Project of Expertise France 5% Initiative
Project name: Capacity Development for Quality Assured Gender Sensitive Harm Reduction Interventions in Ukraine
Financial support: Expertise France 5% Initiative
Implementation period: March 15, 2015– March 15, 2018
Project cost: EUR 997,548
Project goal: Expanding the access of injecting drug users and their sexual partners to quality-assured HIV/STI prevention services through the gender-sensitive approach.
Project tasks:
- Development and implementation of gender-sensitive models of prevention services provision.
- Improvement of professional skills and support for professional development of employees of HIV-service NGOs and government institutions on introducing gender-sensitive approach in harm reduction programs and provision of social and medical services to injecting drug users and their sexual partners.
Key project achievements for 2015-2017.
The comprehensive approach was used within the framework of the project for engagement and retention of female clients, which included:
- Engaging women in harm reduction projects via the chain mechanisms for the female clients outreach and carrying out peer-to-peer information and awareness work on sexual and reproductive health within the Peer-driven Intervention initiative;
- Counseling of couples who use injecting drugs, aimed at facilitating harmonious relations within a couple, change towards safer behavior practices, fostering the responsible attitude to each one’s health;
- Strengthening self-esteem, forming of gender role and personal identity of women who use drugs through the specially designed social and psychological game “New Me”;
- Nurturing leadership capacity of women within the specially developed structured group training sessions using the Group-Level Impact (GLI) intervention model;
- Referral and accompanying of the clients having the positive result of rapid HIV or hepatitis test to the appropriate health specialists to ensure further diagnostics and treatment;
- Encouraging new clients to regularly use harm reduction services.
During the three years of project implementation this integrated approach allowed to increase the number of injecting drug users, especially women adherent to harm reduction programs, namely:
- The PDI method allowed to engage 4,430 new clients and clients from among PWID through five pilot ProfiGender projects (“Convictus”, Kyiv, “Way to Home”, Odesa, “Victoria”, Khmelnitsky, “Return to life”, Kropyvnitsky city, “Public health”, Kryvyi Rih city). For two years these pilot projects have been regularly providing to male and female clients the information services, counseling on topics relevant for them, various group activities, and so on. All male and female clients had been redirected to harm reduction projects funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) to receive counseling and testing services for HIV, hepatitis, and, if necessary, case management, etc. 1,666 PWID regularly used both the services of the Profhender project and the services of harm reduction projects funded by the GF at the same time.
- In total, 5 organizations held more than 360 group sessions attended by 1,800 PWID. The key topics of counseling, awareness and group sessions were as follows: sexual and reproductive health, viral hepatitis, sexually transmitted infections, safe sex rules, recommendations on safer use of drugs, overdose assistance etc. During the consultations and group tasks the clients also practiced correct use of condoms and injection equipment. Additional sessions included the following topics: “Bringing up children”, “PC skills”, “Cooking”, “Healthy nutrition”, “Employment: learning to draft a CV”, “Household budget”, “Self-esteem and meditation” etc. During these sessions the participants were focusing on the issues of gender roles, gender equality and prevention of risky behavior.
- 147 couples who use drugs took the complete cycle of interactive counseling (4 counseling sessions on various topics with some practical skills training) and improved their relations. In particular, couples learned to communicate, to negotiate safe practices of sexual intercourse and drug use, to use a condom properly, to help in case of overdoses, etc.
- 253 female clients of the project successfully completed all structured group sessions and became community leaders and secondary exchange volunteers, which carry out active educational work among PWID. For example, 3 female clients from Kryviy Rih and registered a joint new organization: Dnipropetrovsk Oblast Branch of the Charitable Organization “All-Ukrainian Charitable Organization “Legalife-Ukraine”.
- 226 sessions of the “New Me” game were held, attended by 981 male and female clients of the project. It allowed them to enhance their self-esteem, obtain information on project services and take a conscious decision to receive harm reduction services on the regular basis.
- On 3 OST sites (Kirovohrad Oblast Drug Dispensary Clinic, Odesa City TB Dispensary clinic, Kyiv City Narcological Clinic “Sociotherapy”,) the Mentorship support model for women was established. The mentors provided counseling and support of new clients of the OST program. The “mentorship” approach is based on the peer-driven consolidation of female OST clients. A total of 38 mentors worked on 3 OST sites. Due to the work of mentors on these sites, the adherence of female clients to the program increased, more clients refused to take “street” drugs, alcohol etc. These mentors helped 68 women to dispel myths and stereotypes about OST, gain knowledge on various aspects, including OST and pregnancy, reproductive and sexual health. Through their work the mentors became involved in the volunteering, gained peer education skills and improved their effective communication skills. This enabled most mentors to become volunteers in harm reduction projects and 5 women were employed as outreach workers, case managers in HIV service NGOs.
The HIV-service NGOs that directly participated or had internships within the project, included the services, individual interventions and methods developed and tested in the project, to the package of services provided to the clients of harm reduction programs funded from different donors. In addition, these NGOs are making efforts to obtain funding for these services from the local budgets through various mechanisms. For example, “Convictus-Ukraine” submitted a request to the Desniansky district state administration in Kyiv on allocating the funds for the intervention “Counseling for Couples Who Use Drugs”. Odesa Charitable Foundation “Way to Home” advocates for the mechanism for obtaining funding, including gender-sensitive harm reduction services, through the procurement of services from NGOs by the municipal institutions.
Considering the fact that gender-sensitive approach is still fairly rare in Ukraine, the project included a component of training and support for the professional development of specialists of different specialties, which ensure the uninterrupted continuum of services for injecting drug users. The multidisciplinary teams from all regions of Ukraine were trained in the framework of the project, benefiting from advanced training courses and study visits/internships. The specialists included in these teams provide gender-sensitive and gender-oriented social and medical services to representatives of various target groups, including the most-at-risk populations, which provides a lasting effect from the project implementation.
4 new training programs were developed and implemented within the framework of the professional development component:
- 72-hour program “Specifics of providing medical and social services for key affected populations using gender-sensitive approach”, in partnership with the Ministry of Social Policy of Ukraine, the National Dragomanov Pedagogical University, Center for Public Health of the Ministry of Health of Ukraine.
- 108-hour program “Providing gender-based social and medical services for adolescents and young people at risk”. The course was developed and implemented in partnership with the Ministry of Social Policy of Ukraine, the Ministry of Youth and Sports of Ukraine, the Ukrainian Center for Public Health, the Academy of Labor, Social Affairs and Tourism.
- 108-hour program “Specifics of social work among adolescents and youth from key affected populations, taking into account a gender-sensitive approach”. The course was implemented in partnership with the Ministry of Social Policy of Ukraine, the Ministry of Youth and Sports of Ukraine, the State Institute of Family and Youth Policy.
- 48-hour program “Specifics of gender approach implementation into social and preventive work in penitentiary facilities, pre-trial detention centers and among the clients of the authorized probation body”. The course was implemented in partnership with the Ministry of Justice of Ukraine and National Dragomanov Pedagogical University.
The multidisciplinary teams which attended professional development courses, included representatives of HIV-service NGOs, specialists of centers for social services for the family, children and youth, territorial centers for social services, social protection departments, medical workers in treatment and prevention facilities (doctors, medical nurses), teachers of higher educational institutions, etc. In total, during the 2016-2017 academic years, 478 specialists were trained, 301 of them received a state standard certificate of professional development, and the other obtained certificates of completion of the training.
The developed educational programs are approved by the scientists of the boards of all educational institutions and were integrated in the training and methodological curricula.
Lecturers of higher education institutions that have completed training on the above-mentioned professional development programs have developed drafted materials on gender-related topics, incorporated them in separate training courses and present these curricula at their universities.
Upon the implementation of professional development courses for specialists providing social and medical services, a training manual “Specifics of providing medical and social services for key affected populations using a gender-sensitive approach” was issued.
During 2016, 10 study visits/internships were organized on the basis of ProfiGender pilot projects in 5 regions, which were attended by 115 people ? representatives of NGOs implementing programs on harm reduction, care and support of PLWH, medical facilities, state social institutions and establishments, penitentiary service authorities, etc. During the study visits, all participants could familiarize with the work of the pilot ProfiGender projects, had an opportunity to communicate with the employees and clients of the project. They also obtained theoretical knowledge about basic gender concepts, gender-sensitive services, counseling, and mastered practical skills on the use of “New Me” socio-psychological prevention game, the development of gender policies of the organization and supervision, and gained other knowledge in similar areas. The training supervisors of the project organized and carried out trainings together with the specialists of pilot projects.
For the first time in Ukraine, research of the current drug scene was carried out within the framework of the project, which included the study and description of injecting drug user profiles, gender aspects of the use of psychoactive substances and related behavioral practices. There phenomena require thorough an in-depth research, because the Ukrainian drug scene is rapidly changing, new psychoactive substances emerge that cause various side effects, including high risk of overdose and a significant impact on the mental health of consumers. The results of the study will become the basis for developing innovative outreach strategies, combinations of services and models for their delivery.
