Independent evaluation: Community Action on Harm Reduction

On 1 January, 2011, the International HIV/AIDS Alliance began implementation of a four year project entitled, 'Community Action on Harm Reduction (CAHR)', funded by the Social Department/Health and AIDS Division of the Ministry of Foreign Affairs (Buitenlandse Zaken) of the Government of The Netherlands as Project Number 23389.

CAHR is an ambitious project involving five countries – China, India, Indonesia, Kenya and Malaysia – and a number of international technical partners with the overall objective to expand coverage of HIV prevention, treatment and care, sexual and reproductive health and other services to a total of more than 230,000 people who inject drugs (PWID), their partners and children. Due to specific higher-risk behaviours, PWID are at increased risk of HIV irrespective of the epidemic type or local context; they often have legal and social issues related to their behaviours that increase their vulnerability to HIV.

The programme is implemented through a consortium of Alliance Linking Organisations (LOs): AIDS Care China, India HIV/AIDS Alliance (Alliance India), Rumah Cemara in Indonesia, the Kenya AIDS NGO Consortium (KANCO) and the Malaysian AIDS Council (MAC), in collaboration with four international policy partners: the International HIV/AIDS Alliance, Harm Reduction International (HRI), the International Drug Policy Consortium (IDPC) and the International Network of People who Use Drugs (INPUD). Several other agencies also provide specialised technical assistance in various areas.

Although each of the five CAHR countries are at different stages in the development of a comprehensive package of harm reduction services for PWID, all but one objective of the CAHR programme have been achieved and many of them have far exceeded their original target. As a result, CAHR is a practical demonstration of the approaches recommended by WHO, UNODC and UNAIDS for the prevention, treatment and care of HIV for PWID that include the following interventions:

1. Needle and syringe programmes (NSPs)
2. Opioid substitution therapy (OST) and other evidence-based drug dependence treatment
3. HIV testing and counselling (HTC)
4. Antiretroviral therapy (ART)
5. Prevention and treatment of sexually transmitted infections (STIs)
6. Condom programmes for people who inject drugs and their sexual partners
7. Targeted information, education and communication (IEC) for people who inject drugs and their sexual partners
8. Prevention, vaccination, diagnosis and treatment for viral hepatitis
9. Prevention, diagnosis and treatment of tuberculosis (TB)

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