The Global Fund HIV & AIDS Program; PWID (People Who Inject Drug) Component

General information

Principal recipient (P.R): Save the Children International (SCI)

Fiscal sponsor: SPARSHA Nepal

Project name: - HIV Prevention & Harm Reduction Program for People Who Inject Drugs (PWID)

Working district/s & target area: Kathmandu

Primary beneficiaries: People Who Inject Drugs (PWID), People (Adult and children) living with HIV & AIDS 

Project Summary

Sathi Samuha (S.S.) pioneered the implementation of the Global Fund (G.F.) HIV & AIDS Program on February 1, 2009, marking a significant milestone as one of the first community-led organizations of HIV & HCV positive individuals and people who use/inject drugs (PWIDs) to assume the role of sub-recipient for a substantial grant, like the GFATM Grant Round-7. This partnership was established under the Principal Recipient (P.R.) - Save the Children International (SCI) in the Kathmandu district. Over subsequent years, S.S. remained committed to executing the same G.F. project, adapting to various frameworks, including the Single-stream of Funding (SSF) and New Funding Model (NFM), and it is now recognized as the "HIV Prevention & Harm Reduction Program for People Who Inject Drugs (PWID)."
Currently, we are working in the Kathmandu district as an implementing partner of SPARSHA Nepal, the fiscal sponsor for the G.F. project in the Kathmandu valley. We have two major objectives:

(1) To prevent and reduce the HIV prevalence ratio among PWIDs.
(2) To improve access to quality HIV treatment, care, and support services for PLHIV, emphasizing the achievement of Millennium Development Goals (MDG) numbers 4, 5, and 6, commonly known as Sustainable Development Goals (SDG) - Number 3.

S.S. implements its harm reduction (H.R) program, including the Needle and Syringe Exchange Program (NSEP), through its five service centers commonly known as Drop-in-centers (DICs) & Needle and Syringe Exchange Centers (NS Exchange Centers) strategically located across project areas. We have two DICs and three NS Exchange Centers functioning in areas most affected by injecting drug use in the district, providing clean syringes, new & sterilized injecting equipments and other H.R. supplies to PWIDs. 

S.S Service Centers & Programs:

Drop-in Center (DIC):

In pursuit of the primary project goal, which is to "Prevent & reduce the HIV prevalence ratio among PWID," S.S. offers a range of harm reduction services, including Needle and Syringe Exchange Program (NSEP), through its two Drop-in Centers (DICs). These centers actively engage in regular outreach activities and peer education for PWIDs, among various other services.
Recognizing the dynamic nature of how injecting drug users adapt their methods of buying and selling drugs for comfort and safety, often embracing virtual means, we, as service providers, are committed to staying attuned to their evolving needs. Consequently, these service centers are strategically established and relocated based on the aforementioned considerations, including the volume of PWIDs and service demands in specific locations/areas.

Currently, our DICs are located in following areas:
⦁ DIC-I in Tilganga (Near International Airport and SCI office) and
⦁ DIC-II in Chabahil (Near Gopi Krishna Film Theatre)

The key activities and service provisions at the Drop-in Center (DIC) include:
⦁ Needle and Syringe Exchange Program (NSEP) services.
⦁ Primary health care (PHC) services, including abscess management.
⦁ Regular field and home-based outreach services with targeted HIV intervention.
⦁ Peer education (P.E.) program.
⦁ Routine behavior change communication (BCC) sessions.
⦁ Community-led HIV testing program (CLT) conducted both at static sites and in the field.
⦁ Planned and Focus Group Discussions (P/FGD).
⦁ Referral and linkages to various social, legal, and medical services, as needed, such as Hepatitis C testing and treatment, STI and Tuberculosis diagnosis and treatment, OST, legal aid & assistance and Drug Rehabilitation centers, among others.

Needle and Syringe Exchange Center (NS Exchange Center):
To address the gaps in DIC coverage within the district, S.S. has instituted three NS Exchange Centers. The primary goal of these centers is to enhance harm reduction (H.R.) services and extend the coverage of Needle & Syringe exchange services while ensuring the retention of identified PWIDs in the H.R. program. Alongside the stated objectives, these Exchange Centers specifically offer Needle and Syringe exchange services, as well as other essential H.R. supplies, to PWIDs in a more convenient and accessible manner.
Our NS Exchange Center are located in:
⦁ Kapan
⦁ Dallu and
⦁ Jorpati (This site is specifically designed to cater to female injecting drug users.)

Outreach Program:
Outreach stands as a foundational cornerstone of any program, thus in Drug Use and H.R. program its one of the strongest pillars. S.S. regularly conducts outreach activities incorporating targeted HIV interventions, encompassing the distribution and exchange of needle & syringes, and field-based BCC education sessions and Focus Group Disucssions (FGDs) , condom distribution, and the dissemination of Information, Education, and Communication (IEC) materials to PWIDs. This evidence-based and scientifically-proven intervention plays a pivotal role in diminishing HIV, Viral Hepatitis and other blood-borne infections among PWIDs and the broader community. Currently, total of 18 Outreach Workers (ORWs) divided/ditributed into all five DICs and NS Exchange Centers conduct regular outreach activities across 232 hot-spots within 37 clusters in Kathmandu district, covering the project area and the geographical regions served by DICs and NS Exchange Centers .
The success of our outreach program is attributed to its effectiveness in reaching marginalized, socially excluded, and hidden population of people who inject drugs (PWIDs). With over 90% of the staff involved in the H.R. component having lived experience as injecting/drug users, the program brings compassion, empathy, and quality to the services as a peer-led intervention.

Community-led HIV Testing & Counseling (CLT):
Globally, around 60% of individuals living with HIV remain unaware of their status. Acknowledging the low HIV testing rates among PWIDs in Nepal, the G.F. program introduced a Community-led HIV testing (CLT) initiative. This program focuses on reaching the hidden population of PWIDs through a community or peer-led approach, employing Outreach Workers trained to administer rapid HIV tests.
Despite encountering different challenges, such as the complexity of conducting CLT in local communities, primarily due to factors like stigma & discrimination against drug users, the program has proven successful thus far. Its objective is to enhance the prevalence of HIV testing among PWIDs by utilizing simpler and faster testing methods.

Community Care Center (CCC):
Established under the G.F. project,  CCC of S.S. is dedicated to achieving MDG Goal-6 now known as SDG-3 and fulfilling the project's second goal of 'Improving the quality of life for PLHIV and enhancing access to quality HIV and AIDS services'. Until the end of 2023, the CCC has delivered a range of HIV treatment, care and support services to 1,581 PLHIVs from across the country, wheras 521 PLHIVs have initiated Antiretroviral Treatment Therapy (ARV) under the supervision of S.S's CCC.
Services provided at CCC include:
⦁ Residential care (Providing shelter, food and nutrition for PLHIV and their families)
⦁ ARV observation facility
⦁ Round-the-clock hospital-based aid & assistance
⦁ Counseling (individual, couple, and family)
⦁ Primary health care services
⦁ Minor treatment support (pathological tests, CD4 count, viral load test, etc.)
⦁ Critical treatment supports (Specifically to PLHIVs with poor financial condition
⦁ Comprehensive information and education on HIV & AIDS, ARV, HIV/AIDS Treatment Preparedness, Treatment Literacy, Opportunistic Infections (O.I.s), Positive Prevention and Positive living, Reproductive Health etc.

Community & Home-Based Care Program (CHBC):
In an effort to enhance the provision of quality HIV care and support services, coupled with essential medical, social and nursing care for local PLHIV, S.S. operates a CHBC program in the Kathmandu district. The CHBC team, comprised of professional Health Care Providers (H.A) and Community Mobilizers (from PLHIV community), regularly conducts visits to the community and homes of local PLHIV.
Key activities within the program encompass:
⦁ Regular community and home-based visits
⦁ Provision of medical and nursing care
⦁ Counseling and information on ARV Adherence
⦁ Delivery of medicines (ARV) to PLHIVs in thier home, who are otherwise unable to get ARV on their own 
⦁ Individual, couple, and family counseling
⦁ Information and education on Positive Prevention and Positive Living
⦁ Follow-up visits
⦁ Family counseling on HIV prevention and treatment
⦁ Referral and linkages as per individual need.

CABA (Children Affected by HIV/AIDS) Monthly Cash Transfer Program:
Addressing the needs of HIV-positive children remains a crucial focus within Nepal's HIV & AIDS Program, requiring significant attention. Presently, the primary initiative in place is the CABA Cash Transfer Program, which disburses a monthly financial support of NPR 1,000/- ($7.57) in cash to each child living with HIV under the age of eighteen (18). The aim of this monthly assistance is to specifically contribute to the education and treatment of these children.
However, since the inception of the CABA program in 2017, there has been no indication of an increase in the monthly cash transfer support of NPR 1,000/-, despite various advoccay and lobbying efforts. This lack of adjustment raises concerns, as neither the donor (the Global Fund) nor the Government of Nepal has shown an interest in augmenting the financial assistance provided to these vulnerable children. The fixed support amount of NPR 1,000/- for each child underscores the challenge of fulfilling the state's responsibility towards its citizens, especially the thousands of HIV+ children in urgent need of economic, social, and psychological support. This situation emphasizes the pressing need for increased attention and commitment to address the diverse needs of these children in our society.