Mobilizing Thai pharmacies to improve the health of Thai drug - - PowerPoint PPT Presentation

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 1st 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
• ver 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

• pen 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

80% of drug users using the pharmacy project had no previous contact with an HIV prevention project

20% 80%

Kyrgyzstan Pharmacy Project Results

41% of drug users were under age 30

59% 41%

Kyrgyzstan Pharmacy Project Results

76% 66% 58% 47% 39%

68% 55% 54% 53% 45%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Less than 1 year from 1 to 2 years inclusive from 2 to 4 years inclusive from 4 to 8 years inclusive more than 8 years

2003 2004

Reaching Young IDUs is Critical

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 16th, 2007

Low Global Coverage of IDUs

Pharmacies

An untapped resource for Global Harm Reduction

Thank you!