Rapid PEER Study To Strengthen The Injecting Drug Users' Quality of Life Programme

PSI Thailand
Rapid PEER Study

to strengthen the
Injecting Drug Users Quality of Life Programme

(IDU QOL)
April 2011
Final report prepared by:

Rachel Grellier (Options Consultancy Services Ltd)
Yaowalak Jittakoat (PSI Thailand)
Duangta Pawa (PSI Thailand)
Options Consultancy Services Ltd, 20-23 Greville Street, London, EC1N 8SS, UK www.options.co.uk t: +44 (0)20 7430 1900
Acknowledgements
Many thanks to Gary Mundy of PSI for his support with this work and to all the Peer
Interviewers, respondents and programme staff who gave up their time to participate in the
Rapid PEER study.
We are grateful to Pharisa Tanglumlert for her assistance and interpreting skills in the
Bangkok component of the study.
Thanks also to Piya Shome of Options Consultancy Services for her administrative and
organisational contribution.
Contents
Acronyms
Executive summary
Page
1
2
1.
1.1
1.2
1.3
Introduction
Background to the research
Methodology
Research sites and participants
5
5
5
7
2.
2.1
2.2
2.3
2.4
2.5
Context
The project
Project activities
Injecting drug use and HIV/AIDS in Thailand
Project beneficiaries
Quantitative data from the project to date
8
8
10
11
12
13
3.
3.1
Findings
How beneficiaries were introduced to the project
Implications for the project
Why participants became involved in the project
The difference made by the project according to beneficiaries
The difference made by the project according to DIC Managers
15
15
15
16
17
17
32
32
38
Challenges
From the perspective of project beneficiaries
From the perspective of DIC Managers
39
39
42
42
44
The Future
45
45
48
48
48
6.
Conclusion
49
7.
7.1
7.2
Annexes
Rapid PEER methodology and daily itinerary
Rapid PEER interview transcripts
50
50
52
3.2
3.3
3.4
4.
4.1
4.2
5.
5.1
5.2
Acronyms
ART
Antiretroviral Therapy
DIC
Drop-in-Centre
IDU
Injecting Drug Users
MARP
Most At Risk Populations
MKK
Metta Khao Khao
MMT
Methadone Maintenance Treatment
NGO
Non Governmental Organisation
NSP
Needle and Syringe Programme
OI
Opportunistic Infections
ONCB
Office Of Narcotic Control Board
PEER
Participatory Ethnographic Evaluation and Research
PMTCT
Prevention Of Mother To Child Transmission
PR
Principal Recipient
PSI
Population Services International
STI
Sexually Transmitted Infection
TDN
Thai Drug Users Network
TTAG
Thai AIDS Treatment Action Group
VCT
Voluntary Counselling and Testing
EXECUTIVE SUMMARY
PSI/Thailand commissioned Options Consultancy Services to undertake a participatory
research study to understand the experiences of beneficiaries and staff involved in a
harm reduction project for injecting drug users (IDUs). The purpose of the project is
to promote safer injecting and sexual behaviour among IDUs through peer education
and drop-in centres (DIC). The project also employs a social marketing strategy to
increase access to and availability of needles, syringes, and condoms; and to refer
IDUs into HIV and Sexually Transmitted Infection (STI) testing and treatment services.
Community advocacy and stigma reduction are also emphasized in the project.
The aim of the research was to help strengthen the projects efforts to improve the
health and quality of life of IDUs. A further aim of the research was to train PSI
project staff in the participatory qualitative methodology and to build their capacity,
through ongoing in-country and desk-based support, to undertake similar research.
Five project sites participated in the study. To capture the voices of the beneficiaries,
the study used the Rapid PEER (participatory ethnographic evaluation and research 1)
methodology which has been widely used by international health programmes to gain
insights into the perspectives of vulnerable and marginalised community members.
The method is particularly strong in collecting stories and examples, and avoiding
normative responses (what interviewees feel they should say) as discussions take
place between trusted friends rather than with an external researcher.
Project staff selected approximately six ordinary project beneficiaries at each site to
be trained as Peer Interviewers. The group spent a day discussing their activities,
developing interviewing skills, and learning how to obtain informed consent from
interviewees. They then conducted conversational interviews with two people from
their existing social networks who were also project beneficiaries or had had some
involvement in the project. Over two days they then fed back qualitative interview
data to the consultant who then coded and analysed the data. This process
generated an insider view of the project and its context.
The project appears to be making considerable progress towards meeting its key
objectives. It is highly regarded by the beneficiaries and clear examples were
provided of the benefits they are gaining in terms of increased knowledge about
harm reduction behaviour change. Many are managing to put this new knowledge
into practice in their daily lives.
Access to health services is increasing, particularly HIV and STI services. Safer
injecting practices, increased use of condoms and improved quality of life are also
reported as a result of programme activities.
Expanding social networks, improved health and a sense of being valued members of
society with similar rights to other citizens is resulting in beneficiaries having
expectations of the project to provide opportunities for employment, and
1
See www.options.co.uk/peer for more information. PEER is described in detail in: Researching
sexual and reproductive behaviour: a peer ethnographic approach, Neil Price, Kirstan Hawkins. Social
Science & Medicine 55 (2002) pp 13251336.
rehabilitation facilities to support cessation of drug use. This is raising challenges as

to how these growing expectations can be managed and supported.
Project staff also perceive the achievements that the project is making but
experience challenges in striking a balance between meeting programme targets and
using the opportunities provided by Global Fund support to facilitate IDU behaviour
change that goes beyond the programme remit e.g. moving from harm reduction to
support for quitting injecting altogether.
The project is still at an early stage and has made significant progress over a short
period of time. The views expressed by both project beneficiaries and DIC managers
align well with the projects objectives. It is suggested, however, that the project
would benefit from inclusion of an explicit focus on gender issues and the differing
needs and vulnerabilities of female and male IDUs. Other than that, descriptions of
challenges currently being faced are more a reflection of the early stage of the
project rather than weaknesses in the design and implementation of the project. As
a result, a series of implications for consideration by the programme team are
flagged up at the end of each section. These are purposefully less didactic than
conventional recommendations and are more in alignment of the purpose of the
research, which was to provide information to inform planning on future activities of
the programme.
The key implications resulting from the study are:
The project may wish to consider whether there is a need to use additional
approaches to inform IDUs about the project.
There appear to be under-utilised opportunities to use pharmacists and health

facility staff, particularly those working in methadone and HIV/AIDS clinics, to
disseminate information about the project.
Adopting the approaches suggested above would be a cost effective way of

contributing to scaling-up the programmes reach.
There is no evidence that IDUs who join the project perceive free needles as an
opportunity to inject more; instead the qualitative data show a very active desire
to engage in harm reduction practices.
Gender issues do not appear to be explicitly addressed in project activities

despite the specific needs and vulnerabilities of female IDUs. A greater focus on
gender issues in project activities would be beneficial in terms of optimising the
benefits of project activities.
Safe needle disposal is an important component of harm reduction. The

qualitative data from this study (supported by quantitative project data) suggest
a need for greater emphasis on safe needle disposal at all project sites.
Significant progress is being made in terms of increasing IDUs access to health

services. There is little evidence, however, that IDUs currently are able to assert
3
their rights without the presence of a Peer Educator. It is suggested that the
project continues to work towards achieving this by continuing to actively
promote attitudinal change among health service providers and providing IDUs
with appropriate skills to enable them to assert their rights.
On-going advocacy and networking efforts with government, policy makers,

service providers, police and communities need to continue and there may be
benefits to exploring whether these could be expanded to reach greater numbers
of service providers and other public sector workers, particularly the police.
DIC managers appear to view skills education as playing a greater role in bring
about change to project beneficiaries lives than do the beneficiaries themselves.
It would be helpful for the project team to consider additional ways of

networking within IDU communities to ensure that awareness of the project is
raised without, potentially, putting Peer Educators at risk.
Providing all Peer Educators with anger management and conflict resolution
training; and providing opportunities for project beneficiaries to meet Peer
Educators on a one-to-one basis for additional counselling and support after
conflict has occurred at DICs may be beneficial.
DIC Managers are highly committed to the CHAMPION project and are proud of
the achievements to date. However, there is a risk that, over time, frustration
may increase about effectively balancing the need to meet quantifiable targets
with achieving longer-term qualitative change in IDUs lives that Managers felt are
key components of achieving sustained behaviour change.
It would be beneficial to meeting, and going beyond, the original aims of the
project to consider how best to support IDUs who wish to cease any form of drug
use.
It appears that there is a need to support DIC Managers in fulfilling the multiple
objectives and needs of the project.
INTRODUCTION
1.
This project changes IDUs from ghosts to humans

(Female Peer Interviewer)
1.1
Background to the Research
Population Services International (PSI) is a non-profit non-governmental organization

(NGO) that specializes in social marketing of AIDS prevention, family planning and
maternal and child health products and services.
PSI/Thailand has been operating in Thailand since 2002, and with support from the
Global Fund to Fight AIDS, TB and Malaria in 2009, expanded implementation of its
programme targeting Injecting Drug Users (IDUs) across 15 provinces in Thailand. The
purpose of the program is to promote safer injecting and sexual behaviour among
IDUs through peer education and drop-in centres (DIC). The programme also employs
a social marketing strategy to increase access to and availability of needles, syringes,
and condoms; and to refer IDUs into HIV and Sexually Transmitted Infection (STI)
testing and treatment services. Community advocacy and stigma reduction are also
emphasized in the program.
The ultimate goal of the programme is to improve the quality of life of IDUs through
better access to products, health and social services. PSI Thailand requested
Options Consultancy to undertake research to help strengthen the interventions
efforts to improve the health and quality of life of IDUs. A further aim of the
research was to train PSI research staff in the Rapid PEER methodology and to build
their capacity, through ongoing in-country and desk-based support, to undertake
Rapid PEER research in a further four programme sites.
The aim of the research was to enable PSI research staff to better understand how
the programme is perceived by beneficiaries and staff, and to use the information to
strengthen programme efforts.
The objectives of the research were to capture the voices and stories of beneficiaries
and programme staff to:
1.2
Better understand IDUs perspectives about their quality of life and health.
Explore the contribution that the programme intervention has made to date
in improving the quality of life of IDUs who engaging with the programme.
Gain insight into the key strengths and challenges of the programme from the
perspective of beneficiaries and programme staff.
Methodology
The research took place in two main stages. The first stage involved fieldwork in
Bangkok alongside which two PSI research staffs were trained in Rapid PEER
methodology (see below). The second stage of the research was led by the PSI
research staff who undertook Rapid PEER fieldwork in the Southern and Northern
Provinces, with desk-based support provided by Options Rapid PEER specialist.
5
Stage One:
a. Fieldwork: In order to generate rapidly a detailed understanding of the
programme, the consultant visited Alden House, one of the Drop-In Centres (DIC)
under the CHAMPION project in Bangkok for five days, holding discussions and
interviews with programme beneficiaries and DIC staff.
The research took a case study approach, using a participatory, qualitative
research method. This was an adapted (rapid) version of PEER (participatory
ethnographic evaluation and research2), which is highly effective for capturing
the voices of vulnerable beneficiaries. Rapid PEER has been widely used by
international health programmes to gain insights into the perspectives of
community members, especially vulnerable and highly marginalised groups. In
Rapid PEER, ordinary members of a community or project/programme conduct
in-depth, conversational interviews with others in their social network. They feed
back the results of these discussions to a social scientist. The method is
particularly strong in collecting stories and examples, and avoiding normative
responses (what interviewees feel they should say) as discussions take place
between trusted friends rather than with an external researcher.
In preparation for the research, the research staff selected 5 men and 3 women
IDUs to be trained as Rapid Peer Interviewers. The group, who were all regular
participants in the programme, spent a day with the consultant and research
staff discussing their activities and practicing interviewing skills, including asking
interviewees for consent to take part, and how to ensure the anonymity of
interviewees.
They then conducted conversational interviews with two friends who were either
also beneficiaries of the programme. Over two days, the Rapid Peer Interviewers
fed back qualitative interview data to the consultant. This process generated an
insider view of the programme and its context.
Other methods used during the research included:
Individual semi-structured interviews with project staff and service
providers.
Conducting a group discussion with peer interviewers at the O-Zone dropin centre.
A detailed outline of the methodology and itinerary can be found in Annex 1.
b. Capacity building: Two PSI research staff participated alongside the consultant in
all stages of the study in order to gain experience in undertaking Rapid PEER
Research.
Stage 2:
See www.options.co.uk/peer for more information. PEER is described in detail in: Researching
sexual and reproductive behaviour: a peer ethnographic approach, Neil Price, Kirstan Hawkins. Social
Science & Medicine 55 (2002) pp 13251336.
Following completion of Stage 1, PSI research staff undertook Rapid PEER studies in
four (4) further Provinces. They were provided with desk-based support from the
consultant who then undertook detailed desk-based analysis of translated Rapid
Peer Interviewer de-briefings and data which had been coded into initial broad
themes by the PSI research staff.
This report represents findings from all five Rapid PEER sites. The findings are
reported by theme rather than by site; however when clear differences were noted
between sites these are also reported.
1.3
Research sites and participants
The Rapid PEER research was undertaken in a total of five Provinces within the
Northern, Central and Southern Regions. Details of the sites and Peer Interviewers
are provided in Table 1 below.
Table 1: Rapid PEER research sites and Peer Interviewers
Site No.
Region
Province
1.
Central
Bangkok
Total
Number
8
2.
3.
Southern
Satul
Trang
4.
5.
Northern
Total
Peer Interviewers
Male
Female
Age Range
5
33 - 54
5
5
5
4
27 - 44
19 29
Chiang Mai
Chiang Rai
4
4
3
3
1
1
32 - 55
18 - 45
26
20
In addition to interviewing two friends, the Peer Interviewers also provided

information on their own experiences of engaging in the project. Three Peer
interviewers were only able to interview one friend or, in error, interviewed friends
who had no connection with the CHAMPION project. Thus this report is based on
information from a total of 74 project beneficiaries.
The report includes many quotes to illustrate the research findings. Attribution of all
quotes is as follows: (Site No., Peer Interviewer No., Friend No., Gender of Friend).
Thus a quotation ending ....... (Site 1, P.I.2, F1m) is from Site 1 (Bangkok) and was
provided by Peer Interviewer No. 2 debriefing on Friend 1 who is male.
2.
CONTEXT
2.1 The project

The Comprehensive HIV Prevention among Most at Risk Populations (MARP) by
Promoting Integrated Outreach and Networking
Definition of Harm
(CHAMPION) Project is a five year harm Box 1:
Reduction
reduction programme (2009 2014) supported Harm Reduction refers to
by the Global Fund to Fight AIDS, TB and Malaria policies, programmes and practices
(a definition of harm reduction is provided in Box that aim primarily to reduce the
1). Population Services International (PSI) is the adverse health, social and
Principal Recipient (PR) of funds for the IDU economic consequences of the use
of legal and illegal psychoactive
component of Round 8 of the Global Fund. PSI drugs without necessarily reducing
channels funds into five O-Zone Drop-in-Centres drug consumption. Harm reduction
(run by PSI staff). PSI also supports Sub- benefits people who use drugs,
Recipients and Sub-Sub Recipients (national or their families and the community.
local NGOs) who operate 11 DICs in 15 Provinces (International Harm Reduction
Association: www.ihra.net/what-isthroughout Thailand.
These local partners harm-reduction)
include: Raks Thai Foundation, Access Quality
International, the Pharmacy Network Co. Ltd., Thai AIDS Treatment Action Group
TTAG), Thai Drug Users Network (TDN), Alden House, Thai Red Cross and Metta Khao
Khao (MKK) House (Fig. 1).
Figure 1: CHAMPION Partners
Global Fund
Government partners:
DDC
Tanyarak Institute
Dept of Corrections
BMA
NAMc
PCMs
ONCB
CCM
PSI
O-Zone
Metta Khao Khao
Raks Thai Foundation
Thai Drug
Users
Network
Alden
House
Access
Quality
International
Pharmacy
Network Co.,
Ltd
Thai AIDS
Treatment Action
Group (TTAG)
Thai Red
Cross
(Source: Project Documentation acronyms not supplied)

The project goal is to reduce HIV incidence among IDUs in Thailand by 50% through a
focus on three strategic supply-side objectives:
Strengthening and scaling up delivery of comprehensive HIV prevention
services for IDUs.
Building a strong enabling environment for equitable and sustainable delivery
of HIV services for IDUs.
Strengthening the strategic information system for programme and policy
improvement for IDUs.
8
The projects aim to support, defend and advocate for IDUs to receive
comprehensive HIV prevention services is also reflected in the demand-side
objectives which it aims to achieve by supporting the following behaviour change
objectives among IDUs:
Increase in the use of voluntary counselling and testing (VCT) and STI
services.
Increase in the use of opportunistic infection (OI) and anti-retroviral
treatment (ART) among IDUs living with HIV.
Increase in the use of methadone maintenance treatment (MMT).
Increase in condom use with regular partner(s).
Decrease in sharing of injecting equipment.
The programme is currently operational in 13 out of the planned 15 provinces in
three regions (Table 2):
Table 2: Programme Coverage
Region
Northern
Province
Chiang Mai
Chiang Rai
Mae Hong Son
Central
Bangkok
Samut Prakarn
Pathumthani
Nonthaburi
Ratchaburi
Southern
Songkhla
Satun
Surat Thani
Trang
Phattalung
Yet to be included
Krabi
Nakhon Sri Thammarat
The engagement of programme partners in each province is shown in Fig. 2.
Figure 2: Programme Intervention Areas by Province and Partner
O-Zone
Raks Thai
TDN
Alden House
MKK House
Thai Red Cross
North
No DIC
DIC in Yr.2
15 provinces
Central
South
NAKHON SRI
THAMMARAT
2.2 Project activities

A wide range of demand- and supply-side activities are undertaken at all sites. These
combine access to safe injecting equipment, health education, psycho-social

support, recreational opportunities, rights-based information and, in some cases,
skills training through a combination of DIC and Peer Educator activities. Those that
are relevant to the Rapid PEER study are listed in Box 2 below.
Box 2: Programme activities relevant to the Rapid PEER study
Objective 1: Strengthen and scale-up delivery of HIV services
BCC through peer education and Drop-in Centres
Distribution of sterile injecting equipment and collection and safe disposal of used
needles and syringes, through Peer Educators and Drop-in Centres (and pharmacies in
Bangkok)
Distribution of condoms
Referral to voluntary counseling and testing (VCT) and sexually transmitted infection
(STI) services
Co-ordinate voucher scheme and capacity building for distribution of sterile injecting
equipment through community pharmacies in Bangkok
Work with Office of Narcotic Control Board (ONCB) on establishing agreement on
protection of Peer Educators from police action when performing outreach activities.
Advocate with government agencies for appropriate methadone maintenance treatment
(MMT), VCT and STI services in open and closed settings, and work with them to
strengthen referral systems.
Develop standardized system of VCT, STI and MMT referral and follow-up
Co-ordinate capacity building in:
o Training of trainers on harm reduction
o Peer education and outreach
o Needle and syringe programme (NSP)
10
o
o
o
o
o
o
DIC management
Negotiation, motivational interviewing and counseling
Pathways to Recovery
HIV/AIDS
Sexual and reproductive health
Gender-based violence and human rights
Objective 2: Build enabling environment

Hold Pathways to Recovery workshops/meetings with community stakeholders to
explain the program and promote the harm reduction approach.
Co-ordinate capacity building for program staff in advocacy for harm reduction.
Co-ordinate workshops and study trip to promote harm reduction to the following target
audiences:
o Health care providers at site level
o Policy-makers and parliamentarians
o Police officers
o (Correction officers)
o Media
o Community stakeholders at national and provincial level
Advocate for appropriate health and social support services for IDUs
Serve as watchdog on quality of government services for IDU, e.g. MMT, opportunistic
infection (OI)/ART
Represent IDU interests in drug use issues, development of national harm reduction
policy, and on 26 June (International Day Against Drug Abuse and Illegal Trafficking)
(Source: Project Documentation)
In addition to providing information on harm reduction, and facilitating needle and

condom distribution, and needle exchange initiatives; each DIC hosts a range of
additional activities which include jewellery-making, music, computer skills, cooking,
and screen painting.
2.3 Injecting Drug Use and HIV/AIDS in Thailand
The illegality of injecting drug use and high levels of stigma of IDUs within Thai
society mean that information on IDUs in Thailand is limited. This is reflected in
recent estimates of the total number of IDUs as being between 160,000 and
270,000.3 Knowledge is clearer, however, on their vulnerability to HIV transmission,
with almost 5% of all HIV cases in Thailand being reported in IDUs. A survey
published in 2006 estimated that HIV prevalence among IDUs was 39.3% in Bangkok
and 32.1% outside the capital.4 Approximately 25% of all new HIV infections occur
through contaminated injection equipment.5 It is estimated that up to 68% of IDUs
share contaminated needles.6
Canadian HIV/AIDS Legal Network (2009) Drug Use and HIV/AIDS in Thailand
www.aidslex.org/site_documents/DR-0026E.pdf)
4
PSI Thailand (2009) FOQUS:What Affects Safer Injecting and Sexual Behaviors of Injecting Drug
Users?
5
Canadian HIV/AIDS Legal Network (2009) Drug Use and HIV/AIDS in Thailand
(www.aidslex.org/site_documents/DR-0026E.pdf)
6
Ibid.
11
While targeted HIV prevention programmes have been highly effective in Thailand,
there has been little focus on HIV prevention among IDUs. Although the National AIDS
Plan (2007-2011) contains a commitment
to ensuring IDUs access to HIV prevention,
treatment and care,7 and there is a stated
intent by government agencies to
implement harm reduction programmes,8
in practice implementation has been
limited (Box 3) and has met with resistance
particularly among health workers and the
police.
The CHAMPION project is
responding to this long-perceived area

of need.
2.4
Project Beneficiaries
Box 3: UNGASS Country Progress Reports relating to

IDUs
2004: Thailand should act quickly to scale up
outreach and related harm reduction programmes
particularly in urban areas where drug supply and use
was most likely to continue. Such interventions had
been shown to reduce risk of HIV transmission and do
not result in more people using drugs ([Thailand]
National AIDS Prevention and Alleviation Committee,
UNGASS Country Progress Report: Thailand, 2004:
www.ua2010.org)
2008:
*t+he prevention work among IDUs is
extremely inadequate with limited coverage. (Ibid
2008: http://data.unaids.org)
Over the eighteen-month period from

the projects start in 2009 up to the
time of the Rapid PEER study in February 2011 the majority of IDUs (74.2%) engaging
with the project are aged 25 or over and largely (37.9%) reside in Bangkok. Other
key IDU populations with whom the project engages are in Chiang Rai (15.9%),
Nontaburi (13.7%) and Chiang Mai (12%). In other provinces the project engages
with fewer IDUs, thus forming an important but far smaller percentage of the
projects coverage (Figure 3).
Figure 3: Province of residence of IDUs engaging with the CHAMPION project
40%
37.9%
35%
Percentage %
30%
25%
20%
15.9%
15%
13.7%
12.0%
10%
5.8%
4.4%
5%
1.0%
2.1%
0.9%
2.7%
2.5%
0.9%
lu
ng
ng
P
ha
tta
ra
T
at
hu
n
S
ee
tth
an
ur
a
S
on
gK
hl
a
ut
pr
ak
ra
am
nt
ab
ur
S
N
o
ta
ne
e
K
K
ra
tu
m
B
P
on
gs
on
ai
ae
h
ia
ng
r
M
C
h
C
h
ia
ng
m
ai
0%
Location
A summary of the key demographic characteristics of all IDU project beneficiaries to

date are shown in Table 3 below. The profile of IDUs engaging with the CHAMPION
project is perceived to be broadly in line with national data on IDUs in terms of
gender and age (for IDUs primarily injecting heroin) and suggests that the project is
succeeding in engaging with key target groups.
Table 3: Demographic Profile of Project Beneficiaries
7
The National Committee for HIV and AIDS Prevention and Alleviation (2007, November) The National
Plan for Strategic and Integrated HIV and AIDS Prevention and Alleviation 2007-2011.
8
[Thailand] National AIDS Prevention and Alleviation Committee, UNGASS Country Progress Report:
Thailand, 2008
12
Demographic Profile
Male
Female
Gender
87.8%
12%
Age
25 years and over: 74.2%
Total number of IDUs reached by the Project
3,914
(Source: Project monitoring documents June 2009 December 2010)
2.5
Quantitative data from the Project to date
This section summarises quantitative data provided by the Project team which show
achievements over the eighteen month period between 2009 and 2011, up until the
time of the Rapid PEER research (Table 4). The data are included in this report to
provide important contextual information; and as a form of data triangulation to
validate the qualitative data obtained by the Rapid PEER methodology.
The quantitative data are not included for evaluation purposes. There are likely to
be many reasons why the number of IDUs referred to VCT were below the project
target during the period covered by the data. This report gives indications why this
may be the case by highlighting the challenges faced by the project. These include,
among many others, gaining the confidence of IDUs in the project, and their
reluctance to engage with health service providers. The qualitative data provided in
this report do, however, also provide some likely explanations on why some
quantitative targets are being surpassed at such as early stage in the life of the
project. It is likely that they are a reflection of the trust shown in the project, peer
educators and other DIC staff once IDUs start to engage with the project and gain
the benefits of the information and services it provides.
13
Table 4: Quantitative results for the CHAMPION Project up to Quarter 6 (June 2009December 2010)9
Issue
Gender of Peer Educators
Age of Peer Educators
Numbers of IDUs reached by
each Peer Educator10
Average number of contacts
per month (June 2009-Dec
2010) between Peer Educators
and each IDU11
Means of needle distribution
Data
84.8% male
15.2% female
95.8% aged 25 years and over
4.2% aged less than 25 years
32% of Peer Educators reach 40 or more IDUs
68% of Peer Educators reach fewer than 40 IDUs
44.6% once per month
27.7% twice per month
0.0% three times per month
9.8% more than four contacts per month
83.9% distributed by Outreach Workers (Peer Educators)
12.1% distributed via Drop-in-Centres
1,074 in total (approx. 64% below project target)
Number of IDUs referred for

VCT
Number of IDUs receiving an 220 in total (approx. 34% above project target)
HIV test who know their results
Number of IDUs participating in 694 in total (approx. 16% above project target)
harm reduction workshops
Not all percentages add up to 100% - only significant percentages drawn from Project presentations
are included in this table.
10
Each Peer Educator is responsible for engaging with 40 IDUs. The high proportion of Peer Educators
engaging with less than 40 IDUs is likely to be a reflection of the early stage of the project and the
challenges associated with gaining the trust of IDUs, as described in this report.
11
Each Peer Educator is meant to engage with each IDU at least twice per month.
14
3.
FINDINGS
3.1
How beneficiaries were introduced to the project
Respondents at all five sites learnt about the CHAMPION project in broadly similar
ways. The most common way was through friends who were already either
attending a DIC (all sites) or were project Peer Educators (Bangkok and Chiang Rai).
In Bangkok the IDUs reported that they also learn about the project through Peer
Educators who regularly visited the Methadone Clinic in order to inform IDUs about
the project (and in some cases to obtain methadone for themselves). At Satul and
Chiang Rai the local hospital was described as a key place for Peer Educators to
attend in order to inform IDUs about the CHAMPION project. In only one instance
(at Satul) was it reported that someone, a hospital nurse, from outside the project
had recommended the Drop-in-Centre as a place where free needles could be
obtained. In only one case did an interviewee describe learning about the project by
attending a community-based training session.
The limited ways in which interviewees learnt about the project are not surprising
given the illegality of injecting drug use, their suspicion of people they do not know,
and the highly marginalised existence of many IDUs. Respondents described how
their engagement with wider society and, often, family members is typified by
distrust, stigma, rejection and aggression. As a result, the project is understandably
highly dependent on Peer Educators using their own social networks to reach out to
potential beneficiaries.
It is interesting, however, that referrals via health professionals such as nurses and
pharmacists were not more widely reported, particularly since the project engages
with pharmacies and health facilities for needle provision, a voucher scheme for
needles and other equipment (in Bangkok only), and advocacy work on the rights of
IDUs to access appropriate care.
Implications for the project:
The project may wish to consider whether there is a need to use additional
approaches to inform IDUs about the project, assuming that there are sufficient
Peer Educators to be able to absorb greater numbers of project participants or
that existing Peer Educators could take on a greater work-load. Injecting drug
use is illegal in Thailand and this imposes challenges in terms of ways in which
information about the project can be disseminated and IDUs persuaded to join.
As one Peer Interviewer said: The IDU community is quite small, so its better to
have friends helping friends (Site 1, male P.I.). The current approach of using
existing social networks runs the risk that particularly isolated IDUs, especially
women, may not easily be able to access information about the project.
There appear to be under-utilised opportunities to use pharmacists and health

facility staff, particularly those working in methadone and HIV/AIDS clinics, to
disseminate information about the project. This could be done verbally to
15
individuals or at group meetings, or through greater use of communication

materials such as posters and leaflets.
Adopting the approaches suggested above would be a cost effective way of

contributing to scaling-up the programmes reach, but also optimising
opportunities for vulnerable IDUs to learn about and engage with the
programme.
3.2
Why participants got involved in the project
Peer Interviewers and their friends (interviewees) described multiple reasons for
wanting to become involved in the CHAMPION project. Most often the project was
seen as an opportunity to:
Access free needles and equipment

Learn how to protect themselves e.g. injecting safely and obtaining other
health related information
Access health services
Meet supportive people and make friends through whom courage is gained
to engage in behaviour change
The reasons listed above are not described in depth here as they are covered in
detail later in this report. However, they show clearly that there is demand among
IDUs for this project, and that many are eager to engage in project activities. In
many cases the desires to both reduce social isolation and to obtain knowledge
about harm reduction practices were equally important.
He joined the CHAMPION project because he can meet new friends, he can get free needles
and equipment. He thinks that when he gets needles and equipment he will not share with
others. (Bangkok Site 1, P.I.3, F1m)
Many people come to the DIC because they want to improve their behaviours, attend
activities and learn how to protect themselves to save their life and gain more knowledge.
(Satul Site 2, P.I.1, F1m)
When he knew that the project provided needles and coupons he wanted to know more
about the project. (Bangkok Site 1, P.I.7, F1m)
To get knowledge about HIV; and to get needles, equipment and referrals to VCT and STI
tests. (Chiang Rai Site 5, P.I.4, F1m)
Peer Educators invited him to the DIC. They explained about risk reduction and health. He
wanted to come to the DIC to see this with his own eyes. When he came in, he felt confident,
just as the Peer Educator said. (Trang Site 3, P.1.5, F2m)
A friend invited him to come and talk and to confide in other IDUs. To improve his mind and
emotions, so he would become friendlier. (Chiang Mai Site 4, P.I.4, F1m)
A few interviewees also described how a growing sense of responsibility, either in

terms of providing for their children or supporting other IDUs to inject safely, led to
their engagement with the project.
16
As his kids are growing up he thinks about taking care of his kids, but he still needs to inject
when he can. (Bangkok Site 1, P.I.5, F1m)
He was interested in helping others and in exchanging information and ideas with other
IDUs. Helping others is about helping them to know how to use drugs safely because its
difficult to quit, and also knowing where to get free needles and how to inject safely.
(Bangkok Site 1, P.I.3, F2m)
Running through the descriptions about why people joined the project, both during
debriefing sessions and during the Peer Interviewer group discussions, was a clear
emphasis on the importance of being able to access clean, free needles and other
equipment within a supportive environment. Seeing the physical and emotional
difference that the project was making to their friends was also a strong incentive to
join the project.
He saw that his friend went to the DIC and after that he looked healthier, so he was curious
to know why his friend had more courage. (Satul Site 2, P.I.1, F1m)
Wanting to make friends was important to many respondents. Reducing IDUs social
isolation is a significant component of the project and is discussed in detail later in
the report. However as all those participating in the Rapid PEER study are currently
injecting, with the exception of some Peer Interviewers who are also Peer Educators,
many participants described a very practical interest in obtaining free needles as a
key reason for joining the project. This is highly significant as it shows a clear desire
to engage in harm reduction. It is also a first step towards embarking on other
behaviour change practices leading to improved health and reduced risk of HIV
transmission.
Implications for the project:
3.3
There is no evidence that IDUs who join the project perceive free needles as an
opportunity to inject more; instead the qualitative data show a very active
desire to engage in harm reduction practices. This is an important point to
emphasise when engaging with external stakeholders and in advocacy activities,
for example in terms of the long-term costs and benefits of harm reduction
programmes versus the economic and social cost of HIV/AIDS.
The difference made by the Project according to beneficiaries
Peer Interviewers and their friends reported that the project has made a substantial
difference to their lives. Improvements in physical health have been achieved
through risk reduction behaviour and increased access to services, particularly HIV
and STI services. Social isolation has been reduced through friendships formed by
attending DICs; and, with the support of Peer Educators, many project beneficiaries
have developed better relationships with their families. Participants also described
how engagement with the project has increased their sense of self-worth and
enabled them to move forward constructively towards leading more structured lives,
engaging in harm reduction behaviour change and, in some cases, reducing or
quitting injecting drug use.
17
3.3.1 Harm reduction

A key objective of the project is to achieve harm reduction i.e. reduced transmission
of HIV and STIs through behaviour change. Two main areas of behaviour change
which the project aims to achieve are consistent use of clean needles for injecting
(coupled with a cessation in sharing needles); and condom use with sexual partners.
Accessing information and education
Information and education about safer
injecting practices was described by
participants at all sites as a key benefit
of engaging with the project (Story 1).
Information provided on safer injecting
practices included:
Story 1: Staff helped him to have more

knowledge. It is more than anything; it is
better than food or water, it is so valuable
for him. In the past he injected drugs so
often and he could not work. He had no
money, not even a Baht. When he reduced
his drug use he has more energy and is able
to work more. (Site 2, P.I.4, F1m)
The importance of using clean needles and the dangers of sharing needles.
Overdose avoidance methods.
Safe injecting methods e.g. sites and the importance of not re-using (as opposed
to sharing) needles.
Information on safer sex and condom use was also valued by many beneficiaries.
She got knowledge from the CHAMPION project. She learnt how to protect herself for sex
and using drugs. (Bangkok Site 1, P.I.1, F2f)
The Peer Educators give her more knowledge about how to use drugs and safe injections,
and avoiding overdoses, and having safe sex. Even though she is positive she knows she has
to use condoms. (Bangkok Site 1, P.I.1, F2f)
CHAMPION staff gave him information he never knew before. For example, those who are
already HIV positive, when they have sex with other positive people they should use condoms
because its dangerous for them. (Bangkok Site 1, P.I.5, F1m)
He feels good after receiving the training from Peer Educators that IDUs should not use the
same needle, thus reducing infection risks it makes IDUs healthier. (Trang Site 3, P.I.5,
F1m)
Before knowing CHAMPION, she did not know if she injected (with) the right method or not.
CHAMPION made her have more knowledge. (Chiang Rai Site 5, P.I.2, F1f)
He used to be afraid of getting HIV infected but after he got knowledge about not sharing
needles with others he feels more confident. He has more knowledge and feels cleaner in his
body. (Chiang Rai Site 5, P.I.3, F1m)
18
Participants also described the value of other health-related information they

obtained through the project. This included information about the rights of IDUs;
how to access healthcare; and
information on preventing mother-to- Story 2: Since they (the interviewees) joined
child transmission (PMTCT) of HIV. the CHAMPION project they have had a better
life. They have knowledge about HIV, STDs,
The benefits obtained from this
TB, Hepatitis C and other diseases. The staffs
information are described later in this give them the necessary knowledge, so overall
section of the report.
their lives are better. Before joining the
Participants also valued, and were
able to act on, broader information
that they received on healthy living,
for example learning about the need
for, and how to achieve, a healthy
diet and good sleep patterns (Story
2).
Accessing safe injecting equipment
and condoms
CHAMPION project their lives were very bad.

They were very thin but now they have gained
weight, they get fatter and they get knowledge
and also equipment like needles, condoms,
pure water, alcohol and cotton. They dont
have to pay and they feel very happy. They
have knowledge because every Thursday there
is a group activity and the staffs teach them
about how to protect themselves and how to
inject safely, and there are also health topics
about food and sleeping. (Bangkok Site 1,
P.I.3m)
Participants at all sites viewed provision of free clean needles as highly significant in
enabling harm reduction behaviour change. Needles are accessed as part of a safe
injecting kit, through needle exchange or, in Bangkok only, a voucher system. Access
to condoms was viewed as important by those who needed and used them,
particularly those IDUs who are living with HIV and involved in sexual relationships.
However, significantly fewer participants talked about the importance of accessing
condoms (as opposed to needles). Peer Interviewers explained the lower levels of
interest in accessing condoms as a result of low levels of sexual activity among many
IDUs.
Participants were in many cases aware of the risks of sharing needles before they
joined the project. However, this knowledge was, on its own, insufficient to bring
about behaviour change. Lack of money, or need to spend money on other things,
including in some cases drugs, previously resulted in project participants preferring
to re-use old needles or share needles with other IDUs.
Before joining the project he had to buy needles himself. He receives free needles and
coupons. (Bangkok Site 1, P.I.1, F1m)
Providing clean needles to IDUs makes them feel clean and safe. They are not at risk for HIV
infection from using the same needle. (Chiang Mai Site 4, P.I.m)
He gets free needles from CHAMPION, and also suggestions. It saves some money because
he doesnt need to buy needles. There is no need to ask for money from parents. He feels
that there is no need to inject with used needles and is not afraid of getting HIV infected.
(Chiang Rai Site 5, P.I.3, F1m)
He used to boil needle and re-use it, but when he met the Peer Educator, he never did it
again because he has new needle on hand. (Chiang Rai Site 5, P.I.3, F2m)
19
The CHAMPION project provides safe injecting equipment in three ways: through kits
which contain one needle, a syringe, an alcohol pad, pure water and a tourniquet;
through a voucher system with local pharmacists (Bangkok only); or through a
needle exchange scheme based at DICs. Each system was described by participants
as having specific advantages and disadvantages. For example, some participants
valued the autonomy they gained from the voucher system as this enabled them to
access equipment when they needed it from preferred pharmacists; while others
appreciated the incentives (cash and/or practical goods such as bars of soap) of the
needle exchange system. Interviewees most frequently described their preferred
method of accessing equipment (needles and/or condoms) as directly from Peer
Educators during home visits. This is echoed in quantitative data for the project
which shows that 83.9% of project participants obtain needles through outreach
(Peer Educators); 12.1% access needles from DICs; and 4% use the Bangkok voucher
system.
Home visits were preferred by beneficiaries because of their fear of arrest if found in
possession of needles in a public place.12 Peer Educators are better able to carry
needles as these are stored within sealed project-specific kits and the Peer Educators
are provided with ID badges showing their formal status with the project. However
inconsistent implementation of the policy means that many Peer Educators remains
anxious about this part of their work. This is discussed in the Challenges section of
the report.
Enabling IDUs to access information and equipment through a range of options is
important as their life circumstances vary. Interviewees with jobs described the
voucher system as useful since meeting up with Peer Educators outside working
hours is difficult. Those who are particularly isolated and vulnerable appreciated the
opportunity to receive home visits from Peer Educators. For others, however,
attending the DIC provided a chance to make and meet friends.
Female interviewees and Peer Interviewers described the opportunity to access free
injecting equipment and condoms through the DICs and Peer Educators as
particularly important since social norms and cultural tradition make it difficult for
women to access needles and condoms from public facilities such as hospitals and
pharmacies.
She thinks its good to provide her with condoms because she is a woman and she is shy to
buy condoms or get them from another place such as the hospital. The CHAMPION package
of condoms is ok no one knows what is inside it, so she likes it. Normally she doesnt use
12
The Canadian HIV/AIDS Legal network notes that The legality of syringes in Thailand is
insufficiently clear. According to the Narcotics Control Act B.E. 2519 (1976), possession of syringes
may be considered as reasonable grounds to test someone for use of a controlled substance.
Further, the Act gives authorized officials the power to enter and search any dwelling place or
premises on a reasonable ground to believe ... there is property the possession of which used or
intended to be used in the commission of the offence relating to narcotics. On the other hand,
needles can be purchased from a pharmacy in Thailand without a prescription. In 2006, a
memorandum was issued by The National Police Office acknowledging that possession of injecting
equipment should not be grounds for arrest. However, recently, The State Council of Thailand
recently overturned the Ministry of Health proposal for a National Harm Reduction policy on the
grounds that distribution of injecting equipment encourages drug use and therefore violates Section
93/14 of the Narcotics Act B.E. 2522 (1979),
20
condoms because its expensive to buy them. She can get them free from the hospital but
she is very shy, and there must not be too many people around the place. At the hospital
there are many people. (Bangkok Site 1, P.I.1, F1f)
Throughout the course of the study the specific vulnerabilities of female IDUs were
raised on a number of occasions. The numbers participating in the Rapid PEER study
are small but the issues raised by female participants are highly likely to reflect those
of the wider, but often hidden, female IDU community.
Evidence of behaviour change
At all sites, Peer Interviewers and their friends described how, even though they are
still injecting, the project has enabled significant behaviour change and adoption of
harm reduction methods, particularly using clean needles, as the quotes throughout
the report show.
Participants also described how the combination of education, information and
provision of needles is helping project participants to gain a sense of control over
their drug use. This was viewed as important in terms of enabling them to reduce or
stop injecting (Story 3).
Story 3: In the past we had to go out to buy needles, but now there is no need to buy
them. We know that injecting with the same needle can put us at risk for getting infected.
Now we use the needle only once and throw it away. My friend knows how to control
himself. He has changed his behaviour from injecting so often to less injecting, and from
sharing needles to using new needles. He does not want to inject with used needles. Even if
it is his own needle, he really does not want to use it. In his mind he feels that using new
needles is clean and has no diseases. After injecting he will clean it and return it to the DIC.
In the past the drugs controlled him, but now he can control the drugs. (Satul Site 2, P.I.4,
F1m)
Some interviewees described how the project has incentivised them to attempt to
stop injecting altogether. Examples were given of participants who have been
successful, in other cases they were still in the process of quitting, supported by the
projects Peer Educators.
Peer Educators gave him knowledge about health and suggested him to quit drugs. Now he
is not using drugs anymore. He feels so proud that he can improve his behaviour and be
stronger. His parents also feel proud of him. (Bangkok Site 1, P.I.3, F1m)
He is trying to quit, but even if he cant it is still ok because he has sterile equipment on
hand. He does not feel scared about getting infected. He got HIV because he used the same
needle with his friend. If he uses new needles it will help him and prevent other diseases.
(Satul Site 2, P.I.1, F2m)
The knowledge about risks of drugs that he received is very important for him. When he
learned about these risks he wanted to quit. After reducing the quantity of drugs he used he
felt health and strong enough to work. (Trang Site 3, PI.4, F2m)
In the past, he injected drugs every day, together with Methadone. After he attended
(CHAMPION) activities he changed from injecting to smoking, and in his mind he thinks that
he wants to quit drugs completely. (Chiang Mai Site 4, P.I.4, F2m)
21
He reduced using drugs when he got involved in the CHAMPION project. He hardly uses
them because his friends in the DIC have educated him. (Chiang Rai Site 5, P.I.4, F1m)
In one interview a participant described how project activities had prevented an

existing drug user from starting to inject.
A friend of his used to think about starting injecting, but when he talked to his friends at the
DIC, and attending group activities, all of his friends told him that it is not good to inject
because there are many disadvantages. So he decided not to inject. (Satul Site 2, P.I.5, F2m)
Project participants also described

increasing use of condoms by both male
and female participants irrespective of
their HIV status. However, there is some
lack of clarity about how consistently
condoms are used (Story 4).
For project beneficiaries who continue to
inject, the DICs have introduced safe
needle disposal (exchange) facilities. The
only site at which needle disposal facilities
were discussed in detail was Chiang Rai,
when the subject arose during the final
group discussion with Peer Interviewers.
Story 4: Before he joined the project he

had a wife and children, but he had sex
with other women who are commercial
sex workers and did not use a condom
because he thought it was safe he was
not prepared. After that he has no job
and separated with his wife and children
because his mother in law does not like
him. He was a security guard but the
money was not enough. After he joined
the project he has used condoms with
his wife and she comes to visit him every
weekend. But he does not use a condom
with the other women. (Bangkok Site 1,
P.I.4, F2m)
In the past he used to discard needles in garbage cans or bunt them together with grass.
Now it is more convenient to discard it in the needle disposal box. (Chiang Rai Site 5, P.I.m)
It is more convenient to discard needles in (the) disposal box. There is no need to burn it
because Im afraid of fire; and it prevents someone getting hurt from treading on the
needle. (Chiang Rai Site 5, P.I.m)
In the past, when he injected he kept used needles in a drawer. But now Peer Educators
gave him a needle disposal box, so he discards them in the box. (Chiang Rai Site 5, P.I.4,
F1m)
Quantitative data from the projects internal monitoring and evaluation (June 2009
December 2010) reflect the relative absence of discussion about safe methods of
needle disposal (showing a difference of 42.5% between the number of needles
distributed and those returned). However, the number of needles returned has
been increasing every quarter since the start of the project.
Project participants also described behaviour change occurring in terms of their diet.
Many were using information provided by project Peer Educators to improve their
nutritional status, and to a lesser extent, their sleep patterns. This was seen by
those adopting an improved diet as leading to a noticeable improvement in their
health and enabling them to gain weight. This visible change in IDUs appearance
was noticeable by other IDUs and sometimes served as an incentive to engage in the
CHAMPION project.
22
He saw that his friend came to the DIC, and after that he looked healthier, so he was
curious. (Satul Site 2, P.I.1, F1m)
Overall, participants described the key differences that the project was making in
terms of harm reduction as provision of information and education on safer injecting
methods; coupled with free, easily accessible injecting equipment, particularly
needles. These were described as enabling behaviour change across a spectrum
from continuing to inject but doing so safely; reducing the frequency of injecting;
through to attempting, and in some cases succeeding, to stop injecting altogether.
The other key behavioural change was increased use of condoms by both male and
female project participants. Female IDUs are particularly isolated and vulnerable,
and experience even greater levels of stigma and discrimination than male IDUs.
Enabling women to easily access condoms and reports of increased use by female
IDUs are important achievements of the project.
3.3.2 Increased access to services and knowledge of IDUs rights
Peer Interviewers and their friends reported that the project has also made a
difference to their lives by informing them of their right to access services, and
facilitating engagement with service providers at public health facilities. Fear of
stigma, discrimination by health service providers, and fear of being arrested
currently prevents many IDUs from accessing the services to which they are entitled.
Through the efforts of its Peer Educators, the project is enabling IDUs to access
voluntary counselling and testing (VCT); general practitioner and hospital-based
services for drug-related and other conditions; and prevention of mother-to-childtransmission of HIV (PMTCT) services. This is an important area of progress in terms
of achieving sustained harm-reduction among project beneficiaries.
Increasing IDUs knowledge of their right to access health services
The Projects efforts to educate both participants and service providers on the rights
of IDUs were not described by interviewees at every site. However, the description
provided by a Peer Interviewer in Bangkok of the importance of knowing about
rights and being able to act on them clearly illustrates the real and perceived
importance of this issue. He described the project as being innovative in its inclusion
of rights and explained how this information is significant for IDUs in terms of raising
their awareness of their right to access services and improving their experience of
care at facilities where the project has engaged with service providers.
Its good to know about rights, and about what disease they have. Its good to know what
kind of medicine they need to take care of themselves. Its also good so that the doctor
cannot hide information. Some hospitals wont give information to the patient. Sometimes
the illness can be cured easily but they wont tell the patient because they want to make a
profit. This happens not only to IDUs. Even if the doctor knows about IDUs rights, he
(friend) knows that the doctor still feels kind of dissatisfied but the doctor still takes care of
him better and gives him a better diagnosis. The doctor improves his behaviour in front of
him, and the medicine he gets is also better. This is even if the doctor does not think better
of him inside himself. (Bangkok Site 1, P.I.m)
23
The quote above illustrates that the

projects efforts to inform health
service providers of the rights of IDUs
are showing progress and resulting in
better quality of care for project
participants. However, the quote
also demonstrates that there is still
substantial progress to be made in
terms of changing deeply embedded
attitudes among health professionals.
Story 5: At the government hospital the

IDUs are like the second class population
because the hospital sees them as not
important. There is even an advertisement
saying its easy to get HIV, but there are still
no opportunities for those who get HIV. For
those who are HIV positive, at some health
clinics when he goes to the dentist they treat
him very badly. Sometimes they make him
go last in the queue, or say the machinery
isnt working and he must come back
tomorrow, or they just give him
paracetamol. But the CHAMPION staff work
with health clinic staff about patient rights
and help with referrals for treatment.
(Bangkok Site 1, P.I.5, F1m)
At present, there is still a need for

on-going inputs from project staff to
ensure that IDUs do not experience
poor and discriminatory care at
health facilities.
The projects
advocacy work with service providers is an essential component of its supply-side
work. At this stage of the projects life changing the attitudes of staff is still at an
early stage and much still remains to be done to prevent IDUs receiving poor quality
of care or being denied access to care through obstructive tactics used by service
providers (Story 5).
Despite these challenges, the CHAMPION projects three-fold approach to this issue
by undertaking advocacy work with service providers, providing IDUs with
knowledge of their rights; and using Peer Educators to facilitate interaction between
service providers and IDUs is resulting in positive progress and increasing
opportunities for IDUs to access services successfully.
The CHAMPION project is very active... the staff will take him to the hospital and talk about
his rights to get treatment. The staff knows about rights. There are equal rights for
everybody, no matter who he is or what disease he gets...The CHAMPION project works for
everything about his rights and its the first project that works on this. He has never seen any
project like this... When CHAMPION staffs work with health clinics the IDUs get a good
response from the health centre staff and doctor. Thats because CHAMPION staff work with
them on the rights of the patients, and let the IDUs know about their rights and also give
them information about how to protect themselves, about contraception and condoms and
safe injections to make sure other people dont get HIV positive. He says it is the CHAMPION
project that makes them know their rights because most IDUs dont know they have rights
equal to others. The staffs of the CHAMPION project tell IDUs which hospitals provide ARVs
and about the IDUs rights, so people go there and get their CD4 counts and tests. (Bangkok
Site 1, P.I.5, F1m)
He knows more about the rights of IDUs. If he didnt know about the project he would die
because of the pressure and stress. (Trang Site 3, P.I.2, F1m)
He learns about rights. In the past the police would trick IDUs to delude the Agency of Drugs
(sic) or test their urine. When Peer Educators went out to distribute brochures in the
community, IDUs learned more about their rights so they were not afraid of the police.
(Trang Site 3, P.I.3, F1m)
24
Accessing VCT
The project is resulting in increasing numbers of IDUs accessing VCT for both STIs and
HIV. This is viewed as an important achievement by Peer Interviewers and their
friends. Those who tested positive for HIV described using this information, together
with the support they received from the project, to take good care of themselves
e.g. injecting safely, using condoms and eating more healthily; while those who
tested negative for HIV were more motivated to engage in harm reduction practices
and test regularly to remain aware of their HIV status.
The Peer Educator introduced him to the project and told him he will give him needles and
will take him to see the doctor. If he is HIV positive the Peer Educator will arrange for him to
get ARV treatment. Or if the methadone treatment he receives is not appropriate the Peer
Educator will take him to another hospital. (Bangkok Site 1, P.I.5, F1m)
Before joining the project her friend did not know anything but when she joined the project
she knew more about how to receive needles and get a health check up...and the CHAMPION
project helped her know about her health status and her life changed. (Because) she knew
her health status she takes good care of herself and feels she is lucky to know the friend who
introduced her to the project. (Bangkok Site 1, P.I.f).
He was not scared because he did not have knowledge. When the staff at the DIC talked to
him about the risks of using the same needle, he was afraid of HIV infection, and then he
came to the DIC to test his blood. While waiting for his results he was so nervous. But his
blood was normal and that made him very happy. Now he is afraid of using the same needle
with other IDUs and tries to quit drugs. Now he is stronger and healthier and he can help his
parents by working. (Trang Site 3, P.I.5, F2m)
After he was released from the prison, he still used drugs all the time ...When he knew he
had HIV infection he changed his behaviour. He takes good care of himself. If there is
training he always joins it. (Chiang Mai Site 4, P.I.3, F1m)
The Peer Educator took her to get a blood test at the hospital. He (PE) coordinated getting
the hospital card, and talked to staff, and that made her feel more comfortable. (Chiang Rai
Site 5, P.I.2, F1f)
Peer Interviewers and their friends also described how the project is helping both
IDUs and their family and friends overcome prejudice against HIV through education,
information and mediation. This is resulting in reduced stigma and discrimination
and is enabling project participants who are living with HIV to cope better with their
positive status.
At first when he got HIV his family rejected him. His parents feel afraid of him and feel that
he is not clean. They dont want to use the same plates as him. The CHAMPION staff went to
talk to the parents to explain about HIV. So right now his family feels better about him. They
love him more and also love his child. (Satul Site 2, P.I.5, F1m)
At first his parents were afraid of sharing cloth, soap or a spoon with him, thinking this will
cause them to get HIV infected. His cousins did not want to associate with him. But when
the Peer Educator worked with them, his parents went to talk to his cousins about HIV. Now
they can live together. They can use spoons and plates together. (Satul Site 2, P.I.2, F2m)
25
In the past he hated people who are HIV positive. He couldnt have a meal at the same
table. After he received knowledge from the staff his behaviour was changed about people
who are HIV positive. He can drink alcohol with the same glass. (Chiang Mai Site 4, P.I.3,
F1m)
He got HIV infected and he did not want to go anywhere. He was afraid of the community
not accepting him. He stayed only at home. The Peer Educator visited him at home and
suggested to him to go and see a doctor. The Peer Educator took him to see the doctor. He
has more courage now. ... He never feels anxious and he feels more confident. (Chiang Rai
Site 5, P.I.1, F1m)
26
Accessing PMTCT services

In two sites (Bangkok and Chiang Mai) interviewees described how Peer Educators
have enabled them to access PMTCT services despite opposition from health service
providers. This was achieved by the Peer Educator accompanying them to the
services in person. This is a significant achievement in terms of preventing further
HIV infections. Realising that it is possible to have a baby who is HIV negative,
despite one or both parents status, was described as having a significant impact on
the interviewees in terms of positive living. They also described how it has provided
them with an incentive to engage in harm reduction activities in order to be better
able to care for their families (Stories 6 and 7).
Story 6: He said that his wife got pregnant and the doctor said why didnt you use
contraception, why did you let yourself get pregnant. You are a burden on society...
When his kid was born he found out that the kid did not get HIV, and thats because
when his wife got pregnant she got ARVs. At first, when he saw the doctor at the
hospital he was worried because there is a project that will get rid of the baby if the
mother or father get HIV. The staffs from CHAMPION make sure that everyone knows
that at this hospital there is another project that helps mothers who get pregnant get
ARVs to protect their babies. Someone from CHAMPION project went with them to help
them join that project. When she gave birth to the baby and he knows the baby is not
HIV positive, right now he has courage to take care of his kid. There is no need to worry,
no matter that the father and mother are HIV positive. (Bangkok Site 1, P.I.5, F1m)
Story 7: When she got pregnant she felt loneliness and did not know what she was
going to do. Because she is HIV positive she thinks her child will have HIV too, but she
decided to keep her child. When she went to see the doctor he said: do you want to keep
this child or not? Why did you let yourself get pregnant? At the meeting with the DIC
staff and the hospital officers the Peer Educator said to the doctor: You are a doctor so
you should give them advice and not look down on IDUs. After the meeting that doctor
changed a little bit. When her child was born she found out that the kid did not get HIV.
Her own doctor (not that other doctor) said that he would take good care of her. That
encouraged her very much. Moreover, he advised her about how to take pills. So she
tried to quit drugs. She didnt manage 100% but she was a little bit better. Finally she
did it. She is a model for other IDUs who want to quit drugs. (Chiang Mai Site 4, P.I.4,
F2f)
The Rapid PEER interview data show that the project is making a significant impact
on beneficiaries lives in terms of enabling them to engage in behaviour change to
reduce the risk of HIV transmission and STIs. Participants also described how the
project is increasing both IDUs and service providers knowledge of the rights of
IDUs to access good quality health care. The interview data show that while service
providers personal attitudes may remain ambivalent and sometimes hostile towards
IDUs; from a professional perspective it appears that there is increasing acceptance
of IDUs rights and of better quality of care being provided, particularly when project
staff are present at facilities to ensure that IDUs are able to realise their rights to
non-discriminatory health care.
27
3.3.3 Improved emotional well-being

The Rapid PEER interview data show that the project is also having a significant
impact on participants lives in terms of improving their emotional well-being.
Project beneficiaries described how engaging with the CHAMPION project has
reduced social isolation; improved relationships with their family and neighbours;
lowered stress, anger and anxiety levels; and given them a sense of being normal
and valued individuals. They reported that a greater sense of self-worth, often
strengthened by being able to help and support other IDUs, has given them courage
to manage, reduce or quit injecting, and has enabled them to adopt harm reduction
practices. They also described how this has also led on, in many cases, to obtaining
employment and/or becoming project Peer Educators, thus passing on their
knowledge to other vulnerable IDUs.
Reduced social isolation
As has been described earlier, many IDUs live highly isolated lives. This is a result of
stigma and discrimination, fear of arrest and, particularly in the case of female IDUs,
previous experiences of rape or gender based violence. Respondents described the
project as providing a supportive environment to develop friendships and supportive
relationships with Peer Educators and other project beneficiaries.
Interaction with friends was described as extremely important since social
interaction through chatting, watching DVDs or videos, and filling their time with
other activities helped participants to reduce the frequency of injecting.
Because he is Muslim he must not be an IDU. It makes things very difficult in the
community. When he is in the community he has to be hidden (secretive). It is better when
he is at the DIC, he does not have to be hidden (he can be himself). (Bangkok Site 1, P.I.5,
F2m)
His body and mind have become better and better. In the past he could not accept that he
is HIV positive and hid himself from his family, even though his friends and neighbourhood
already know that he is an IDU. Even himself, he knew that he was sick but its hard to
accept. After that when he talked to friends and PEs he got support so he feels less stress
and more relaxed. (Satul Site 2, P.I.2, F1m)
Coming to the DIC is important to him because no one looks down on him...When he got
sick, the staff took his friends from the DIC to visit him at the hospital, and he cried when he
saw them. He was delighted. Even his parents did not come to visit him. They didnt care or
ask about him. (Trang Site 3, P.I.m)
She stayed home alone so her friend introduced her to the DIC. Because she had a bad
experience in the past she had become repressed. But after knowing the project she is
friendlier. (Chiang Mai Site 4, P.I.4, F2f)
This project makes him change his life. Instead of injecting drugs he came to the DIC. He
exchanged his opinion with other IDUs at the DIC. In addition, some IDUs helped him find a
job. Now he sells roasted pork in front of a school. (Chiang Mai Site 4, P.I.1, F1m)
Although little information was provided by beneficiaries on whether formal training

is provided, for example in anger-management or conflict resolution, it appears that
28
consistent supportive interaction providing positive harm reduction messages is

enabling engagement with other IDUs and with family and the wider community.
Improved relationships with neighbours
Several interviewees described how engagement with the project has improved their
relationship with neighbours. This is important as it reduces the likelihood of
harassment, arguments and even arrests. Interviewees perceive this change
occurring partly as a result of Project efforts to work with local communities to
reduce stigma and discrimination; but primarily because house-to-house visits by
Peer Educators reduced the likelihood of them being seen going to pharmacies to
obtain needles.
The CHAMPION project has changed his life because when he has needles he doesnt have
to buy them. In the past his neighbour knew he is a drug user, but right now there is no need
to go to the pharmacy to buy needles and his neighbour thinks he has quit and thinks better
about him than in the past. In the past his neighbour was afraid of IDUs. He thinks they are
thieves; and knowing why they go to the pharmacy they are not buying paracetamol but
needles. IDUs are not like normal people, in the past they used to be thieves, but right now
when they have the new needles at home, after they buy drugs they just stay home. So his
neighbour thinks he has improved and does not disturb him. When he injected outside the
house it was obvious to the neighbour. (Bangkok Site 1, P.I.1, F1m)
In the past his neighbours hated him. They were afraid that he was a thief. However, now
his neighbours are better. They understand him, and that is because the DIC has worked
with them. He feels happier. (Satul Site 2, P.I.4, F2m)
He has matured. In the past he was a troublemaker in the community. Now he changes
and learns from Peer Educators. They taught and warned him Do not make trouble in the
community because people will hate you. This made him think and now he tries to improve
himself. (Trang Site 3, P.I.2, F2m)
A key advantage of improved relationships with neighbours is not just the reduction
in stress for IDUs but the decrease in likelihood of arrest by the police, which is a
constant source of anxiety for IDUs. Across many communities in Thailand, it is
common for community members to provide the authorities with names of people
who they suspect may be breaking the law, essentially composing blacklists as one
particular individual gets repeatedly identified by different people in the community.
These community blacklists are then used by the police to initiate investigations. As
such, the CHAMPION project seems to have reduced the potential for members to
be identified on future community blacklists.
Improved relationships with family
Another key aspect of participants emotional well-being that was report to be
improving as a result of the CHAMPION project is the relationship of many IDUs with
their families. Many had become estranged from their families or had troubled
relationships with them due both to the antisocial behaviour of the IDUs themselves
but also as a result of widespread stigma and fear towards both IDUs and people
living with HIV.
29
As a result of the projects efforts to educate families about injecting drug use and
HIV, several participants described how their parents were now supporting them in
behaviour change and harm reduction. In some cases, interviewees who have found
employment as a result of joining the CHAMPION project are now contributing
financially to their family.
His parents accepted that he is an IDU. It is better than hiding. Peer Educators talked to his
parents about how to take drugs so they have more understanding about diseases. (Satul
Site 2, P.I.2, F2m)
This project makes him more aware. He gets more knowledge and changes his life. His
relatives change their viewpoint of him. Nowadays he has self-esteem and his parents love
him too. (Trang Site 3, P.I.2, F2m)
Now he is stronger and healthier, he can help his parents by working. (Trang Site 3, P.I.5,
F2m)
He used to inject drugs so often and got angry easily. After he joined CHAMPION activities
his mind is getting better. His mother feels proud of him. (Chiang Rai Site 5, P.I.1, F2m)
In the past, he did not take care of himself. He was a drug addicted person. He thought
only about where to find drugs. His friends told him that he smells so bad. He felt sad that
no one likes him. After he got methadone treatment he pays more attention to himself. He
feels like his parents love him more. They call him for breakfast. The Peer Educator gave
support to him about getting MMT. He told him to take care of his parents. (Chiang Rai Site
5, P.I.3, F2m)
His mother did not talk to him in the past. After CHAMPION staff took him to get MMT,
sometimes his mother took him there too. She gives support to him because she wants him
to quit. He feels that there is a way for drug quitting. (Chiang Rai Site 5, P.I.4, F2m)
Other participants who had children described how the project has given them an
incentive to support their own families by encouraging them to reprioritise their
spending from drugs to paying for their childrens education.
His habits have changed from the past. Now he has work and a family. He thinks of his
children, about their education and that he needs to use money for this. So he stopped using
drugs. (Trang Site 3, P.I.4, F2m)
Her parents were quite rich so she was not courteous to other people. She used money to
buy drugs. She abused her parents if she did not receive money from them. She would do
anything for drugs. When she had a child that reminded her about her own past behaviour.
Thus she tried to quit drugs by coming to the DIC. The staff at the DIC encouraged her a lot
and supported her fight. They used her child as a reason to quit drugs...Now she is very
happy because she has quit drugs. (Trang Site 3, P.I.1, F1f)
The following section illustrates how the projects positive outcomes contribute to a
broader sense of being valued individuals among Peer Educators. They describe how
engaging in outreach activities and helping other IDUs to change their lives have
increased their self-esteem and enabled them to continue to practice harm
reduction techniques.
30
Feeling valued and valuable

The combination of gaining knowledge; using it to engage in behaviour change; and
perceiving the benefits in terms of improved health and social relationships has led
to significantly enhanced feelings of self-worth among beneficiaries. Interviewees
who described learning about IDUs rights also perceived this as contributing to their
increased feelings of self-worth since it increased their awareness that these are
legitimate feelings, supported by national legislation.
The Peer Educators feel proud to help their friends get better health. (Bangkok Site 1, P.I.m)
She feels very happy about helping friends; and friends say thank you to her, so she feels
very happy. (Bangkok Site 1, P.I.f)
He feels so proud to have friends. He feels that he has more value. He can protect himself
and he is not at risk. (Satul Site 2, P.I.1, F1m)
He likes himself more than in the past. He doesnt want to use drugs any more. If he wants
to inject drugs, he will only use a new needle. (Trang Site 3, P.I.1, F1m)
Other people look at her like trash, but she knows she is good. After joining the project it
makes her feel her self-worth. (Trang Site 3, P.I.f)
He has more self-worth. He helps his parents by work such as slitting the rubber trees or
cleaning the house. In the past they said a dog is better than him. (Trang Site 3, P.I.m)
They feel proud of themselves, that they can help friends, suggest and encourage them.
When they go to visit a friend at hospital or go to a funeral together, this makes them more
united. The feeling that they can help others makes them feel more valued. (Chiang Mai Site
4, P.I.m)
Although not all beneficiaries participate in every project or DIC activity, the overall
approach has enabled many to adopt safe injecting and contraceptive methods. In
addition, there is clear qualitative evidence that a significant number of participants
are accessing health services, particularly testing for HIV and STIs and using the test
results to embark on further behaviour change to prevent transmission of infection
and to lead healthier lives.
The key focus of the project is on reduction of risk of HIV transmission. The findings
of this study illustrate the importance of accompanying behaviour change messages
such as using clean needles and condoms, with providing psycho-social support
through home visits, DICs, community sensitisation and other activities. For
participants in the Rapid PEER study, being seen as valued and normal individuals,
and being able to engage in meaningful relationships with others was described as
an important incentive to adopting a healthier lifestyle and consistently engaging in
HIV risk reduction behaviours.
31
Gender issues do not appear to be explicitly addressed in project activities

despite the specific needs and vulnerabilities of female IDUs. A greater focus on
gender issues in project activities would be beneficial in terms of optimising the
benefits of project activities; ensuring that the specific needs of female IDUs are
fully addressed; and by including male IDUs in awareness-raising of gender issues
it would increase opportunities for the project to reduce gender-based violence
and pressure being placed on female partners of IDUs to start injecting.
Safe needle disposal is an important component of harm reduction. The

qualitative data from this study (supported by quantitative project data) suggest
a need for greater emphasis on safe needle disposal at all project sites.
The Rapid PEER data show that significant progress is being made in terms of
increasing IDUs access to health services. At present it appears, however, that
Peer Educators generally need to be present to ensure that project beneficiaries
receive non-discriminatory, quality care. There is little evidence that IDUs
currently are able to assert their rights without the presence of a Peer Educator.
It is suggested that the project continues to work towards achieving this by
continuing to actively promote attitudinal change among health service
providers and providing IDUs with appropriate skills to enable them to assert
their rights without needing the presence of a Peer Educator to support them.
3.4
The difference the Project has made according to DIC Managers
Drop in Centre Managers were interviewed at three sites: Bangkok (Central Region),
Trang (Southern Region) and Chiang Mai (Northern Region). Staff at the other two
sites were not interviewed as it was felt inappropriate for PSI staff leading the Rapid
PEER research to interview their own PSI colleagues about the progress of the
CHAMPION project (Trang and Chiang Mai DICs are run by Global Fund subrecipients and the external Rapid PEER specialist interviewed DIC staff in Bangkok).
As a result, data on staff perceptions of the project are limited but are presented
here as they provide useful information, although whether the views expressed can
be extrapolated to the other sites is not known. The data do provide, however, a
useful starting point for the projects future engagement with DIC staff at all sites.
Unlike the project beneficiaries, whose descriptions of change focused on how the
project has helped them in terms of their daily lives e.g. using clean needles, meeting
friends etc.; DIC managers (some of whom are ex-IDUs) perceptions of the changes
that the project is making to beneficiaries lives reflects a more strategic and longer
term perspective.
Reducing IDUs social isolation
DIC managers viewed reducing the social isolation of IDUs as an essential first step
towards achieving sustained behaviour change. Their view is that when IDUs realise
that they are not alone, and are provided with a safe and supportive environment
32
then this enables them to develop the confidence to adopt harm reduction practices,
access services and, potentially, consider quitting injecting.
All IDUs have an equal chance to receive needles. But once people join the DIC they expose
themselves (their feelings and emotions) to others. They find out that they are not alone.
This is very important. (DIC Manager 3, Bangkok)
If they think they are alone, and keep themselves isolated from society this means that there
is self-stigmatisation. If they realise they are not alone they will have confidence. Then
accessing services will happen, and they will also be able to learn their rights. (DIC Manager
2, Bangkok)
A key component of support networks for project participants were other IDUs met
at the DICs, but Managers are also working to develop more strategic networks of
support that include external stakeholders such as police, service providers and local
government officials.
Every three months there is a big meeting of IDUs, the local District Officer and the clinic,
also the controller of the prison. When IDUs have a problem sometimes the group can help
them e.g. a nurse in the meeting group knows where HIV positive mothers can buy powdered
milk; or if someone wants a job, someone in that group can teach the skills for that job. The
staff who go to that meeting, one is from the job recruitment department, so they will
update him on positions that are not posted publicly but are specifically for IDUs, like security
guards. (DIC Manager 1, Bangkok)
These networks serve multiple purposes. Members provide information on

employment opportunities for IDUs, they strengthen stakeholders engagement with
the project, and also serve as informal advocacy opportunities for DIC Managers to
generate support for the project and its messages among influential professionals.
This reflects the Managers views that the project creates change by providing a
supportive environment not only in terms of encouraging harm reduction but
developing wider opportunities to improve health and longer-term life opportunities
by reducing discrimination towards IDUs and enhancing their opportunities to access
health care and other essential services.
33
Enabling IDUs to feel valued and productive members of society

DIC managers expressed similar views to project participants about the way in which
the project is enabling many, but not all, IDUs to increase their sense of self-worth.
This is achieved through working actively with the project to support other IDUs,
learning about the rights of IDUs, and gaining paid employment.
The IDUs have a job in this project when they are trained as Peer Educators. If a Peer
Educator does good work the manager will ask the Peer Educator to become a member of
staff. This makes the IDU feel valuable, not a person that society looks down on because he
is a bad person. They get an income and do not have to ask their family for money. They can
look after themselves and survive in society. But this is not the case for all IDUs. Some
cannot move on. (DIC Manager 2, Bangkok)
Overcoming stigma and discrimination and regaining a sense of being normal was
perceived by DIC managers to be fundamental to achieving sustained behaviour
change,
particularly
quitting
injecting. Their perception is that
Story 8: One IDU took methadone all the
the project is achieving this and is
time. When he became a Peer Educator...he
told a friend that he wants to stop methadone
giving IDUs a sense of purpose and
because he now has hope...He wants to be a
hope which was previously lacking
normal person in this society...That is the
(Story 8).
Skills training
DIC Managers perceived the
project
to
be
changing
beneficiaries lives by providing
life- and skills-training.
They
viewed the project as being able to
go beyond providing needles and
knowledge by creating increased
life and employment opportunities
that then improve IDUs quality of
life and facilitate opportunities to
quit injecting.
starting point to having hope. The rehab is

about thinking in his mind that he can be
better. He has to change inside first and then
this will be reflected on the outside by positive
things. Now he has positive thinking and he
has a job. In the evening and morning he is a
motorcycle messenger. The rest of the time he
works at the DIC helping others. The DIC
helped him learn to repair computers so he has
a part time job doing this as well he does this
at home. When he has more income he can
have his own motorbike. He sees the value of
his life and has moved away from drugs. He
has learnt that even the small things he does
have value. (DIC Manager 3, Bangkok)
Getting a job and stopping using drugs tends to happen together...Income generation
makes IDUs feel they have some security in their life. Then they feel like valuable people
because IDUs have little chance of getting a job because of drug history, stigma and many
IDUs have tattoos. (DIC Manager 1, Bangkok)
Providing IDUs with the skills and knowledge to be able to resolve practical but
significant problems such as lost ID cards was seen as not just enabling them to lead
less stressful lives but to also exert their rights as citizens.
34
The change is about how IDUs think about life skills and the opportunities they see. In the
past some IDUs dont know what to do when sick e.g. those without ID cards. Now friends
will help them to go to the hospital and sort out this problem When someone loses their
purse they dont know what to do, but now they know and go to the police station and it is
easy to deal with this problem. (DIC Manager 1, Bangkok)
Increased life- and job-skills training were seldom mentioned by project beneficiaries
as key areas of change brought about by engaging with the project. Instead, these
were more frequently described as something they would like the project to place
greater emphasis on. This is discussed further in the Future section of the report.
The apparent discrepancy between management and beneficiary perspectives on
opportunities for skills training is something that needs to be addressed by the
project management team.
Advocacy
One of the reasons that DIC Managers believe the project is able to facilitate the
changes described above is because of advocacy work undertaken by staff with
health service providers, the police, prison staff and neighbourhood communities.
The project makes good use of networking and engaging with external professionals
to facilitate and support change.
Changing attitudes of service providers
The project is seen as bringing about
change in the attitudes of service
providers as a result of consistent and
focussed advocacy activities. Managers
described
typical
examples
of
discrimination faced by IDUs and then
went on to explain how they are
working to achieve change in service
providers attitudes through sustained
advocacy messages, education on
injecting drug use, but also by actively
engaging them in project working
groups and other activities (Story 9).
Story 9: At first the police captain

arrested IDUs...Now they are still arrested
but his (DIC Manager) work has proved to
the police that when IDUs come to the DIC
as much as possible then the crimes
outside decrease. If there is no DIC, the
IDUs are strung out and inject and commit
crimes. But when you have a DIC the IDUs
get more knowledge and skills, and they
get rehab skills for themselves for both
body and mind. (DIC Manager 3,
Bangkok)
Most IDUs know their rights and for those who dont have a card, if there is no emergency
they go to prepare the documents. If there is an emergency their friends or family have to do
this. It is more about the attitudes of nurses. In the hospital those who are HIV positive will
have a special colour [files are colour coded RG]. If a couple go to the dentist, even if they
are second in the queue, if the nurses see the colour they will go to the back of the queue
because the nurses dont want to see HIV positive people. (DIC Manager 1, Bangkok)
Examples of the meetings we go to are 12D (all CHAMPION project partners regarding
policy for IDUs); and a meeting/meetings with doctors, nurses, social services, activists,
police, Office of Narcotic Control Board (ONCB) and others. This meeting is about harm
reduction activities and the standard of DICs in Thailand. At his last meeting with doctors
and nurses they discussed whether giving IDUs needles makes them inject more. The
35
government has a bad attitude to IDUs, so when the project gives needles they think it will
make them inject more. He says the project does not support IDUs to use more drugs but to
check up on their health; to use new needles. IDUs should exchange old needles for new. By
providing them with new needles the Peer Educators also provide them with knowledge such
as harm reduction, safe sex, opportunistic infections and ART. (DIC Manager 3, Bangkok)
The CHAMPION project makes harm reduction policies actually work. It makes government
and non-government stakeholders work together much better than in the past, and makes
people interested in harm reduction policies, especially the prison service. Prisoners want a
methadone clinic in the prison. In the past prison officers would not agree even to condom or
methadone use within prisons. But now they are actually planning a methadone clinic. (DIC
Manager 2, Bangkok)
Changing community attitudes

Managers also gave examples of how project activities are managing to change
community attitudes towards IDUs. By initiating activities that enable IDUs to very
visibly contribute to their local communities the managers perceive that the project
is simultaneously increasing IDUs perceptions of their self-worth, but also increasing
community acceptance of the IDUs living within the neighbourhood.
He talks the head of the community and people inside the community about this project to
make them understand IDUs. IDUs will not make any trouble in the community. (DIC
Manager, Trang)
There are some advocacy activities with the community and the IDUs are involved in these
activities. An example is this Sunday an event will give me the chance to do well and make
more clean areas in the community. The IDUs will give the community a tree13, and that
community has a high number of IDUs living in it. Sometimes they will help to clean the
roads and community. So this kind of activity will make the IDUs feel part of the community,
and the community leaders and IDUs will get closer. At one IDU funeral the leader of the
community went to the funeral to show his respect. (DIC Manager 1, Bangkok)
The project is also engaged in community based advocacy work to prevent young
people becoming IDUs by linking with provincial departments of public health to
undertake school-based drug prevention sessions and delivering evidence-based
drug prevention messages in schools in the project locations on an ad hoc basis.
Increased access to health services
A result of the above activities is that IDUs are accessing health services more
frequently.
The IDUs use services more than in the past. These services are VCT, MMT, STI, ART. (DIC
Manager 2, Bangkok)
This is in part due to participants awareness of their right to access services but also
due to gradually improving attitudes of service providers and the support of Peer
Educators. The key services accessed by IDUs are methadone treatment clinics but
also a range of HIV-related services including testing and treatment.
13
Trees are obtained from the District Administrative Office
36
In conclusion, project beneficiaries largely focused on the day-to-day difference that

the project is making to their lives through information and education, clean needles
and reducing social isolation. In contrast, DIC managers placed more emphasis on
the strategic differences that the project is achieving through advocacy activities and
supporting long-term sustained behaviour change. What both perspectives have in
common, however, is that they provide evidence of the importance of creating an
enabling environment which utilises policy, practical support and a rights based
approach to support change among IDUs, service providers and the community.
Harm reduction, which is a key focus of this project, places emphasis on preventing
or reducing negative consequences of, in this case, injecting drug use without
necessarily aiming to eliminate it. In the case of the CHAMPION project, both
beneficiaries and managers stories show that the project is effectively
encompassing but also moving beyond this pragmatic approach by also pressurising
for correct policy implementation and attitudinal change in order to facilitate
strategic and long-term change.
As well as addressing both supply- and demand-side issues, the project activities also
allow for the differing needs and perspectives of individual IDUs to be included and
covered by project activities. The IDUs who participated in the Rapid PEER study
described different ways in which the project was changing their lives. These can be
summarised as:
Those who do not intend to alter their level of drug use injecting safely and
avoiding blood-borne infections such as HIV
Those who wish to reduce or quit injecting information and support to
succeed
Those who quit injecting opportunities to gain employment and remain
independent of drugs
From a behaviour change and harm reduction perspective, the project has achieved
a great deal in its first eighteen months and shows clear signs of being able to
achieve sustained change and substantial progress in preventing HIV transmission
among IDUs, and enabling those living with HIV to access appropriate and quality
care.
37
Changing the attitudes of government, policy makers, service providers, police

and communities is essential, as is raising awareness among public sector
workers of recent policy changes regarding the rights of IDUs. Advocacy and
networking activities are a key aspect of the work of DIC managers and other
programme staff. However, overcoming long-standing hostility, stigma and
discrimination is challenging; as is encouraging advocacy efforts to be
disseminated by those who sit on various committees to their colleagues. Ongoing advocacy and networking efforts need to continue and there may be
benefits to exploring whether these could be expanded to try to reach greater
numbers of service providers and other key public sector workers, particularly
the police.
DIC managers appear to view skills education as playing a greater role in bring
about change to project beneficiaries lives than do the beneficiaries
themselves. As will be seen in the following section of this report, project
beneficiaries viewed this as an area which they would like the project to place
greater emphasis on. It might be beneficial for the project to give greater
consideration to clarifying and internally monitoring project policy on skills
education and providing clear guidelines on what is meant by skills education and
how this should be addressed at each DIC.
38
4. CHALLENGES
Project beneficiaries and staff were asked about the challenges they faced in their
involvement with the project. All respondents had less to say about challenges than
they did about the benefits of the project. However, understanding the challenges
of being involved with the project is important as they offer insight into ways in
which the project can be strengthened during its next phase.
4.1
Transport
Not surprisingly interviewees who lived some distance from the DICs commented on
facing challenges in finding money for public transport. This prevented them from
attending the DIC as often as they wished. This appeared to be a greater challenge
for interviewees at the sites in the North and South. To an extent, the project is able
to compensate for this by encouraging house visits by Peer Educators, however, one
of the benefits of the DIC is that it reduces social isolation and enables IDUs to
develop wider social networks, as well as benefiting from the wide range of activities
that take place at the DICs. It is difficult to know what the project can do to
overcome this challenge (other than increasing the number of DICs) since purchasing
project vehicles is expensive and would carry with it the risk of participants using the
vehicles being identified within their community as IDUs. This anxiety was
mentioned by a few participants who are already anxious that being seen to attend
the DIC would result in neighbours or the police being able to identify them as
injecting drug users.
Fear of arrest
Project beneficiaries at all five sites described fear of arrest as a key challenge that
impacts on their participation in the project. Peer Educators were particularly
anxious about on-going interactions with the police, as were many interviewees.
Despite injecting equipment being packaged in project-specific kits and legislation
which protects against arrest for possession of needles, interaction with the police is
still a source of anxiety and reflects the long time period needed to overcome deeply
entrenched suspicion on the part of both IDUs and the police.
He said about the package of needles when he meets the Peer Educator its not at home
but at the methadone clinic. He is afraid when he carries the needles back home its not
safe for him as he can be arrested carrying the new needles. (Bangkok Site 1, P.I.1, F1m)
At first he did not trust the CHAMPION staff. He thought why do they need my name? But
later he realised that the staff had come to help him to give counselling to help him with his
life. (Bangkok Site 1, P.I.5, F1m)
She is afraid of the police because they have a checkpoint for arresting the IDUs. (Trang
Site 3, P.I.1, F1f)
When he comes to the DIC for needles and returns back home he avoids the police
checkpoint. Although he doesnt have drugs, he only has clean needles, he feels scared.
(Chiang Mai Site 4, P.I.3, F2m)
39
He does not dare to come to the DIC because it has many IDUs. He is afraid that the police
will have a checkpoint nearby the DIC. (Chiang Mai Site 4, P.I.3, F2m)
She cannot go downtown to buy needles because she has no vehicle and is afraid of getting
arrested. (Chiang Rai Site 5, P.I.2, F1f).
Peer Educators also described their anxiety about undertaking outreach work. While
no examples were given of any arrests being made, and Peer Educators are provided
with ID cards and contact details for police to call if they are suspicious of Peer
Educators activities, this is a very real anxiety for Peer Educators and project
beneficiaries. In some instances it is preventing IDUs from coming to the DICs,
preferring instead to rely on outreach visits from Peer Educators, and thus
preventing them from accessing information, support and other project facilities
which many beneficiaries described as being key advantages of engaging with the
project.
Safety of Peer Educators
Related to the above point, is an issue raised by Peer Educators in Bangkok, who
were anxious about their own safety when undertaking outreach activities on behalf
of the project. IDUs are constantly anxious about the possibility of arrest and are
suspicious of people who are not already part of their own small social networks.
Sometimes he is at risk working as a Peer Educator, because when he goes to the
community they think he is a spy...This happens because they go to the community and look
like strangers, so people who do not know them think they are spies. (Bangkok Site 1, P.I.m)
Again, no examples were given of Peer Educators coming to harm while carrying out
outreach activities, however, this was a cause of anxiety for Peer Educators and
helps to explain why the project may not be reaching some of the most isolated and
vulnerable IDUs.
Isolation
There is some evidence that a key challenge faced by IDUs and Peer Educators is that
of enabling the project to support the most isolated and vulnerable. For those that
know about the project, not being able to access transport to reach the DICs is
limiting the benefit they are able to gain from the project, while Peer Educators were
aware that there are IDUs who they are not able to reach due to difficulty in
breaking into their social networks and gaining sufficient trust to be able to
encourage them to engage with the project.
40
The challenge is finding the new IDUs and taking them to the centre. Because those IDUs
must think he is a spy of the police. (Bangkok Site 1, P.I.7, F2m)
The problem is that he does not have money to come to the drop in centre or to MMT clinic,
he has to depend on his friends. (Bangkok Site 1, P.I.4, F1m)
He could not go to the DIC because he has no vehicle. It is very difficult. (Satul Site 2, P.I.1,
F2m)
He is shy and cant talk with other people who are not his close friends, so he doesnt often
come to the DIC. (Trang Site 3, P.I.2, F2m)
The problem is about transportation to come to the DIC. Because the DIC is far away from
his home and he is scared of the police. (Chiang Mai Site 4, P.I.3, F1m)
Although little data exist on female IDUs, anecdotal evidence obtained during the
Rapid PEER study indicates that many of the most vulnerable and isolated IDUs are
women. In addition to the physical challenges of reaching the DICs, the few women
who participated in the study also described a shortage of female Peer Educators as
impacting on womens ability to engage with the project, both in terms of outreach
Peer Educators and the DICs.
DICs can be a stressful environment
DICs were described very positively by the majority of participants in the Rapid PEER
study. However, not all participants found them an easy environment.
A challenge about the project is that he doesnt like his friends quarrelling and being thieves.
When the friends go to the DIC for coffee, sometimes they steal coffee from the DIC. Inside
his heart he knows his friend is not that kind of person but it is the effect of drugs.
Sometimes his friends have different opinions about things and so when they go to the DIC
they quarrel, and sometimes the police have to come to the DIC. They mostly quarrel about
amounts of drugs if they have given someone money to buy drugs for them. Once someone
injected drugs in the bathroom of the DIC so there was quarrelling with the DIC staff. This
makes him feel very bad. Because of this he felt very bad and did not go to the DIC for a
week. The reason he goes to the DIC is because he wants to be relaxed and when this
happens he doesnt feel relaxed at all. But it doesnt happen frequently and its usually the
same person that makes the problem. (Bangkok Site 1, P.I.3, F1m)
While each DIC has rules about acceptable behaviour (both social and drug-related)
there is some evidence that these rules are not always adhered to. This is hardly
surprising given the range of health and social problems experienced by many IDUs.
The limited evidence of disruptive events occurring at DICs is in many ways indicative
of the very positive environment that they provide. However, the fact those such
events have sufficient impact on project participants that they can disrupt
attendance shows how valuable and valued they are as a calm and structured
environment for IDUs whose lives are often characterised by stress and isolation.
41
Reaching the most isolated and vulnerable IDUs are an on-going challenge for the
project. At present there is a strong dependence on using existing social
networks to inform IDUs about the project as this reduces suspicion that Peer
Educators are acting as informants for the police and, equally, reduces Peer
Educators anxieties about their own physical safety. It would be helpful for the
project team to consider additional ways of networking within IDU
communities to ensure that awareness of the project is raised without,
potentially, putting Peer Educators at risk. Methods of raising the profile of the
project could include additional posters displayed prominently within health
facilities, pharmacies and throughout communities, for example on walls or
fences etc.; encouraging service providers to refer IDUs to DICs or to individual
Peer Educators; and to consider hosting additional community events with onsite facilities for confidential counselling and testing as is often carried out by
HIV/AIDS projects.
Providing all Peer Educators with anger management and conflict resolution
training; and providing opportunities for project beneficiaries to meet Peer
Educators on a one-to-one basis for additional counselling and support after
conflict has occurred at DICs might be beneficial to ensure that project
beneficiaries continue to attend and are able to discuss how to cope with stress
and to diffuse confrontational situations.
4.2
Overcoming stigma and discrimination

The key challenge described by DIC Managers is more strategic in nature than the
challenges described by project beneficiaries. All DIC managers who participated in
the Rapid PEER study described government policy as creating a major challenge to
their work. Although policy relating to IDUs has become more supportive, its
implementation, particularly by police and service providers is less than optimal and
overcoming this remains a pressing challenge for project staff.
The most challenging part of the project is working with other people in society, or
government or the police. Most of them have a bad attitude to IDUs. They think IDUs cannot
change. (Bangkok Site 1, DIC Manager 1)
In the harm reduction concept IDUs are the client, therefore the harm reduction concept
should be IDU centred. But government is not IDU centred. It wants to push IDUs into
compulsory treatment. Since the harm reduction programme has been launched
approximately 30,000 IDUs have been arrested so the government isnt moving in the same
direction as the project. (Bangkok Site 1, DIC Manager 3)
Government policy is an obstacle ...two years for doing this project is not enough to solve
problems. (Trang Site 3, DIC Manager)
The policy of the government is the obstacle of this project, because the government wants
to suppress IDUs and drug users. But the DIC wants IDUs to come (into) the health system.
So they are opposed to each other. (Chiang Mai Site 4, DIC Manager)
42
Managers described spending considerable amounts of time engaging with external

stakeholders to increase understanding and acceptance of IDUs and to facilitate
implementation of government policy. One Manager, however, described how
progress is dependent on developing strong individual relationships. These take
time to develop and this investment of time and energy can be lost if that individual
moves on into another position or relocates to another city or district.
Every three months there is a big meeting of IDUs, the local District Officer and the clinic,
also the controller of the prison... I work with staff who comes to the meeting but I have to
work hard with that person. If that person leaves the organisation and then another person
comes, I have to change their attitude again... I work with ten community leaders and I have
to keep covering the same thing over again because it is better to see them one by one. One
by one they communicate well with me, but in a meeting (Bangkok Site 1, DIC Manager 1)
Project Targets
DIC Managers in Bangkok described balancing the short term targets of the project with
longer-term strategic objectives as a challenge that they found difficult to resolve. In all
cases the Managers recognised the value and necessity of project targets as a means to
effective monitoring and evaluation of activities, but also because of their relevance to the
harm reduction objectives of the project. However, from a personal and professional
perspective they described the importance of meeting project targets as taking time away
from their efforts to focus on longer-term and more strategic objectives or, in some cases,
dealing with urgent personal crises.
It is challenging taking IDUs to go to test for STIs because some IDUs dont have sex for
more than seven years. But still he has to get them to test because its an indicator. He
worries about other work but he has to focus on STI indicators because if the project does not
reach its targets it will not get more funding. An example is if an IDU wants to do (sic) suicide
because he is HIV positive he (Manager) thinks he should focus on working with him, rather
than taking someone who has no risk for an STI test because its an indicator. Working with
someone who wants to do suicide is not an indicator. (Bangkok Site 1, DIC Manager 1)
If he sees the solution to the IDU problem as taking them to referral services, this is looking
at the tip of the problem not the root. He is trying to solve the problem at the root that is
family and IDU behaviour. If they both change their behaviour and minds everything will be
better. The CHAMPION project, with its needles and condoms those dont solve the
problem. The problem would go on forever. Providing needles and condoms is important but
these are tools to protect or prevent. Its also a way of connecting with IDUs. Indicators need
targets like how many friends you can find, and how many needles you can provide. This sort
of work makes the staff and peer educators fall into the trap of concentrating on this and not
the bigger issue. (Bangkok Site 1, DIC Manager 3)
The DIC Managers discussion about their ambivalence towards project targets raises
an important challenge for the CHAMPION project. While none of the Managers felt
that the existing targets and indicators are inappropriate, and all recognised their
practical importance in recording progress; they were also frustrated by what they
perceived as the limitations that the existing targets also impose on them. However,
many of the issues relating to what the Managers saw as the bigger picture are
difficult to quantify and thus impose challenges in terms of effectively
communicating the projects progress.
43
DIC Managers are highly committed to the CHAMPION project and are proud of
the achievements to date. However, there is a risk that, over time, frustration
may increase about effectively balancing the need to meet quantifiable targets
with achieving longer-term qualitative change in IDUs lives that Managers felt
are key components of achieving sustained behaviour change. The use of
monitoring tools such as Rapid PEER are a way of revealing the complex, deeprooted work of the CHAMPION project and raising the profile of the holistic work
that underlies target-based achievements. It is suggested that it would be
beneficial for the project management team to review existing targets and
indicators to see if it is possible to achieve a balance between short-term
behaviour change indicators and others that represent longer-term progress and
reflect sustained and broader dimensions of change.
44
5.
THE FUTURE
The project is funded up until 2014. As a result participants in the Rapid PEER study
were asked what they would like the project to focus on in the future. Beneficiaries
described additional activities which they felt would support their day to day lives
and help them to achieve their aspirations for the future. These included quitting
injecting or reducing the frequency of injecting, raising and supporting a family, and
gaining paid employment.
The DIC Managers are highly dynamic and ambitious for the project and their plans
revolved around dual strategies for supporting IDUs in harm reduction and
behaviour change but also more strategic goals to address the root problems that
underlie IDUs addiction problems and a focus on continuing to address policy-related
problems.
5.1
From the perspective of beneficiaries
Addressing the needs of female IDUs

The majority of IDUs and project beneficiaries are male. As a result it is not
surprising that most Peer Educators are also male. These Peer Educators are
sensitive to the particular needs and anxieties of female IDUs and some female
beneficiaries have been able to develop good relationships with male members of
staff. However, other female Peer Interviewers and interviewees described a need
for the project to better cater for the specific needs of female IDUs. Many have had
traumatic experiences in the past which make interaction with male Peer Educators
and the largely male-attended DICs difficult.
She said most of the Peer Educators that she meets are men and she is afraid to talk one to
one with a man. This is not Thai culture, its her past experience. He (Peer Interviewer)
thinks she has had a terrible experience in the past because she does not like to meet men
one to one. She would like more PEs to be women. (Bangkok Site 1, P.I.1, F2f)
One DIC in Bangkok has put in place specific activities for female IDUs (described
below by a DIC Manager in an extended quotation), and another DIC is beginning to
focus on reaching out to female IDUs. However, women-only activities do not
appear to be consistently implemented at all sites.
In one DIC there is a womens group and the Peer Educator who runs this is a woman. All
the information is confidential in this group activity. The topic that they discuss is about the
effect of drugs and harm reduction information. This activity runs very well. At another DIC
they dont have direct experience with women IDUs in the community. But the CHAMPION
project has been a good opportunity for them to do this. They now have two women peer
educators. The two women peer educators will go out into the community and talk to
women IDUs.
Its important to look at the rights of women IDUs who are part of a couple. For example it is
tradition that the man injects first and then the woman follows him, using the same needle.
But peer educators can talk to them about changing that practice. Women IDUs not only
experience violence from society but they get violence from the police.
45
Working with women IDUs should involve women Peer Educators. Sometimes women wont
be honest with male Peer Educators. They wont admit to being an IDU. They wont expose
themselves. (Bangkok Site 1, DIC Manager 3)
The specific vulnerabilities of female IDUs also need to be included in mens activities
in terms of addressing issues such as gender based violence. This issue also needs to
be addressed with external stakeholders such as health professionals and police in
order to increase awareness of the need to refer female IDUs to the project and to
put in place efforts to reduce the additional discrimination and violence to which
they are exposed.
Skills-based education
DIC Managers described a range of skills-based activities which are implemented at
DICs in order to increase employment opportunities for IDUs. In contrast, these
were seldom mentioned by project beneficiaries as aspects of the project that had
brought about change. Instead, skills education was raised at a number of sites as
something that beneficiaries would like a greater focus on. This may be explained by
a lack of consistency between sites in how skills-based education is addressed. At
some sites classes are provided in computers, cooking, handicrafts and other skills.
At other sites project participants are expected to be pro-active in putting forward
proposals for training which are then put forward for approval by the DIC manager.
In some sites, the DIC managers use networks of external stakeholders to facilitate
employment opportunities.
Project participants recognised the limited employment opportunities that are
available to them if they are currently injecting. However, there was a general view
that the project should do more to support participants in seeking employment.
She started to talk about her life. Her life right now is in trouble because its difficult to find
a job and she used to work but when her boss found that she used drugs she got fired. Then
when she tried to find a new job its a requirement to have a medical check up which includes
HIV and urine tests. She said that for IDUs, when they get fired or have no permanent job its
very hard to find a new job. Most IDUs are HIV positive persons and no one wants an HIV
positive person to work with, and she said she will say thank you if the CHAMPION project
can help with this. (Bangkok Site 1, P.I., F2f)
For working in department stores or restaurants you need a medical certificate. But for
some other jobs you dont need one. There is no organisation that can help get these jobs;
the CHAMPION project is about health and treatment. (Bangkok Site 1, P.I.m)
There should be more skill building at the DIC to help them to be able to find a job like hair
dressing, birdcage making or furniture making. (Satul Site 2, P.I.1, F1m)
Project staff reported that their previous experience in IDU harm reduction projects
has shown that providing skills-education does not automatically result in IDUs
managing to find employment, and self-employment has also been challenging due
to the highly competitive market in which IDUs need to be successful. It may be
beyond the scope of the CHAMPION project to provide specialist support in terms of
employment skills but there is a need for consistency in terms of dealing with IDUs
46
expectations. It may be that increasing links with other specialist NGOs who are
better equipped to provide appropriate training would be a cost-effective approach
for the future.
Rehabilitation facilities
The focus of the CHAMPION project is harm reduction. A number of Peer
Interviewers and their friends in Bangkok, however, described a desire to move from
harm reduction behaviour change to quitting drug use altogether. This desire
reflects the Bangkok DIC Managers wish to move the project beyond addressing
harm reduction to enabling the root causes of injecting drug use to be addressed
with the aim of supporting participants to stop using drugs.
It is perhaps a reflection of the success of the project in enabling behaviour change
that participants expectations and aspirations are becoming more ambitious. At
present the extent to which the project is able to support this significant step is not
clear.
He would like a rehab centre for IDUs, and job skills training. This is because a rehab centre
would keep them away from drugs. It would keep them away from groups of people using
drugs...Many IDUs want to quit drugs but at the methadone clinic there is lots of buying and
selling drugs so it is hard to quit completely. The Peer Educators can only make suggestions
and give knowledge like to quit slowly. For example if you use a drug 3 times a day then
decreases it slowly day by day until you no longer use it. And encourage him to quit and give
advice about not stopping too quickly. (Bangkok Site 1, P.I.7, F2m)
DIC Managers also expressed a desire to move beyond harm reduction and to
support IDUs to quit drugs completely. Whether this is within the scope of the
project is something that needs to be considered by the project management team.
Provision of rehabilitation facilities would require a considerable investment which
may not be feasible or in line with Global Fund objectives. However, supporting IDUs
in their desire to stop injecting is something that the project needs to address. A
possible solution may be by facilitating referrals to specialist clinics and providing a
bridging service between these, the DICs and Peer Educators.
Project kits
Peer Interviewers and their friends made a number of suggestions about ways in
which they felt the project could make the harm reduction kits more appropriate to
the different needs of IDUs. Suggestions included: provision of needles only,
inclusion of large diameter needles, no condoms, more condoms, non-transparent
containers, fewer needles, and more needles.
No consistent message emerged from the data provided and it is likely that the
differing suggestions reflect a) the difficulty in providing kits that suit all
requirements; and b) the varying needs of the wide range of IDUs engaging in the
project.
47
Gender issues are important and at present there does not appear to be any
specific project policy on how to address these within the day to day activities
of the project. There is a need to consider what more can be done both to reach
out to female IDUs and to address their specific needs. It is suggested that
consistent messages and activities be implemented at all sites. These could
include: active recruiting of female Peer Educators, increasing the awareness of
health service providers to refer vulnerable female IDUs to the project,
strengthening the life skills of female IDUs, particularly in terms of negotiation
skills; and provision of education to male IDUs on the need to reduce genderbased violence.
It would be beneficial to meeting, and going beyond, the original aims of the
project to consider how best to support IDUs who wish to cease any form of
drug use. It may be that this could most effectively be supported by increasing
links with specialist organisations and acting as a referral and back-up facility
working in tandem with NGOs who have the necessary infrastructure and
facilities to support this.
5.2 From the perspective of DIC Managers

DIC Managers emphasised the need for the project to build on its existing activities
and its relatively long period of funding to take a long-term perspective and focus on
addressing policy issues and resolving the attitudes of service providers in order to
create a sustained environment for harm reduction behaviour change.
He thinks the CHAMPION project should play a role in coordinating with government and
the public because (project) work has changed from underground to over-ground (publicly
visible). If these people can accept his work it can be sustainable: working in public is to
prepare for the future. (Bangkok Site 1, DIC Manager 2)
Partners and PSI should change their thinking from indicators coming first, to the quality of
work...when the money goes, how will the life of the Peer Educators and the problems of
society be solved? This is the chance to have the money to solve the bigger problem. So he
thinks what needs to be done is to tackle the longer term problem. But at the moment its
hard to see the long term. (Bangkok Site 1, DIC Manager 3)
They perceived strength of the project as providing an opportunity for high level
engagement with government, policy makers and other influential external
stakeholders to advocate for sustained improvements in policy, awareness of the
rights of IDUs to treatment and services, and acceptance of those rights through the
provision of high quality health care.
It appears that there is a need to support DIC Managers in fulfilling the multiple
objectives and needs of the project. At present they appear to find it difficult to
strike an appropriate balance between day-to-day work to achieve the agreed
project indicators and targets, while also being able to use their position within
the project and the opportunity this brings to engage in high level advocacy work
to influence government policy and its implementation.
48
6.
CONCLUSION
The project appears to be making considerable progress towards meeting its key
objectives. It is highly regarded by the IDUs who attend DICs and engage with Peer
Educators, and clear examples were provided by many participants of the benefits
they are obtaining in terms of increased knowledge about harm reduction behaviour
change which many are putting into practice in their daily lives.
Access to services is increasing, enabling IDUs to learn their health status,
particularly in terms of HIV and STIs. This is leading to safer injecting practices, use
of condoms and improved quality of life. All of which are essential to sustained
behaviour change in order to prevent transmission of infections and positive, healthy
living for those who are HIV positive.
A sign of the success of the project is that the expectations of many beneficiaries are
increasing. Increased social interaction, improved health and a sense of being valued
members of society with similar rights to other citizens is leading to greater
expectations of the project to provide opportunities for employment, and
rehabilitation facilities to support cessation of drug use. In many ways this is a
reflection of the change in perspective that the project is managing to engender
among participants, but it raises challenges as to how these growing expectations
can be managed and supported.
Project staff also perceive the achievements that the project is making but
experience challenges in striking a balance between meeting programme targets and
using the opportunities provided by Global Fund support to facilitate IDU behaviour
change that goes beyond the programme remit e.g. moving from harm reduction to
support for quitting injecting altogether.
The project is still at an early stage and has made significant progress over a short
period of time. The views expressed by both project beneficiaries and DIC managers
are in alignment with planned project activities. Descriptions of challenges currently
being faced are more a reflection of the early stage of the project rather than
weaknesses in the design and implementation of the project, although it is suggested
that the project would benefit from inclusion of an explicit focus on gender issues
and the differing needs and vulnerabilities of female and male IDUs.
It is intended that the information provided in this report be used as a starting point
to support on-going project implementation and planning. This report highlights
what the project can do and is doing well. It also draws attention to aspects where it
is felt that further benefits could be obtained by recognising the limitations of what
the project itself is able to achieve, but where added value could be achieved.
Examples of this are the possibility of developing links with other specialist
organisations; and acting as a referral and support service to facilitate project
participants engagement with these organisations. The findings of this study also
highlight the efforts of senior project staff such as DIC Managers and their desire to
build on and consolidate advocacy skills and activities to support longer-term
strategic objectives. These include supporting development and implementation of
appropriate policy and practice among external stakeholders to support IDUs, reduce
stigma and discrimination, and enable the project to make a clear contribution to
furthering the Thai governments efforts to reduce the impact of the HIV epidemic.
49
7.
ANNEXES
7.1
Rapid PEER Methodology
DAY 1: Peer Interviewer Workshop

The consultants will liaise with the appropriate project staff prior to arrival to ensure the
correct group of project beneficiaries/participants is selected for this workshop. Eight ten
people who are involved with the project should be selected. They should be available to work
with the consultant for 4 consecutive days. Timings of activities will be planned around their
existing commitments (e.g. work), as far as possible.
The consultant will give guidance to the project staff prior to arrival as to what needs to be
provided for the day of the workshop (materials, venue, support staff, translators etc). It is
anticipated that the main requirements will be a room large enough for ten people to hold a
workshop, flip chart paper, marker pens and refreshments/meals/childcare as appropriate.
The following is template for the workshop, which will be adapted to the timeframe available
and the needs of each target group:
10.00am Introductions
1. Explain to participants that we are here to help tell the story of their project from their point
of view, and from the point of view of other people they know who have been involved in the
project.
2. Group discussion with participants:
Ask participants to write or draw what the project means to them on a section of wall
covered with paper. Participants will be probed with questions such as:
o How does involvement with the project make you feel and why?
o What values do you associate with the project?
o Whats the most important part of the project to you?
10.45am Break and snacks

11.00am Peer Interviews in pairs
3. In pairs, ask participants to interview each other (using everyday language) to find out:
How they got involved in the project and why?

What difference the project has made to them and why?
What difference the project has made to other people like them, and why?
What they value most about the project and their involvement in it?
What they have found most challenging?
Where they want the project to go in the next year
Finally, in order to generate stories for the final workshop with project staff, each peer
14
interviewer should ask: During the last year , in your opinion, what was the most
significant change that took place for beneficiaries of the project?
4. Feedback: participants tell the group what they have found out from their partner, focussing
on stories and examples that capture the projects impact.
1.00pm Break and lunch
2.00pm Preparing to interview others
14
NOTE: This time frame need not necessarily be one year, but can be adjusted according to the
project.
50
5. Explain to participants that over the next two days we need them to talk to other people
who have used the services of the project, to capture their stories. They need to talk to two
other people they know about how the project has made a difference to their lives.
To prepare for this, participants will be asked, in addition to the questions that you used to
interview your partner before lunch, what questions could you ask your friends to get them to
tell their story of what the project means to them and how it has made a difference?
The group will then brainstorm ideas for good questions. The issue of asking probing
questions to get more detailed information will be discussed.
The participants will then practise introducing the interview to their friend, describing why they
are asking these questions, for example, by explaining that the people supporting this project
are interested to hear their story and share it with others.
6. Finally, a timetable for meeting and de-briefing all peer interviewers will be set.
By 4.00pm - End
DAY 2: In-depth interviews with project staff
We will ask that selected project staffs are available to work with us for an hour each during
the day. Which members of staff will be interviewed will be discussed beforehand with the
project management team.
Simultaneously, participants from the Day 1 workshop (the peer interviewers) will be
interviewing other programme beneficiaries.
The consultant will discuss the following key issues with staff:
The background to the project and their involvement in it

How they perceive their role in the project
The difference they consider the project to have made and how, and how they would
show this to others
What they value most about the project and their involvement in it
What they have found most challenging
Where they want the project to go in the next year
Depending on the size of the project we would ask that before the consultant arrives, a
timetable has been developed where project staff have been allocated a time to spend with
the consultant on a one-to-one basis. These appointments could be arranged at 1.5 hourly
intervals (e.g. 9.00am, 10.30am, 2.00pm, 3.30pm and 5pm, if appropriate).
DAY 3 and 4: One to one interviews with peer interviewers and participant observation
in their communities
On days 3 and 4 the consultant will meet with different peer interviewers over the course of
the day. The consultant will debrief the peer interviewers to capture the stories and narratives
that they have heard from interviewees
DAY 4: Late afternoon (3 pm) final peer interviewer workshop (c. 2 hours long)
Peer interviewers will meet with the consultant as a group. The main activities are:
Peer interviewers discuss as a group what they think are the most important findings
from their interviews with peers.
Consultant probes the group with any remaining unanswered questions that may
have arisen over the week
Peer interviewers are thanked and given a small gift/certificate for their participation
(as appropriate)
DAY 5: - Interviews with project staff and other key stakeholders (if appropriate)
51
The consultant will finish conducting in-depth semi-structured interviews with the project staff
and other key stakeholders.
At the final staff workshop members of staff and management will meet for approximately 1-2
hours to discuss what they feel to be the most significant change from a selection of stories
presented to them (which have been collected by peer interviewers). Staff will be encouraged
to explain why they have chosen to prioritise certain stories. This process gives the consultant
an insight into programme priorities and values, perceived impact, and how these might differ
between staff and project beneficiaries.
7.2
Rapid Peer Interview Transcripts
The transcripts in this section are produced exactly as they were transcribed by the three
researchers who were involved in de-briefing Peer Interviewers. Two out of the three
researchers have English as their second language. Quotations within the report have been
drawn from these transcripts. In a few instances the quotes used in the reports have been
slightly re-worded to allow them to read better in English. The meanings of the quotations
have not been changed in any way and the Thai-speaking researchers have checked and
approved the re-worded quotes for accuracy.
The transcripts from site 1 show the Peer Interviewer debriefings in full. The transcripts from
the remaining sites are incomplete. These debriefings were carried out in Thai and then
coded and analysed by PSI research staff. The transcripts below show key extracts of each
interview which, after initial coding, were translated into English. Thus the information shown
is categorised under key headings.
Site 1: Bangkok
PEER INTERVIEWER 1 (MALE)

Friend 1 male (38)
He knows the outreach work. Before joining the project he had to buy needles himself. He
receives free needles and coupons.
He said he needs more needles rather than coupons because its not convenient to go to the
pharmacy. And the pharmacy is in the community. He doesnt want anyone to know he is an
IDU.
About the packages of the needles he suggests it should not be transparent, because it is
not easy (safe) to carry needles. If he is stopped by the police he can be arrested.
The CHAMPION project made a difference to his life because it saves money, because there
is no cost to (getting) needles and he doesnt have to hide himself away, because in the past
he had to go to the pharmacy and everyone knows he is an IDU. Now, after work he goes
home and he has needles at home.
He used to go to get the HIV test and he thinks it is good because it is free of charge and he
received money for getting the test. He has no permanent job, and now when he has an HIV
test he gets money. When he gets an HIV test he gets a little incentive and transport costs.
In total he gets 400 Bahts.
Sometimes he has to buy needles himself because normally Peer Educators go to see their
friends at about 8am, but he has to go to work so he misses them and he has to buy needles
himself.
52
He wants PEs to work on weekends also, because on weekdays he works Monday Friday
and he likes to see them, so its better if they can work on weekends.
He would like the PEs to provide more needles to him. Right now he gets 5 needles per
week but he wants 10 needles per week, but he doesnt want to go to the pharmacy. He
prefers to receive needles more than coupons.
Its about how to negotiate with PEs some friends get 5 needles and 5 coupons in one
package, but some friends get 10. He gets only 5 needles and so he uses used needles.
He suggests can PEs go and see him twice a day, in the morning and afternoon, because
sometimes he cant see them in the morning.
The CHAMPION project has changed his life because when he has needles he doesnt have
to buy them. In the past his neighbour thought he is a drug user, but right now there is no
need to go to the pharmacy to buy needles and right now his neighbour thinks he has quit
and thinks better about him than in the past. In the past his neighbour was afraid of IDUs.
He thinks they are thieves and knowing why goes go to the pharmacy they are not buying
paracetamol but needles.
IDUs are not like normal people, in the past they used to be thieves, but right now when
they have the new needles at home, after they buy drugs they just stay home. So his
neighbour thinks he has improved and he does not interrupt (disturb) the neighbour. When
he injected outside the house it was obvious to the neighbour.
He said about the package of needles when he meets the PE its not at home but at the
methadone clinic. He is afraid when he carries the needles back home its not safe for him
as he can be arrested carrying the new needles.
Friend 2 - female (38)
She knows about the CHAMPION project from her friends. A group of friends talked about
what they get from the CHAMPION project its about free needles, condoms and free HIV
testing.
She thinks its good to provide her with condoms because she is a woman and she is shy to
buy condoms or get them from another place such as the hospital. The CHAMPION package
of condoms is ok no one knows what is inside it, so she likes it.
She would prefer the condoms to have two sizes in one package because she doesnt know
what size her boyfriend likes. Right now its only one size 42 or 52.
Normally she doesnt use condoms because its expensive to buy them. She can get them
free from the hospital but she is very shy, and there must not be too many people around
the place. At the hospital there are many people.
She talked about the cost. From this project she gets free needles and condoms. She does
not have to go out and buy them as she is shy. In the past she did not use condoms but now
she can have protected sex. She is HIV positive, in the past she did not use condoms and
when she got a medical check up her cD4 count was very low and she had hepatitis C.
She got knowledge from the CHAMPION project. She learnt how to protect herself for sex
and using drugs. The PEs take her to have tests, they also give her brochures and suggestions
and she has more friends.
53
In the past she had few friends. IDUs have a small group of friends, but now she has lots of
friends and she is not alone any more. She exchanges mobile phone numbers with friends.
The PEs give her more knowledge about how to use drugs and safe injections, and avoiding
overdoses, and having safe sex. Even though she is positive she knows she has to use
condoms.
Some IDUs think they can quit by themselves. Those that change their minds (about this),
they talk to their friends who have already changed by going to the methadone clinic and
they make more friends there at the clinic.
She said most of the PEs that she meets are men and she is afraid to talk one to one with a
man. This is not Thai culture, its her past experience. He (Peer Interviewer) thinks she has
had a terrible experience in the past because she does not like to meet men one to one. She
would like more PEs to be women.
She started to talk about her life. Her life right now is in trouble because its difficult to find
a job and she used to work but when her boss found that she used drugs she got fired. Then
when she tried to find a new job its a requirement to have a medical check up which
includes HIV and urine tests. She said that for IDUs, when they get fired or have no
permanent job its very hard to find a new job. Most IDUs are HIV positive persons and no
one wants an HIV positive person to work with, and she said she will say thank you if the
CHAMPION project can help with this.
Peer Interviewer 1 comments: It is the same for most IDUs for working in department
stores or restaurants you need a medical certificate. But for some other jobs you dont need
one. There is no organisation that can help get these jobs, the CHAMPION project is about
health and treatment.
Story:
In the past one of his friends lived day by day, trying to find money to use just for that day,
and then he joined the CHAMPION project. He got what he never received in his life. He got
the test (blood test for HIV and STIs) and the incentive from testing.
He has new friends who he can talk to and exchange ideas. He talks with his friends about
work, about how to get jobs, and his friend recommended a job for him. Its being a security
guard and you dont need a test for that.
In the past he could not find the solution for his life. He did not know many persons, but
now his life is better. He has a salary and has no need to borrow money from others. So
nowadays he is still in contact with his friends from the CHAMPION project. He meets them
at the methadone clinic, and he can manage his time for work and meeting with his friends.

Friend No. 1 (male aged 54)
His friend said he likes the project because he gets needles free of charge, and besides the
needles he has knowledge from the project about harm reduction.
He says he doesnt come to the DIC too much because he has a job. He has no time, so its
difficult to come to the DIC. It is open every day 5 am 4 pm.
54
He met the PE at the methadone clinic and he gave him the needles. He takes methadone
daily. He gets the needles from the PE once or twice a week, or sometimes once a fortnight.
The project makes him very happy because he feels comfortable and learns things from the
PEs.
Friend No. 2 (male aged 53).
He learnt about the project from PEs who give him needles. The PEs also give him
knowledge. He met the PEs at the methadone clinic too. He said that he knows more about
how to use needles safely and how to check up his health and how to protect against HIV.
He also knows more friends. He feels comfortable. Before he knew more friends he wanted
to learn more knowledge and to talk to others.
His friend joined the CHAMPION project because he can meet new friends, he can get free
needles and equipment. He thinks that when he gets needles and equipment he will not
share with others. He also receives information about health and how to protect himself.
The difference the project makes is great because he knows how to protect himself and gets
knowledge about disease, and he instructs his friends about how to protect themselves.
The most important thing is meeting new friends and exchanging opinions. He feels happy
when meeting his friends. No matter that some of his friends he doesnt like he likes to
spend time with the friends he does like.
A challenge about the project is that he doesnt like his friends quarrelling and being thieves.
When the friends go to the DIC for coffee, sometimes they steal coffee from the DIC. Inside
his heart he knows his friend is not that kind of person but it is the effect of drugs.
Sometimes his friends have different opinions about things and so when they go to the DIC
they quarrel, and sometimes the police have to come to the DIC. They mostly quarrel about
amounts of drugs if they have given someone money to buy drugs for them. Once someone
injected drugs in the bathroom of the DIC so there was quarrelling with the DIC staff. This
makes him feel very bad.
Because of this he felt very bad and did not go to the DIC for a week. The reason he goes to
the DIC is because he wants to be relaxed and when this happens he doesnt feel relaxed at
all. But it doesnt happen frequently and its usually the same person that makes the
problem.
The CHAMPION project is all good. They provide equipment and the DIC is not too far away,
and they also give him knowledge about protecting himself.
Story (told by 2 friends together):
Since they joined the CHAMPION project they have had a better life. They have knowledge
about HIV, STDs, TB, Hepatitis C and other diseases. The staffs give them the necessary
knowledge, so overall their lives are better.
55
Before joining the CHAMPION project their lives were very bad. They were very thin but
now they have gained weight, they get fatter and they get knowledge and also equipment
like needles, condoms, pure water, alcohol and cotton. They dont have to pay and they feel
very happy.
They have knowledge because every Thursday there is a group activity and the staffs teach
them about how to protect themselves and how to inject safely, and there are also health
topics about food and sleeping.
They have made new friends at the DIC. They found out about the project from their friend
who is a peer educator. They now have needles and also condoms. The DIC is the centre for
IDUs.
A friend introduced him to the CHAMPION project. He was interested in helping others and
in exchanging information and ideas with other IDUs. Helping others is about helping them
to know how to use drugs safely because its difficult to quit, and also knowing where to get
free needles and how to inject safely.
At the CHAMPION project he has met new friends and learnt about how to protect himself.
He has learnt about drugs and overdose prevention.
The most important thing about the project is learning how to prevent disease due to using
drugs; and also exchanging ideas. People exchange ideas about injecting safely. In the past
he did not know about where to inject safely so he injected into his groin. When he
exchanged ideas and knowledge he learnt where to do it safely in the arm. They talk about
places to buy drugs and the prices; and they also talk about where are the dangerous places,
such as the places where they can be arrested.
PEER INTERVIEW NO. 4 (FEMALE)

Friend No 1 . (Male, 42)
He likes being involved in CHAMPION because he has made more friends and he can
exchange opinions with them, sometimes they eat lunch together. He feels happy in group
activities in DIC and feels comfortable to talk with friends.
A peer educator from CHAMPION introduced him the project when he went to the
methadone clinic. He receives free needles and condoms.
He can sit in MMT until 10 am because he scare that policeman might be arrested him but
in DIC he can sit in all day. His parent rejects him and not allowed him to stay at home
because he has many tattoos, so he has no place to go. Because he has a lot of tattoos it
makes people scared of him.
He has better life when involve in CHAMPION project, before that he has not many friends
because he has many tattoos and got TB but in CHAMPION, he got many friends to talk and
he feel comfortable when he is with friends. He feels happy he has joined the CHAMPION
project and has a better life.
The problem is that he does not have money to come to the drop in centre or to MMT clinic,
he has to depend on his friends.
56
Right now the group activity in DIC has only on Thursday and activity is to provide only
knowledge about disease. He wants the drop in centre to have many activities such as a
cooking club, music club, and more group activities such as Paper-Mache and Batik cloth.
These will give friends have something to do and its better than asking for money from
other people because IDUs use their free time asking people for money. Thats why he
needs the centre to have these activities.
Friend No. 2 : Male 36 years old
By being involved in the CHAMPION project he has made many new friends who he did not
know before at the drop in centre and now knows more about contagious diseases, not only
about ones that happen because of drugs, and he knows how to protect himself, such as by
using a condom when he has sex. He goes to DIC every day. In the morning he always has
breakfast at the drop in centre and watches movies all day. He always got teasing by his
friends in DIC, the IDUs, because they think his gay and they dont like him. He unhappy and
sad, some friend in DIC tries to stop them for not teasing him. He still comes to the centre to
read a book or watch TV at the drop in. Because he looks like a gay that why the IDU always
tease him. But he said he is not a gay.
He has more friends when he comes to the drop in and he has a place to live. But he feels
unhappy inside his mind even though he has a food to eat. Before the IDU tease him, he is
strung out and went to the drop in the he stole the mug and used drugs in the drop in centre
then the officer not allows him to come in the centre for 1 month. After that he thinks he
will not be strung out in the centre and he will not use drugs when he goes to the drop in
centre. He used to be an officer at the centre before but he made a lot of problems and did
not reach his targets. He sole methadone to friends in the drop in centre, so the centre fires
him. In the past, he was security guard
Before he joined the project he had a wife and children, but he had sex with other women
who are commercial sex workers and did not use a condom because he thought it was safe
he was not prepared. After that he has no job and separated with his wife and children
because his mother in law does not like him. He was a security guard but the money was
not enough.
After he joined the project he has used condoms with his wife and she comes to visit him
every weekend. But he does not use a condom with the other women. He would like to stay
with his wife but he thinks it is impossible because his mother in law does not like him.
Nowadays he rents a condo but he has no job.
He would like to get job, he request budget for sale cart from some foundation and waiting
for the results.
P.I. 4 own story:
Before she joined the project she was housewife. She knows that she got HIV infection
when she was pregnant. She had an abortion at 3 months. Her ex-husband was a drug user.
He always scolded her and abused her in front of the neighbours. This made her run away
from home, she met a new husband and they live together. When she was with her new
boy friend (husband) for month, he introduced her for drug and invited her to be an IDU.
Before involve in CHAMPION project she hid from everybody that she used drugs, she was
very isolated. When she comes to the drop in centre she feels comfortable and was able to
tell the project officer that she and her husband are positive and that she had an abortion at
the hospital. She knows for DIC staff that you are OK even you got positive and you can use
condom. The staff taught her to use a condom when she has sex, even though both she and
57
her boyfriend are positive. Nowadays she feels comfortable because she can talk with the
staff. She also talks with DIC staff about t CD4 and ARV. Nowadays, She feels comfortable,
warmth, and confident to talk with DIC staff. Compared to the past, she thinks she can talk
with people more and more.

Friend No. 1 (male, 49)
He started to use drugs because he wanted to be part of a group and it is cool to use drugs.
He has a wife and kids and still uses drugs but tries to hide it from his wife. He only injects
drugs occasionally because it is expensive.
As his kids are growing up he thinks about taking care of his kids, but he still needs to inject
when he can. He also uses other drugs, when he cannot find heroin he uses domicum or
methadone.
He is afraid of the police.
He met the peer educators from the CHAMPION project at the methadone clinic. The PE
introduced him to the project and told him he will give him needles and will take him to see
the doctor. If he is HIV positive the PE will arrange for him to get ARV treatment. Or if the
methadone treatment he receives is not appropriate the PE will take him to another
hospital.
He compared the CHAMPION project with the government service. At the government
service patients have to go to the hospital to receive the service and expose themselves. For
example, if he or she wants to know their HIV result they have to go to the anonymous
clinic at the hospital and people will automatically think that person is HIV positive. It is like
disclosing himself to others. The CHAMPION project is very active, but going to
government services is passive. At the CHAMPION project the staff will take him to the
hospital and talk about his rights to get treatment. The staffs know about rights. There are
equal rights for everybody, no matter who he is or what disease he gets.
He said that his wife got pregnant and the doctor said why didnt you use contraception,
why did you let yourself get pregnant. You are a burden on society. At the government
hospital the IDUs are like the second class population because the hospital sees them as not
important. There is even an advertisement saying its easy to get HIV, but there are still no
opportunities for those who get HIV.
For those who are HIV positive, at some health clinics when he goes to the dentist they treat
him very badly. Sometimes they make him go last in the queue, or say the machinery isnt
working and he must come back tomorrow, or they just give him paracetamol. But the
CHAMPION staff work with health clinic staff about patient rights and help with referrals for
treatment. Moreover when there is an accident the staffs help, and take care of him, and
contact the accident insurance for him.
The CHAMPION project works for everything about his rights and its the first project that
works on this. He has never seen any project like this. It also provides needles and
equipment. He thinks its a risk for the project to work like this because some people think
this makes IDUs inject more.
58
When CHAMPION staff works with health clinics the IDUs get a good response from the
health centre staff and doctor. Thats because CHAMPION staff work with them on the
rights of the patients, and let the IDUs know about their rights and also give them
information about how to protect themselves, about contraception and condoms and safe
injections to make sure other people dont get HIV positive.
He says it is the CHAMPION project that makes them know their rights because most IDUs
dont know they have rights equal to others. CHAMPION staff gave him information he
never knew before. For example, those who are already HIV positive, when they have sex
with other positive people they should use condoms because its dangerous for them.
At first he did not trust the CHAMPION staff. He thought why do they need my name? But
later he realised that the staff had come to help him to give counselling to help him with
his life. The staffs suggest what to do to make the community accept him. So today, even
though he has had HIV for more than ten years he can live well. He thinks the most
important thing is that he can talk to friends, because he cant talk to his family. Its better
to talk to friends because they understand and know what happens when you get infected.
Theres no need to blame anyone for getting infected it can happen to anyone.
When his kid was born he found out that the kid did not get HIV, and thats because when
his wife got pregnant she got ARVs. At first, when he saw the doctor at the hospital he was
worried because there is a project that will get rid of the baby if the mother or father get
HIV. The staffs from CHAMPION make sure that everyone knows that at this hospital there
is another project that helps mothers who get pregnant get ARVs to project their babies.
Someone from CHAMPION project went with them to help them join that project. When
she gave birth to the baby and he knows the baby is not HIV positive, right now he has
courage to take care of his kid. There is no need to worry, no matter that the father and
mother are HIV positive. The staffs of the CHAMPION project tell IDUs which hospitals
provide ARVs and about the IDUs rights, so people go there and get their CD4 counts and
tests.
He is Christian, and at first when he got HIV his family rejected him. His parents feel afraid
of him and feel that he is not clean. They dont want to use the same plates as him. The
CHAMPION staff went to talk to the parents to explain about HIV. So right now his family
feels better about him. They love him more and also love the child. But they still reject his
wife because they think it is because of his wife that he is infected. Maybe he got infected
from a needle.
In some places there are lots of PEs. In other places there is no one to work there.
Sometimes when he asks PEs about knowledge the PE doesnt know the answer they just
give out needles. But they give out too many needles. Also people need counselling but the
PEs cant give it. When he gets too many needles and he has to carry them with him its
dangerous because the police will think why do you have so many needles? They will think
he is going to sell them.
There are many PEs who try to give needles to him. Thats because PEs need to reach the
target of providing needles to IDUs. Sometimes its too many so the PEs throws them away.
Three packages is the most appropriate number to carry. One package contains one needle,
a syringe, an alcohol pad, pure water and a tourniquet. Also he said, what is useful in that
pack is the needle and syringe. Some throw the other stuff away.
Friend 2 (male, 49)
59
He is Muslim. In Muslim communities if someone uses drugs or is HIV positive the

community will discriminate against them. Also, their family will think that they are dirty.
But he is not HIV positive. Also if someone has tattoos the family will also reject him. He has
tattoos and uses drugs.
The CHAMPION staff talked to the family. The family thinks he quit. He does still inject but
not often. If a son knows his father uses drugs the son will not respect him.
He met the staff from the DIC (Ozone) because some PEs live close to his home and they
have know each other since they were teenagers.
The PEs gave him information about drugs and contraception. Because he is Muslim he
must not be an IDU. It makes things very difficult in the community. So when he is in the
community he has to be hidden (secretive). It is better when he is at the DIC, he does not
have to be hidden (he can be himself).
He is a driver for his family and his father and mother pay him. When he uses drugs
sometimes he does not inject, but he uses other methods he smokes. He quit injecting
because he got a medical check up and found out that he has Hepatitis C. He got the result
from the methadone clinic. He also quit injecting because he has three kids and he has to
take care of them. He also got methadone because he is getting older and his body is not
like a teenagers any more. He doesnt want to go to prison again. Right now his family does
not know he uses methadone. They think he quit.
The PEs give him too many things. Sometimes he only needs condoms but the PEs give him
needles as well as they are in the same package. Sometimes the PEs give them to him at the
bus stop so he is afraid of what people will think. This happens because sometimes he
happens to meet the PE there and he knows that when the PE goes to the methadone clinic
he will pass that way. Sometimes he goes to the DIC, sometimes he calls to the PE to
arrange to meet somewhere.
General thoughts from P.I. 5:
Its good to know about rights, and about what disease they have. Its good to know what
kind of medicine they need to take care of themselves. Its also good so that the doctor
cannot hide information. Some hospitals wont give information to the patient. Sometimes
the illness can be cured easily but they wont tell the patient because they want to make a
profit. This happens not only to IDUs.
Even if the doctor knows about IDUs rights, he (friend) knows that the doctor still feels kind
of dissatisfied but the doctor still takes care of him better and gives him a better diagnosis.
The doctor improves his behaviour in front of him, and the medicine he gets is also better.
This is even if the doctor does not think better of him inside himself.
The project does not support people to inject more. It wants to stop people sharing needles.
They dont want people to share needles. Its good because when people cant find clean
needles they share, or they try to clean the used needles. In the package is everything they
need not just for injecting but for other purposes as well! For example, the alcohol pad
can be used if they injure themselves - not just for injecting. Pure water can be used for
filling car batteries. They sometimes dont use the tourniquet for injecting they use if for
headbands. Some people prefer using other tourniquets or the bottom of a cigarette for the
filter.
PEER INTERVIEWER 6 (FEMALE) (unedited version from PSI research staff)
60
Friend 1 Male, aged 53

He heard his friend talk about Ozone that he can go and get free needle and condom there
so he was interested. At first, he was not sure about what Ozone is. He saw his friends
always go there. Someone told him that it is project that teaches you about how to take care
of yourself and receive treatment. He thought it is interesting and tell his friends about it.
There was Ozone staff that talk to him about knowing his own HIV status and how did he
feel about HIV test and knowing result right away. After getting test, he knew that he got
HIV so he asked for referral to get treatment. In the past, he looked very sad. When he went
to Ozone, he did not talk to anybody. But now he feels happier. He was sad because he did
not know about his status, but when he knew about his status exactly and staff took him to
receive treatment, now he talk to other more frequent. In the past that he did not want to
talk because he was afraid that his friends will discriminate him. Now he looks more
cheerful.
At Ozone, he has more friends. He has got supportive. His friend took him to apply for a job
as a security guard which he is now working.
When he went out to buy drugs, he was afraid of getting arrested so when he went home
directly. It is good that he has needle at home. In the past, when he had sex with partner, he
never used condom. Now he has got knowledge from his friends at Ozone so he takes care
of himself by use new needle and use condom. He knows that using new needle can make
his arm no scratch.
At Ozone, there are food and computer for us.
The first time that he went to Ozone, he felt impressed that both staffs and peer educators
are friendly. No one ask him that why he was there. He can talk to friends ie time in prison
and past experience. In the past, his neighbours were afraid of him. They thought he was a
theft. His family did not want to left money in the house. But now they can leave money in
the house.
Knowing HIV status makes him receive treatment right away, went to hospital and CD4
checking. That because Ozone staff refer him to get the test.
He feels that his body is getting better. Pimples are cured. In the past, his CD4 count was
below 200 but now it is around 300.
He suggest CHAMPION project to have more sport activity because beside this, there already
covered other activities. Peer educators should go to his house sometime.
He impress about knowing his own status and get free needle and condom because he
doesnt has to buy it.
Knowing his own status is the most important thing for him because the quicker he know,
the quicker he can get treatment.
He goes to Ozone frequently because he feels safe and has many friends. There are many
activities such as computer and music club.
Friend 2 Male, aged 50
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Normally, he stays at Ozone during the day. At night, he works as a security guard. He knew
Ozone from his closed friend. At Ozone, there are food and movies for everybody.
In the past, only few people knew Ozone, but now there are so many people and that make
it more crowded.
At first, he did not know his status and he like to have sex with commercial partner. He did
not want to go back home because his siblings did not like him. His family has business about
house rental but his siblings did not trust him to do the business because he is IDU. His
siblings repeat it so often.
There are movies and food at Ozone. He can also get HIV test, know result, and get free
needle and condom.
He likes to go out and has sex with commercial partner. In the past, he did not use condom
because he thought that his partner already had husband so it was ok. However, when he
learned about STI and he used to have pimple on his skin, he has changed his mind to use
condom and pimples were cured. Staffs also told him to use condom consistently.
The most important thing in CHAMPION is free condom and needle. Using new needle help
scratch cure quickly.
He would like to see peer educators dress more polite. Some of them wear short and not
proper shoes and talk to him impolitely. There should be peer educators who work around
his house.
Knowing test result is the most important thing. To know it earlier make people treat
themselves right away. Although at first when know that you are positive but it is about your
mind. You must have a strong mind. If not, receiving supportive from friends will also help
you be stronger. If he did not have friend on that day, he will never go to get the test and
still doesnt know that he is positive.
If no CHAMPION project, when he has sex with partner, he will never use condom still.
Friend 1 (male, 30)
He said he knows about the CHAMPION project because a PE took him for a blood test
then he realised this was part of the CHAMPION project, and that the CHAMPION project
also does free needles, so he thought, wow, this is a safe cause.
When he knew that the project provided needles and coupons he wanted to know more
about the project.
The CHAMPION project changed his life as there was no need to share needles, but the
problem he faced was that he wanted a bigger size of needle and the project does not
provide that for him.
He says that every day he used to have to go out to buy needles, but now he knows about
the project he does not need to go out and risk being arrested to face his neighbours who
think he is a bad person. He gets the needles from the PE in the packet. He makes
appointments with his friend, the PE, and invites him to meet for a meal near the DIC.
Friend 2 (male 30)
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He met the PE at the methadone clinic. Then the PE took him to another clinic to get a blood
test and the PE went there with him. He gets the package from the DIC.
He would like a rehab centre for IDUs, and job skills training. This is because a rehab centre
would keep them away from drugs. It would keep them away from groups of people using
drugs but the IDUs who want to join the Rehab centre would have to have their backgrounds
checked for safety reasons. Now there is no activity to help them find a job. Many IDUs
want to quit drugs but at the methadone clinic there is lots of buying and selling drugs so it is
hard to quit completely. The PEs can only make suggestions and give knowledge like to quit
slowly. For example if you use a drug 3 times a day then decreases it slowly day by day until
you no longer use it. And encourage him to quit and give advice about not stopping too
quickly.
In addition, if in the center has some areas for plant the backyard garden, it will be valuable
for IDUs to use their time.
He thinks this project help him to reduce the cost for buying needles and not risk to the
police at the pharmacies.
Before the project coming, IDUs always use the old needles and share the needle with other
IDUs. So when he know the CHAMPION project, he not risk for the police and the disease
from sharing needles.
When he was a teenager, he wants to try and enjoyable the drugs. He starts with the
cigarette then marijuana and finally inject heroin. After that he was arrested and lived in the
prison for 10 years. His wife leaved him that made him think he would not touch the needle
again. He has no place to go after released from the prison. His friends introduce him to
know some peer educator and come to the drop in center. He go to see the staff in the
dropped in and he was encourage by them. Now he was a trainee staff and work as an
outreach to find new IDUs and invite them to be like him.
He thinks the challenge is finding the new IDUs and taking them to the center. Because those
IDUs must think he is a spy of the police.
Info from Peer Interviewer 7 himself:
When you use needles for a long time its hard to inject with them as they become blunt. So
getting needles is important. If you inject an old wound with a blunt needle its easy, but if
you change the place it makes a big wound.
Everyone says because the package is free you can throw the needles away once youve
used them. But they dont need the condoms because they dont have sex.
Based at Alden House (was based at methadone clinic but shifted over at the invitation of a
friend). They do outreach and he works 6 days a week. He goes into the community and
talks to the IDUs that he takes care of. They talk about things and he asks them if they want
needles.
His supervisor tells him which community to visit. In the first week of being a PE you have to
find 5 new IDUs to come to the DIC. He takes care of two communities and because he is
new he is going to the methadone clinic to recruit people.
Apart from providing needles he has to give knowledge about how to use needles and talk to
them to get them to trust him.
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Sometimes he feels uncomfortable inside because the IDUs do not have time to talk to him.
Sometimes the police catch IDUs at the methadone clinic so they go there in the very early
morning and leave quickly.
When the police search for needles, if the package has the CHAMPION name on it they can
call the DIC to check he is genuine. At the beginning of the day he may have about 20
packets on him. He will go together with another PE they go out in pairs.
The DIC provides him with an identity card but because he is training he does everything
with a buddy.
Feedback from Peer Interviewers at the final workshop:
Thoughts relating to gender issues:
Men talk to men quite easily. When men talk with women the women are shy about talking
and find it difficult to take condoms and needles from men.
The number of women in every centre is less than the number of men.
Women peer educators would like more women peer educators.
Male peer educators say that because women often find it hard to accept openly that they
are IDUs it could be a good idea to talk to their boyfriend first and get him to invite
(encourage)her to join the project.
Women say: In one DIC there are women only meetings so she can invite her women friends
to come. But these meetings are only once a month. In the group meetings they talk about
violence against women by their husbands.
Improvements in health what this means:
Their health improves through exercise like doing tennis, ping pong, hoola hoop and javelin
throwing they do this at the DIC.
A friend said he would like to have a rehab facility and skills training to help him get a job.
Site 2: Satul
5 Peer Interviewers (5 men ages between 27 and 44)
MAIN THEMES FOR CODING
1. HOW THEY GOT INVOLVED IN THE PROJECT
Know CHAMPION from friends
- Staff told him about CHAMPION project. He saw his friends came to DIC so he
wanted to go as well. (PI1, F1m)
- He saw his friend like to go to DIC and also suggest him to go there to change his
drug use behaviour. (PI5, F1m)
- He knew CHAMPION because DIC manager introduced it to him. (PI2, F1m)
Know CHAMPION from hospital
- Staff is a friend of him. When he went to hospital, nurse suggested him to go to DIC
to get needles. (PI1, F2m)
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He knows CHAMPION when he went to hospital. PE introduced the project to him.

(PI2, F2m)
He went to DIC because he was sick. PE went to see him at home and took him to
DIC. PE gave support to him when went to hospital. When he has nobody, PE always
takes him to hospital. (PI3, F1m)
2. WHY DID THEY GET INVOLVED IN THE PROJECT

Need courage
- His friend known DIC from staffs. He saw his friend came to DIC and after that look
healthier so he was curious to know why his friend had more courage. (PI1, F1m)
- He saw his friend still alive so he needed support from him. Courage make him to
live his life. He also saw his friend healthier. (PI1, F1m)
- He has more friends and supportive. Many IDUs lack of courage. (PI1, F2m)
- When he comes to attend activities or party, he feels more relax because his friends
make him feel more courage. (PI1, F1m)
- PE always gives supportive to my friend about his life. Even he is sick but he has to
be strong. (PI1, F1m)
- PEs met him at his house and suggests him to go to party. He felt very fun. When he
was at home, he felt so stressed and think too much. Live alone at home is trouble.
(PI1, F1m)
Learn about how to protect themself
- Many people come to DIC because they want to improve their behaviours, attend
activities, learn how to protect themselves to safe their life and gain more
knowledge. (PI5, F1m)
- He like to go to DIC because he can talk to many friends, He can consult them and
have more knowledge about harm reduction. (PI1, F1m)
Other
- There are foods, coffee, and staffs at DIC. (PI1, F2m)
- At CHAMPION, he can talk to friends and receive counselling from staffs and PEs. DIC
manager took my friend to see doctor. (PI2, F1m)
- My friend feel commit to DIC. He came here everyday. (PI2, F1m)
3. DIFFERENCE MADE BY THE PROJECT:
Got knowledge, new needle, safe injection
- His friend got suggestion about how to use drugs, exchange knowledge and after
that PE always go to his house to distribute needles. (PI1, F1m)
- CHAMPION project provide him knowledge about how to inject safely. In the past,
one needle was being used by many IDUs but now only one needle per person to
reduce risk. (PI1, F1m)
- My friend can talk about drug injecting with his friend. He is trying to quit but even
he cant, it is still ok because he has sterile equipment on hand. He does not feel
scare about getting infected. He got HIV because he used same needle with is friend.
If he use new needle, it can help him and prevent other diseases. (PI1, F2m)
- If there were CHAMPION long time ago, his friends will not die. Most IDUs who got
HIV infected still has no chance to get treatment. CHAMPION teaches us about harm
reduction. They also provide needle and equipment. (PI1, F2m)
- If there is no CHAMPION, my friend will still go out to buy needle or use unclean
needle. (PI2, F1m)
- In the past, we had to go out to buy needle but now there is no need to buy it. We
know that injecting with the same needle can put us at risk for getting infected. Now
we use the needle only once and throw it away. (PI4, F1m)
Friend gives support/Social relationship
- He has more courage, more friends to talk to and have someone who understand
him. In the past, after got ARV, everyone always go back right away. (PI1, F1m)
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Before CHAMPION, friends live separately, not meeting often. CHAMPION makes us
become closer and have more courage. (PI1, F2m)
- His body and mind become better and better. In the past he could not accept and
hide himself from his family that he is HIV positive, even his friends and
neighbourhood already know that he is IDU. Even himself, he knew that he was sick
but its hard to accept. After that when he talked to friends and PEs, he got
supportive so he feel less stress and more relax. (PI2, F1m)
- At DIC, there many friends who can give suggestion and knowledge. In the past
there were only 1-2 friends there but after CHAMPION started, there are many new
members who we can exchange knowledge, group activities, have more knowledge,
not only about drugs but also about jobs. (PI2, F2m)
- Others look at him better than it used to be. In the past he had little knowledge and
had no one to talk to. When he came to DIC, he has more friends to consult. His
friends told him to earn money himself, not steal anybody. (PI5, F1m)
Quitting drug
- Before met PEs, he still used drugs. PEs gave him knowledge about health and
suggested him to quit drug. Now he is not using drug anymore. He feels so proud
that he can improve his behaviour and be stronger. His parents also feel proud of
him. (PI3, F1m)
- My friend knows how to control himself. He has changed his behaviour from
injecting so often to less injecting and from sharing needle to using new needle. He
does not want to inject with used needle, even it is his own needle. He really does
not want to use it from his mind. He feel that using new needle is clean and no
diseases. After injecting, he will clean it and return it to DIC. In the past, drug control
him, but now, he can control drug. (PI4, F1m)
Neighbourhood acceptance
- In the past, his neighbour hates him. They were afraid that he was a thief. However,
now his neighbours are better. They understand him. And that because DIC has
worked with them. He feels happier. (PI4, F2m)
- In the past, he injected drug in forest, roadside or in rubber plantation. His
neighbourhood could not accept him. He used to buy drugs at pharmacy or got it
from health office. The owner of rubber plantation usually thought that he was a
thief so they called a policeman to arrest him. But now everyone knows that he is
IDU. He can live as normal people. Sometime he can inject drug at home. (PI5, F1m)
4. MOST IMPORTANT THING ABOUT THE PROJECT:
Social Relationship
- He impressed that he has a best friend from here that make him feel having better
mental health. When he has a good friend, he feels more courage. In the past, he
had few friends because most of them have their own work to do. Now, when he
has time, he can go to see and talk to his friends. He can consult them when he is
sick and talk about knowledge. (PI1, F1m)
- He feels impressed that he has friends to help him while he was sick. His friends
always take care of him, provide needle and condom. He does not feel of getting
arrested. (PI1, F2m)
- He has more friends from here. He feels so proud to have friends. He feels that he
has more value. He is not at risk and he can protect himself. (PI1, F1m)
New needle make them safe from HIV and getting arrested
- Now he is not at risk for diseases because he has new needle to use. There is no
need to go out to buy new needle. It is great because he is afraid of getting arrested.
(PI1, F1m)
- Some of his friends are shy when they go to buy drug at pharmacy. He told his
friends to buy it for him because he is afraid of getting arrested. CHAMPION work
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with policemen then they have more understanding of us so they dont arrest us.
(PI1, F2m)
- If there is no this DIC and no CHAMPION, there will be lots of diseases ie. AIDS and
STI. (PI3, F1m)
- He feel more relax. He can protect himself. He can be a consultant to his friends. He
has new equipments on hand. He can understand the problems in his life. (PI1, F1m)
More convenient when go to see doctor
- Its more convenience to do to see doctor. In the past it was very difficult because if
he went there alone, he had to wait for a long queue. If he go there with PE, PE will
contact and coordinate for him. PE always gives me suggestion. (PI2, F1m)
- When he was sick, PE took care of him. When he wants to go to hospital, PE took
him there. PE always gives support to him for everything, sickness, health and mind.
(PI2, F2m)
5. CHALLENGES:
- He could not go to DIC because he has no vehicle. It is very difficult. (PI1, F2m)
- It is quite difficult for some friends who live far away from DIC. PE will go to see
someone who live alone and give support to them. (PI5, F1m)
6. THE FUTURE:
Skill building
- There should be more skill building for friends at DIC to make them be able to find
job ie. Hair dress, birdcage maker or furniture maker. He wants his friends to have a
job so they can take care of their family. (PI1, F1m)
- CHAMPION should have more skill building for members to make them be able to
work because in the time that there is no rubber plantation, they have no job. (PI1,
F1m)
- There should have skill building, supporting when friends are sick, give support to
them and help them about money to buy food. (PI1, F2m)
- There should be skill building for members in order to learn. In the future if they
dont work as employee, they can do their own business. (PI4, F1m)
7. STORIES
- In the past, he was in trouble. He really needed new equipment but he could not
find it and had no money to buy it. Now, there is no need to buy new needle. He is
not at risk. He can meet his friends and when he is in trouble, there are many people
who can help him. (PI1, F1m)
- In the past, his health was quite bad. He got TB. He took medicine and saw doctor
inconsistently. PE from CHAMPION gave support to him. He told him to take fully
medicine. Then, his health was getting better. In the past he was sick all the time but
now he has more courage. He does not have to take medicine anymore. When he
was sick, he could not work but now he can go out, visit his friends and work in
rubber plantation. (PI2, F2m)
- His parents accepted that he is IDU. It is better than hiding. PE talked to his parents
about how to take drugs so they have more understanding about diseases. At first,
his parents were afraid of sharing cloth, soap or spoon with him will cause them get
HIV infected. His cousins did not want to associate with him. But when PE worked
with them, his parents went to talk to his cousins about HIV. Now, they can live
together. They can use spoon and plate together. (PI2, F2m)
- Before he can control himself to quit drug, it took many years to think about it. It is
easier to just think than action. But when time passed, he consulted his friends and
received support from staff, he could restrain his passion. Staff helped him to have
more knowledge. It is more than anything. It is better than food or water. It is so
valuable for him. In the past he injected drugs so often and he could not work. He
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had no money, even a Baht. He slept at his workplace. When he reduced his drug
use, he has more energy and be able to work more. (PI4, F1m)
In the past, he has nowhere to live. He lived alone. He used drugs started from
smoke and then change to injected. When he was dope sick, he tried very hard to
find drugs. When he saw DIC near his house, he came there and wanted to get
methadone treatment. This DIC has no brick as a wall but there is a brick in my heart
to control myself. When someone is sick, staffs give support to him and talk to
doctor for him. His friend is healthier because receiving courage from friends. There
is no more medicine needed except courage which we can find it from this DIC. (PI4,
F2m)
When he is at DIC, he feel relax and fun. He lives alone at home. When he came
here, he knew staffs and friends. He learned about drug overdose, how to control
himself. This place is like a centre for us. He likes to read newspaper, sleeping, and
food. (PI5, F2m)
His friend used to be very thin. Now he is getting fat. Staffs help him about medicine.
PEs take care of him until he is getting better. He has better mood. In the past, he
was not a talkative person. He lived alone. But now he received supporting from
friends. He has a stronger mind. He is not give up anymore. (PI5, F2m)
A friend of him used to think about start injecting but when he talked to his friends
at DIC and attend group activity, all of his friends told him that it is not good to inject
because there are many disadvantages so he decided not to inject. (PI5, F2m)
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Site 3: Trang
5 Peer Interviewers (4 men and 1 woman ages between 19 and 29)
Emerging themes from Day One:
ACHIEVEMENTS:
Project helps to achieve:
1. Improvement in health
This happens through:
a. Providing information about safer sexual and injection practices (with few
opportunity costs).
CHAMPION project makes him know how to use the needle such as do not use the
same needle, and feels safer when he uses the new one. (Male PI)
He feels safe because in the past he used the unclean equipments. But this project
gives him knowledge and makes him safe. (Male PI)
Preparing the needle and everything ready before injection. (Male PI)
In the past, he didnt know how to inject. Now, he uses a new needle every time and
knows how to inject safely. (Male PI)
PEs gave him the brochure about how to inject, the way to use a needle and the
position for injecting safely. (Male PI)
In the past, she thought she was useless, so she only injected day by day. After she
received the knowledge from PEs, it made her realize she is the same as everyone.
(Female PI)
b. Behaviour change (in relation to drug use through safer injection practices, and
HIV through use condoms).
After joining the project, the behaviour changes from an IDU to a DU and reduced
the risk of infection. It makes him feels good about himself. (Male PI)
They never used condoms in the past but the project made IDUs aware of them.
Now they use condoms every time they have sex. (Male PI, Female PI)
2. Improved access to services.
Receiving knowledge from PEs, and talking with them makes him healthy. (Male PI)
The package makes her feels good because people dont know whats inside. And
its free of charge. (Female PI)
The PEs always gave her the package without questions, and say that she can come
back to get more anytime when she needs it. (Female PI)
When he got sick, he didnt go to see the doctor but he went to see the PEs instead,
because PEs can take him to see a doctor who understands IDUs life. (Male PI)
The PEs take him to see a doctor that makes him feels like they take a good care of
him. When goes to the hospital, he can go to see a doctor without the queue like he
is special. (Male PI)
3. Reduction in social isolation for IDUs.
Sometime we cant talk with the family, but we can come to DIC where we can say
everything, and express our emotions. This helps us to relieve the pressure. (Male
PI, Female PI)
Sometime he uses a computer at DIC, or comes to have lunch or to talk with other
friends. It is as if he stays at his home but he feels better than at his real home.
(Male PI)
4. Increased feelings of self-worth
The other people look at her like a trash but she knows she is good. After joining the
project, it makes her feel herself-worth. (Female PI)
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He has more self-worth. He helps his parents by working such as slitting the rubber
trees, or cleaning the house. They said dog is better than him in the past. (Male PI)
He takes a good care of his health to have a long life. At least he has the hope to quit
drugs. (Male PI)
He thinks this project can help IDUs to quit drugs. Do not let drugs order us we
should order drugs. (Male PI)
We are not shy to carry condoms. Receiving condoms from DIC and providing them
to our friends make us very proud. (Male PI, Female PI)
Receiving the knowledge from DIC made her love her life more and more. (Female
PI)
He is brave enough to show up. IDUs want to have more work in the community,
such as painting the temple, which changes the perspective of people in that
community. (Male PI)
Although he is an IDU, he has some use. Friends who didnt want to see or say a
word to him, now smile and talk with him. (Male PI)
CHALLENGES:
(In addition to those above)
1. Safety of IDUs
Risk at the police. (Male PI, Female PI)
He worries always that the police will catch him. (Male PI)
Returning used needles is risky, because if the police catch him, the used needles
still have his blood. (Male PI)
He is afraid of friends who do not trust him and think that he is a spy. (Male PI)
If police have arrested a drug user before, and they see him again, the police will
arrest him again, even though now he doesnt use drugs. (Male PI)

- A friend took him to DIC because there was a party held by the members. After
coming in to DIC, he knows that they provide needles and condoms. (PI1, F1W)
- PEs took him to DIC for explaining about drugs, and made more new friends. (PI1,
F2m, PI3,F2m)
- PEs went to the community to give the training; the IDU suspects what they are
doing so he applied for membership in DIC. (PI2,F1m)
- He knew about the project from PEs. At first, he feels indifferent but after joining the
project he feels good and has more knowledge about drugs and receives clean
equipments. (PI3,F1m)
- A friend took him to DIC because he had free time at home. When his friend saw him
free, he invited him to come to DIC. (PI4,F2m)
Know CHAMPION from PEs
- PEs went out and told him about the project, and invited him to join. (PI5, F1m)
- PEs invited him to join the project and talked about harm reduction. (PI5,F2m)
Need courage
- She feels happy when comes to DIC because it has lots of activities, such as
computer, having a meal together or sharing her opinion with the other IDUs. (PI1,
F1w)
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This DIC looks like a spittoon, which listen to her everything even though her privacy.
It makes her feel happy that it has someone who listen to her and suggest her about
the good things should follow but the bad things should not follow. (PI1, F2m)
When he comes to DIC, he feels good. In the past, he felt uncomfortable for a long
time because he used the same needle with other IDUs. He was not brave enough to
go to the hospital. These made him consider committing suicide. But at DIC, his
situation will be kept secret. In addition, the staff does not force him. This relieves
the pressure on him. (PI2, F1m)
He feels like staying home. But when he comes to DIC, he talks with the staff, or has
lunch with them or plays a game. (PI3, F2m)
PEs told him about the project and gave the information about drugs. These make
him turn himself around and impresses him very much. He applied as a member.
(PI4, F1m)
Learn about how to protect themselves
It makes him receive more knowledge about how to use needles and condoms
safely. He knows more about the rights of IDUs. If he didnt know about the project,
he would die because of the pressure and stress. Now he changes from IDU to DU.
(PI2, F1m)
He thinks drugs are not dangerous so he wants to know what harm reduction
means. When he comes in to DIC, he learns the purpose and methods of it. (PI2,
F2m)
He gets knowledge about drugs and receives clean equipment.
He listens to the staff about the dangers of drugs and he wants to change his
behaviour. He wants to reduce the risk of using the same needle. (PI2, F2m)
PEs train him on how to use a needle safely. He learns how to avoid infection and
the risks of using the same needle. Now he never uses needles of other IDUs
because he is afraid of infection. (PI5, F1m)
PEs invited him to DIC. They explain about risk reduction and health. He wants to
come to DIC to see with his own eyes. When he came in, he feels confidence as the
PE said. (PI5, F2m)

Behavior change
- Her quality of life is better. She gets stronger, and eats and sleeps well. (PI1, F1w)
- He knows how to love himself more and more. Because he was a dissolute man in
the past. So he takes a good care of his health. (PI1, F2m)
- He changes from injecting everyday to one or two times a week or month. He helps
his parents work because he wants to be a good man. (PI2, F1m)
- He matures from the past that he was a troublemaker in the community. Now he
changes and learns from PEs. They taught and warned him that do not making
trouble in the community because people will hate you. Then he thinks and tries to
improve himself. (PI2, F2m)
- He reduces the risk of injections from everyday to 1-2 times a month. It makes him
happy. (PI3, F1m)
- His habits change from the past. Now, he has work and a family. He thinks of his
children about their education that he needs to use money. So that he stopped using
drugs. (PI4, F2m)
Got knowledge, new needle, safe injection
- Now he uses the equipment provided by the project that makes him safer. PEs told
him that one injection can destroy the plasma and he is afraid to die. Then he
changed from an IDU to a DU. (PI3, F1m)
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He learned about HIV infections and the harmfulness of drugs affecting his body. He
always comes for blood tests every year. He feels nervous while he waits his result.
But after that he is relieved and happy. (PI3, F2m)
He feels good after receiving the training from PEs that IDUs should not use the
same needle thus reducing infection risks. It makes IDUs healthier. (PI5, F1m)
He knows about risks of each drug. PEs provided him clean equipment. It is good for
his health. (PI5, F2m)

Increased feelings of self-worth
- He likes himself more than in the past. He doesnt want to use drugs anymore. If he
wants to inject drugs, he will only use a new needle. (PI1, F1m)
- Coming in to DIC is important to him because no one look down on him. The staffs in DIC
do not leave him alone make him feels happy. When he got sick, the staffs took his
friends from DIC visited him at the hospital. And he cried when he saw them. He was
delighted even his parent did not come to visit him. They didnt care or ask about him.
Got more knowledge about harm of drugs and IDUs rights
- When he came and joined the project, he learned about the dangers of infection and
other facts such as the rights of IDUs. (PI2, F2m)
- He learns about the rights. In the past, the police would trick IDUs to delude the agency
of drugs or test their urines. When PEs went out to distribute brochures in the
community, IDUs learned more about their rights so they were not afraid or indifferent
with the police. (PI3, F1m)
- The knowledge about risks of drugs that he received is very important for him. When he
learned about these risks, he wanted to quit. After reducing the quantity of drugs he
used, he felt healthy and strong enough to work. (PI4, F2m)
- The equipment provided by DIC made them reduce the risks of infection. (PI5, F1m)
- He feels happy that his blood test results indicated no infection. (PI5, F2m)
12. CHALLENGES:
She is afraid of the police because they have a checkpoint for arresting the IDUs. (PI1,
F1w), (PI1, F2m)
He is shy and cant talk with other people who are not his close friends, so that he
doesnt often come to DIC. (PI2, F2m)
When he comes to DIC for needles and returns back home, he avoids the police
checkpoint. Although he doesnt have drugs, he has only clean needles, he feels scared.
(PI3, F1m)
He doesnt have a motorbike to come to DIC for receiving the needle. He asks his friend
to get it for him. (PI4, F1m)
He is afraid of the police when he comes to DIC to receiving a needle. Sometime he asks
his friend to receive it for him. (PI4, F2m)
He is concerned that the head of the community talks about him in a negative way. (PI5,
F1m)
13. THE FUTURE:

Equipment
- She wants to change bottles of the distilled water from glass to plastic because when a
glass bottle is broken, it is dangerous for IDUs. (PI1, F1w)
Spread education and get in to the community
- He said that PEs should go out to educate the children in the community about the risks
of drugs more often. PEs should take IDUs to develop the community for changing their
appearance and to show that they are improved. (PI2, F1m)
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He wants IDUs to go to develop the community more and more so that the people in
that community see the value of IDUs because all IDUs are not bad. (PI2, F2m)
Services of PEs
- PEs should get the used needles from IDUs home and provide them with new ones. (PI3,
F1m), (PI4, F1m)
- He wants the sport equipment such as table tennis tables and rattan balls for IDUs to
play, and not immerse themselves in drugs. (PI3, F2m), (PI5, F1m)
14. STORIES
She was the only child of her parents and she has bad habits. Her parent was quite rich
so she was not courteous to other people. She used money to buy drugs. She abused her
parents if she not received money from them. She would do anything for drugs. When
she has a child that reminded her about her own past behavior. Thus she tried to quit
drugs by coming to DIC. The staff at DIC encouraged her a lot and supported her fight.
They used her child as a reason to quit drugs. When she faces any problems, the staff
always help her solve them. The staff never neglected her and remained beside her. She
was proud of the way that they pay attention to IDUs. They do not separate themselves
from the IDUs, but live with IDUs like a family. Now she is very happy because she can
quit drugs. (PI1, F1w)
When he knew his blood result at first time, he was so sad. The staff at DIC taught him to
use condoms to protect himself and other people. And they told him to love himself and
others too. Until he has a daughter who didnt have any infection. He tried to quit drugs
and received the spirit from the staff. After he can stop using drugs, he can eat more and
get stronger. But his body still needs time to adjust. (PI1, F2m)
After quitting the school, he had nothing to do, not even silt the rubber trees. He went
out to find drugs and hide from his family to keep his secret. He used more and more
drugs until he joined the project. The staff at DIC told him that do not think that you are
useless or have no future, Even if he has an HIV infection he still survives. If he died, how
would his family continue. So you have to take a good care of yourself too. In the past,
his mother scolded him every day, but now he never hears those words because he
takes responsibility for his job. He uses drugs in the evening. Before he dropped out of
school, his teacher told him you will regret this someday. Please remember my words.
And he remembers those words today. When he saw old friend who had graduated from
the school, he was ashamed to show his face. This project makes him more aware. He
gets more knowledge and changes his life. His relatives change their viewpoint of him.
Nowadays, he has self-esteem and his parents love him too. He wants his younger
brother to learn about life too. He talks with the staff at DIC like they are his parents,
brothers or friends. He can talk about everything and relieves the pressures. Moreover,
the staff does not defame him but encourages him. (PI2, F2m)
When he was a teenager, he was lazy but he had money. He used drugs a lot which
made him lazier, and he only slept. He couldnt work, he was so weak. He couldnt even
raise his arm. When he joined the project, he received training and a brochure to read at
home. After reading it, he changed his mind and behaviour. He knew how to use the
needle and risks of drugs. His health is stronger so now he can work. IDUs who come to
get free needles and condoms are single, and they will provide the condoms to other
IDUs. Hes happy that there is no need to go out to buy condoms. This is the reason for
him to come to DIC more often, to receive needles and condoms. Sometimes he comes
to use a computer or have lunch with his friends and the staff. He can talk with the other
IDUs like him. (PI3, F1m)
He loves his friend more than his parents. He can die for his friend. He has to inject drugs
when he wakes up. At first when he joined the project, he received many needles, and
he used more drugs. After he received more training about the harm of drugs, he
changed his behaviour. He tried to quit using drugs. He came to DIC for get more
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knowledge about how to use needles and condoms. He meets new friends and travels to
new places. Hes very happy right now. (PI3, F2m)
He loves to go out at night. He used drugs every day so he couldnt work. He was very
thin, and his weight was 40 kg. He was a pilferer. He knew a friend who is a member of
DIC and saw that this friend often came to DIC. He wanted to join this project. He gets
the knowledge of the risks of drugs from the staff. It makes him think, so he stops going
out at night and uses fewer drugs instead of injecting. He became stronger and
healthier. Moreover, he saw his friend who can quit drugs, as a model. And the staff
always encouraged him, so he wants to have a family. (PI4, F1m)
When he was young, he often went travelling and he met new friends who are IDUs. He
wanted to try it and that made him a drug addict. Then his friends invited him to DIC and
he got the training about using condoms and needles. After that he attended many
activities of DIC. Now he has a better life and works as a musician. People around him
feel good that he has improved himself. (PI4, F2m)
In the past, he used lots of drugs. His family tried to stop him and they were fighting all
the time. When he needed drugs, he stole something to sell and buy drugs. The staff at
DIC told him how to use the needle and the risks of using the same needle. He was so
scared. Then he changed from IDU to DU, but still injected sometimes. Nowadays, he is
happy that he can help his parents to work. He takes more responsibility of his work.
(PI5, F1m)
In the past, he injected drugs every day, one or two times a day. He couldnt go to work.
He said he wanted to stay still or sleep. His life was sleeping and injecting. His parents
tried to stop him but he did not obey them. He was not scared because he did not have
the knowledge. When the staff at DIC talked to him about the risks of using the same
needle, he was afraid of HIV infections. Then he came to DIC to test his blood. While
waiting for his results, he was so nervous. But his blood was normal that made him very
happy. Now he is afraid of using the same needle with other IDUs and tries to quit drugs.
Now, he is stronger and healthier and he can help his parents by working. (PI5, F2m)
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Site 4: Chiang Mai

4 Peer Interviewers (3 men and 1 woman aged between 32 and 55)
Emerging themes from Day One:
ACHIEVEMENTS:
Project helps to achieve:
5. Improvement in health
This happens through:
c. Providing information about safer sexual and injection practices (with few
opportunity costs).
Providing the clean needle to IDUs, make them feel clean and safe. They are not at
risk for HIV infection from using the same needle. (Male PI)
This project makes IDUs know that use condom and new needle can protect them
from HIV disease. (Male PI)
There are some friends he knew from DIC and they provided him the needles. They
introduce him a new friend and give him knowledge. So he reduces the risk and the
danger of infection. (Male PI)
DIC has a project about bring the used needle to exchange the new one. This makes
him feel good. (Male PI)
When he received the new needle, he felt cleaner and safer from getting arrested
and HIV infections. (Male PI)
This project changes IDUs from ghost to human and makes them have a better life.
(Female PI)
d. Behaviour change (in relation to drug use through safer injection practices, and
HIV through use condoms).
From daily uses to once a week and once a month. It changes his life. So he invites
other IDUs to join the project. (Male PI)
Before knowing DIC, he uses drug and drinks alcohol every day. But now, he gets
better life and has more knowledge about HIV which is not easy to get infected.
(Male PI)
6. Improved access to services.

The nurse, part of the project, helps IDUs too much. When my friends are sick, she
can be their consultant, refer them to treatment and getting VCT and STI test.
Its good to have this DIC because IDUs can come to talk with PEs and get the advices
from them. They also take IDUs to get HIV test.
7. Reduction in social isolation for IDUs.
DIC means the place for IDUs to take a rest anytime. When IDUs feel worry, they can
go to DIC and talk about their life. They meet new friends at here. When they have
no one to talk to, they go to DIC and feel more relax.
They feel proud of themselves that they can help friends, suggest and encourage
them. When they went to visit friend at hospital or went to funeral together, these
make them more united. The feeling that they can help others make them feel more
valued.
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CHALLENGES:
Overcoming stigma
Lack of peer educator to provide condom to friends. Sometimes, when providing

condom with other at shopping center, security guard get rid of them even they
already asked for permission. (Female PI)
He tried to convince friends to visit DIC but some IDUs who are hill tribe dont have
ID card so they cant apply for the member and they cant access to the services.
(Male PI)
He invited his friends to visit DIC and apply for the member but they dont want to
disclose themselves. Because they dont want to expose their ID card number. (Male
PI)
If my friend go to DIC, its not easy to get a job because the company might know
that they used drugs. (Male PI)
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DEBRIEFING FROM 5 PIs


-
A friend took him to DIC. When he came in, he met new friends and talked with
them that make me feel happier. When he is alone at home, he always feel depress
so he want to come to DIC. (PI1, F1m)
A friend introduced him to the project and gave him knowledge about how to inject
safely. (PI1, F2m)
His friend invited him to DIC. He got free condom and other services at DIC. (PI2,
F1m)
He knew DIC from his friend. He came here for hang out and has lunch with his
friends. Normally, he is a suspicious person when he sees crowded people so he
doesnt like to come to DIC. (PI2, F2m)
His friend took him to DIC. At first that he came to DIC, he didnt scare because he
saw lots of friends. He was happy about that. (PI3, F2m)
A friend invited him to DIC. He feels happy because DIC has many activities. He met
new and old friends at DIC. (PI4, F1m)

Need courage to quit drug
- After he knew the project, he reduced the injection from everyday to once a week.
He can work as normal people. PEs and staffs from DIC told him that other IDUs can
do it so you can do it too. PEs talk to him in other topics not related to drugs. (PI1,
F1m)
- He wants to quit drugs. (PI1, F2m)
Social relationship
- He feels good when he talks with new friends at DIC once a week. When he feels
lonely, he will go to DIC to talk to friends. (PI2, F1m)
- A friend invited him to talk and to confide with other IDUs. It can improve his mind
and emotion. So he becomes friendlier. (PI4, F1m)
- At DIC, she met new friends who can protect and sincere her. She can smile and has
happiness. (PI4, F2w)
Opportunity to access free needles and equipment
- He has a blood test at DIC together with getting a clean needle. He doesnt want
other people know that he is IDU so he doesnt come often to DIC. He has to come
to get the needle because he has no money. Come to DIC, hes happy like brotherly.
He can exchange his opinion, talk and help each other. (PI2, F2m)
- His friend told him that it has a free blood test at DIC and he receives some money.
After that he knew he had HIV but he got more friends to talk to. Sometime, he goes
to DIC to use computer. (PI3, F1m)
- He knew the project from PEs who provided the needle to IDUs in the community
and told him to keep the used needle for exchange with the new one. (PI3, F2m)

Improvement in health
- He has a better life after knowing this project. He had to work hard for money to
raise his family. But he needs money for drugs too so it is uncomfortable. When he
77
came to DIC, there is a doctor who gives the advice to IDUs. This doctor gave him
knowledge about drugs and referral to treatment. He feels good about knowing his
health status. (PI1, F1m)
- He came to DIC made his life better. He was happy when he knew that he didnt
have the infection. (PI2, F2w)
- In the past, he hated people who have HIV positive. He couldnt have a meal at the
same table. After he received the knowledge from the staffs, his behaviour was
change about people who have HIV positive. He can drink alcohol with the same
glass. (PI3, F1m)
- His life is better because he has more knowledge and has training from DIC. (PI3,
F2m)
Quitting drugs
-
When he was released from the prison, his parent was broke up. His mother has
new husband whose age the same as him. His father has new wife at the different
place. So he wanted to protect his mom by quitting drug. Its not easy to do but the
staffs at DIC encourage him all the time. (PI2, F1m)
- He reduced to use drug when he knew the CHAMPION project. He hardly to use it
because his friends in DIC educate him until his health is stronger. (PI4, F1m)
Sharing information with others
- The project makes his life better. Sometime he gave the advice or suggestion to
other IDUs to change their life. (PI1, F2m)
- He did not know anything about HIV infection or how to use drugs. He avoided
peoples eyes all the time. After learning everything, he realizes that everyone
should have self-esteem. So he can make eye contact with people. (PI4, F2w)
Social relationship
- She stayed home alone so her friend introduced her to DIC. Because she had a bad
experience in the past, she became repressed. But after knowing the project, she is
friendlier. (PI4, F2w)
Social relationship
- This project makes him change his life. Instead of injected the drug, he came to DIC.
He exchanged his opinion with other IDUs in DIC. In addition, some IDUs can help
him find the job. Now he sells the roasted pork in front of the school. (PI1, F1m)
- He saw other IDUs lives, someone had HIV infection, and so he wanted to change
his life to be better. After coming to DIC, he has a good mind, friendly and hard
working. (PI2, F1m)
Safe from HIV infection
- He has no infection from the blood test at DIC. The staffs at DIC educate him how to
use the condoms safely. (PI2, F2w)
Got more knowledge and access the services
- It has a meeting every Friday and they give the money to IDUs for waste their time.
IDUs received the knowledge from PEs made them very happy. Before knowing the
project, he did not know anything after that he knows many contagious diseases. His
parent understands him and not blames him anymore. (PI3, F1m)
- Receiving the services, the knowledge and free needle from the project is very
important for him. (PI3, F2m)
- He attends many activities of the project. He can see the world wilder and spread
the knowledge to his friends. (PI4, F1m)
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She proud of herself that she can quit drugs. She can control it and happy to help
other IDUs who obey her. (PI4, F2w)
19. CHALLENGES:
- Sometimes, the peer educators sell the needles which provided to IDUs. They want
some money to buy drugs. (PI1, F1m)
- Its easy to find drugs at DIC so his wife doesnt like him to come often. She think
when he came to DIC, hes easy to induce to use drugs again. (PI2, F1m)
- Some IDUs hide PEs to use drugs in DIC. So she wants to stop those IDUs seriously
because sometime the peer educator use drug in DIC too. (PI2, F2w)
- The problem is about the transportation to come to DIC. Because DIC is far away
from his home and he scares of the police. (PI3, F1m)
- He does not dare to come to DIC because it has many IDUs. He afraid that the police
will have a checkpoint nearby the DIC. (PI3, F2m)
20. THE FUTURE:
- The thing that should be improved is increasing the number of peer educators. (PI1,
F1m)
- He wants the peer educators are more generous and charitable to IDUs. They should
follow the members home to see how is going on. If the member disappears, they
will pay attention to find this member. (PI3, F1m)
21. STORIES
- He was released from the prison not reach 1 year. His friend invited him to DIC. That
made him has a better life. He uses fewer drugs. He receives the new needles and
equipment from DIC or PEs and its free of charge. He does not want to assemble
for drugs. Now he sells the roasted pork in front of the school and the weekend
market. (PI1, F1m)
- He was a truck driver. His friends induced him to use drugs so he can drive longer
than normal. Later, he injected drugs and become a seller because he needed some
money to buy drugs. Finally, the company grab and fire him. After that there are
some friends introduce him about the project. He has new friends and has a place to
go. Now he uses fewer drugs. (PI1, F2m)
- When he was young, he was insolent. He was a gangster in the school. He was cruel
and easy to lose temper. Because he used drugs every day then he was arrested.
After he was released from the prison, he depressed very much. His friend took him
to DIC and met new friends. He can talk, drink coffee or have lunch with other IDUs.
Moreover, he can consult with the staff and make him feel happy. So he changes
himself to a good person, friendlier, more generous. Until he has a family, he can
quit drugs at the end. (PI2, F1m)
- He never heard about this project before. After he was released from the prison, he
still used drugs all the time. His friend told him about this project so he applied for
the committee at DIC. When he knew he had HIV infection, he changed his
behaviour. He took a good care of himself. If somewhere has training, he always
joins it. That makes him very happy. He said If it doesnt have DIC, he never has
today. He died since he admits at the hospital. Now, he has a good health and not
assembles with drugs anymore. (PI3, F1m)
- He was poor and used only heroin. In the past, heroin was cheap and easy to find
but now its very expensive. He couldnt find heroin in town so he went to the
mountain to find it. Until he was arrested. His wife left him and his child to the other
place. When he was released from the prison, he tried to find a job. His friend
invited him to DIC. After knowing this project, he gained more knowledge. In
addition, from his condition, HIV infection, he has to take care of himself too much.
He wants to have a better life so he can do hard working. (PI3, F2m)
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When she got pregnant, she felt loneliness and did not know what going to do
because she has HIV positive. She thinks her child will have HIV too. Her relatives can
accept this child or not. But she decided to keep her child. When she went to see the
doctor, he said do you want to keep this child or not, why did you let yourself get
pregnant. At the government meeting with DIC staffs and the hospital officers, PE
said to them you are a doctor so you should give them the advice and not look
down on IDUs. After the meeting, that doctor changed a little bit. When her child
was born she found out that the kid did not get HIV. Her own doctor (not that
doctor) said, He will take a good care of her that is a word which encourage her
very much. Moreover, he advised her about how to take pills. So she tried to quit
drugs not 100% but a little bit is better. Finally, she can do it. And she is a model of
other IDUs who want to quit drugs. (PI4, F2w)
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Site 5: Chiang Rai

4 Peer Interviewers (3 men and 1 woman, ages between 18 and 45)
Know CHAMPION from peer educator
- Peer educator visited them and provide needle and equipments (PI, Group1)
- My friend know CHAMPION from peer educator that went to see him and talked to him
about CHAMPION work, HIV/AIDS, risk reduction from getting HIV (PI)
- My friend knows CHAMPION from peer educator visiting their house and that because
my friend is a hidden IDU. (PI4, F1m)
- Peer educator went to see him do he was interested in visiting DIC. He is HIV infected
person and he lives alone. (PI4, F2m)
Know peer educator for a long time ago (before became peer educator)
- Peer educator already knows my friend for a long time ago. They contact each other
quite often. PE told friends about CHAMPION and also provides sterile equipment. (PI)
- He know peer educator. At first h hill tribe did not know about this project but peer
educator went to mountain village and provides needles. (PI2, F1f)
- My friend know CHAMPION because he know peer educator. They live in the same
village. Peer educator told him about how where to inject safely. (PI3, F1m)
Know CHAMPION from hospital
- My friend know CHAMPION because there was a staff talked to him at the hospital (PI1,
F1m)
- My friend knows CHAMPION from his friend in HIV group at hospital. There is a group
activity about herb. (PI1, F2m)
Got knowledge, needle and referral to other services
- Peer educator provided condom to us and suggested how to use it. There is no need to
drive into downtown to buy it. I dont have to be shy and I can get it as many as I need.
There is no need to go to Health office to ask for it and I dont have to pay for it too. (PI,
Group1)
- My friend got needle and knowledge from peer educator. He also got needle and
suggestion about how to use it. (PI1, F1m)
- Before knowing CHAMPION, he did not know that he injected the right method or not.
CHAMPION made him have more knowledge. Peer educator provide needle and snack to
him. (PI2, F1f)
- He got knowledge about HIV and he also got needle, equipment and referral to VCT and
STI test. (PI4, F1m)
- He got knowledge about how to inject safely and how to use condom. (PI4, F1m)
- Peer educator took him to DIC and after that, he came to DIC by himself. If not, peer
educator will bring needles to give to him. (PI4, F2m)
- He got free needle from CHAMPION and also the suggestion. It saves some money
because he doesnt need to buy needle. There is no need to ask for money from parents.
He feels that there is no need to inject with used needle and not afraid of getting HIV
infected. (PI3, F1m)
- Peer educator suggests him about Methadone treatment. (PI3, F2m)
- He know about HIV prevention both safe injection and sex. (PI4, F1m)
- He got knowledge about how to protect himself from getting diseases. (PI3, F1m)
- Peer educator visit and provide him needles. It makes him have more knowledge. (PI4,
F1m)
Other
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Peer educators gave support to him and want him to quit drug. Peer educator also visits
him 1-2 times per month made him feel good and have more courage. (PI1, F1m)
He likes to meet with friends, get knowledge and talking with friends. (PI1, F2m)

Needle Disposal
- In the past, he used to discard needle in garbage can or burnt them together with grass.
Now, it is more convenience to discard it in needle disposal box(PI, Group1)
- It is more convenience to discard needle in disposal box. There is no need to burn it
because Im afraid of fire and prevent someone get hurt from tread on needle. (PI,
Group1)
- In the past, when he injected, he kept used needle in drawer but now, peer educator
gave him needle disposal box so he discard them in the box. (PI4, F1m)
Benefit of using new needle
- Use new needle make him reduce risk, no transportation to buy needle, safe, no afraid
of getting arrested and save money. (PI, Group1)
- In the past, when he injected alone, he injected with used needle. Now, he use new
needle because peer educator provide him and he has more brave to buy new needle.
(PI1, F1m)
- In the past, when he injected with used needle, it makes him getting injured. But when
he knew CHAMPION, he knew how to protect himself and getting medical check up.
(PI2, F1f)
- He used to afraid of getting HIV infected but after he got knowledge about not sharing
needle with others, he feels more confident. He has more knowledge and feels cleaner
in his body. (PI3, F1m)
- He used to boil needle and reuse it. But when he met peer educator, he never do it again
because he has new needle on hand. (PI3, F2m)
Benefit from referral to health services
- CHAMPION staff referred him to get MMT so he can live without drug longer. He could
spend time with community ie. Grass cutting, or organize event. Due to his body is quite
normal, not high on drug and dope sick, so he could help others and community accept
him more. (PI)
- Peer educator took him to get blood test at hospital. He coordinated for hospital card
and talked to staff and that make him feel more convenience. (PI2, F1f)
Benefit from decreasing drug use
- My friend feels more self-confident. He can talk with friends more. In the past, he was
not a talkative person. He has got supportive from his friends who use drug together,
parents, relatives, neighbours and peer educators. (PI1, F1m)
- He used to inject drug so often and got angry easily. After he joined group activities at
Mae Lao Hospital, his mind is getting better. His mother feels proud of him. Peer
educator visited him and gave support to him until he feels better. (PI1, F2m)
- CHAMPION project make him decreasing drug use. Peer educator did mind support to
him. (PI1, F2m)
- He has more knowledge from CHAMPION. In the past, he injected drugs everyday
together with Methadone. After he attended activities, he changed from injecting to
smoking and in his mind, he think that he want to quit drug finally. (PI4, F2m)

If there is no peer educators, he will inject wherever he want. (PI, Group1)
He used to inject with used needle but after he got suggestion, he used new needle. (PI,
Group1)
Peer educator visited him at home and brought instant noodle to exchange with used
needle. (PI, Group2)
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Nowadays, peer educator provide new needle to us so there is no need to share needle.
He can save money and no need to afraid of getting HIV infected. (PI, Group2)
The most important thing about this project is IDUs are more safe, risk reduction from
HIV STI infected and getting equipment and knowledge. (PI)
Peer educator provides equipment and knowledge to him. If he wants to quit, peer
educator will refer him to get MMT. Peer educator also suggests him about career. (PI)
If he doesnt want to quit, he need to have a better quality of life and not sharing the
needle. (PI)
He feels good when peer educator visit and provide information to him. (PI1, F1m)
The most important thing is needle and equipment because he use it regularly.(PI4,
F1m)
He learns how to live from CHAMPION. (PI4, F2m)
26. CHALLENGES:
He afraid of getting arrested while going to DIC (PI1, F2m)
Sometimes, peer educators provide too short needle to him which he could not inject
opium and made him feel dope sick. (PI3, F1m)
She cannot go to downtown to buy needle because she has no vehicle and afraid of
getting arrested. (PI2, F1f)
If he could not find needle, he will clean needle because peer educator taught him to
clean needle. (PI, Group1)
27. THE FUTURE:
More activities are needed. (PI1, F1m)

My friend want to go to DIC even there is not much activity. He thinks that more
activities are needed. (PI1, F1m)
More activities are needed to make her friend feel more confident. (PI1, F2m)
Activities to provide information about CHAMPION project are needed in order to
promote project. (PI3, F1m)
28. STORIES:
He got HIV infected and he did not want to go anywhere. He was afraid of community
not accept him. He stayed only at home. Peer educator visited him at home and
suggested him to go to see doctor. Peer educator took him to see doctor. He has more
courage now. (PI1, F1m)
His life is better since peer educator visit him. He never feels worry and feel more
confident. He feels glad that he can spend time with friends. (PI1, F1m)
He used to ask needle from his friends or asked money from parents to buy needle.
Sometimes, he was afraid of getting arrested while carrying needle. Now, he feels safer.
He does not have to share needle with others. He knows more about how to inject safely
because peer educator told him. (PI3, F1m)
In the past, he did not take care of himself. He was a drug addicted person. He thought
only about where to find drug. His friends told him that he smell so bad. He felt sad that
no one like him. After he got MMT, he pays more attention to himself. He feels like his
parents love him more. They call him for breakfast. Peer educator gave mind support to
him about getting MMT. He told him to take care of his parents. (PI3, F2m)
Even his body is not so good but his mind is better. He feels not too stressed. In the past,
he was afraid that friends and community will not accept that he is HIV positive but after
peer educator took him to have noodle outside often, now he can go there alone as
normal people. (PI4, F2m)
83
His mother did not talk to him in the past. After CHAMPION staff took him to get MMT,
sometimes, his mother took him there too. She gave support to him because she wants
him to quit. He feels that there is a way for drug quitting. (PI4, F2m)
84
85

Rapid PEER Study To Strengthen The Injecting Drug Users' Quality of Life Programme

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Rapid PEER Study To Strengthen The Injecting Drug Users' Quality of Life Programme

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PSI Thailand

Rapid PEER Study

Injecting Drug Users Quality of Life Programme

Final report prepared by:

Injecting Drug Users

Most At Risk Populations

Metta Khao Khao

Methadone Maintenance Treatment

Non Governmental Organisation

Needle and Syringe Programme

Office Of Narcotic Control Board

Participatory Ethnographic Evaluation and Research

Prevention Of Mother To Child Transmission

Population Services International

Sexually Transmitted Infection

Thai Drug Users Network

Thai AIDS Treatment Action Group

Voluntary Counselling and Testing

rehabilitation facilities to support cessation of drug use. This is raising challenges as

There appear to be under-utilised opportunities to use pharmacists and health

Adopting the approaches suggested above would be a cost effective way of

Gender issues do not appear to be explicitly addressed in project activities

Safe needle disposal is an important component of harm reduction. The

Significant progress is being made in terms of increasing IDUs access to health

On-going advocacy and networking efforts with government, policy makers,

It would be helpful for the project team to consider additional ways of

This project changes IDUs from ghosts to humans

Background to the Research

Population Services International (PSI) is a non-profit non-governmental organization

Research sites and participants

In addition to interviewing two friends, the Peer Interviewers also provided

2.1 The project

Metta Khao Khao

Raks Thai Foundation

(Source: Project Documentation acronyms not supplied)

The engagement of programme partners in each province is shown in Fig. 2.

Figure 2: Programme Intervention Areas by Province and Partner

2.2 Project activities

combine access to safe injecting equipment, health education, psycho-social

Objective 2: Build enabling environment

In addition to providing information on harm reduction, and facilitating needle and

responding to this long-perceived area

Box 3: UNGASS Country Progress Reports relating to

Over the eighteen-month period from

A summary of the key demographic characteristics of all IDU project beneficiaries to

Quantitative data from the Project to date

Number of IDUs referred for

How beneficiaries were introduced to the project

There appear to be under-utilised opportunities to use pharmacists and health

individuals or at group meetings, or through greater use of communication

Adopting the approaches suggested above would be a cost effective way of

Why participants got involved in the project

Access free needles and equipment

A few interviewees also described how a growing sense of responsibility, either in

3.3.1 Harm reduction

Story 1: Staff helped him to have more

Participants also described the value of other health-related information they

CHAMPION project their lives were very bad.

In one interview a participant described how project activities had prevented an

Project participants also described

Story 4: Before he joined the project he

The quote above illustrates that the

Story 5: At the government hospital the