Asian Harm Reduction Network (AHRN)

Annual Report
Executive Summary
1 January 2005 – 31 December 2005
Internationally and especially in Asia, decisions relating to drug use and HIV/AIDS are
generally driven by short-term domestic political agendas. In addition, national drug control
and HIV/AIDS policies are commonly not integrated or even complimentary, leading to
competitive approaches in turn creating a counterproductive and ineffective environment.
Such policies, often based on ‘zero tolerance’ platforms, place the lives of many hundreds of
thousands of people at risk.

Other international stakeholders are largely at the mercy of major donors who impose their
national agendas on the rest of the world. Already, ADB and UNAIDS have noted that only
10% of required resources are available for adequate scaling up of programmes to reduce
drug related harms. Further pressure from morally driven donors has significantly
constrained available funds to a greater degree while increasing the criminalisation,
stigmatisation and marginalisation of people who use drugs.

In this context, the need for a rapid scaling up of harm reduction services has perhaps never
been greater, and AHRN stands as a bastion of hope for regional and international harm
reduction practitioners. AHRN is one of the few agencies working
on advocacy, information sharing, capacity building, technical
assistance, and programme and policy development. AHRN’s
experience in the region and its context specific and culturally
tailored responses represent a much needed value-added in
considering that up to 70% of new HIV/AIDS in Asia relate to
injecting drug use.

Activities - 2005

AHRN’s information services operate through the

Clearinghouse, which represented the largest programme
department in 2005. The AHRN newsletter, started in 1996,
continues to receive praise for being a key vehicle for regional
updates while promoting community level voices. In 2005, two issues were published while
distribution was rationalised and quality of contents and presentation improved with a
consideration for cost-effectiveness. In turn, management of the activity improved with the
deployment of a standard operating procedure. The AHRN website also continues to be a
key mechanism providing members/subscribers access to all of AHRN’s information services
including the newsletter, library, Daily News Digest, fortnightly Net Bulletin, and other key
resources. See Graph 1 for details of visits to the AHRN website.

Graph 1 – Number of Visits to the AHRN website per month in 2005

350
312
300
261
244
250 233

191 190
200 169 174
157 165
136 144
150

100

50

0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
In 2005, over 1,600 members/subscribers were receiving regular information updates
through AHRN’s various Clearinghouse services. The number of members/subscribers
increased by 65%, from 1,063 in January to 1,618 in December. The majority (64%) of
AHRN’s members/subscribers are based in Asia (See Graphs 2 and 3 for additional
membership details).

Graph 2 – Increase in number of members in 2005

Member in 2005

1700
1618
1600 1561
1512
1500 1454
1401
1400 1353
1301
1300 1262
1215
1187
1200 1124
1100 1063

1000
900
800
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Graph 3 – Employment details of AHRN members in 2005

Field of w ork

Academic/res
earch institute
14%
Others/
Individual Donor agency
33% 1%
Government
11%
Healthcare
organization
5%
International
Multi-lateral Organization
agency 7%
2% Local NGO International
18% NGO
9%

With close to 2,000 documents on HIV/AIDS, drug use and harm reduction in the AHRN
library, members/subscribers downloaded more than 3,000 documents and another 85
requests for hard copies and over 200
for general information were processed
in 2005. In addition, AHRN assisted
other organisations in developing their
own libraries while the librarian was
exposed to programmatic issues for
capacity building, proving AHRN’s ability
to effectively transfer knowledge.

The Clearinghouse team oversaw the

production and distribution of a variety of
materials ranging from printed
documents to banners, T-shirts and
CDs. These materials were used to
profile AHRN, send clear advocacy
messages, and raise general awareness on harm reduction related issues. 255 documents
were distributed weekly during 2005.

Quantity of
Type of materials Remaining
distributed
(Printed hard copies) amount
in 2005

Newsletter (Issue 35-36) 500 10

Newsletter (Issue 37-38) 400 200
Newsletter (Issue 39) 0 1000
Brochure (Eng) 1200 800
Brochure (Thai) 550 450
Country profile (Myanmar) 1,050 450
Country profile (Indonesia) 1,050 450
Position paper (Evidence-based HIV/AIDS
1,100 400
prevention)
Position paper (Scaling up anti-retroviral treatment
1,100 400
to (injecting) drug users in Asia)
Breaking the link (Eng) 200 300
Breaking the link (Thai) 600 1,500
Breaking the link (Vietnam) 400 1,600
Breaking the link (Myanmar) 50 1,500
Myth and Fact (Thai) 400 600
Films 200 0
Button 2,000 300
Library CD 60 0
Manual CD 600 130
Conference CD 600 500
Weekly average distributed 255

The Clearinghouse also serves as a networking hub for the organisation and for its
members/subscribers. In 2005, collaboration, mutual support, and assistance was provided
to CCD (Bangladesh), the North East India Harm Reduction Network (NEIHRN), the Thai
Harm Reduction Network (THRN), the Thai Drug User’s Network (TDN), Health and
Development Networks (HDN) and Health Action Information Network (HAIN) amongst
others. Activities ranged from translations, cross- and joint publications, participation and
organisation of workshops, knowledge transfer, programmatic inputs, sharing of materials,
and involvement and participation in international advocacy campaigns. Additionally, AHRN
attended and/or delivered information sessions to the BBC World Service Trust – Burma
Project, Canadian University Students Overseas – Thailand, Margins to Mainstream
partners, the Positive Learning Working Group, TREAT Asia, UNODC Vietnam, Health and
Development Networks (HDN), the Coalition of Asia Pacific Regional Networks on HIV/AIDS
(also known as the 7 Sisters) as well as more than 12 visitors to the AHRN Secretariat in
Chiang Mai, Thailand. Amongst others, AHRN Clearinghouse team members also attended
the International Harm Reduction Conference (IHRC) in Belfast, Ireland and, as co-sponsors
and participants at the 7th International Congress on AIDS in Asia and the Pacific (ICAAP),
ensured the adequate coverage of harm reduction related issues as well as the delivery of
key sessions on those topics.

The objective of AHRN’s Media department is to produce in-house

audiovisual films and multi-media presentations on subjects relating to
drug use and HIV/AIDS in Asia. Film has several advantages over
purely written documentation in that it is much more accessible and
stimulating. In 2005, the Media unity developed three short films
addressing regional programmes and issues. The Drug Users’
Perspective was developed with support from the World Bank for
diffusion and presentation at the 7th ICAAP in Kobe, Japan. The script of
this film was subsequently translated into Thai and subtitles were added. Later, Scaling Up
HIV Prevention and Harm Reduction in Iran as well as Persepolis Harm Reduction films were
released to highlight the progressive developments occurring in Iran. In addition, research
was conducted and filming was done on location and covered:

Iran harm reduction projects (sponsored by UNAIDS), Iran;

Indonesia harm reduction projects (sponsored by World
Bank), Indonesia;
Sharan social health organisation and related communities
in Delhi, India;
From Margins to Mainstream Project workshop, Chiang
Mai, Thailand;
Thai AIDS Seminar (NGOs), Bangkok, Thailand;
World AIDS Day activities, Chiang Mai, Thailand.

Two of the three films made in 2005 were submitted to the IHRC 2006 Film Festival (Scaling
Up HIV Prevention and Harm Reduction in Iran won the Film of Excellence Award at the
conference in 2006). Other AHRN short films were adapted throughout the year for specific
events and purposes. The Media unit also developed an archive of filmed materials for future
use as well as a library of existing film and multimedia materials relevant to AHRN’s
operations.

During 2005 AHRN continued to provide a range of tailored capacity building solutions for
organisations and individuals working towards the reduction of drug use-related harm
through the Training unit. Like training programmes in 2004, the participants of AHRN’s
2005 workshops and seminars were drawn from diverse backgrounds including government
and non-government health professionals (ranging from policymakers to street-based
outreach workers), law enforcement, and undergraduate and post-graduate students.
Significant training activities during the year targeted Japanese and ASEAN medical experts
from the Faculty of Tropical Medicine, Mahidol University, Bangkok; the 15th North American
Syringe Exchange Convention; Health and Development Networks’ (HDN) NGO Forum;
Chiang Mai University’s Faculty of Nursing; the ASEAN Institute of Health Development
(AIHD), Mahidol University; curriculum development assistance for AHRN Indonesia; the
Thai Harm Reduction Network; and a UNODC Vietnamese Delegation Study Tour to
Thailand. Numerous other informal presentations were made, mostly for short notice visitors
to AHRN, and for purposes of promotion of AHRN’s training services to potential partners.
An online training request form for incoming training enquiries was developed in May, and
two new training staff were recruited in October: A technical capacity building short course on
harm reduction: health and social care for people using drugs was scheduled for December
2005, but was postponed until March 2006 to allow for a longer scholarship and early bird
registration period.

AHRN’s Research unit was involved in a five country research

project on the evolution of drug use ‘careers’. The study was
released in Kobe, Japan at the 7th ICAAP. Concurrently, the
Research unit was involved in developing frameworks for a
mapping of harm reduction programmes and services currently
available in Asia. The pilot stage was completed in 2005 and
further developments were pending additional funding at the end
of the year. The AHRN Benchmarking – performed by the
Société Générale de Surveillance (SGS) – coordinated through
the Research unit led to AHRN accreditation as an NGO
complying with international standards of good practice and
governance. A few months later, AHRN’s Core Funding
Evaluation was conducted by the Dutch Ministry of Foreign
Affairs (Minbuza) with the direct assistance of the Research unit.
Both the Benchmarking activity and the Core Funding Evaluation led to recommendations
which, for the most part, have been taken up leading to significant performance
improvements.

‘From Margins to Mainstream’ is a poverty alleviation project funded by the Dutch Ministry
of Foreign Affair (Minbuza). This four-year project (2005-2008) is being implemented
through a partnership between Mainline Foundation and AHRN to develop practical and
replicable interventions which will reduce the causes and alleviate effects of poverty incurred
through injecting drug use and HIV/AIDS in Asia. The project’s objective is to support
marginalised communities in seven Asian countries – Cambodia, India, Indonesia, Iran,
Malaysia, Nepal and Pakistan – currently responding to drug use through the provision of
health and social care services and the development of small business initiatives. The
project’s vision is inclusive and embraces not only individuals and communities in an effort to
guide them from the margins back to mainstream social life but also to support organisations
and take projects from margins into mainstream in the provision of services. The central
platform of the project is the cooperative working relationship established between AHRN
and Mainline.
Through discussions with the involved stakeholders, the Project Management Team (PMT)
was formed as the central agency which would steer the project. In 2005, three PMT official
meetings led to discussion on relevant issues including agreements on future directions.
Mechanisms were deployed to insure transparency and accountability of all partners. A
project workshop was also held and was considered essential for networking and sharing
lessons learned by project partners.
AHRN’s administrative role in the project has been finalised and its indispensable
programmatic role as implementing partner is in large part due to the recognition of its
experience operating in Asian cultural contexts which will ensure a ‘fit’ with ground realities.
To streamline this cultural fit, missions to all implementing partner countries took place which
led to the production of detailed mission reports. As a result of missions and negotiations,
contracts pertaining to each partner organisation and their activities have been signed:
 Friends International (in partnership with Mith Samlanh), Cambodia
To support its existing street-children including harm reduction project and to
scale up its renowned business component to provide recovering drug users
with job skills, employment and income.

LARAS, Indonesia
To support the only NGO active in the province of Kalimantan to strengthen
their capacity for providing health and social care services/harm reduction
services to marginalised drug users and sex workers.

Nai Zindagi, Pakistan

To develop a far-reaching continuum of care for marginalised recovering drug
users including job-training skills and employment. Through this project, Nai
Zindagi is scaling up the production of table grapes through extension of its
vineyard capacity, and introduction of organic varieties for export.

Pelangi Community Foundation, Malaysia

To provide hospice care to homeless drug users who are HIV positive and sick.

Persepolis, Iran
To strengthen its social health care/harm reduction services to drug users in
Tehran.

SHARAN (in partnership with Sahara House), India

To provide continuum of care by providing services to recovering drug users
going through detoxification and marginalised transgender group. SHARAN’s
experience in the field of holistic street-based public health services to
marginalised communities will be made available to other local organisations
working in similar fields.

Youth Vision, Nepal

To scale up its social health care/harm reduction services including harm
reduction advocacy in Kathmandu.

AHRN has a country office in Jakarta, Indonesia. The operations of the Indonesian office
are based on two specific objectives: to promote and advocate for harm reduction targeting
the criminal justice system, the police and law enforcement agencies at national and regional
levels, as well as within the national parliament; and to support the creation and development
of JANGKAR, the national network of Indonesian NGOs implementing harm reduction
programmes. Based on the first objective, AHRN Indonesia was able to initiate and reinforce
assessments, developments and testing
of Police-NGO cooperation frameworks
in six provinces; develop a harm
reduction training in the context of the
National Police Training Curriculum for
all police academies; and conduct harm
reduction advocacy and trainings in
police hospitals through the Indonesian
National Police health and medical
section (PUSDOKKES).
Regarding the second objective, a
series of capacity building trainings
were organised targeting Jangkar
members while a resource database
was maintained and updates through a
librarian. In the end, it is widely recognised that Jangkar has become an important vehicle for
stakeholders in the area of harm reduction in Indonesia, in particular for grassroots
organisations. Through networking, information exchange and coordination, Jangkar has
indeed become an ‘anchor’ to the responses to drug related transmission of HIV in
Indonesia. Jangkar is truly owned by Indonesian players, a network not to be under
estimated.
AHRN Indonesia was also responsible for organising a joint JANGKAR-POLICE harm
reduction workshop attended by 25 policemen, and over 50 individuals from 33 NGOs
nationwide which supported both objectives.
In addition to the two objectives detailed above, AHRN Indonesia, in partnership with the
Centre for Harm Reduction (MacFarlane Burnet Institute – Melbourne), was involved in
delivering technical support and capacity building to JANGKAR with financial support from
the Levi’s Strauss Foundation Grant (15 June 2005 – 15 June 2006). The grant covered 1-
technical assistance and capacity building to a local NGO at one site in Java, Indonesia, to
implement evidence-based harm reduction and HIV/AIDS programmes (under CHR’s
technical management); and 2- support to the ongoing development of the JANGKAR
network of organisations specialising in HIV responses amongst IDUs. Because of its current
relationship with JANGKAR from its inception, Component 2 was developed by AHRN in
consultation with the network through its General Secretary. AHRN is currently providing the
national harm reduction network with technical support and fund management and
administration for this Levi’s grant.
AHRN Indonesia also secured a 6-month funding from the Indonesia HIV/AIDS Prevention
and Care Project (IHPCP, funded by AUSAID) to provide capacity building and training in
service delivery, and harm reduction for NGOs, community health centres and law enforcement
agencies in Indonesia. The objective is to build capacity within the Jangkar network to make it
independent and sustainable. Under this component, AHRN Indonesia was responsible for the
following activities:
Training on prevention, care, support and treatment for HIV/AIDS among IDUs
for field workers of new implementing agency partners (NGOs and community
health centers) in 6 provinces;
Capacity building for implementing agencies on harm reduction for alcohol use
for field workers of new implementing agency partners Papua and West Timor;
Enabling environment for implementing agencies and IDUs through awareness
and capacity building for law enforcement agencies;
Training for field workers on needle and syringe programme (NSP) service
delivery, and outreach.
In 2005, USAID, instructed by US Congress, ceased funding recipient programmes whose
activities did not coincide with US Government policies. Numerous harm reduction
programmes for people using drugs and sex workers were terminated as a result, including
AHRN’s activities in Indonesia (under management of Family Health International). Many
other organisations received notice of the cessation of funding for harm
reduction-oriented programmes, and in most instances, no alternatives
were provided.
AHRN also has a country office based in Yangon, Myanmar. In 2005,
AHRN Myanmar had 30 staff – eight operating at the administrative office in
Yangon and another 22 in Lashio (Northern Shan State) implementing field
operations. The year’s operations were financially supported by the Fund
for HIV/AIDS in Myanmar (FHAM – until 2007) and the Global Fund
(GFATM).

Under the FHAM grant, AHRN Myanmar was responsible for

organising/chairing the coordination meetings for all implementing partners of drug use
related interventions; representing and advocating for the interests of drug use related
interventions and harm reduction activities in FHAM management structures (Technical
Working Group) and with donors (Expanded Theme Group); consultancy on development of
harm reduction materials, including IECs; and operating a Drop-in-Centre (DIC) with Primary
Health Care and Outreach Programme in Lashio, Northern Shan State. Reports indicate that
the activities in Lashio were highly successful when considering the following:

943 (injecting) drug users accessed the DIC; a total of 5,345 medical and
1,231 nursing interventions were given; there were 52 referrals to specialised
services and 459 counselling sessions (including VCTT).
6 outreach workers had 2,559 contacts with (I)DUs in 2005.
25,747 condoms were
distributed free of charge;
more than 9,000 free
needles/syringes were
distributed; 10,000 IEC
materials on HIV, safer
injecting, etc. were
disseminated.
73 health education sessions
on HIV, safer use, harm
reduction, overdose
prevention, etc has been
organised for a total of 957
participants, including partners
and families of the drug users.

To enable the project to operate, 66 advocacy and steering committee meetings were
organised with local officials from health, law enforcement, social welfare and other
stakeholders. Social volunteers worked as go-between with the neighbourhood and the three
recruited drug users were active as ‘needle patrol’ (i.e. cleaning up discarded
needles/syringes) in the community.

With GFATM monies, AHRN Myanmar conducted two Rapid Assessment Response (RAR)
on HIV and (injecting) drug use in Northern Shan State (Lashio and Laukkai). Additionally, 10
multiple-day trainings on harm reduction, outreach, peer education, drug use and HIV
prevention were delivered throughout Myanmar to more than 150 participants of different
organisations (including UNODC, WFP, World Vision, Care, MDM, AZG-MSF, Myanmar Anti-
Narcotics Association).