Final Push

I just finished my final week and a half of work at Juventas and it has been very busy. For much of the beginning of last week, I entered data from the July outreach work into the excel database I created earlier. The data was much easier to enter with the new format I created and, as I worked on this with one of the outreach staff, he will now be able to quickly and easily enter data each month to update the database. The last three days of last week were dedicated to compiling final reports for each project for the Global Fund. This not only included writing conclusions and summaries of all the projects and data collected, but also sorting and presenting all the receipts and summaries of where and how money was spent. I mostly edited reports written in English and helped a lot with sorting receipts and making sure everything added up accurately. I also completed the outreach form which is now being used for the outreach work. I have saved all these documents and will be sending them once I get back to the US with faster internet speed.

I also went with one of the outreach staff to help him take care of some things related to the outreach work. First, I helped him type up schedules for the following few months about when each group is supposed to go out as he is not very comfortable with computers. I then also helped him sort through all the client?s names and codes to try and match them up. Technically, each client is supposed to be written in through a code, however, once a client is seen more regularly, the staff tends to just start writing in their first name or nickname on the form. However, at times, different outreach groups know clients through a different nickname or one group may know a client better than another and then that group writes just the first name while the other writes the code and then it is difficult to see that it is the same person. Therefore, we tried to look through all the outreach reports for the last year to make a list of all the names that match up with a specific code so that it could be available to all the outreach staff. I feel that writing nick names could breach confidentiality and that even the code used is a little too personally related to the clients, but I am not sure what a better system would be to remember each client but in a way that is completely unrelated to that client.

I also went out for the outreach work itself almost every night for the last week. On Friday, we went to a city, Niksic, which is 40 minutes away from Podgorica. This city is known for having a lot of fights and for having some of the most reckless drivers. In general, traffic here is extremely hectic and people drive very dangerously. Almost every two miles or so on one of the highways to the beach there are flowers hanging on trees which mark spots where someone died in a traffic accident. Just along the street outside the apartment complex in which I live, I can see three flower arrangements set up by the side of the road. In Niksic, the problem is even worse and I was a little scared that we would be driving there and through the town. Everything turned out well although there definitely were some moments where I froze up a little such as when a car passed us while another car was coming the other way and then our three cars drove side-by-side on a narrow road on which I didn?t even think two cars could pass by comfortably. In Niksic, we handed out supplies to several clients that our outreach staff knows and who have been responsible in distributing those supplies to anyone who needs it in the town.

Our outreach work in Podgorica has been a little slow and stressful. Many drug dealers and transport paths have recently been uncovered by the police and lots of arrests have been made. Thus, there is currently a big lack of drugs in the area and everyone is a lot more scared and cautious to avoid arrest. Many people we have thus recently seen have been in a crisis and it has not been uncommon for them to offer us money if we can find them some drugs. This really

bothers me as it completely counters everything the program is set up to do and makes me feel that the clients don't accurately understand what our goals are and what our purpose is with the outreach work. Additionally, a lot of them have been taking low quality drugs and anything else, such as pills, that they can get their hands on, and thus they have not been feeling very well and have been much harder to talk with. Also, when they take pills and such for a while and then get some cleaner type of heroine, it is much easier for them to overdose and to have serious side effects from the drugs. One of the outreach staff who is a doctor and works in an emergency room has seen three overdoses in the last week which is very high for such a small city. I am not really sure what will happen now if the access to drugs keeps decreasing, although, most likely,

dealers will find new routes and they will recover the supply soon.

Other than that, today I am getting ready to head to Serbia to see my mom's side of the family for the next 10 days before returning to the US. Overall, working with Juventas has been a great experience and I have learned more than I could ever imagine about non-profit work, harm reduction programs, and drugs in general. This experience has really showed me different sides of the city in which I was born that I would never have been able to learn about from taking

short summer vacations here. I was really able to see what it is like to live here and what it means for a country to be in a transition. Finally, I formed many new friendships and am looking forward to staying in touch with everyone I have met and to hopefully see them again next year!

Reaching Out

I had a great time spending the four-day weekend in Zabljak. I haven't been there since I was a baby so it was great to see where my great grandparents house used to be and to hike and see all the beautiful lakes. I wore long-sleeve stuff almost all the time and it was nice to be cold for a change. Zabljak really epitomized for me the transition that Montenegro is undergoing. There is a booming tourist industry in Zabljak so in the main town there are new hotels and a new ski resort and in the fields you can see newly built, large vacation houses. All this is being built right in the vicinity of the old, run-down houses and barns in which the families that live year-round in Zabljak and whose whole family history is centered around those fields and mountains live. They live of what they can produce and it is often a very poor lifestyle. As my mom spent most of her childhood in Zabljak, we know many of the families there and I went to visit one of the families. They live and sleep in a barn house with a dirt floor that is filled with flies. None of the elders have any teeth and the kids (a 4-year-old and a 6-year-old boy) have teeth that are already rotting. There is only an elementary school and most kids from the area don't get past 8th grade. They barely get by on what they produce in the warmer months which they have to use during the winter-time and they mostly live of bread and dairy products. Among families such as this where kids have almost no opportunity to obtain an education come thousands of tourists year-round from Serbia, Montenegro, and the rest of Europe and their presence seems to almost swallow all the native inhabitants and the history of the location. The country is doing everything in its power to promote this tourism and to build new, giant, impressive hotels, etc.

In general, Montenegro seems to have forgotten about maintaining and improving the old and is just focused on building as many new things as possible. There are so many new, beautiful bridges, apartment buildings, restaurants, and hotels, but they are all being built right next to 60-year-old, run-down buildings which have never been painted or renovated. The city is the strangest mix of brand new buildings with peeling, broken, and falling apart buildings. They seem to be trying so hard to catch up to the rest of Western Europe that they have skipped key steps in the development process. I went to see the university my parents attended and the inside has not changed one bit since they went there twenty years ago. Every street is thus an example here of the transition this country is undergoing and it is perfectly clear what was the old and what is the new.

I took the time to try and develop some new forms for the outreach work that I think will be
more efficient so I can show them to the director when she gets back from the seminar on Monday. I already showed them to one of the outreach staff and he seemed excited about them. I think they will be much easier to fill out quickly when doing the outreach work and so it will help them keep more accurate records of everything they give out and all their contacts rather than counting on memory of who was seen on a certain night several weeks ago. I also went out to do outreach work two nights this week and helped with filling out the forms to test my new layout. I did not have trouble getting everything down even on one of the more busy nights we had. That night was a really tough outreach night for me as many of the clients were really under the influence of drugs and many could barely talk or walk when we saw them. Interacting with them was just a completely new experience for me and, at times, I was scared that something would happen to them medically. We had a client who had completely destroyed his legs from injecting as that area is extremely sensitive and one has to go really slowly and accurately or else the site of injection swells up. Both his legs were completely swollen and he told us that he had begun to inject in the veins in his groin area. I could no longer see a single vein in his arms and he really looked like he was in a critical state. We spent a while trying to talk
with him and convince him to stay clean for at least several days while the swelling calms down.

That same night, another girl got really mad at us as we would not give her a ride somewhere and none of us had 1 euro to give her so she refused any help and stumbled away. In that one night, I saw so many things that were new to me that it was a little overwhelming. I am still having a hard time understanding why and how people get involved in such things and how they can do so much harm to themselves. I guess it mostly comes from the influences one has growing up and, if you are surrounded by family or friends who are all involved in such things, it is difficult to escape it. And once you start, it becomes a vicious cycle that only a few can get out off. I just really feel helpless sometimes during the outreach work as there is nothing you can really do to stop the problem at the core and all you can do is minimize the risk but it just doesn't seem like that is enough. Hopefully, our work at least makes them think about the health effects of what they are doing and hopefully in at least a few cases that brings some motivation to think about and commit to stopping. I have finished all my work with the data gathering and designing
the new forms. I will definitely show her my ideas and, if she likes them, work on finalizing versions of the forms and preparing them to be used for the outreach work. In addition, I really want to work with her to set up a meeting with the HIV doctor in the near future which I still haven't been able to do.

On Monday or Tuesday, I plan on going again to the Voluntary Counseling and Testing Center to see if I can observe some of their counseling sessions. I will also continue going out to the outreach work. Finally, I will definitely try and see with the director if there are any trends in which they would specifically be interested for me to look into. There are some I would be
particularly interested to explore so I will see with her if that would be helpful for them for me to do.

Progress & Note on HIV/AIDS Stigma

I have had a very productive week here especially in terms of organizing and completing all the data summations for the 2008 year for my partner organization's outreach work. I added all the necessary missing forms and compiled all the summed data for each month into an excel file. Now they have ready data which they can present concerning the amount of materials distributed and the number of field visits done and clients seen. I also compiled all the data for new clients who have to fill out a longer form. Some interesting trends I have seen that I believe are very positive is that almost half of the people have been tested for HIV and about 70% of sex workers have been tested for various STDs. However, for intravenous drug users, a large portion (close to 90%) have shared their equipment with others in the past. In addition to organizing the data, we spent a whole day preparing materials for the EXIT show which is a four day music festival with multiple stages in whichbands from all over the world play held in Serbia over this weekend. They saythat during the event there is a lot of drug use, especially ecstasy, and an increased engagement in risky sexual behavior. Each year Juventas has a booth there at which high school students volunteer to distribute condoms and educational materials. Therefore, we spent a whole day packing condoms into custom made boxes which have quotes on them such as "reduce the risk" and counting and packaging brochures into boxes so they can be transported to

Serbia.

In addition to office work, I have gotten much more involved in the outreach work this week. I went out 3 nights this week and have started leaving the van more often to interact with and meet the clients. I have also learned how to put together the packages of needles, syringes, condoms, etc. that we give to the clients and am learning what specific things known clients typically ask for. It has been great getting to hear the client's stories as we distribute the materials. There is really no set profile for either intravenous drug users or commercial sex workers. They all come from so many different backgrounds and each has a unique life story. In one night, we met with 15-16 year old boys who just started experimenting with drugs most likely because they were bored, with a guy in his twenties who had finished his second year of law school and is very intelligent and well- spoken, and with an older man who has been using

heroine for a long time and started because all his brothers had been doing it. They come from both families who are well off with regard to this area and from poor families who are refugees from areas such as Kosovo. The sex workers are mostly younger women and they say that 90% of them come from Serbia. Initially, it was very hard for me to talk with them as I just did not know what to say or what I could ask and what I couldn't. The commercial sex workers especially are very open about everything they say and they often make statements I just do not know how to respond to especially in Serbo-Croatian. They definitely talk about a world with which I have had very little experience so it is hard for me to relate and to find things to talk about. However, I have seen that they are all actually very open about their experiences and are willing to talk about themselves and their lives more so than I expected. Each time I become more relaxed and find it easier to talk with them. Also, I am starting to see the same clients over again so it makes it easier. Also, for the first time I saw one client ask the doctor we have go with us about Hepatitis C symptoms and such and then ask for which doctor he could visit to set up a treatment for quitting. It was interesting to see how she advised him on everything and we gave him the phone number of the doctor with which Juventas collaborates. They say that it is an extremely positive sign when they even begin to talk about quitting as they do not typically do this unless they are seriously considering it.

As for the data collection during the outreach work, I have been observing how they fill out the forms during the night to see what would be the best areas for improvement. I really think that there is a way to change the form a little to make it much easier to fill out in a uniform manner and to make the final summations much easier to do. This I believe would solve many of the problems in the most efficient way. Next week a lot of the Juventas staff will be gone for a seminar so the one outreach group will have to go out each night. As they are going to be very busy, I offered to go along and to help with recording the data. I will then try to set up the form in the way I envision and take down the data in that manner and then I will see what they think. I believe it is going to help a lot with making it easier to quickly record the necessary information in a way that will be easily accessible for calculating total sums and finding the necessary information for the data organization I have been doing this week.

I was also able to set up a visit to the voluntary counseling and testing center here in Podgorica and met with one of their counselors this week. The center opened about five years ago and early on very few people visited but now there are about 3 visits per work day. They are open Mondays and Tuesdays from 4-8pm and patients can pick up their test results on Wednesdays. However, the counselor I met with is a doctor who works in the clinic every day so she usually will also take clients in on other days if they can not come in. Also, since this clinic opened, 4 others have opened in Montenegro, most of which are in coastline cities that have large tourist industries. She explained how a typical counseling session goes during which she discusses their engagement in risky behavior, assesses how much they know about HIV, Hepatitis, STDs, and any other disease at which they may be at risk of contracting, and discusses with them what would happen if they were positive and who they would have to go to for support. This last part she says is most important as many come without having considered this at all and really become

reflective during such questions. At the end of the session she asks them if they would like to be tested and they can get tested right there for HIV and Hepatitis. Throughout this counseling and testing process, the patients can remain anonymous and they need not give their name or reveal any personal data. However, here, once a patient has been found to be positive for HIV, their name must be put in the registry and revealed. They are then sent to various doctors in infective disease and such and thus those doctors plus all the nurses that work in those units know the name of the positive patient. As this is in general a small town which is known for gossiping, it does not take much for the information that so and so is positive to get out. Unfortunately, with a

small population, everyone knows each other so the information can quickly get to friends and family. While all the hospital staff is expected to follow a confidentiality code, miscommunications can happen. Therefore, she also discusses this with the patients before they get tested saying that they do everything possible to maintain confidentiality but that that can't be guaranteed at this time. Despite this problem, she also spoke with me about a very interesting phenomena that exists here in Montenegro but that she did not see in other areas of the world. When a family member is found to be positive for HIV, rather than throwing him/her out or isolating him/her,

the whole family (here, this includes a much more extended family than would be typical in the US) really sticks by him/her and goes out of their way to help him/her. She said that she observes this most when patients come for check ups during which she says almost always at least 5-6 people from the family call to see how they are doing and someone always accompanies them. While the patient will undoubtedly face stigma from the society here, it is interesting to see how much the family takes care of one of its members during a difficult time. This comes from the general culture here in which family is the most important thing and everyone is expected to do everything they can to help any family member no matter how distant. She said that she hoped research studies could be done to statistical show this as she believes it is something very different and positive that would be exciting to show the rest of the world. In general, the stigma here comes some from the belief that those infected with HIV must either be very promiscuous, involved with drugs, or must be homosexual all of which are things that the culture here looks down upon. However, she says that in general people know about the disease and its transmission and understand that it is a global epidemic. They are now looking at ways in which they can educate the incoming tourists and the tourist workers about safe behavior. Overall, it was a great experience being able to speak with her and see the center. I will hopefully be able to visit the center again during its working hours and get to sit in on some of the counseling sessions if the patients allow it.

For next week, Monday and Tuesday are holidays here (Independence Days) so there is no work. Thus, I am spending the four day weekend in Zabljak, a small town up in the mountains in which my family has a house. The nature there is beautiful with lots of open fields, beautiful lakes, and mountains and the weather is much cooler than here. Hopefully, with the cooler weather and the peaceful isolation I will be able to get a lot of work done on medical school secondary essays which have been piling up and which I have not been able to work on adequately yet. For the end of the week, I will be doing outreach work each day and will be in charge of recording the data. I am not yet sure what I will be doing in the office during the day but the director said she would email me with things to do over this weekend. Overall, I am learning more and more each week here and am really excited about my involvement in the outreach work.

Moving Along

I have had a much busier week here. I spoke with the director and she gave me an overview of the summer. They are going to spend much of the summer putting together all the data gathered from outreach work and the research study in order to prepare to start writing grant proposals and renewals in the following months. I will thus be involved in both helping sort and sum up data and in writing and editing some of the proposals and interest letters as many of these need to be written in English.

This week, I began to organize and sort much of their outreach work data. Each night when they go out to do outreach work, they record the nature of the contact with the client and the issues discussed, if any.

The forms are supposed to be filled out in a specific manner so that it is easy to see what was given out on each night and I was supposed to sum up everything for each night and then record the number of clients seen, resources given out, etc. for each month. I spent much of this week trying to organize all this data. I filled out missing forms to the best of my ability and tried to re-write the outreach work data in a more cohesive manner. I worked with a member of the staff, who has been doing outreach work for the longest time so he was able to help me sort through the paperwork. I have been able to get through a lot of it and have May and June left for next week. As I really like to organize things, this was a fun project for me. I definitely could see ways in which cooperation and guidelines on uniformly could really help make the process more efficient. This is something I would really like to help out with and it is something I believe will be very helpful in the future so we do not have to spend as much time later sorting through data. Also, I am thinking of ways in which we could make more of it computerized sooner.

In general, I want to get more involved with the outreach work as I feel I can contribute in that area and it is very interesting to go out at night and meet the clients and get to hear their stories. In speaking with the team, there are two other aspects of the outreach work that need improvement and in which I would like to get involved. One is that now they are starting to be spread out too much throughout Podgorica as they know more of their clients and where they live and each client expects them to come to their apartment or house to deliver the clean needles and other materials. Because of this, they have to do a lot of driving and are starting to find that they do not have time to visit everyone. Therefore, they want to try and institute several central areas as meeting places and have a set schedule of when they come to each place.

I am excited about getting involved in all these aspects of the outreach work and I will start this next week. My main goal for next week is to finish organizing the paper work and to have the final summed data ready. I want to go out for the outreach work as much as possible and to start working with the outreach team on alleviating some of these issues. They are also saying that it is supposed to cool down a bit here next week so I am excited about that. I have found a path home that has a lot of shade so the walk to work and back is not that bad. I am really looking forward to the following week!

Private & Social - The Local Health System

This week has been a little slower than the first two weeks here. Juventas was moving offices this week so I helped a lot with that and it took some time to sort through all the papers and material and organize them in the new office. It was interesting though to see how many brochures and other promotional materials they had made. I read through many of their brochures on topics such as contraception, HIV, Hepatitis, drug addiction, and many others and I was personally very impressed by the material presented and the manner in which it was written. These brochures are especially well tailored for young people and one of their major projects for which high school students volunteer is helping distribute the educational material to schools throughout Montenegro.

This week I did finish making a list of possible donors for the drop-in center and I found an especially good website of grant listings that was helpful in finding some very good grant possibilities. I also really want to talk with the Juventas staff about looking more into local companies and corporations for donations for the projects. They told me that that doesn't work here but it was very hard to find outside funding sources that include non-profit organizations in Montengro in their eligibility. I may look into talking with people I know who work in local banks and such to see what their thoughts are on the matter as well. Since I didn't have much work at Juventas, I organized a trip to a microbiology lab here that does all the testing for HIV, Hepatitis, and lots of other diseases. There, one of the microbiologists showed me around the lab and talked with me about all their protocols and procedures. It was really interesting seeing and learning about everything as what they do is actually quite similar to what is done in the US. They, for example, have all the necessary equipment to do ELISA tests for various viruses and they do confirm all positive HIV cases with a western blot. Basically, beside the older equipment and the fewer amounts of it, they are able to do any test that may be needed by a patient. It was fun to see my microbiology class pay off as I had done some of the tests she was showing me and it felt good to be able to ask her more detailed questions about everything and to be able to understand

alot of the science she was talking about. For HIV in Montenegro there have currently been about 70 cases of which I think about 46 are currently alive. It is very interesting that there is only one doctor here who works with each HIV patient in Montenegro. He knows every patient really well and follows them throughout their life. I hope to be able to meet with him while here. All his patients are on antiretrovirals which are paid for by the national health plan. Every three months they have their CD4 count and viral load checked which is done at this microbiology lab. In general, there are fairly good health care options for those with HIV although some do have to travel several hours by car to see the one doctor. Just another interesting fact from the lab is that they were very excited to show me their new PCR machine. They had just recently bought it and it is I think one of the only ones in Montenegro!

Also, from my experiences thus far, I am very confused by the healthcare system here. It seems to be something in between a socialist and private system. I guess Montenegro is in the process of privitizing lots of things and health care is one of them. So right now there is both a social system where everyone gets some type of health care but then there are also private hospitals and labs where people with good jobs and health care insurance can go. These private clinics have better equipment and resources and patients don't have to wait as long to get seen and to receive test results but they do have to pay more. The woman I met with at the microbiology lab worked during the day in this non-private lab and then worked afternoons in a private lab which provided slightly better pay. I don't really understand why if the socialist health care system has worked so well in England and France and the private system is so terrible in the US that Montenegro would want to go towards privitizing health care but that is what is happening. Also, last week lots of doctors and nurses were on strike because of the super low pay they receive for the long hours they work. Imagine being a doctor and not having a salary big enough to buy an apartment. It is really strange how little they make here. It was a big mess though because lots of patients couldn't be seen as most doctors weren't working. The politicians are still discussing how to resolve all this and a big issue is under the counter payments patients have to give lots of doctors to be seen.

For next week, one of my biggest goals is to really work out a long-term plan with Juventas so I can better understand what to expect for the next two months. Even now, I don't know exactly what I will be doing next week so it is hard to set goals and make plans. I will most likely be doing work on the report on sexual health workers which I have started but am currently waiting for a response from the police department for more specific data. Also, the research study will be done next week so there will most likely be lots of work in analyzing the data obtained and organizing and writing up all the results. I will also be battling the heat as the temperature here is really starting to rise now. It is consistently over 100 degrees and I have been told that throughout July it is commonly in the 110-120 range. My 20 minute walks to the office and back are definitely getting harder.

Generating Trust, Understanding the Needs of a Population, Outreach

My second week here in Podgorica has been very exciting. I am continuing to grow accustomed to the work atmosphere here and have been fitting in well with Juventas. The research I needed to do for the report on the current status of commercial sex workers in Montenegro has been somewhat difficult to do as there is very little information available. It has been a little frustrating trying to find the necessary information as I do not know exactly who needs to be contacted to obtain the needed data and the people I am working with inJuventas have been very busy and unavailable this week. We have managed to sendan email to the police headquarters and they should be able to provide us with much of the data we need at least in terms of the current numbers they have of current sex workers, arrest rate, etc. I hope to receive a reply from them at least by Monday although I am not completely optimistic about this.

In addition to this, I have been working in the office on helping Juventas initiate a new project. They would like to build a drop-in center for individuals with HIV/AIDS or Hepatitis B and C or individuals at risk, such as those who are injection drug users, commercial sex workers, or the MSM population. Here, people would be able to obtain needed information, receive counseling, seek help, and possibly get tested for the various diseases. I have spent much of this week looking for possible donors for this project and editting and helping write-up a letter of interest for the project. It is interesting to be able to participate in projects at various levels of their

implementation.

The research study they are conducting at the hospital has been going fairly well although fewer and fewer people are coming for the study. They are really scared as several of the people who previously went to the study have recently been arrested for possession of drugs so they think there might be police spies around the hospital. Nevertheless, I am learning a lot from the staff at the microbiology clinic and from the Juventas staff about the three diseases, their treatment, the different effects of various drugs, and the current available rehabilition options. Just recently, a drug rehabilitation center has been opened in Podgorica and I have heard that it is very nice with fairly good health care and lots of different opportunities for patients to engage in

athletic and social activities that will help them with their recovery. This is one of the first such centers in Montenegro and I really hope I will be able to visit it soon. An alarming fact from the study that I have come across is the number individuals affected with Hepatitis C. From the current data and the patients I have seen thus far, I think it is estimated that about 80% of

injection drug users are Hepatitis C positive!

I have also been out with Juventas to do outreach work this week. This has been a very interesting experience. Many of the people we see during the outreach work are long-time clients of Juventas and are either injection drug users, commercial sex workers, or both. They actually have the phone numbers of several of the Juventas staff and thus whenever they need clean needles or condoms or just someone to talk to, they can call the staff and we visit them

in their homes during the outreach period. For all new clients, we advice them to come to the clinic during the study period so that they can get information and counselling so that most of the people we eventually see have all the needed information on drug addiction, the various diseases, safe behavior, etc. I am very impressed with the relationship Juventas has built with its clients

and the trust that has been formed between them. For the outreach work, we basically drive around Porgorica in a van, first making all the planned stops to visit the clients that have called us earlier that day. They either come to the van or we go up to their apartment and give them clean needles, syringes, and condoms. We also have a doctor with us who works in an emergency room and she can provide them with any medical care or advice they may need. I am currently in charge of writing down everything we give each client for that night. I have met a few of the clients although I do not go out to each visit as I am new and the people are often scared of new members as they do not yet trust that I am not with the police. After going out several times and having them see me around for a while without any negative consequences for them, then I will be able to interact with them a little more.

After making the planned visits, we drive around some of the areas in Podgorica known to have hang-out spots for drug users or sex workers. Two nights ago, we visited an area called Konik which I never knew existed in Montenegro until this year. It is basically an area in which all the refugees from Bosnia, Kosovo, and other war zones, the roma population, and many delinquints live. It is an extremely poor area and many of the houses are barely standing upright, there is a lot of trash everywhere, and it just looks very run-down and scary in general. I was shocked that I had never seen or heard of this area before and it is very strange that some of the most marginalized populations in Montenegro all live in one location. The outreach work is really making me aware of how hurt this country has been by the war. It has also showed me how widespread the drug problem is here and how it affects individuals from some of the most diverse backgrounds.

Through all this work, I have been making a ton of friends here at Juventas. I really like that I get to work on so many different projects and get to see how this organization runs as a whole. I have been pleasantly surprised with how well everything is organized here and the work they are doing is, I believe, very effective. The only thing that is missing is support for organizations

such as Juventas from the general public, and especially from local cooperations and the government here in Montenegro. There are very few donors within Montenegro and Juventas is really having a hard time finding funding for its projects. I also had the opportunity to attend a press conference held by Juventas this Wednesday during which it announced all its upcoming projects and work to the media. I have attached some pictures from this conference so you can

meet the three main people I'm working with here.

For next week, I plan to continue my work searching for donors and hope to have a list ready for Juventas by the end of the week. I will also continue going to the research study and outreach work. I hope to make some progress with the outreach work so that I can communicate more with the clients and begin making more of the visits with the other Juventas staff. While I am having a hard time with the fact that most of what I am going to be doing each day here is not

planned and organized in advance, I am learning to adjust to this cultural difference here and am beginning to trust that even though I might not have every detail of my project planned, I am still getting interesting and new experiences each day and am able to contribute to Juventas' projects.

Relaxed Work Culture, Significant Progress

Overall, my first impression is that there will be some very interesting things for me to do and see while I am here and I am really enjoying getting to know all the staff here. They are very friendly and easy to work with and have been very good about teaching me and explaining everything to me. The workday here has been slightly strange for me even though I am from here. We all get to work at 9am but this does not mean that we start working at 9am. First, everyone gets together to drink coffee and just chat for about 45 minutes and then we start working. After a few hours, we all go out again together to get something to eat and then sit down at a café for coffee again and take another hour or so break. Throughout the day, they take these coffee breaks and the general work atmosphere is very relaxed and laid back.

It is a little strange for me as I am always used to working and getting things done and taking short breaks, but it is really interesting to have time to talk with them and get to know them outside the work setting. I feel that I will really gain a lot from this experience not only in learning how to work with injection drug users and commercial sex workers and seeing their status in Montenegro, but also in observing and being a part of a completely different work culture. Also, I am very pleased to see the relationship this organization has built with the populations they serve. They know many of their clients for a long time and have built very strong bonds with them. I feel that the clients really trust this organization which not only helps in promoting the safe preventive behavior but also serves as a gateway through which Juventas can work with their clients to help them stop using drugs or to get them away from sex work.

The first week here has been great. I met with Senad and started working at Juventas on Monday. I have spent most of this week getting to know the Juventas staff, their programs, and how they are organized. My projects have slightly changed due to last minute changes in what Juventas will be doing in the summer but the overall project is similar. I will mostly be working with them on one of their bio-behavioral study that looks at the incidence and prevalence of HIV, Hepatitis B, and Hepatitis C among injection drug users and commercial sex workers. Furthermore, it looks, through a survey, at the general behavior of these populations in terms of reproductive health and general safety.

In addition to some office work during the day, I have been going in to the clinic from 5-9pm three times a week. Here, test subjects can come and have their blood drawn. The blood is then tested for the three diseases. After, we go through the survey with them and, if needed, give them clean needles, syringes, and condoms. Also, I will be going 2-3 times a week to do outreach work on the streets from about 9-12am where we talk with injection drug users or sex workers doing some counseling and distributing again clean needles, syringes, and condoms. I am in the office from about 9-3pm each day and this includes entering fieldwork data into the computer, attending meetings to discuss project difficulties and ideas or how to improve the work, and working on several reports with which I will be helping this summer. Right now I am helping them to write a report on the current status of commercial sex workers in Montenegro, including an analysis of their rights, their health status, and their behavior. As this needs to be written in English, I will be writing most of the report and will be working together with several of the staff to conduct the research. Research will include visiting the epidemiology and infectious disease clinics to speak with doctors and obtain data and internet research.