National Council On Drug Abuse Offering Hope to the Homeless
DEFINITION OF HOMELESSNESS According to Board of Supervision A person is considered homeless if they reside In places not meant for human habitation - cars, parks, sidewalks, abandoned buildings, gullies and on the Street In transitional and supportive homes for homeless persons for less than 30 days.
DEFINITION OF ADDICTION According to Gorski and Miller Addiction is a condition in which a person develops bio-psychosocial dependence on any mood-altering substance is accompanied by obsession, compulsion, and loss of control when not using the addict thinks about, plans and looks forward to using again despite painful consequences relieves their pain
ADDICTIVE DISEASE PROGRESSION Addiction is a complex but treatable disease that affects brain function and behaviour - NIDA Treatment should be a comprehensive care plan just consider diabetes and hypertension how would you treat these Clients?
The Genesis of TEK IT TO DEM High HIV prevalence in homeless substance users 82% (9 of 11) at a location tested (2009) These Clients are not interested in being institutionalized for treatment Hence we Tek it to Dem Take practical care/service to the Clients Take Client to referral
TEK IT TO DEM Objectives Through funding under the Behaviour Change Communication component of the National HIV/STI Programme of the Ministry of Health : To provide a coordinated prevention and treatment approach: Emphasis on substance abusers and those tested positive with HIV\AIDS Target Three hundred (300) vulnerable homeless persons in Kingston and St. Andrew
TEK IT TO DEM Objectives - Years 1 & 2 # OBJECTIVE YEAR 1 YEAR 2 1. To identify and quantify persons (with no fixed address) sleeping on the streets in Kingston & St. Andrew 333 246 2. To map street sites where the homeless reside 152 215 3. To conduct prevention and treatment interventions within the population Yes Yes 4. To conduct VCT and Substance testing among the target population Yes Yes 5. To transport the homeless to referral institutions e.g., clinics and counselling centres Yes Yes 6. To co-ordinate activities of services rendered to the homeless, including the police, churches, Ministry of Health & Environment and local businesses Yes Yes 7 To collect baseline data about this population and their health habits Yes Yes
WHAT WE DO
What we Found
CLIENTS REACHED Quadrants Male Female TOTAL Male Female TOTAL Year 1 Year 2 0 3 0 3 0 0 0 1 1 0 1 11 2 13 2 12 1 13 3 0 3 3 3 0 3 9 0 9 4 6 0 6 7 3 10 5 46 2 48 29 1 30 6 33 7 (16%) 40 25 7 32 7 107 (37%) 29 (66%) 136 74 (36%) 16 (40%) 90 8 77 (27%) 5 82 44 (21%) 10 (25%) 54 9 1 0 1 4 1 5 Total 289 44 333 206 40 246
HOMELESS CASES IN KSA
% testing HIV Positive Among Homeless Persons Tested In KSA
% testing HIV positive Among Homeless Persons Reached by TITD in KSA
HOMELESS HIV CASES IN KSA
Percent testing positive for at least one substance Among Homeless Persons
HOMELESS SUBSTANCE USERS IN KSA
COCAINE USERS IN KSA
Year 2 Testers Male (n=206) Average (SD) Female (n=40) Average (SD) Average Age 45 (12.57) 42 (13.55) Average Age at First Use 16.33 (7.38) 21.78 (12.61)P % positive for any substance 80% 73.6% Number of substance 1.4 (1.05) 1.32 (0.93)
DRUG OF IMPACT By Substance & Gender Year 2
HOMELESS % HIV POSITIVE By Poly-Substance Use Year 1
HOMELESS % HIV POSITIVE By Poly-Substance Use Year 2
HIV RATE AMONG DRUG USERS By Substance & Gender Years 1-2
CASES OF HIV & SUBSTANCE USE IN KSA
Our Response
ACHIEVEMENTS YEAR 1 YEAR 2 Comprehensive Health Clinic 25 19 Kingston Public Hospital 12 15 Food for the Poor Clinic 6 6 CHARES 1 8 Tek It To Dem Doctor 0 182 Placed in Open Arms Drop-in- Centre Sheltered in JASL (now back home) 3 3 1 0 Placed at Missionaries of the Poor 2 4 Marie Night Shelter 0 2 Condoms Distributed 7,585 22,033 Clients Fed 1,713 3,884
ACHIEVEMENTS YEAR 2 UHWI Detox 4 Patricia House 4 Client Placed in Golden Age Home 1 Clients Taken to Visit Families 3 Reunited with Families 3 Now Working 1
TEK IT TO DEM and CHARES Clinic Collaboration CASE Gender Weight (kg) Haemoglobin (g/dl) CD4 (cells/ml) WHO Classification 1 F 55.9 *** *** III 2 M 191 12.0 497 I 3 F *** *** 521 II 4 M *** *** *** III 5 M *** *** 332 III 6 F 95 *** 499 II 7 F 55 11.5 *** II
TEK IT TO DEM and CHARES Clinic Collaboration CASE Substance Abuse Sex Worker Incarceration Previous STI 1 13 2 9 3 17 4 13 5 15 6 *** 7 16 Age of Sexual Debut
PARTNERSHIPS Provision of Food Nutrition Products Chelsea Jerk Centre Webster Memorial Church St. Stephen s United Church Sonia s Home Style Restaurant Loshusan Supermarket Tastee Limited SOS Foods Limited Wisynco Traders Virginia Dare Provision of Medical Care & Medication CHARES Missionaries of the Poor Clinic UHWI Detox Unit Patricia House Comprehensive Health Centre Community Mental Health Services Our Lady of the Poor Clinic DRUGSERV
PARTNERSHIPS Provision of Shelter Open Arms Drop-in-centre Marie Atkins Good Samaritan* (will open a female facility) Missionaries of the Poor Golden Age Home Provision of Other Products/Services/Funding Board of Supervision CARIMED Kirk Distributors *National HIV/STI Programme of the Ministry of Health Global Fund and USAID The Gist
CHALLENGES FOR TREATMENT & Prevention Among Homeless - Pre and post test counselling is challenging based on the mental challenges of some of the population - Commercial and transaction sex prevail - Condom access limited unless provided free of cost on a consistent basis and when provided it is often sold - In the absence of the project persons don t seek treatment - Untreated STIs and other illnesses - Highly susceptible to HIV re-infection
CHALLENGES FOR TREATMENT & Prevention Among Homeless Treating Clients with Poly-diagnosis - e.g. substance and psychosis Unable to access ARVs because of their poor nutrition, adherence to medications and substance use There is no shelter for the Homeless HIV substance user especially the female Clients
CHALLENGES FOR TREATMENT & Prevention Among Homeless The available facilities in Kingston and St. Andrew are full and are unable to accept new clients Clients report that some shelters are too restrictive; or they are concerned about physical and sexual abuse Persons unwilling to undertake substance testing due to the length of time the test takes and 11 have actually aborted the process
CHALLENGES FOR TREATMENT & Prevention Among Homeless Unable to locate the HIV+ persons for follow-up referral appointments as they are nomadic or have to hustle to exist. Difficult to provide comprehensive sexual and reproductive health education due to mental status of some clients Struggling to reintegrate and re-socialize the homeless as there are insufficient resources such as low threshold drop-in-centres, rehab centres and facilities for skills training.
CHALLENGES FOR TREATMENT & Prevention Among Homeless It takes too long to access care at the Public Clinics and Hospitals Inconsistent supply of HIV Test Kits Inconsistent supply of Project Funds The Clients are unable to access National ID/Voters ID No Low-threshold Programmes for building skills of Homeless persons No Government facility catering to the needs of Substance Abusers
BARRIERS TO CARE Low literacy of target population Lack of motivation No coping skills No current residential rehabilitation offering Skills Training Lack of Governmental Support No access to National ID/Voters ID
RECOMMENDATIONS For Homeless HIV/Substance Abuser We need to develop a holistic and comprehensive package of services for Homeless persons especially for those who are HIV positive and substance users which should include A dedicated hostel for Homeless Substance Abusers who are HIV +VE and increasing the available low-threshold drop-in shelters Offer general medical services Provide access to ART Provide consistent nutritional support Increase Detoxification\Rehab facilities with skills training Consistent supply of condoms for free distribution
RECOMMENDATIONS For Future Response Social Support Skills training Reintegration with family and community Job placement Additional research to improve decision making Access to PATH programme Provide I.D., NIS, TRN to assist with reintegration Peer support groups to provide psychosocial support to clients and families as part of reintegration process
PROPOSED OBJECTIVE The project will assess, rehabilitate and reintegrate homeless persons in Kingston and St. Andrew into independent, productive members of the society
TEK IT TO DEM Care Cycle for the Homeless in KSA
Thank you from the Team