marker pens.
Process
The facilitator uses the power point presentation to walk participants through the qualities of a PE
and ORW
2 Participants brainstorm about who can be a PE and an ORW. Participants are asked to present valid
reasons and examples
The facilitator uses a situation card (situation card- “Neel faces a challenging situation:- attached) to
explore challenges and strategies faced by ORWs when managing PEs
The facilitator uses the Power Point presentation to walk participants through the roles of ORWs and
PEs and the management of PE
27
Day 2
N AC O
SESSION 4:
Neel faces a challenging situation
Neel, an ORW, finds that of late IDUs in his site have stopped visiting the DIC. Upon enquiring from the
IDU community, he is told that one of the Peer Educators, Dipankar, has been behaving in an arrogant
manner with them and treating them with condescension.
Ask the participants

What are the possible consequences of Dipankar’s attitude and behaviour on the project?
Do Peer Educators and Outreach Workers find themselves in similar situations often? What can
be the underlying cause of such situations?
How can the Peer Educator be helped in the above situation to change the way he behaves?
What are some of the other challenging situations vis-à-vis PEs that call for skillful management
strategies on the part of the Outreach Worker?
Note to trainer
Facilitate a discussion around the dynamics between an Outreach Worker and his team of Peer
Educators in an IDU project.
Generate strategies that may be used in specific situations, for example, conflict between being a
professional health care worker and maintaining peer status, occupational stress, issues
concerning keeping own drug use under check, and such like.
Discuss staff recruitment, training needs assessment, as also options for capacity building both in
terms of on-job learning as also building skills through formal training.
28
Day 2
N AC O
SESSION 4:
Key Learning
The facilitator uses the Power Point presentation given in the supplementary manual to emphasise the
following key learning points.
A PE should remain non-judgmental; exhibit a willingness to work with the community; have strong
facilitation skills; exhibit potential and confidence for leadership; have the strength and ability to
control drug use at work.
Maintaining confidentiality: The outreach team working with IDU should always remember to main-
tain confidentiality, in terms of information that they receive from the communication
An ORW should be non-judgmental; have strong communication, have organizational and record
keeping skills; have the ability to network; have strong commitment to work with the IDU commu-
nity; have respect for IDUs and their partners; view him/herself as an advocate for those at risk; be
flexible in his/her approach to various lifestyles of IDUs
A PE may be a current/ex-user who exhibits the desire to work among peers; is a local resident of
the project area; has a good understanding of the drug use context of the area; has the goodwill of his
peers; has knowledge of the local language
An ORW should ideally be from the drug using community (e.g., an ex-user and/or someone un-
dergoing OST); be a local resident of the project area; know the local language; have basic literary
skills; and possess a cultural and social understanding of the project area and context.
The roles and responsibilities of a PE include initiating contact with peer IDUs/ rapport building and
maintaining contact in a planned manner; sharing information within and between networks; facili-
tating linkages between peers and project staff and services; educating peers on STI and HIV and
harm reduction through one-to-one and one-to-group sessions and delivering harm reduction ser-
vices; teaching peers to negotiate safer sex and practice safe injection; assisting in referrals to ICTC,
DOTS and allied healthcare services.
29
Day 2
N AC O
SESSION 4:
The roles and responsibilities of an ORW include developing project work plans; meeting regularly
with PEs, monitoring, supervising and building capacities of PEs, providing the IDU community
with education on HIV and STI, safer injecting practices and sexual practices, sex, sexuality,
gender, drug overdose and importance of early treatment; ensuring regular and uninterrupted
delivery of harm reduction materials; engaging in behaviour change communication; organizing
advocacy; facilitating group meetings.
A critical role and responsibility of ORWs includes managing PEs. PE management by ORWs
involves understanding common problems faced by PEs, supporting PEs; strengthening capacities
of PEs; mentoring PEs and evaluating the work of PEs through supervision and monitoring.
List of materials to be carried in the field by the PE/ ORW

1. New needles and syringes (N/S) of sizes preferred by the client in the area (may include 1ml,
2ml, or 5ml). The quantity will be based on the microplan estimates
2. Puncture -proof box for carrying used needles/needle-syringes
3. Abscess prevention materials – spirit, swabs
4. Dressing materials for wound management
5. Condom packets
6. Thick rubber gloves (for picking up the N/S lying on the ground)
7. Long forceps/ tongs (for picking up the N/S lying on the ground)
8. PE/ORW record keeping diaries / formats
9. IEC materials on HIV prevention and safe injections provided by the TI
10. Thick colour coded plastic bag for carrying used syringes
11. Referral forms (in triplicate) for ORWs
12. Thick puncture- proof bag to carry all the above materials in the field
30
Day 3
DAY 3
N AC O
Enhancing Communication Skills, Understanding NSEP and Condoms
Session Plan
Recap of Key Learning of Day Two 9:30am - 9:45am 15 Minutes
Session One
Importance of Trust and Confidentiality 9:45am - 10:15am 30 Minutes
Exercise 10 Minutes
Reflection 20 Minutes
Session Two
Behaviour Change Communication 10:30am - 12:30 pm 2 Hours
Introduction to BCC and its Importance 20 Minutes
Small Group Work 40 Minutes
Presentations and Discussion 60 Minutes
Lunch Break 1 Hour
Session Three
Needle and Syringe Exchange Programmes 1:30pm - 3:00pm 1.5 Hours
Introduction to NSEP Concept
and its Operational Aspects 75 Minutes
Needle and Syringe Demonstration 15 Minutes
Session Four
Condoms: Understanding their Importance and 3:15pm - 5:15pm 2 Hours
Correct Usage
Wrap Up & Evaluation of Day 3 5:15pm - 5:30pm 15 Minutes
31
Day 3
IMPORTANCE OF TRUST AND
N AC O
SESSION 1:
CONFIDENTIALITY*
Objective Now ask participants to return the secret
To help participants understand issues of confidentiality to the person who gave it to them and the
when leading IDU projects and to stimulate reflection on pieces of paper may then be destroyed.
aspects such as ethics and sensitivity.
Duration Once participants have relaxed, reassured in
30 minutes the knowledge that no one has to share their
secret, facilitate reflection around the points
given below.
Process
Request participants to sit in a circle and Reflection

explain that this is a serious exercise about
trust. What does the game tell us about
confidentiality in our work in IDU projects?
Ask participants to think of a secret which they
would not want anyone else to know. What kinds of things might people share that
we must keep confidential?
Request them to write it on a piece of paper,
fold it and not show it to anyone. What are the likely consequences of breach
of confidentiality?
Now ask participants to pass this piece of paper
to the person on the left. What other aspects assume importance when
working with vulnerable populations?
Ask them how it feels to have their secret in
someone else’s possession. And, how it feels to
have someone else’s secret in their possession!
*Adapted from ‘Tools Together Now!’- International HIV/AIDS Alliance-Frontiers

Prevention Project
32
Day 3
BEHAVIOUR CHANGE
N AC O
SESSION 2:
COMMUNICATION
Objective In order that Injecting Drug Users move
To provide participants with an understanding of the from harmful practices to safer and less
key objectives of Behaviour Change Communication
risky behaviour, it is important that they are
(BCC) and its importance in HIV prevention among
IDUs. equipped with information and knowledge
Expected Outcome that will help them make the right choices.
Participants have an understanding of effective BCC
strategies and how a change in IDU communities’
However, experience in public health has
knowledge, attitude and environment will contribute
to behaviour change. shown that the mere provision of informa-
Duration tion does not automatically result in ac-
2 hours tion arising from that information; in other
words, individuals do not change their
Presentation, group work and discussion
Materials/Preparation required behaviour merely upon receiving correct
Power Point presentation, flip charts, marker pens. and complete information.
Process For behaviour change to happen, it is es-

The facilitator uses the Power Point presentation to sential that individuals receive appropriate
walk participants through the key objectives of BCC information, and beyond that, recognize
and its importance in HIV prevention among IDUs. the value of that information, its relevance
to their situation, acknowledge the benefits
Participants are asked to break into small groups. that would arise by acting on the informa-
Each group is asked to develop sensitive tion, and above all, feel equipped with the
messaging on one of the following IDU topics: a) skills to act on the information. It is also
needle sharing, b) drug overdose, c) abscess recognized that environmental factors must
management, and d) benefits of accessing services. be supportive of the behaviour change for
it to take place, and for the change to be
Participants return to the group and make their consistent over time.
presentations.
If the above is applied to the IDU context,
then the objectives of a behaviour change
Key Learning
communication strategy would broadly
The facilitator uses the power point presentation given in
be to provide information and education
the supplementary manual to emphasise the following key
for example on drug-related harms, on the
learning points.
33
Day 3
BEHAVIOUR CHANGE
N AC O
SESSION 2:
COMMUNICA TION
ways to reduce harms including safer injecting practices such as NSEP, on safer sex options, on
services available, and ways to prevent and manage abscesses. Beyond the information provi-
sion component, the BCC strategy would seek to then motivate IDUs to act on the information
received, and also to build their capacity to do so, for example by equipping them with the neces-
sary skills for correct condom usage and safer injecting practices. Further, a comprehensive BCC
strategy would also encompass a component of advocacy among key stakeholders in order that
a supportive environment exists for behaviour to change, and would include a communication
skills building exercise for the service providers too, enhancing their skills in inter personal com-
munication and in the use of effective strategies to encourage behaviour change.
Behaviour change is a process, and takes place over a period of time. While the final outcome of
the process would be a positive change in behaviour resulting in risk reduction, there would be
many ways of monitoring interim changes that would be indicative of whether the change process
is in the desired direction. For example, indicators that projects could use can include:
- Are IDUs seeking more information on harm reduction?
- Is there an increase in knowledge among IDUs on modes of transmission?
- Is there an increased perception of personal risk?
- Have IDUs started accessing services / seeking information on services?
- Are service providers at all levels empathetic in their attitude towards IDUs? (an indicator of
BCC interventions aimed towards creating a supportive environment)
Effective BCC goes beyond messages to include a two-way dialogue and to encompass both so-
cial mobilization and advocacy efforts. While it makes use of media materials and inter personal
communication skills, it is thus a broader concept that seeks to work on all fronts- the individual,
the family and society he lives in, and the service providers who are instrumental in generating a
demand for services by ensuring that they are accepted by their clients and are seen to be avail-
able and accessible.
34
Day 3
NEEDLE AND SYRINGE
N AC O
SESSION 3:
EXCHANGE PROGRAMMES (NSEP)
Objective Process
To provide participants with an understanding of the The facilitator uses the Power Point
key objectives of Needle and Syringe Exchange presentation to walk participants through
Programmes (NSEP) and their importance in HIV the concept of NSEP and its key
prevention among IDUs. operational aspects.
Expected Outcome
Participants have an understanding of the primary Participants conduct a needle and syringe
purpose of NSEP and its key operational aspects. demonstration.
Duration
1.5 hours Participants are asked to break into two
Suggested Teaching Method groups. One group is asked to
Presentation, needle and syringe use exercise and demonstrate needle/syringe collection and
discussion the other needle/syringe disposal. Each
Materials/Preparation required group is asked to brainstorm about the
Power Point presentation, needles and syringes, tongs, precautions needed in collecting and
needle and syringe disposal container, labels, tape, flip disposing needles and syringes
charts, marker pens. respectively.
“thatTheevery
goal of NSEP is to ensure
injecting act is covered
Participants return to the larger group and
make their presentations.
with a safe needle/syringe ”

COMMODITIES DISTRIBUTED BY NEEDLE
AND SYRINGE PROGRAMMES
1. Needles: 24”, 26”
2. Syringes: 1ml, 2ml, 5ml, 10ml
3. Other equipment: filter, cooker, tourniquet (where budget permits)
4. Need based IEC
5. Alcohol/ spirit swabs (to prevent abscesses)
6. Swabs, bandages, etc (to manage abscesses)
7. Condoms
8. Distilled Water
35
Day 3
NEEDLE AND SYRINGE
N AC O
SESSION 3:
Needle and Syringe Use Exercise

This exercise is designed to assist participants in becoming familiar with handling needles and
syringes and with drug-related HIV transmission risks.
All participants are provided with needles, syringes and injecting equipment and are shown
how to advise IDUs on safer injection technique. The exercise demonstrates that:
HIV contamination is possible at several points in drug preparation and injecting.
Used needles returning to a common spoon or other drug container can result in the contami-
nation of containers with HIV/BBV (even if the same person has kept his or her own needle
and syringe)
A needle or syringe used by someone else can transmit HIV/BBV. Remember to note that,
where a separate needle or syringe are used, HIV can be transmitted via sharing either the
needle or the syringe
Sharing a filter or spoon can result in HIV/BBV contamination and transmission
Injecting—even with all the right equipment—in a public place, where a lot of injecting
occurs, tends to be done hastily, which increases the likelihood of mistakes and HIV
contamination and transmission.
In real-life situations, IDUs often need to negotiate the difficulty of sharing various materials.
Again, this often has to be done quickly, enhancing the chance of health risks such as HIV
transmission.
36
Day 3
NEEDLE AND SYRINGE
N AC O
SESSION 3:
Key Learning
The facilitator uses the Power Point presentation given in the supplementary manual to emphasise
NSEP is a key component of harm reduction under NACP III.
Sharing of injecting equipment places IDUs at high risk of contracting blood-borne viruses such as
HIV, Hepatitis B and C.
The goal of NSEP is to ensure that every injecting act is covered with a safe needle/syringe.
In addition, education and information on safer injecting practices to help prevent transmission of
HIV and minimise the potential health consequences of injecting is offered.
The key objective of NSEP is to facilitate safe injecting practices by providing new N/S, safe
disposal points and education and information on safer injecting practices.
The following materials should be available with the TI for ensuring that disposal of sharp wastes is proper:
puncture proof boxes - serially numbered, marked with biohazard symbol; thick colour coded plastic bags -
marked with biohazard symbol; thick rubber gloves; tongs/ large forceps; plastic bin with sieve; plastic bin
without sieve; disinfectant solution - sodium hypochlorite, bleach; large plastic bins (translucent white or
blue coloured); hub Cutter for mutilating disinfected syringes, if syringes are disposed off by burial on-site1
To be operationally effective NSEPs need to be available when and where IDUs most need the service.
The basic components of NSEP include distribution, collection, disposal and information on safer
injecting practices
NSEPs face major resistance from the general community and require significant advocacy to be effective.
NSEPs not only provide a safe method of injecting, but also an entry point into the IDU community.
1
Refer participants to “Guidelines on safe disposal of Used Needles and Syringes in the Context of Targeted Intervention for Injecting Drug Users”
37
in the supplementary manual.
Day 3
Condoms: Understanding their
N AC O
SESSION 4:
importance and correct usage
Objective
To help participants understand the importance of
communicating on condom usage and to enable them
to acquire skills in demonstrating correct usage.
Expected Outcome
Participants understand barriers to condom use and
ways to overcome them through communication and
how to conduct a condom demonstration.
Duration
2 hours
Group work, Condom demonstration and Discussion
Condom demonstration models, flip charts, marker
pens, handouts
Process
The facilitator introduces what a condom is, and discusses the benefits of its usage.
Participants are then divided into three groups. One group deliberates on the myths and
misconceptions surrounding condom usage, the second on the barriers to usage, and the third on the
key messages to be communicated on condom usage to injecting drug users.
The groups come up and take turns to present their work to the larger audience of participants.
After this, the facilitator conducts a condom demonstration using the penis model available (if there is
no model, s/he can refer to the pictures provided in the handout to explain the same).
Finally, participants take turns using the penis model to conduct a condom demonstration and are
provided feedback on how they may improve their skills in communicating on the same. The handouts
on correct condom usage and disposal are distributed.
38
Day 3
Condoms: Understanding their
N AC O
SESSION 4:
importance and correct usage
Key Learnings
A condom is a rubber sheath that is used on the erect penis, before any sexual contact is made. After
ejaculation, semen is collected in the tip of the condom.
A condom acts as a barrier preventing the contact between infective secretions (semen or genital
fluids, vaginal fluids) and the mucus membrane of the vagina, anus, glans, penis or urethra.
Thus, condoms prevent transmission of STI/HIV infection. They also act as contraceptives by the
same mechanism.
There are several barriers to condom usage. They are sometimes not easily available or accessible.
Also, a person who buys and asks for condoms is looked upon with suspicion and stigma that he could
be indulging in high-risk behaviour. Most important, there is lack of knowledge on the correct use of
condoms and the existence of several myths and misconceptions related to condoms.
Myths include ‘using a condom is not manly’, ‘women do not like it’, ‘condoms are sticky and oily’,
‘condoms are reusable’, ‘they tear during intercourse’, and others.
It’s important to explain to Injecting Drug Users the importance of correct and consistent usage of
condoms. Also, it’s important to communicate that sometimes, under the influence of a drug, a person
can forget to use a condom, or may not be able to use one correctly, thereby increasing the risk of
transmission of sexually transmitted infections including HIV/AIDS.
39
Day 4
DAY 4
N AC O
Operationalising Outreach
Session Plan
Recap of Key Learning 9:30am - 10:00am 30 Minutes
of Day Three
Session One
Drop-in-Centres 10:00am - 12:00pm 2 Hours
PowerPoint presentation 30 Minutes
Energizer 15 Minutes
Situation Cards and Discussion 75 Minutes
Session Two
Referral and Networking 12:15pm - 1:15pm 1 Hour
Introductions to Referral and Networking 15 Minutes
Brainstorming 45 Minutes
Lunch Break 1 Hour
Session Two (Continued)
Situation Card and Discussion 2:15pm - 3:15pm 1 Hour
Session Three
Abscess Prevention and Management 3:15pm - 4:45pm 1.5 Hours
Introduction to Abscess Prevention and Management 30 Minutes
Body Mapping 30 Minutes
Short Clip Presentation, Discussion and SPYM film 30 Minutes
Wrap Up & Evaluation of Day Four 5:00pm - 5:15pm 15 Minutes
40
Day 4
DROP-IN-CENTRES (DIC)
N AC O
SESSION 1:
Objective
To provide participants with an understanding of the
need for and operation of a DIC.
Expected Outcome
“IDUs
A DIC is a doorway for
and their sexual part-
Participants have increased knowledge of objectives of ner/s to a welcoming and
a DIC and the specific processes and rules of running caring environment. It is a
a DIC. hub for all services which
Duration an IDU can access as per
his/her need and conve-
”
2 hours
Suggested Teaching Method nience.
Energizer, presentation, situation cards and discussion
Power Point presentation, situation cards, flip charts,
marker pens.
SWITCHING CHAIRS ENERGIZER

Set up chairs beforehand in a circle or square around the walls of the room. Allocate roles to each person
going round the circle—“PLHA, IDU, Partner of IDU.” Continue until everyone has been assigned a role.
Then explain how the game works. The trainer is the caller and does not have a chair. When the trainer
calls out two roles, “PLHA” and “IDU,” all the “PLHA” and “IDU” have to stand up and run to find a new
chair. The trainer will try to grab a chair. The person left without a chair becomes the caller - and the game
continues. The caller may also shout “revolution”—and when this happens, everyone has to stand up and
run to find a new chair. Then shout: “PLHA and IDU” and get the “PLHA” and “IDU” to run to a new
chair. This starts the game.
Debriefing
Ask: “How did it feel to be called a PLHA or IDU?”
Participants reflect on the need for sensitivity and respect as well as confidentiality and informed consent
when working with vulnerable communities.
41
Day 4
N AC O
SESSION 1:
Process
The facilitator uses the Power Point presentation to walk participants through the concept and objec-
tives of a DIC.
The facilitator uses situation cards (situation cards attached) to explore the benefits of a DIC from
the outreach programme and IDU perspectives. The situations are used to brainstorm about the basic
rules (e.g., do’s and don’ts) and requirements (e.g., location, infrastructure) of setting up and
operating a DIC. Participants are divided into two groups. One group is exposed to “Sunil handles an
angry crowd”. The facilitator gives the first group a set of questions to discuss depicted in Situation
Card “Sunil handles an angry crowd”. The second group is exposed to “Ricky tries to reach out”. The
facilitator gives the second group a set of questions to discuss depicted in Situation Card “Ricky tries
to reach out”. Questions to be asked and the tips to the trainer facilitating the session are printed on
the reverse of each card to facilitate ease of usage by the trainer.
The facilitator sums up the discussion by highlighting the importance of the location of a DIC,
processes and rules at a DIC, services provided at a DIC and DIC staff and their roles.
42
Day 4
N AC O
SESSION 1:
Sunil handles an angry crowd
Sunil, an ORW working with an IDU project comes to work to find that an agitated crowd has gathered
to protest against the opening of a DIC in their locality. They fear that crime in the neighbourhood will
increase. Sunil knows that the DIC is very important for his project and it must be opened in this locality.

Why does Sunil think that the DIC is important for the IDU project?
What are some of the fears that the community can have with regard to setting up a DIC?
Is it important to gain the acceptance of the community?
What can Sunil tell the agitated people to help them understand the need for the DIC?
Could such a situation possibly have been avoided? If so, how?
Note to Trainer
Discuss how the DIC adds value to an outreach project.
Brainstorm with the participants on the ideal location of a DIC.
Discuss how these concerns can be addressed and emphasise the value of advocacy efforts in IDU
projects.
43
Day 4
N AC O
SESSION 1:
Ricky tries to reach out
Moina has been injecting drugs for the past 3 years. Ricky, a PE working with an IDU project has been
trying to convince Moina to come to the DIC with him, but Moina seems hesitant to do so. This is
Ricky’s second meeting with him!

Why do you think Moina is hesitant to come to the DIC?
How can Ricky convince him?
What would be some of the services that Moina could avail of at the DIC?
Besides Moina, who else can visit the DIC?
Note to Trainer
Help participants generate strategies for motivation and persuasion.
Ask participants to enumerate the various DIC services (recreation/rest, access to condoms, STI
management, counselling, group discussions, referrals etc).
Stress the basic rules of confidentiality and informed consent at the DIC.
Discuss the various points of referral as well as who can access the DIC (IDUs, partners of IDUs,
family members of IDUs, general community).
44
Day 4
N AC O
SESSION 1:
Key Learning
The key objective of a DIC is to provide services through user-friendly centres/clinics, which are
geographically accessible to IDUs.
All the services that IDUs require cannot be provided by outreach alone. Thus, DICs serve to
meet the unmet needs of IDUs.
DICs are also useful venues for service providers to address their clients (IDUs and partners) as a
group.
DICs are a safe space where IDUs can come together and find a ‘common voice’.
The following important steps should be followed before choosing a location for DIC; mapping
of IDUs and hotspots; mapping of services and referrals; consideration of feasibility and
budgetary issues; opinion of IDUs through group discussions; opinion of the general community
residing nearby.
A DIC should be located where - IDUs reside; IDUs congregate; IDUs find it easy to access the
DIC; IDUs do not face discrimination and/or stigmatisation; IDUs can enter freely without any
fear of the surroundings.
DICs provide various products and services, including outreach, NSEP, IEC dissemination,
psychosocial support, ulcer/abscess management, STI treatment, condom programming, referrals
and recreation/rest facilities.
Basic requirements of a DIC include a recreation room, counselling room, treatment room, a
toilet and a kitchen.
45
Day 4
N AC O
SESSION 1:
DICs may be accessed by IDUs, spouses/sexual partners of IDUs; family members of IDUs; general
community.
Some basic rules of DIC include no drug use on the premises; no drug dealing on the premises; no
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
The DIC can also serve as a place for community mobilisation.
46
Day 4
REFERRAL AND NETWORKING
N AC O
SESSION 2:
Process
Objective
To provide participants with an understanding of the
presentation to walk participants through
objectives of establishing referrals/networking and the
the rationale for networking and the key
process of building linkages by outreach programmes.
steps in the process of setting up a referral
Expected Outcome
network for outreach programmes.
Participants have increased knowledge of the
importance of linking services to address the multiple
Participants are asked to conduct a
needs of IDUs and steps needed to set up a referral
brainstorming exercise. In this exercise,
network for outreach programmes.
participants place themselves “in the
Duration
shoes” of an IDU at the local level. How
2 hours
does the day begin? What needs to be
done? How will the IDU accomplish what
Presentation, brainstorming, situation card and
needs to be done? What kinds of problems
discussion
does the IDU face? Then participants list
the types of assistance an IDU might need.
Power Point presentation, situation card, flip charts,
After these lists are completed, a
marker pens.
discussion is held about the wide range of
“useful
needs of IDUs in their localities and the
Referrals and networking are inability of an outreach programme by
to ensure that IDUs and itself to meet all those needs. Participants
their sexual partners have access then list agencies in their locality that can
to the existing medical, social meet the needs, like food and job. These
support and legal services.
” are the first steps in creating a referral
database.
47
Day 4
N AC O
SESSION 2:
The facilitator then uses a situation card (situation card - “Rajesh comes to Sumon’s help” -
attached) to explore - services that an IDU who is positive is likely to need; a potential referral
and networking plan; steps that need to be followed for referrals, including a follow-up plan.
Questions to be asked and the tips to the trainer facilitating the session are printed on the reverse
of the card to facilitate ease of usage by the trainer.
The facilitator sums up the discussion by highlighting the steps in networking and importance of
establishing a system of referrals.
48
Day 4
N AC O
SESSION 2:
Rajesh comes to Sumon’s help
Sumon, an IDU who is HIV+, has received the results of his latest CD4 test. He shows the report to Rajesh,
the Outreach Worker whom he knows well. Rajesh is worried as he finds that the CD4 count appears to be
quite low. Rajesh consults Manoj, his Programme Manager on what to do next.

What kind of services will Sumon now need that Rajesh could help him access?
What specific steps would Rajesh need to take to ensure that Sumon receives the appropriate
services?
What are some of the challenges Sumon may face while trying to access services? How can Rajesh
help him face these?
What role can Manoj, the Programme Manager, play in this situation?
Note to Trainer
Discuss services that an IDU who is positive is likely to need including ART, nutrition-related
advice, shelter and such like.
Explore how a referral and networking plan may be devised by an IDU project.
List all potential organisations with which an IDU project could network.
Discuss the steps that need to be followed for referrals, including follow-up.
49
Day 4
N AC O
SESSION 2:
Key Learning
The key objectives of referrals and networking are to ensure that IDUs and their sexual partners
have access to the existing medical, psycho social support and legal services.
A number of unmet needs of IDUs can be met through effective referral networks.
Networks strengthen and build linkages among all key stakeholders.
Networks provide access to health care services over and above those offered by TIs for IDUs.
Gaps in services can be gradually filled through collaborative work and strengthened networks.
Referral networks are needed for effective prevention of HIV and other infections.
Steps in networking include mapping healthcare providers, services or facilities and actors that
affect the enabling environment; interacting with identified services to inform them about TI
activities; advocating for making the service available to IDUs and partners; and establishing a
system of referrals.
Networking with agencies that either obstruct or assist the TI implementation should be carried out
regularly.
Potential entities for networking, include health care providers (ICTCs, ART, DOTs providers); non-
health services and facilities (charities that provide food, clothes, shelter, Government centres running
various schemes; agencies implementing income generation programmes); actors that affect enabling
environment (police, narcotics control bureau); general community; influential persons; religious
groups; pressure groups; legal aid; and other forums and network (e-groups, forums, networks).
Analysis of referrals and networks should be conducted regularly.
50
Day 4
ABSCESS PREVENTION AND
N AC O
SESSION 3:
MANAGEMENT
Objective injecting (e.g., identifying the difference
To provide participants with an understanding of how between veins and arteries and the risks
abscesses form and the various stages of abscess levels of injecting into different areas of
development. the body).
Expected Outcome
Participants have increased knowledge of basic The facilitator shows the short clip on
preventive measures as well as techniques of Abscess Prevention and Management
management and care for abscesses. [prepared by Society for the Promotion of
Duration Youth and Masses (SPYM), Delhi.]. The
1.5 hours facilitator should pause the film in the 8th
Suggested Teaching Method minute. The rest of the film will be shown
Presentation, body mapping, audio visual viewing and when dealing with the topic of OST. This
discussion is followed by discussion on the issues
Materials/Preparation required addressed in the film.
Power Point presentation, SPYM film, flip charts,
marker pens. Key Learning
Process given in the supplementary manual to emphasise
to walk participants through the process of abscess Abscesses may result from injecting
formation and the stages of abscess development. non-soluble substances, bacteria
contaminating the site of the injection
Participants discuss the aims of abscess care and and/or from dead tissue at the site of the
techniques of management of complications. injection.
The facilitator asks one participant to volunteer to Preventive measures include

draw a sketch of a body. Participants map the sites educating clients about safe injecting
that are safe to inject and those to avoid during methods, proper injecting techniques and
injecting. care in selection of injecting sites.
The facilitator uses the Power Point presentation to The aims of abscess care are to prevent
guide a discussion around proper techniques of increase in abscess size and
51
Day 4
complications. This is done through provision of early treatment to heal the abscess as quickly as
N AC O
possible, provide appropriate pain relief and to refer complicated cases for early medical treat-
ment.
Management for abscesses requires timely identification, treatment and reporting of complications.
52
Day 5
DAY 5
N AC O
Advocacy, Community Mobilisation and OST
Session Plan
Recap of Key Learning of Day Four 9:30am - 9:45am 15 Minutes
Session One
Advocacy 9:45am - 11:45am 2 Hours
Introduction to Advocacy 15 Minutes
Situation Card Exercise 90 Minutes
Discussion 15 Minutes
Tea/Coffee Break 11:45am - 12:00pm 15 Minutes
Session Two
Community Mobilisation 12:00pm - 1:45pm 1.45 Hours
Introduction to Community Mobilisation 15 Minutes
Group Work 90 Minutes
Lunch Break 1:45pm - 2:45pm 1 Hour
Session Two (Continued)
Presentations and Discussion 2:45pm - 3:30pm 45 Minutes
Session Three
Oral Substitution Therapy (OST) 3:30pm - 5:30pm 2 Hours
Introduction to OST 15 Minutes
Group Work 60 Minutes
Presentation 15 Minutes
Short Clip Presentation and Discussion 30 Minutes
Wrap Up & Evaluation of Day Five 5:45pm - 6:00pm 15 Minutes
53
Day 5
SESSION 1: ADVOCACY
N AC O
Participants are divided into 3 groups. Each
Objective
group is given one of the following three key
To provide participants with an understanding of what
audiences - media, healthcare providers and
advocacy is, the benefits of advocacy in an IDU context
community leaders – to discuss advocacy
and how to develop an advocacy strategy.
for. For each audience, the groups need to
Expected Outcome
work out an advocacy matrix indicating the
Participants have increased knowledge of the need for
key issues for advocacy, the messages to be
and the role of advocacy as well as the critical steps in
communicated, the methods for advocacy
conducting advocacy with stakeholders.
and the indicators they would propose to
Duration
monitor the advocacy outcomes.
2 hours
Participants return to the larger group and
Presentation, small group work and discussion
make their presentations. Feedback is
invited from all participants.

presentation to discuss the importance of an
“Advocacy ultimately raises issues advocacy strategy.
and forces the community to
change the way they think
about and behave with IDUs. ”
Process
The facilitator uses the Power Point presentation to

walk participants through the definition of advocacy
and the need for advocacy in the IDU context.
The facilitator uses the situation card (situation card

- “Bikas seeks Maya’s support” - attached) to
generate a discussion around the kinds of challenges
faced by IDUs, i.e., in the context of obtaining
support from law enforcement agencies.
54
Day 5
SESSION 1: ADVOCACY
N AC O
Bikas seeks Maya’s support
Bikas has come to meet Maya, a counsellor with the IDU project. Yesterday, for the third time in recent
months, Bikas was rounded up by the local constable when he was caught exchanging a needle-syringe.
Maya has spoken to several other IDUs in her project area who are facing the same problem.

Why do you think Bikas and the other IDUs face this problem? Is this a common problem that
they encounter?
What can Maya do to help Bikas and the others?
Besides the local police, are there other groups whom the project may need to address in its
advocacy efforts? Who would these be and why would it be important to address them?
Note to Trainer
Discuss the various problems faced by IDUs and the underlying causes for the same.
Generate a discussion on the various steps to be taken for advocacy efforts (analysis, strategy,
action/reaction, evaluation).
List the key target audiences for this situation as also other audiences that must be addressed
under a comprehensive advocacy plan for IDUs.
55
Day 5
SESSION 1: ADVOCACY
N AC O
Key Learning
Advocacy is the process of seeking support from allies, groups, networks and stakeholders to influence
decision making and adopt effective approaches to meet the needs of IDUs and their sexual partners.
Advocacy is the key to an enabling environment for IDUs to access available HIV prevention and
related services.
Advocacy helps programme staff to implement their projects without interference and risks from
groups.
Regular advocacy in a project helps reduce stigma and discrimination.
Advocacy is successful if it is planned and executed with active involvement of the IDU
community.
The success of advocacy depends upon the careful execution of the steps in the process of
advocacy.
The key steps in the process of advocacy include conducting analysis of the situation, developing an
advocacy strategy, undertaking action to achieve advocacy goals and regular monitoring and
evaluation to assess the outcome of advocacy.
An effective advocacy strategy must clearly identify specific target audiences.
56
Day 5
SESSION 2: COMMUNITY MOBILISATION
N AC O
Objective
To provide participants with an understanding of what community mobilisation is and why it is
important.
Expected Outcome
Participants have increased knowledge of community mobilisation, its opportunities, challenges
and processes.
Duration
2.5 hours
Presentation, small group work and discussion
Process
The facilitator uses the Power Point presentation to walk participants through a definition of
community and community mobilisation and to highlight ‘levels of community participation’ in
programme practices.
Participants are divided into 2 groups. Group 1 is asked to discuss and analyse “levels of partici-
pation” in their projects and identify opportunities for stepping up participation and mobilisation.
Group 2 is asked to work on developing steps in mobilisation and to identify challenges likely to
be encountered at each step.
Participants return and present their work. Discussion takes place in the larger group.
The Power Point presentation is used to highlight the key steps used to formalise a support
group/IDU collective and its challenges.
57
Day 5
SESSION 2: COMMUNITY MOBILISATION
N AC O
Key Learning
Community mobilisation is the process of consulting with community, giving the community a role
in decision making and management of programmes, and building capacity of communities to
assume ownership of programmes.
Community mobilisation improves the quality of TI programmes by strengthening the collective

bargaining power of community.
NACP III lays emphasis on community mobilisation, enabling community leadership

development and community self-organising under TIs with all high risk groups, including IDU.
Mobilising communities ensures the sustainability of interventions by creating community ownership

of interventions.
The community mobilisation process provides the community with an opportunity to

participate in collective decision making on various issues that affect the community through the
establishment of successful democratic processes.
Community mobilisation should provide every community member an opportunity to become a

leader or representative in organisations/forums.
Processes of community mobilisation and ownership building with IDUs should lead to
collectivisation and establishment of community based organisations.
A number of issues unique to IDUs (e.g., the overwhelming need for drugs, stigma attached to IDUs,
low esteem of IDUs) present challenges in formalising the community’s role in the project
management structure.
58
Day 5
ORAL SUBSTITUTION
N AC O
SESSION 3:
THERAPY (OST)
NACP III.
Objective
To provide participants with an understanding of why
The facilitator and participants debunk myths
OST is required and the OST programme under
about substitution treatment.
NACP III.
Expected Outcome The facilitator resumes the SPYM film for the
Participants have increased knowledge of OST, its 8th minute onwards. The two topics covered
benefits and guiding principles of OST programmes are ‘Overdose Management’ and ‘OST’.
under NACP III. This is followed by discussion on the issues
Duration addressed in the film.
2 hours
Suggested Teaching Method Key Learning
Presentation, small group work and discussion The facilitator uses the Power Point presentation
Materials/Preparation required given in the supplementary manual to
Power Point presentation, flip charts, marker pens. emphasise the following key learning points.
Process The key objective of OST is to improve the

The facilitator uses the Power Point presentation quality of life of IDUs by stabilising them
to walk participants through what OST is and and transitioning them from the injecting
why it is required. mode of drug administration to
non-injecting, thus preventing HIV and
Participants are asked to break into three groups. other blood-borne viruses.
Group 1 brainstorms about the benefits of OST
from the medical perspective. Group 2 OST is a well accepted strategy for HIV
brainstorms about the benefits of OST from the prevention under the harm reduction
IDU perspective. Group 3 brainstorms about the
framework (Tier 2, please refer to the Harm
benefits of OST from a societal perspective (e.g.,
Reduction session).
family, friends, employers, colleagues).
OST helps individuals avoid injecting and

Participants return to the larger group and present
benefits them through improved health,
their work.
better relationships, psychosocial
The Power Point presentation is used to discuss rehabilitation and increased employment
the guidelines, criteria and process of OST under opportunities and higher productivity.
59
Day 5
ORAL SUBSTITUTION
N AC O
SESSION 3:
THERAPY (OST)
OST is regulated under the Narcotics Drugs and Psychotropic Substances (NDPS) Act and can be
dispensed only in approved centres.
Eligibility criteria for admission to OST under NACP III, includes a) diagnosed case of opioid
dependence with injecting drug, b) age over 18 years, c) failed detoxification and d) willingness to
provide informed consent for OST.
OST is a medical intervention and requires medical assessment and ongoing medical supervision.
Steps in administration of OST include induction after history taking and physical examination by
a doctor, administration of medicines by a nurse, daily attendance at clinic for receiving medicine
(also called Daily Observed Treatment – DOT), regular follow-up by doctor and nurse and regular
psychosocial therapy with counsellor.
OST also emphasises psychosocial intervention. Family support enhances retention of IDUs to
treatment and improves their chances of success.
OST treatment continues till the client is stabilised psychologically and socially, stops injecting
drugs and starts working and being productive.
The typical duration of OST is 9 to 12 months (some require more time).

OST is a facility-based programme and should be provided in addition to NSEP, BCC, general
health care, and linkages with centres offering other services to IDU clients, including ART, DOTs,
ICTC etc.
Do ensure that participants complete the feedback form for the day and since this is the last
session for the workshop, ensure that participants complete the feedback
form for the overall workshop.
60
GLOSSARY
N AC O
Acquired Immunodeficiency Syndrome (AIDS)
Antiretroviral Therapy (ART)
Auxiliary Nurse and Midwife (ANM)
Behaviour Change Communications (BCC)
Drop-In Centre (DIC)
Female Sex Worker (FSW)
High Risk Behaviour (HRB)
High-Risk Groups (HRG)
Human Immunodeficiency Virus (HIV)
Injecting Drug Users (IDU)
Integrated Counselling and Testing Centre (ICTC)
Interpersonal Communication (IPC)
Men who have Sex with Men (MSM)
National AIDS Control Programme (NACP)
National AIDS Control Organisation (NACO)
Needle and Syringe Exchange Programme (NSEP)
Oral Substitution Therapy (OST)
Outreach Worker (ORW)
Peer Educator (PE)
People Living with HIV/AIDS (PLHA)
Programme Manager (PM)
Targeted Intervention (TI)
61
N AC O
62
N AC O
63
N AC O
National AIDS Control Organisation

Ministry of Health and Family Welfare
Government of India 6th & 9th Floor,
Chandralok Building, 36, Janpath,
New Delhi - 110001
64

A Manual On Working With Injecting Drug Users - A Trainers Manual

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A Manual on Working with

DAY 1 : Session One: Welcome, Introductions and Sharing Expectations 10-19

DAY 2 : Session One: Principles of Outreach 20-30

DAY 3 : Session One: Importance of Trust and Confidentiality 31-39

DAY 4 : Session One: Drop-In-Centres 40-52

DAY 5 : Session One: Advocacy 53-60

Needle and Syringe Exchange Programmes (NSEP)

Design of the Module

How to Use the Module

Expected Outcome: The outcomes anticipated as a consequence of the session.

Duration: Approximate time each session will take.

Key things to remember as Facilitator:

WELCOME, INTRODUCTIONS AND

Objective Expectations from the Workshop

WELCOME, INTRODUCTIONS AND

Option 2: Space on My Right

Option 3: The Sun is Shining On…

THE IDU PROGRAMME UNDER NACP III

Objective Key Learning

THE IDU PROGRAMME UNDER NACP III

these drugs are referred to, including

There are three main categories of drugs:

The different card papers are arranged on

Objective emphasis of the harm reduction approach

“Outreach is a systematic approach to

Participants are asked to brainstorm about the critical

Participants discuss the importance of outreach in

Outreach is commonly linked to (or part of) other

Outreach work involves building rapport with IDUs,

PLANNING OUTREACH FOR IDUs

Objective Key Learning

PLANNING OUTREACH FOR

and 6) individual- level tracking or monitoring.

ROLES AND RESPONSIBILITIES OF PEER

ROLES AND RESPONSIBILITIES OF PEER

Ask the participants

ROLES AND RESPONSIBILITIES OF PEER

ROLES AND RESPONSIBILITIES OF PEER

List of materials to be carried in the field by the PE/ ORW

IMPORTANCE OF TRUST AND

Request participants to sit in a circle and Reflection

*Adapted from ‘Tools Together Now!’- International HIV/AIDS Alliance-Frontiers

Process For behaviour change to happen, it is es-

NEEDLE AND SYRINGE

with a safe needle/syringe ”

NEEDLE AND SYRINGE

Needle and Syringe Use Exercise

HIV contamination is possible at several points in drug preparation and injecting.

Sharing a filter or spoon can result in HIV/BBV contamination and transmission

NEEDLE AND SYRINGE

NSEP is a key component of harm reduction under NACP III.

Condoms: Understanding their

Condoms: Understanding their

SWITCHING CHAIRS ENERGIZER

Sunil handles an angry crowd

Ask the participants

Ricky tries to reach out

Ask the participants

The DIC can also serve as a place for community mobilisation.

REFERRAL AND NETWORKING

REFERRAL AND NETWORKING