1. FILM DISCUSSION CARD 3

3. DROP-IN CENTRE

4. 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

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’

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

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

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

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

10. REFERRAL PATHWAYS DIC  IDUs may reach DIC: Directly Via outreach contact Via Referrals Forcibly by family members OUTREACH CONTACT IDU REFERRAL SERVICE

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

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

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

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

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

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

17. WHO CAN ACCESS THE DIC? IDUs Spouses/Sexual Partners of IDUs Family members of IDUs General community may come to seek information

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

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

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

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

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

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

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

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)

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

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

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

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