"Nowhere in the World has any group ever achieved liberation while they continue to blame themselves"
Ms. Tripti Tandon, Lawyers Collective, India speaking at RBB Consultation Bangkok, 2010
Continuum of care is the integration of services, interventions and technologies that compliment and support street-based persons using drugs and their families to deal with poverty, drug use, HIV and AIDS.
WHAT WE DO
In cities and towns across Pakistan people who use drugs eke out a chaotic existence in dire poverty, homelessness and unemployment. For many, a square meal every day is a luxury. People who use drugs are a stigmatised and marginalised group, and in many countries including Pakistan they form an underclass a vast majority living on the streets. The illegality of their drug use often places them in conflict with the law. Ostracised by local communities, they struggle to obtain gainful employment and often resort to petty crime to survive. As a result of sharing injecting equipment, they are vulnerable to transmission of HIV and Hepatitis B & C viruses.
In Pakistan, as many as 50% of men using drugs are married with young children. The women (wives) are the main breadwinners in their families, with the major responsibility of managing their household and taking care of their children. Because of the ostracism and stigma of drug use, these families are often marginalised and dysfunctional. The future development and prospects of the children are in jeopardy, and their access to health care, stable education, life skills and employment, bleak.
Young people are being drawn into drug use in considerable numbers - many injecting drugs in their early teens. They represent 30% of the population of street based persons injecting drugs in Pakistan. These young people live on the street and are exposed to violence, sexual predation, hunger, and a lack of basic facilities. They also lack health care or opportunities for growth or advancement.
No simple solution addresses the chaos observed on the streets. Vertical interventions planned by key stake holders and governments to prevent the transmission of HIV through drug use do not fully respond to the chronic instability, oppression, and hopelessness faced by people living on the streets and their families.
The vision of the continuum of care is that people vulnerable to poverty, drug use, and HIV have access to affordable, accessible, and supportive services that meet their needs, vulnerability and aspirations. The principle behind the continuum is that services should respond to identified needs, and do so in the most effective way possible. The continuum also recognises and acknowledges the potential of each individual. The specific shape of services is arrived at via assessments of the contexts, needs, and capacities. Services are then strategically linked so that they complement and enhance each other.
The reality is that poverty, drug use, and HIV require a wide range of strategic responses in our context. The continuum provides an effective framework by combining the various responses: street-based outreach programmes and drop-in centres, drug treatment, employment training and employment, HIV and AIDS treatment care, and support services.