Mobilizing Thai pharmacies to improve the health of Thai drug users Robert Gray IDU Technical Expert Population Services International Harm Reduction 2009 Conference Bangkok, Thailand April 21, 2009
Thailand Global Fund Round 8 Project • 5 Year Program • 3 Principal Recipients (Thai MoPH; Raks Thai; PSI) • 4 target groups: SW; MSM; Migrants; IDU • PSI is PR for IDU programs • July 1 st 2009 launch • Serving 12,000 Thai drug users • NSPs & outreach in north, central, south Thailand • Mobilizing pharmacies to distribute injecting equipment & condoms to IDUs
Pharmacy Component Overview • Year 1-2: 75 community pharmacies distributing injecting equipment & condoms to Bangkok IDUs • Year 3-5: Expand to 150 or more pharmacies in the 15 target provinces • Distribution: 340,000 needles and syringes to be distributed over 2 years • Implementor: Community Pharmacy Assoc of Thailand (CPAT) • How does it work?
Distribute vouchers to drug user
Bring voucher to pharmacy
Receive Products
Training for pharmacists to reduce stigmatization of IDUs Trainings & MoUs with police to prevent “trolling” of pharmacies
You might ask… Such a simple thing. Why is it important?
Why Pharmacies? NSPs often have • Limited opening hours • Few locations • Tendency to attract older drug users • Police surveillance Result • Many drug users won’t come • New/young drug users esp. stay away • People reached only after infected • Final result: Overall low coverage
Why Pharmacies? Thai drug users already rely on pharmacies as a source of needles & syringes But barriers exist reducing drug users willingness to use pharmacies, for example: � Fear of stigmatization � Fear of arrest � Cost of needles / syringes
Some Outcomes (if we can reduce those barriers) � Improved access to health products: Improved ease of access to injecting equipment and condoms (pharmacies are everywhere and open all hours) � Improved health outside HIV: Improved access for drug users to a wide range of other health products and advice, to keep them healthy � Drug user integration with health system: Re-connecting drug users to the “front lines” of the Thai health care system � Expanded Coverage: Coverage of many drug users (esp. new and/or young IDUs) who may not be comfortable going to NSP � Sustainability: Thai drug users will continue to utilize pharmacies to improve their health after the end of the Global Fund project
Thai Pharmacies are… Numerous…
Thai pharmacies are… Conveniently located…
Thai pharmacies are… Open (almost) all the time…
Thai pharmacies are… Already existing, thus reducing project costs
Kyrgyzstan Pharmacy Project Results 20% 80% 80% of drug users using the pharmacy project had no previous contact with an HIV prevention project
Kyrgyzstan Pharmacy Project Results 41% 59% 41% of drug users were under age 30
Reaching Young IDUs is Critical 80% 70% 60% 50% 2003 40% 2004 76% 68% 66% 30% 58% 55% 54% 53% 47% 45% 20% 39% 10% 0% Less than 1 year from 1 to 2 years from 2 to 4 years from 4 to 8 years more than 8 years inclusive inclusive inclusive 50% of Kazakh IDUs contracted HCV in 1st year of injecting Centers for Disease Control (CDC), 2006
IDU Coverage How are we doing? “Countries should aim to cover 80% of IDUs by 2010.” Prasada Rao UNAIDS, Regional Director for Asia & the Pacific Warsaw, Poland, May 16 th , 2007
Low Global Coverage of IDUs
Pharmacies An untapped resource for Global Harm Reduction
Thank you!
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