UNMET NEEDS OF IDUS What are the needs of IDUs which cannot be
provided for in outreach alone? Additional Services: Abscess
management, counselling, general health services and so on Rest:
IDUs need a place where they can be away from harassment
Interaction: IDUs need a place where they can interact with each
other & staff freely
Slide 5
NEED FOR DIC All the services for IDUs cannot be provided in
the outreach alone IDUs often need a place where they can rest
peacefully without being harassed / discriminated Service providers
need a place to address their clients (IDUs & partners) as a
group IDUs need a place where they can come together and find a
common voice All these needs can be fulfilled by a DIC
Slide 6
LOCATION OF A DIC A DIC should be located where: IDUs reside
IDUs congregate IDUs find it easy to access IDUs do not face
discrimination and/ or stigmatisation IDUs can enter freely without
any fear of the surroundings
Slide 7
ESTABLISHING A DIC The following steps should be followed
before choosing a location for DIC Mapping of IDUs & hotspots
Mapping of Services and Referrals Consideration of feasibility and
budgetary issues Opinion of the IDUs through group discussions
Opinion of the general community residing nearby
Slide 8
CONTD. The final choice will depend upon: Proximity of proposed
site to: the hotspots, Services and Referrals Acceptability of the
site to the IDU and general community Once a location is chosen on
the basis of the above steps, the TI (NGO) should hold advocacy
meetings with the general community residing around proposed
site
Slide 9
CONTD. Common concerns of general community are normally:
Increase of drug use in the community Thefts in the area owing to
IDUs frequenting the area Initiation of drug use by their children
through direct/ indirect influence of IDUs All the above concerns
should be addressed by the TI staff
Slide 10
REFERRAL PATHWAYS DIC IDUs may reach DIC: Directly Via outreach
contact Via Referrals Forcibly by family members OUTREACH CONTACT
IDU REFERRAL SERVICE
Slide 11
INFRASTRUCTURE AND STOCKS A DIC should have adequate space for:
Recreation / Rest Counselling Treatment / Dressing In addition o A
room for examination of client / sexual partners o Basic amenities
i.e. toilet & kitchen Timings for the DIC should be decided in
consultation with the IDUs
Slide 12
CONTD. Following should be stocked: Needles/syringes Disposal
bins Condoms Abscess prevention & treatment materials IEC
materials Notice on rules and regulations prominently displayed
Confidentiality policy followed in the DIC displayed Essential
furniture Social mapping should be displayed The IDUs may be
actively involved in the day-to-day maintenance of DIC
Slide 13
RECREATION / REST ROOM This will be the Entry room with the
largest space Purpose: For IDUs to spend time For IDUs to rest For
conducting group activities & discussions To attract IDUs,
recreation materials such as carom board, chess, playing cards,
television, video, etc. may be provided For Documentation: A daily
attendance register should be placed at the entrance Record of
consumables bought & used Record of other activities
Slide 14
COUNSELLING ROOM Purpose To provide one to one counselling to
IDUs & family members Referrals Privacy should be maintained
(both audio and video) Counselling should include the following
issues HIV /STI prevention Risk / Harm reduction Pre-post test
counselling Psychosocial counselling Other issues of the
client
Slide 15
EXAMINATION/TREATMENT/DRESSING ROOM Purpose for doctor to
examine, elicit history, treat general medical conditions, etc. for
nurse/doctor to treat abscesses and manage STI If space is
available, there can be a separate room for the doctor and
nurse
Slide 16
CONTD. Materials required in the room: Table and chair for
nurse and doctor Stool for patient to sit Stool for abscess
management Patient examination table Sterilizer Needle crusher
Gloves Cupboard for PEP, OST & STI drugs and other material
Waste disposal container
Slide 17
WHO CAN ACCESS THE DIC? IDUs Spouses/Sexual Partners of IDUs
Family members of IDUs General community may come to seek
information
Slide 18
PROCESSES IN DIC Upon arrival at DIC, the IDU may meet any of
the staff members including ORW, PE, PM, Counsellor, etc Usually if
the client is referred from outreach, the concerned PE or ORW
accompanies the client to the DIC The first contact: Staff at DIC
discuss needs of IDU Services are provided as per identified needs
in active consultation with IDU
Slide 19
CONTD. The IDU is encouraged to visit DIC regularly The dos and
don'ts at the DIC are clearly explained to the IDU Follow-up action
is identified, e.g. referral to hospitals, ICTC, social support,
etc. Follow-up IDU should be made to feel a part of DIC Efforts
should be made to refer maximum number of IDUs to ICTC (HIV
testing) with proper pre-test counselling
Slide 20
CONTD. IDUs should be counselled on harm reduction concept and
principles, safe injection, safe sex, importance of regular access
to NSEP, safe disposal, abscess prevention, what is HIV, Hepatitis
B & C & ways to prevent /acquiring them IDUs should be
involved in group discussions, where above mentioned topics can be
discussed in a group
Slide 21
CONTD. A basic medical history should be elicited by the
counsellor/doctor/nurse Enquire about type of drug and mode and
patterns of use, abstinence attempts in the past, help/treatment
sought earlier Take history of exposure to contaminated blood and
other risk behaviours Glean knowledge and attitude towards diseases
like TB, STIs, HIV/AIDS and Hepatitis B and C
Slide 22
CONTD. Social well-being should be elicited by the counsellor
including but not limited to: Mental health problems Family history
of drug use and family support Legal problems encountered Sexual
behaviour and practices In addition, efforts should be made to
involve general community in DIC through: Advocacy at regular
intervals
Slide 23
CONTD. Observance of important drug/HIV related days Social
activities involving IDU The PM should ensure that: A directory of
services is available for referrals Liaison with hospital and
emergency services to deal with any untoward medical incidents is
established Liaison with local police station officers for enabling
environment is established
Slide 24
SERVICE PROVISION Services at the DIC 1. NSEP 2. Condom
distribution 3. Abscess management (treatment/dressing etc) 4. STI
management (syndromic) 5. Counselling 6. Referrals 7. Group
discussions 8. Recreation/ Rest facilities
Slide 25
HUMAN RESOURCES Staff in DIC Full time Project Manager, Nurse,
ANM, Counsellor and ORW Part time Doctor (min. 3 days per week)
ORWs will take turns to carry out DIC related work One staff member
(PM, Counsellor, or Nurse) must be designated as DIC In-Charge.
(He/she will be responsible for the day-to-day functioning of
DIC)
Slide 26
ROLE OF OUTREACH WORKER & PEER EDUCATORS ORW and PEs play
an important role in bridging the gap between IDU & TI staff
Role/Responsibilities: Making the IDU comfortable in the DIC
Ensuring involvement of IDUs in DIC activities Maintaining rules
& regulations at DIC Conducting group discussions Encouraging
the IDUs to visit DIC and access services
Slide 27
CONTD. Facilitating formation of committees and self support
groups in DIC Ensuring concerns and the voice of the IDUs reach TI
staff (project) Ensuring a respectable environment for IDUs
Participating actively in the advocacy meetings with general
community
Slide 28
BASIC RULES AT DIC 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 Listen to
the whole story
Slide 29
CONCLUSION DIC helps in meeting some of the needs of IDUs and
their partners Establishing & maintaining a DIC requires a
number of steps to be followed DIC service is complementary to
outreach A number of other services including NSEP can be offered
in DIC, which require multi-disciplinary staff DIC can also serve
as a place for community mobilization