Harm Reduction grant in five countries in West Africa Funded by the Global Fund, implemented by ANCS 24 July 2017 (11pt) Paris, France By Vanessa Rousselle

Outline Introduction: Harm reduction in Global Fund programs The context of the PARECO At a glance Objectives What is at stake Methodology Example of activities at regional and national level Recommendations and lessons learnt

Intro: Harm reduction and Global Fund Investment in programs for people who inject drugs (2014-2016) estimated at 230 to 250 million dollars GF will continue to prioritise harm reduction programs as a critical component of effective, evidence informed and rights based HIV response     Trend and preliminary analysis indicates Ratios of total resources within available GF HIV funding have increased for harm reduction A positive shift towards higher impact interventions such as NSP and OST The Global Fund remains the largest single financier globally The gap between funding needs and available resources remains significant Promoting and protecting human rights and gender equality is required to accelerate the end of the three epidemics.

PARECO: Context Facts Rapid increase in the number of people who inject drugs in Sub-Saharan Africa with a peak recorded in West and East Africa 13 out of 47 countries only collected data on the use of injectable drugs Pop. Size est. 1.02M (300,000-6,4M) / est. 5 to 10% living with HIV Gaps and barriers Lack of harm reduction and treatment programs in the sub-region Resources focus on seizure and repression rather than health Opinion: harm reduction increases the use of drugs According to UNODC and West Africa Commission on Drugs, and Global State of Harm Reduction 1.7 million people who inject drugs in Sub-Saharan Africa 221 000 have an HIV infection

At a glance PR: ANCS in Senegal 5 countries: Burkina Faso, Cap Verde, Côte d’Ivoire, Guinea Bissau and Senegal SRs: IPC, Platform of NGOs, MdM CIV, and ENDA GNB Amount: 5.89 Million euros Implementation: January 2017–December 2019 Alliance Nationale des Communautés pour la Santé Senegal

Objectives Overall: Improve access to services (harm reduction) and promote respect for the human rights (HR) of people who inject drugs (PWID) in West Africa Improve the availability of strategic information to guide harm reduction interventions targeting PWID in 5 countries Strengthen the harm reduction capacity of community actors and PWID to improve health services and HR for PWID Enhance the social and legal environment to facilitate implementation of harm reduction activities targeting PWID in the 5 countries Carry out innovative model harm reduction projects, document the best practices and implement them in the 5 countries

What is at stake ? Preparing the ground for the development of harm reduction programs: At sub-regional level: Policy, legal and decision making At national level: Data and information for decision making At local level: Piloting projects that can be replicated and expanded Building capacity and enhancing knowledge In next cycle: Countries have included harm reduction in HIV programming, next NSPs and funding requests

Harm reduction for PWID in WA Methodology MODULE 2 Legal and regulatory review and legal reforms Policy advocacy on legal rights Legal training for civil servants, health workers and police officers Legal rights monitoring at the community level 10% MODULE 1 Strategies and policies Health legislation and regulations 28% Harm reduction for PWID in WA 5.89 M MODULE 4 Analyses, studies and transparency Regular communication of information 26% MODULE 3 Strengthen institutional capacity, planning and leadership within the community sector Social mobilization, strengthening ties between communities, collaboration and co‑ordination Community follow-up on accountability 16% MODULE 5 Policies, planning, co‑ordination and management 20%

Example of activities IBBS and mapping in the five countries Review of legal frameworks in the five countries Elaboration of a Regional Strategic Framework and National action plans Advocacy at Regional level and participation to high level meetings Capacity building workshop for CCM members, 12 countries in the region Training of security forces, journalists, decision makers

Pilot projects: activities in countries 3 models aiming at: Promoting Harm reduction Demonstrating the feasibility of interventions where there is no program and encouraging the others Learning best practices for replicating and scaling up Each country (CCM/SR): Chose a model, based on context, experience, data available Set up a small team (coordinator, social workers, mediators, etc.) Set up the project: Partnerships, situational analysis, BCC tools, M&E tools, training of staff, etc. At the end: evaluation and lessons learnt: relevance, feasibility, replicability, scale up

Three models Model 1 – Outreach in community settings Burkina Faso Guinea Bissau Cote d’Ivoire Model 1 – Outreach in community settings Service delivery and empowerement at community level: supply adequate equipment for drug usage, prevention, condoms, as well as information, etc. Model 2 – Cooperation with Security forces Improve acceptance of Harm reduction programs through knowledge, and cooperation between social workers, users and forces in open settings (streets) Model 3 – In prisons Improve acceptance of Harm reduction programs through knowledge, and cooperation between social workers, users and forces in closed settings (prisons for men and prisons for women) Cape Verde Senegal Model 1 – outreach – burkina, guinea Bissau and cote d’ivoire Model 2 – cap verde and senegal Model 3 - senegal

Recommendations and Lessons Only 6 months of implementation Regional grant cannot support all efforts. It will require champions to make it work: in specific countries and among decision makers to sustain the efforts Financial sustainability of the activities at regional level (advocacy)

THANK YOU 24 July 2017 (11pt) Paris, France By Vanessa Rousselle