Current Projects RPAR was first implemented in 2005 in Szczecin, Poland, and Odessa Ukraine. RPAs were begun that year in Thailand, China and India. So far, only the Polish RPAR has reached its final stage, but preliminary results are available from Ukraine and Thailand. Poland
The RPAR in Poland has identified the following important findings. - Prevention And Reduction Of Drug-Related Harm:
The findings of our research in Szczecin and surrounding rural areas suggest that Poland’s programs to prevent and reduce drug-related harm are not responsive to current conditions. Although well-intentioned, Poland’s administration of health services for users of illegal drugs has not been responsive to their actual needs. In part this is because programs, particularly in the criminal justice system, are not implemented effectively; and partly because drug use is a moving target, with populations and behaviors changing relatively quickly. We are particularly concerned about evidence of an emerging epidemic of amphetamine use in the region, including a rural epidemic of injection use. Drug abuse prevention and treatment offices appear to be unaware of the potentially serious threat and unprepared to address it effectively. According to our research team findings, the reported actual practice in law enforcement and drug treatment differs dramatically from the law “on the books”. Drug treatment is not routinely offered, even when the law requires judges to impose treatment on those convicted. In 2001, 2741 cases legally required treatment, but in practice, only 39 (1.4%) were mandated to treatment. Qualitative interviews with legal professionals confirm the rarity of treatment. Although free legal aid is mandated by law, defendants can rarely obtain it. Interviews with police suggest that drug laws are primarily used for obtaining information and maintaining control of drug users. - Changing Patterns of Drug Use In The Urban And Rural Areas:
Our research team has generated important questions about changing patterns of drug use in the urban and rural areas in their relation to treatment resources. In Szczecin inhaled or ingested amphetamine is common; in the rural areas injected amphetamine is prevalent. In Szczecin, the city operates a syringe exchange program with fewer clients every year and injection equipment is widely available in pharmacies. Szczecin has a large outreach program and a wide range of treatment options for IDUs. IDUs in Szczecin are aware of HIV injection-related risk and primarily use sterile equipment obtained from either pharmacies or the SEP. In the rural areas there are no harm reduction programs, and equipment is not easily available in pharmacies. Treatment is offered but IDUs are treated with alcoholics. Narcological staff in rural areas appears to have low awareness of IDUs. In rural areas, IDUs reported two primary reasons for not using sterile equipment: 1) difficulty obtaining syringes, and 2) belief that only kompot (homemade heroin) carries an HIV risk. The poorer people of the rural areas cited the efficiency and lower cost of injecting. Finally, in the rural areas, initiation of amphetamine use is much lower (9-11 years) than in the city (16-17 years). As shown above, the RPAR in Poland has identified important gaps between law and practice in relation to drug users and the criminal justice system in the site city Szczecin, Poland. It has also engaged law enforcement agencies in efforts to reduce barriers to drug treatment and HIV prevention. Additionally, it has generated important research questions about changing patterns of drug use in the urban and rural areas and their relation to treatment resources. See the Reports and Outcomes Section for current statements of findings from this project.
Other Sites
The RPAR underway in Odessa Ukraine has produced warning signs of a re-emerging epidemic of home-made amphetamine use and attendant health risks. Further research is being conducted to study the patterns of home-made amphetamine use in Odessa. In China and Thailand, an RPA tool has been designed and is now being implemented to assess the marginal risk to IDUs of participating in an NIH-funded HIV prevention trial. In this RPA, local researchers in three sites will gather data on the implementation of laws on drug use and HIV control to assess the social risks of being a subject in a clinical trial of drug treatment as an HIV prevention tool. Results will be provided to the clinical trial researchers and the responsible IRBs. The RPA in Thailand has produced a report on the relevant law on the books. See the Reports and Outcomes Section for the report of these findings. In India, an RPA tool has been designed to help assess the impact of sex worker collectives funded as an HIV prevention program by the Gates Avahan: India AIDS Initiative. RPA is being used at base line assessment and then in a time-series framework to annually assess the extent to which the collective has changed sex workers’ status vis a vis and relations with law enforcement and social service authorities. Last Updated: February 2006 | 
