项目初见成效，VIP免费

KeepingupwiththeepidemicProgrammesuccessleavesuswithnewchallenges:AnevaluationofprogrammesforinjectingsexworkersBackground•Some90%ofpeoplelivingwithHIVinourdistrictaredruginjectors•WehaveharmreductionprogrammesthatwebelieveareeffectivelypreventingtransmissionamongIDU•Thebiggestriskforonwardstransmissiontonon-injectorsisfromfemaleIDUwhosellsex•WethereforeaimtoprovidesafesexservicesforwomenwhobothinjectandsellsexProgrammelogic•Ourprogrammeaimstoreachwomenwhobothsellsexandinjectdrugs.•EntrypointsarefindinginjectorsamongsexworkersaswellasidentifyingfemaleIDUwhosellsex•Outreachworkerswilldistributecondomstothem,giveskillstrainingtopromotecondomnegotiationanduse,andrefertoSTIservices.•WewilltraindoctorsandsupportclinicsprovidingqualitySTIservices.•FemaleinjectorswhosellsexwillincreasetheiruseofcondomsandSTIscreeningandtreatment.•TheriskofSTIandHIVtransmissionwillfallDataanalysisplanLookatprogrammemonitoringdatatoseeifprogrammeisbeingdeliveredProgrammeandBSSdatatellusifwearereachingthetargetpopulationProgrammeandBSSdatatellusifthetargetpopulationisusingtheservicesBSSdatatellsusiftheprogrammehasaneffectDoesbehaviourchangesovertime?Dopeoplewithprogrammecontacthavedifferentbehaviourthanpeoplewhohavenoprogrammecontact?BiologicalsurveillancedatawillshownoriseinHIVOutreachworkersaregettingcondomstobothsexworkersandIDU项目分人群发放的安全套数(底区1督导评估资料,2003-2005年)020004000600080001000012000140005-6月，20037-9月10-12月1-3月20044-6月7-9月10-12月1-3月20054-6月7-9月#condomsdistributedtoFSW#condomsdistributedtoDU#condomsdistributedtoHIV+veAndtheyseemtobedoinganespeciallygoodjobofreachingthewomenwhobothinjectdrugsandsellsex最近一年收到免费安全套的暗娼,不同吸毒状态Percentofwomensellingsexwhoreceivedafreecondominthelastyear,byIDUstatus(Site1BSS,2003-2005)3868945386840102030405060708090100200320042005PercentIDUNoIDUCondomusewithclientshasmorethandoubledamongwomenwhoinjectdrugsandsellsex%ofwomenwhosellsexusingcondomswitheveryclientinthelastmonth,byinjectingstatus(Site1BSS,womenwhosellsex,2003-2005)6464793286710102030405060708090100200320042005%usingcondomswithallclientslastmonthNotIDUIDUSkillstraininghelpssexworkersusecondomsconsistently,buteventhosewithnoskillstrainingreporthighcondomuse%ofwomenwhosellsexwhousedcondomswithallclientslastmonth,bywhethertheyreceivedskillstraining(Site1BSS,womenwhosellsex,2003-2005)6270836263640102030405060708090100200320042005PercentnoskillstrainingskillstrainingContactwithoutreachworkersappearstohaveabiggerimpactonSTIscreeningbehaviour%ofwomenwhosellsexreportingfreeSTIexaminthelastyear(BSS,Site1,2003-2004)18506331280102030405060708090100200320042005PercentNooutreachOutreachAndtheoutreachismoreeffectiveforinjectingsexworkersthanfornon-injectors%ofwomenwhosellsexwhowentforfreeSTIexam,byinjectingstatusandcontactwithoutreachworkers(Source:Site1BSS,2003-2005)31391447642970590000102030405060708090100200320042005PercentofwomenhavingfreeSTIexaminpast6monthsNotIDU,nooutreachcontactNotIDU,outreachcontactIDU,nooutreachcontactIDU,outreachcontactSohowarewedoing？•Wearedistributingcondoms•Outreachworkersarereachinginjectingsexworkers,whosaytheyreceivecondoms•ThosereachedbyoutreacharemorelikelytousecondomsandgoforSTIscreening,andthedifferenceisgreatestamonginjectingsexworkers…ourprogrammesseemtobeworkingBut…Whatareallthosewell-traineddoctorsdoing？#ofSTIdoctorstrained,FSWwithoutreachreferralstoSTIservicesandfemaleclientsatprojectSTIclinics(Programmemonitoringdata,Site1,2003-2005)0501001502002503005-6月，20037-9月10-12月1-3月20044-6月7-9月10-12月1-3月20054-6月7-9月#STIdoctorstrained#FSWwithSTIoutreachservice#patientvisitstoSTI,femaleTotaldoctorstrained:40Averagefemaleclientspermonth:59EstimatednumberofFSWinprefecture:9,800•There’sroomforimprovement,butourprogrameseemstobecontributingtolimitingonwardtransmissionfrominjectorswhosellsextoclients•Doesthatmeanwe’vereachedourprogrammegoal？Yes!HIVamongsexworkersisnotrisingWellmaybenot.ArewemissinganongoingepidemicinIDU?MethadoneprogrammeintroducedTheproportionoffemaleinjectorswhosellsexisfalling%offemaleIDUwhosellsex,femalesexworkerswhoinject,andIDUwhoarefemale(Source:Site1BSS,2002-2005)192412748354521202601020304050602002200320042005FemaleIDUwhosellsexFSWwhoinjectdrugs%ofIDUwhoarefemale…buttheproportionofIDUwhoarewomenisontheriseWhatmustwedonow?•Sustainprogrammestopromotesafesexandcondomuse,especiallyforwomenwhoinjectdrugs•Re-evaluateSTIprogramming,andstrengthenifnecessary•Analyseneedleexchangeandmethadonedata;urgentlystrengthenprogrammestodecreasetransmissionamonginjectors