Lithuanian AIDS Centre
Conference Secretariat
Nugaletoju St. 14D, LT-2016 Vilnius
Lithuania
Tel. +3705 300125
Fax. +3705 300123
e-mail: aids@aids.lt

Implementation of harm reduction projects in Lithuania:
Isn't it time to stop and think?

 

Nellya Galieva, Sylvia Sax; Heidelberg University, Department of Tropical Hygiene and Public Health. Im Neuenheimerfeld 324, 69120 Heidelberg, Germany

The main objective of the research, undertaken in June 2002, was to investigate the methods used for evaluation by key organisations implementing Harm Reduction Programmes and to develop a framework for evaluating their services.
The methodology was a case study, using mainly qualitative tools and involved documentation reviews, semi-structured and in-depth interviews, observation, and focus-group discussions with elements of participatory assessment.
Results The prevalence of HIV in Lithuania remains low (361 in 2001), which is attributed to early multisectoral response, though in May 2002, 209 new cases were registered (largely due to the introduction of AIDS testing in prisons) compared to 72 new cases in 2001. Intravenous Drug Users (IDUs) are the most important cause for HIV transmission being 2/3 of all cases in Lithuania. Half of all HIV cases happen in prisons.
Many international agencies work on HIV/AIDS prevention in Lithuania. They implement Harm Reduction Programmes (HRP) and other projects to prevent HIV. Evaluation is recognised as an important criterion for decision making in awarding or continuing programmes. Most donors ask for both ongoing and end of project evaluation. However, only 2 donors (22%) consider evaluation as an immediate part of the programme and have a budget line for evaluation. Training in evaluation rarely occurs and specific knowledge and skills in evaluation are lacking. In addition, the reliability of evaluation methods used by different organisations is questioned by those involved.
There is evidence of a lack of cooperation and coordination between similar programmes. Many agencies/projects work independently, sometimes repeating each other's work, while some important activities are missing or even impeded by other agencies.
The attitude of society towards drug users is perceived to be negative and very difficult to change; this negative attitude is sometimes supported by contradictory messages distributed by different programmes themselves about what types of programmes are most successful. In addition, the programmes at times receive unclear direction from decision-makers, society and government; this has a significant influence on the programmes.
Conclusions: There are many activities in Lithuania and much support from both international and government agencies to minimize harm for those who are at the highest risk of contracting HIV/AIDS through intravenous drug use. HIV/AIDS prevention activities and HRP in Lithuania do not undertake systematic evaluations; there is no overall evaluation framework for these types of programmes and scarce designated budget. The lack of systematic evaluation means there is little valid and reliable information on what types of programmes can be the most successful; this affects decision-making and the outcomes of HRP services in Lithuania. The minimal cooperation and coordination between HRP programmes impacts upon the quality of the services being provided to potential and actual service users.
Recommendations: It is necessary to evaluate HRP, this must be based on the needs of the service users and accurate information on the quality of service provision. Donors and those implementing HRP programmes in Lithuania need to incorporate systematic evaluation in their programmes and work towards transparency, consolidation and cooperation. An evaluation framework and further recommendations on evaluation are given in the article.

 
 
[< Back]