While reliable data is scant, UNAIDS believes that Russia may have well over three million people using injecting drugs. That this burgeoning population is driving a major AIDS epidemic in Russia, therefore, is no surprise.

Country Representative Anya Fedorova (rear middle) with staff and children at the Youth Crisis Center.

Up until now, little or nothing has been done to prevent people from starting to inject - the single most important risk factor in Russia and eastern Europe generally. PSI/Russia, however, is planning on changing that and is now working on the design of a major intervention to reduce initiation of this high risk practice. This program will include four key components to change social norms regarding the use of injecting drugs, assuring that youth and other at risk populations have access to accurate information about injecting drugs, enable parents to talk to their kids about the health risks of injecting drug use, and create constructive leisure time opportunities for high risk youth from disadvantaged families.

Anya Fedorova with AIDSMark Director John Berman (right) visiting one of the leading NGOs involved in DDR in Russia.

As part of a recent design mission in April, Country Representative Anya Fedorova and the PSI/Russia team, accompanied by John Berman of AIDSMark, visited the city of Balakova — one of the epicenters of injecting drug use in Russia. Formerly a "closed city" during the Soviet era, this bleak industrial town is home to nuclear power plants and chemical factories. With few opportunities for any healthy recreation, youth fall into injecting drug use and other destructive practices with alarming frequency. PSI Russia has dealt with the problem through the provision of education opportunities and by support of a Crisis Center for children of drug addicts and CSWs. PSI and its partners have received broad praise for this work, and the number of injecting drug users has actually been on the decline over the last several years.

We look forward to learning more as Anya and her team finalize this project and prepare to launch Russia's first national level Drug Demand Reduction campaign.
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Bangkok, Thailand is home to a Master Trainer who is currently working alongside Jessica Greene, the AIDS Division's Research & IPC Program Manager, to design an IPC-focused training for field staff. While in Thailand, Jessica also had the opportunity to visit one of one of PSI/Thailand's IPC programs - Sisters. Following PSI/Thailand's strategy of targeted behavior change communication, Sisters conducts outreach and peer education with the transgender sex workers in Pattaya. Sisters has established a drop-in center, carries out peer education on the beach and at go-go bars, and promotes PSI/Thailand's Lucky brand condoms.

Operation Light House (OPL) in India is one of PSI's highest regarded IPC initiatives because of its extensive reach and strong focus on research. The lessons learned from OPL are crucial to PSI's institutional IPC success. Jessica Greene visited their field operations in Mumbai and spent time meeting with staff at the core office in Mumbai and observing OPL's field activities among truck drivers and high risk men in Vashi.

The insight gained from Thailand and India will help the AIDS Division enhance PSI's IPC knowledge-base and inform an exciting new training which will be essential to the improvement PSI's IPC programs worldwide.
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Since inception in 2002, Renascer VCT sites have experienced continued growth through their partnership with the Ministry of Health. With over 10,000 clients served per month and support of Mozambique's largest VCT sites, PSI is a major player in ensuring high quality VCT services.

Data from 2005 show that in PSI supported sites 70% of Mozambique's VCT clients were female and only 5% were couples, indicating the need to better target high-risk males and couples. Dvora will review this data in combination with her on-the-ground evaluation of existing sites to make recommendations to increase uptake among these groups.

The VCT site assessment is the most valuable part of Dvora's trip because she can personally observe operations, evaluate service delivery and experience services. Dvora has now been tested in over 10 countries! Furthermore, because her suggestions are based on multi-country findings, local staff see themselves as part of a global initiative rather than an isolated project and moral is boosted.

PSI/Mozambique reports that this assessment was the "first of its kind for PSI/Mozambique and extremely useful."
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