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Programming with injecting drug users: a key entry point to other most-at-risk populations
D. Oraby1, S. Keller1, N. Loza2, S. Atallah2, C. Soliman1
1Family Health International, Cairo, Egypt, 2Befrienders NGO, Cairo, Egypt
Background: The 2006 Egypt Biological and Behavioral Surveillance Survey conducted by the Ministry of Health and Population and Family Health International (FHI) revealed that most-at-risk populations (MARPs) exhibit multiple risk behaviors. Most injecting drug users (IDUs) engage in unprotected sex, and some female sex workers and men who have sex with men inject drugs. In a conservative society, IDUs are less stigmatized than other MARPs, and can be used as a safe entry point for outreach and implementation of targeted interventions.
Methods: FHI selected Befrienders NGO, which has active linkages with IDUs, and focused on building its institutional, programmatic, and technical capacity to provide a comprehensive package of HIV/AIDS prevention and care services for MARPs and people living with HIV/AIDS (PLHA). A comprehensive care center (CCC) was established and linked with street-based outreach conducted by former IDUs. The CCC provides peer education, risk reduction counseling, voluntary counseling and testing (VCT), basic medical care for MARPs and PLHA, needs-based referrals, and distribution of needles/syringes and condoms.
Results: Funded by the Ford Foundation, the project began functioning in July 2008. During the first six months, 251 clients were reached at the street level. Most (79%) visited the CCC, of whom 80% were IDUs; 28% of male visitors were men who have sex with men; and 18% of female visitors were sex workers. The majority of visitors (96%) who accessed VCT were motivated by HIV peer education sessions and the sense of security they perceived in the center. Two HIV-positive clients were identified and offered required services, including referral to antiretroviral therapy.
Conclusions: Involving former IDUs to conduct outreach activities and an NGO linked with IDUs to operate the CCC helped to gain the trust of IDUs, who subsequently served as a bridge to other MARPs.
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