1. Executive Summary
2.1 Background
BSDA is an independent, neutral, impartial and non-political NGO established by a group of seven Buddhist monks at WAt Nokor Bachey in January 5, 2005 in Kampong Cham Province Cambodia. A six member Board of Directors supports the work of this organization. BSDA has leaded by Venerable Vandong Thorn and grown to include volunteer workers and supporters from various public stakeholders including monks, students, intellectuals, teachers, lawyers and civil servants, all of whom have a strong social consciousness and the wisdom and desire to develop a better Cambodian society.
The Ministry of Interior officially recognized the organization in July 05, 2005 (under No. 612.S.C.N.) Currently, a number of people, most of whom are monks, are working for the organization under the overall leadership and management of Venerable Vandong Thorn, the Executive Director.
2.2 Project Description
Human Resource Development: In the first step of this process, the Executive Director of BSDA or Program manager will conduct the orientation training for the new staff. The program manager will identify NGOs with projects similar to this project, targeting groups that run a successful HIV/AIDS programs in Cambodia. Before the beginning of the project, and again half-way through, program staff will get the opportunity to make a study visit to exchange experiences and lessons learned from INGO, LNGO and government programs such as the International Friend Organization and others in Cambodia.
Radio program to support HIV/AIDS prevention and harm reduction of drug abuse awareness raising: The radio program to support drug (IDU, UD) and HIV/AIDS awareness raising and prevention to the communities and target areas will be a series of stories on drug abuse, HIV/ AIDS, and safe migration. The goal of the program is to educate the entire community about the problem and solution of IDU, UD and HIV. In order to reach the maximum audience, these programs will be presented to and discussed with audiences in their own environment. The dissemination of Radio programs will cover the whole province and neighboring provinces. Speakers will include: existing and former addicts (volunteers); families affected by drug abuse; local authority, police officers; experts such as psychologist, medical doctor or drug abuse program experts from NGO’s and Government. The show will have phone calls or letters from audiences to ask questions and share ideas or experiences on drug abuse including IDU and DU or PLHA.
HIV/AIDS Prevention and Harm Reduction of Drug Abuse awareness raising This intervention will be done as a mobile workshop at the secondary school and high school about IDU, UD and HIV/AIDS awareness raising program. At the first, BSDA will cooperate with the Ministry of Education, Youth and Sport of Kampong Cham at the province and district levels. After that, BSDA will work directly with school’s director in the target area of project to implement. The peer group of adults and drug addicts will be motivated and engaged to present the story and work as role play in the training. The self-help group of adult at target area of project will be established organizer at the end of training and the school director will be responsible for processing and managing them.
Community capacity Enhancement ‘for community and peer facilitator’ : A selected group of active monks, former drug addict in target areas affected by drug abuse, and a peer group of drug addicts in the districts will get training from this project. The training is provided under the cooperation between BSDA, PDCC and NACD of the Cambodian government. Training and lessons will be given to two groups, a support group and a peer group of drug addicts. Organization and preparation are the responsibility of BSDA with use of documents from KHANA, US DayTop International, NACD and PDCC. The training outline will look as follows:
- The trainers will identify the historical context of IDU, DU and HIV/AIDS, its progression within a society, and responses taken to ameliorate the problem.
- The trainers will orient participants in the basic tenets of the IDU, UD and HIV/AIDS free as a Self Help Prevention Model. This will include prevention, treatment, counseling, health care and rehabilitation.
- The trainers will familiarize participants with research studies on outpatient treatment program approaches and outcomes.
Run Drop-in-Centre in each site : The drop center will be created and located at each target area for supportive environment – strengthening of community based facilitators and peer educator’s facilitator against drug abuse and HIV/AIDS, capacity building for peer group of IDU (injection drug users) and DU (drug users) in community based as well as for local information center. This center will be used for contact information of project implementation, counseling and providing a group treatment. A group treatment will be developed by the primary therapists (BSDA staff and KHANA) or treatment team (BSDA staff and patients already in the program) in consultation with the clients, immediate and extended family members, and, when possible, representatives of the referring agency. Engaging both the clients and family in the treatment process, dealing with withdrawal, blood test to find the positive HIV and detoxification, can promote their willingness to participate in the actual intervention of program. The treatment will be comprehensive, specific, and objective so that progress can be measured. Naturally, the plan will address the environmental factors that may have contributed to the initial usage and that could be a hindrance to recovery. The target areas of the drop in center or outreach Program: treatment, positive- HIV-blood testing and rehabilitation will be done in one community (temple) of each target area. The treatment team includes monks and commune officers selected to be the local facilitators of the outpatient or outreach program. The facilitators from the target area will be selected by BSDA that will respond to implement primary treatment, counseling and rehabilitation. A group treatment will be developed by the primary therapists or treatment team (BSDA staff and patients already in the programme) in consultation with the clients, immediate and extended family members, and, when possible, representatives of the referring agency. Engaging both the clients and family in the treatment process, dealing with withdrawal, blood test to find the positive HIV and detoxification, can promote their willingness to participate in the actual intervention of programme. The treatment will be comprehensive, specific, and objective so that progress can be measured. Naturally, the plan will address the environmental factors that may have contributed to the initial usage and that could be a hindrance to recovery. At a minimum, a treatment will identify the following:
- Target problems of the clients and the family, including substance use and psychosocial, medical, and possible psychiatric disorders. BSDA expects hospitals and doctors, among others, to refer clients to its programme and provide information on the medical/psychiatric background and blood testing to find the positive HIV
- Help clients recognize their involvement with substances and acknowledge responsibility for the problems resulting from substance use and take into account what the client wants to accomplish. An important part is identification of gaps, such as lack of skills, vocational training, and basic education. In the relapse prevention phase there is a possibility of addressing some of these needs
- Time frames for the achievement of the stated objectives
- Appropriate interventions, that is, treatment strategies and services that are needed to achieve the objectives
- Assessment methods for measuring the extent to which goals, objectives, and interventions are fulfilled.
- Contribute the medical material to IDU to protect them from HIV disease
- Educational, legal, seminar and external support systems
The specified treatment strategies and services will include the identification of the persons who will be provided treatment, an expected timetable for achieving the objectives, the date the treatment plan will be reviewed, and where treatment is to take place. The treatment plan will be subject to frequent reassessments to determine whether the client is making therapeutic progress. If progress is not being made, the client, family, therapist, and key interested players should examine whether the therapist’s goals and the client’s goals match.
Both the client and their family will be told in advance that the service providers will contact them regularly. Follow-up, like other elements of the program, is voluntary, so BSDA will ask the clients for written consent to follow-up. The clients are expected to co-operate if convinced of the value of the process. Usually those who are still abstaining are more likely to stay in touch, although a sizable number of them will wish to stay away from the centre or anything else that may remind them of their addiction
3. Rationale and Justification
It is necessary to enhance the capacity and develop the human resource of BSDA’s staff. Before the beginning of the project, and again half-way through, Program’s staff will get the opportunity to make a study visit to exchange experiences and lesson learn from INGO, LNGO and program of Government such as; International Friend Organization and others in Cambodia. The lesson learned from the study experiences will be incorporated into the design of this project and written up and shared with colleagues in order to influence future projects.
Radio program to support HIV/AIDS prevention and harm reduction of drug abuse awareness rising: The goal of the program is to promote, provide information on and educate about the problem and solution of IDU, DU and HIV for the whole community, in order to reach the maximum audience these program. It will be lived, presented to and discussed with audiences in their own environment in community.
HIV/AIDS Prevention and Harm Reduction of Drug Abuse awareness rising: This intervention will be done as a mobile workshop at the secondary school and high school about IDU, DU and HIV/AIDS awareness raising programAfter that, BSDA will work directly with school’s director in the target area of project to implement. The purposed of workshop will be created to prevent the youths, adults and teenagers from IDU, DU and HIV/AIDS at school and community. BSDA’s will be a trainer in that workshop.
Community capacity Enhancement ‘for community and peer facilitator ‘: A selected group of active monk, farmer drug addict in target areas affected by drug abuse and peer group of drug addicts especially IDU in the districts will get training from this project. The training is provided under the cooperation between BSDA, PDCC (Provincial Drug abuse Control Committee) and NACD (National Authority for Combating Drugs) of the Cambodian government. Training subjects include: community capacity enhancement, information on IDU, DU and HIV/AIDS affected that related topics, sharing of hopes and experiences.
Run Drop-in-Centre in each site: The drop center will be created and located at each target area for supportive environment – strengthening of community based facilitators and peer educator’s facilitator against drug abuse and HIV/AIDS, capacity building for peer group of IDU and DU in community based as well as for local information center. This center will be used for contact information of project implementation, counseling and providing a group treatment. Engaging both the clients and family in the treatment process, dealing with withdrawal, blood test to find the positive HIV and detoxification, can promote their willingness to participate in the actual intervention of program.
3.1 General Overview of (specific issue in nationwide)
Evidence from a range of small-scale surveys undertaken by the government, the United Nations and NGO organizations, together with law enforcement and media reports, suggests the incidence of drug use, including injecting drug use, is rising in Cambodia. This has important implications for the development of the HIV epidemic in Cambodia because of the known links between drug use and HIV infection. Specifically, HIV infection can be linked to drug use in terms of unsafe injecting practices and unsafe sexual behavior as a consequence of drug use. Currently, the most commonly used drug in Cambodia is probably “yama”, an amphetamine type substance. Heroin is also increasing in popularity. Other drugs in use include marijuana, ketamine, glue, ecstasy, opium, crystal and cocaine. Data suggest that IDU include people from broad socio-economic strata (O’Connell, 2005); however, the majority of programs working with drug users focus on unemployed youth, including street youth, and sex workers.
3.2 Current Overview of (specific issue in selected province)
Kampong Cham is the largest province in Cambodia and it covers about 20% of the countries population with about 2 million people. The majority of the population lives as farmers along the Mekong River. Since 1998, the area has been peaceful, but the new challenge for this community is the HIV/AIDS problem. The targeted response to the HIV epidemic has been highly effective. The challenge now lies in establishing effective programs for high-risk IDU/DUs (MARP). According to the report of PDCC in 15 January-15 March 2009, it showed that there are 510 drug addicts, 12 female. Most of them use Methamphetamines or Yama (ice). The PDCC report also showed that there are high risks of HIV/AIDS disease with young drug addicts who sell their bodies to raise money to buy the drug. Sometimes MSMs do not use condoms when they get the sex.
There are no NGOs or government programs focusing on HIV/AIDS prevention and harm reduction of drug abuse yet in this area.
3.3 Current Overview of (specific issue in the selected target areas):
According the survey and meeting with PDCC, we found that there are drug users every where in Kampong Cham province such as in secondary school, high school, in the town and rural area. Representative of PDCC said there are no NGOs work with related with Harm Reduction of Drug Abuse and HIV/AIDS prevention yet in this target area. There many criminal case in this target area like violence, steal as well as HIV/AIDS infected, because drug abuse of youth and student in community and school.
3.4 Mapping and Demography:
Province: Kampong Cham
District: Kampong Cham, Kampong Siem and Thbong Kmom
Commune: Bangkok, Kampong Cham, Vealvong, Sambomeas, Ampil, Tonlé Bet
Town: Soung
Sangkat: Soung and Vihea lung
3.5 Major Problems and Needs Identification:
The major problems are:
- Lack understanding and capacity of HIV/AIDS and Drug Abuse of employee who apply for the project officer post and file facilitator as well as how to run the project smoothly.
- The information of problem and solution on HIV/AIDS, Drug Abuse are not reached to local people
- The awareness raising HIV/AIDS and Drug Abuse issues in high school are not increased as well
- The capacity on HIV/AIDS and Drug Abuse of peer educator and facilitator are not enhanced
- To strengthen the capacity of human resource person on HIV/AIDS prevention and harm reduction of drug abuse
- To reach and inform local people about the problem and solution of HIV/AIDS and drug abuse.
- To increase awareness raising HIV/AIDS and drug abuse issues in high school
- To enhance the capacity on HIV/AIDS and Drug Abuse to community and peer educator and peer facilitators
- To provide a drop in center and out reach act for primary treatment of drug users and HIV/AIDS present in the community based including prevention, reduction, treatment, rehabilitation, intervention and counseling.
- To strengthen the capacity of human resource person on HIV/AIDS prevention and harm reduction of drug abuse
- To reach and inform local people about the problem and solution of HIV/AIDS and drug abuse.
- To increase awareness raising HIV/AIDS and drug abuse issues
- To enhance the capacity on HIV/AIDS and Drug Abuse to community and peer group educator facilitators
- To provide a drop in center and out reach act for primary treatment of drug users and HIV/AIDS present in the community based including prevention, reduction, treatment, rehabilitation, intervention and counseling.
- Conduct the orientation training to BSDA staff who work to respond on Haphroda
- Contact with NGO and agency of government who have the similar project and successful implementation
- Exchange visit
- Renting the radio for running the program
- Conduct the schedule and topic for the program
- Conduct the meeting with client, family, authority and other stockholder for interviewing and recording the voice for radio program
- Invite the honorary speaker to speak in the radio program
- Processing the broadcast of radio program
- Contact with the department of Education, Youth and Sport in Kampong Cham for cooperation
- Identify the target school for mobile awareness raising
- Conduct the schedule and topic with School director
- Contact with NACD and KHANA for educational material
- Starting the mobile awareness raising on HIV/AIDS and Drug Abuse in target school
- Invite volunteer monk in target area who is community facilitator to participate in the training
- Invite volunteer-peer educator who are facilitator in the peer group to participate
- Connecting community network
- Trainings
- Select community facilitators
- Creating voluntary community members
- Select the volunteer group of drug addicts to be a peer group
- Intergrading the client (drug addicts) into the peer group or drop in center
- Send the client to VCCT to blood testing
- Treatment training to other dug addicts by the peer group
- Develop the treatment group
- Engaging both the client and family in the treatment process
- External support systems (Counseling, seminar )
- Develop the treatment plan
- Help the client recognize their involvement with substances and acknowledge responsibilities.
- BSDA staff who are working respond on the project will be strengthened the capacity on HIV/AIDS and Drug Abuse and will have a confidence to work as smoothly
- The information on HIV/AIDS and Drug Abuse issue will be reached in to the rural area and public population and will have positive change of individual behavior of audiences
- The understanding and awareness of general issue of HIV/AIDS and Drug Abuse will be increased with youth, teenager and public population
- Community and peer group educator will have the capacity on HIV/AIDS prevention and harm reduction of drug abuse to work in the project
- Blood testing for HIV positive, prevention, reduction, treatment, rehabilitation will be provided in the drop in center.
4. Proposed Strategic Intervention:
4.1 Project Title: HIV/AIDS Prevention and Harm Reduction of Drug Abuse
4.2 Overall Goal: To reduce the HIV/AIDS and Harm Reduction of Drug Abuse in Cambodia.
Purpose:
This project aims to improve better strategic prevention of HIV/AIDS with IDU/DU by following with a number of objectives as below:
4.3 Specific Objectives
This project aims to improve better strategic prevention of HIV/AIDS with IDU/DU by following with a number of objectives as below:
Main activities:
Output 1: Strengthened the capacity of human resource person on HIV/AIDS prevention and harm reduction of drug abuse
Activities:
Output 2: Reached and informed local people about the problem and solution of HIV/AIDS and drug abuse.
Activities:
Output 3: Increased awareness raising HIV/AIDS and drug abuse issues
Activities:
Output 4: Enhanced the capacity on HIV/AIDS and Drug Abuse to community and peer group educator facilitators
Activities:
Output 5: Provided a drop in center and outreach act for primary treatment of drug users and increased HIV/AIDS present in the community based including prevention, reduction, treatment, rehabilitation, intervention and counseling.
Activities:
4.4 Guiding Strategies
……..
4.5 Outputs and Key Activities
Output 1:
Strengthened the capacity of human resource person on HIV/AIDS prevention and harm reduction of drug abuse
Output 2:
Reached and informed local people about the problem and solution of HIV/AIDS and drug abuse.
Output 3:
Increased awareness raising HIV/AIDS and drug abuse issues
Output 4:
Enhanced the capacity on HIV/AIDS and Drug Abuse to community and peer group educator facilitators
Output 5:
Provided the drop in centers and outreach acts of primary treatment for drug users as well as HIV/AIDS presents in the community based including blood testing, prevention, treatment, rehabilitation and counseling
Outcomes:
The expected outcomes of the project are:
