An abstract on shooting galleries was posted previously.  Here is more on shooting galleries and CARE in Myanmar. Thanks to the anonymous reader who sent it to the [him] moderator. Check out all the abstracts on APMG's blog http://www.hivinasia.blogspot.com/.

[him] moderator

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Poster 116: Innovative Approaches to Harm Reduction: Shooting Galleries as NSP Site Partners with CARE Myanmar

One of the most interesting posters at ICAAP reported on the co-opting of 'shooting galleries' and their proprietors as NSP site partners and participants in HIV prevention for IDU in Myanmar. Care Myanmar initiated the project in 2003 with support from UNODC. They found that many IDU in Yangon were not self injecting but instead buying drugs and using the service of a shooting gallery where a 'staff member' injected them – often with equipment that had been used previously. IDU reported that ' a clean fit for every hit' was not the norm and Care changed this community norm by providing clean fits and safe disposal bins in shooting galleries which were collected daily by outreach workers. They reported a significant change in community norms with IDU reporting that they go elsewhere now if shooting galleries are not able to guarantee a clean fit. When Care supplies ran low shooting gallery owners, on their own initiative, purchased new equipment to meet client demand.

Authors: Sarah (Sally) Moore, Dr Kyaw Hlaing, Tammy Hasselfeldt: CARE Intervention in Myanmar.

BACKROUND

Injecting drug use in Myanmar is a significant route of HIV infection with estimates of up to 37.5% IDU being HIV positive. The introduction of Needle and Syringe Programs (NSP) is challenged by the legal environment and socio-cultural factors. Strategic Direction Three in Myanmar National Strategic Plan on HIV AIDS 2008-2010 focuses on the reduction of HIV related risk, vulnerability and impact on IDU. Until the Care Harm Reduction Program began it was common for needles to be shared between users in shooting galleries allowing for rapid spread of HIV and other blood borne viruses (BBVs). Following project completion, new funding was secured through the 3DF to continue NSP activity, DIC, advocacy and harm reduction training with law enforcement officials (ref: National AIDS Program: MoH and WHO 2009; Myanmar HIV Sentinel Surveillance Survey 2008).

RESULTS

In 2003 Care began advocacy to shooting gallery proprietors, educating them on HIV and safe injecting practices. Free sterile needles and syringes were distributed to shooting galleries as part of the CARE outreach work. Basically the shooting gallery staff were supported to use a new needle each time they provided a hit for drug users. One of the conveniences of shooting galleries is that drug users who come to buy drugs and get an injection do not have to carry or share any injecting equipment. CARE provided safe needle collection bins for the shooting galleries and outreach workers collected these for safe disposal each day.

IDU reported that a clean fit for every hit was not the norm and, subsequent to the introduction of this program, they will go elsewhere if there is any risk of equipment being reused. Through discussions with shooting gallery owners, feedback from clients and in collecting used injecting equipment it was clear that shooting gallery owners were responding to clients' demands. When CARE NSP supplies ran low, shooting gallery owners on their own initiative, purchased new single-use needles and syringes from pharmacies to ensure clients continued to use their services. Over a twelve month period in 2007-2008, more than 100,000 sterile needles and syringes have been distributed through shooting galleries and outreach activity.

"Now many injecting drug users no longer want to use nor will they accept non sterile needles so shooting gallery owners have to buy needles and syringes when supplies from CARE run out. Many IDU choose to attend only shooting galleries where clean needles are available and provided. IDU recap and bend the tip of the needle because they do not want their needle to be reused by another IDU" A quote from a Care Project Staff Member.

Over the life of this project IDU have been trained by CARE in peer approaches. Peer-to-peer information sharing has been conducted in shooting galleries on harm reduction topics ranging from safer injecting practice, injecting site rotation, to HIV, Hepatitis B and C risk reduction and management. Recruitment to participate in drop in centre activities such as primary health care, home based care for HIV positive drug users, referral for VCCT and information sharing on treatment options including MMT, ART and home based care for HIV positive IDU has occurred with IDU using shooting galleries.

LESSONS LEARNED

    * Partnerships between shooting gallery and NSP programs offer innovative opportunities to promote harm reduction site and reduce the risks of HIV and blood borne virus transmission to IDU.
    * Access to these sites through peer approaches can ensure that marginalized groups such as IDU are able to obtain correct information, clean equipment and referral to appropriate and client friendly primary health care services.
    * Continued advocacy with law enforcement agencies is required to ensure programs can build sustainable demand for safer practices. Involvement of shooting galleries represents a pragmatic approach to harm reduction along with opportunities to promote supportive services for IDU.

http://hivinasia.blogspot.com/#Poster116