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support of local authorities and institutions
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international funding and technical support
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conduction of rapid situation assessments with the advocacy purposes
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increasing secondary exchange and peer education In addition, the following weaknesses of HR programs were highlighted:
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low coverage level of IDUs by HR services
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absence of sufficient funds for HR programs to do the work required from them
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low level of management partly caused by the general underdevelopment of NGO sector in RF
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reliance on doctors as HR programs workers rather then on IDUs and ex-IDUs.
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lack of democratic structure in HR programs (autocracy and rigid hierarchy)
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patchy quality of services, depending on individual managers of HR programs
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confusion about the aims of the HR program in some cases and abstinence ideology sometimes hindering HIV prevention objectives
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little interest in investing time and money in educating volunteers and outreach workers
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lack of understanding about the need for long-term responses to HIV epidemic
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poor understanding/experience of monitoring and evaluation
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poor networking (cooperation of HR program managers with colleagues in other cities) However it needs to be emphasized that the analysis was undertaken in 2000-2001, when generally harm reduction programs in Russia were very young, with the majority of them operating for a period of less than two years. Little attempts have been made since to understand the evolution of harm reduction strategies in Russia, to further explore successes and failures, and factors which determine these. Thus, results of the current project supported by the World Bank may contribute to the issue of best practice in HIV prevention in the Russia context.
CONCEPTUAL FRAMEWORK As we have demonstrated in our literature review best practice is a slippery concept. Often when characteristics of what best practice in harm reduction are listed purposes are mixed with means of achieving these. For the purposes of this study we shall view best practice as combination of achieved characteristics of the HR program and activities, procedures, rules and interventions which can at one hand help reach good results: process, input and outcome indicators. Since harm reduction programs depend on the context they are placed within, it is important to split context into factors of different degree of stability ranging from those fully determined by the best practices of the HR project to totally non-modifiable. 31