The First AFEW Regional Autumn School Was Conducted in Kazakhstan

Author: Marina Maximova, Kazakhstan

Representatives of 10 countries took part in the first regional autumn school organized by AFEW, which was held from 30 October to 5 November in the Oy-Karagay gorge, not far from Almaty, Kazakhstan. The school was conducted with the support of the Dutch Ministry of Foreign Affairs.

High mountains, hot sun, picturesque autumn landscapes, atmosphere of the national yurt instead of the traditional training hall – combined with the team spirit and expectations of positive changes – contributed to the creative atmosphere of the event. The school participants included representatives of the AFEW network from Kazakhstan, Kyrgyzstan, the Netherlands, Tajikistan, Ukraine, sub-grantees of the project ‘Bridging the Gaps: Health and Rights for Key Populations,’ and partner organizations. Such allies and friends are the biggest guarantee of success.

Learning to bridge the gaps

“The autumn school helps to find the answers to a range of questions and get acquainted with the new innovative practices in working with key populations,” says Dilshod Pulatov, Project Manager, ‘Bridging the Gaps’ programme, AFEW-Tajikistan.

He presented the results of the social study to assess the level of labour migration among people who use drugs. It was conducted for 18 months in Tajikistan and Kyrgyzstan. The study, which covered 600 respondents, demonstrated regional trends and showed interesting results. The main of them is that the labour migrants who use drugs do not know where they can get help and who can offer such help. In both countries, the respondents pointed out that as labour migrants they experienced problems with access to health and social services.

The results of this research study will help AFEW to scale up the access of drug users to quality HIV prevention, treatment, care, and support services and find new partners. Partnerships were created right at the discussion platform. This study proved to be interesting not only to the participants, but also to the guests invited to take part in the autumn school, including representatives of the Project HOPE in Kazakhstan.

Platform for discussion and activism

Today, ‘Bridging the Gaps’ programme is implemented by the organizations from four countries of the region. The autumn school became a platform to discuss strategies, barriers, innovations, and opportunities for cooperation.

“In our country, the biggest gap is an access of underage people who use drugs (PUD) to services. Many services are offered to adult PUD, in particular with support of the international donors. It allows them getting qualified help. At the same time, people often forget that the first experience of drug use happens under the age of 18,” tells Anastasia Shebardina, Project Manager, AFEW-Ukraine.

The project made an important contribution for radically changing the situation: it opened the only rehab centre for drug dependent adolescents in Chernivtsi and supported four civil society organizations.

In each country, there are success stories, which became possible thanks to the project implementation. So far, these are just tiny steps forward in the big scope of the existing problems. Every such step became possible thanks to project staff and activists working hard for a long time, but such victories, even if they are small, enhance personal motivation of people and allow them to set bigger goals.

“One of our achievements is developing the standards of services for PUD serving sentences in the Georgian prisons. We educate prison staff and have drafted a special training module for this purpose. In some organizations, support groups for PUD are already functioning. Rehab centre Help has opened its doors to clients. Now 12 people can stay there and get qualified help. We plan to cover all correctional facilities in the country with our activities,” shares his plans Vazha Kasrelishvili, Project Coordinator of the NGO Tanadgoma.

From knowledge sharing to new rehabilitation models

Sharing knowledge and best practices is one of the goals of the autumn school. Together, it is easier to elaborate strategies and innovative approaches, considering that the tendencies in development of the situation in the region are similar. Today, the search to fund vital projects also requires joint efforts, taking into account the reduction of the funding received from the Global Fund to Fight AIDS, Tuberculosis and Malaria and other donors in the region. So far, national governments are not ready to take over this financial burden in full scope. Despite their broad fundraising efforts, civil society organizations do not have enough grant funds aimed at scaling up access to services for key populations.

“With the support of the Ministry of Health of the Kyrgyz Republic, within our project we developed two clinical guidelines: on managing pregnancy, delivery and postnatal period of female PUD and on mental health and behaviour disorders in children and adolescents caused by the use of new psychoactive substances. We were able to open a social office for women with HIV, which offers counselling of psychologists and peer consultants. In the country, there are two rehab centres for women with HIV and drug dependence, which cooperate with friendly clinics,” tells Natalya Shumskaya, the head of the AIDS Foundation East-West in the Kyrgyz Republic.

Today, there is a need to use new, more effective rehabilitation models. This idea has been supported by all participants of the autumn school. Such models should be aimed at developing inner strength – empowerment – of each of the members of key populations.

“Maybe now it is time to change and expand our understanding of the rehabilitation concept. It is not only detox and psychology. There should be equal opportunities, in particular based on harm reduction, to accept yourself,” points out Anna Sarang, President of Andrey Rylkov Foundation, Russia.

Preparations to AIDS 2018

Participants of the autumn school also discussed preparations to the 22nd International AIDS Conference (AIDS 2018) in Amsterdam, the Netherlands – the main event of the next year for activists of the AIDS organizations. All countries of the Eastern Europe and Central Asia are already actively preparing for the conference. How can decision makers be involved into this crucial event? What channels are most effective in communicating information about the conference? How to make this event significant? Every day, participants of the autumn school discussed these and other questions. Besides, they learned how to write abstracts for the conference and choose catchy titles for them.

It is very important that the participants developed some new ideas, concepts and thoughts, because starting from 1 December 2017 registration for AIDS 2018 will be open. It will be a new and diverse platform for discussions making decisions significant for all countries and communities.

AFEW Tajikistan’s Offers the Range of Unique Services

Success with harm reduction has recently been achieved in Tajikistan. HIV epidemic amongst injecting drug users also seems to stabilize and even decline. Unfortunately, HIV is still increasing as now it also enters wider community around people who use drugs (PUD) and other key populations. Sexual transmission of HIV is rising, and women is the most vulnerable group in this new wave of HIV infections. Besides, in Tajikistan there are other health related issues with tuberculosis, hepatitis and sexual and reproductive health. These are the observations of AFEW International’s director of the programs Janine Wildschut who visited Tajikistan last week to monitor the work of ‘Bridging the Gaps: health and rights for key popualtions’ programme.

Empowering women is the aim

Within ‘Bridging the Gaps’ programme, AFEW Tajikistan with its partners are focusing on service delivery mainly for female drug users, female prisoners, wives and spouses of PUD. Through the Comprehensive Service Delivery Centre in Qurghonteppa, AFEW Tajikistan is delivering a broad range of services for vulnerable groups, where all groups are welcome.

“We face the issues with health and with the rights of individuals. We want to empower women to take care about themselves, and it is very important to support them in speaking out for their interest and needs,” Janine is saying. “AFEW Tajikistan offers the unique opportunity to have HIV test on the base of the NGO. They also offer wider psycho social support and client management for women based on their needs.”

In Tajikistan Janine also conducted assessment amongst PUD that have labor migration experience. With the support of Open Society Institute Tajikistan, AFEW Tajikistan is supporting labour migrating women returnees with client management. During the focus groups, different women were asked about their needs, quality of services they received, ideas for further improvements and their lives.

Starting vocational training

Janine Wildschut also conducted interviews with NGO partners about the situation for civil society in Tajikistan, spoke with governmental partners within the health department and penitentiary system and worked with AFEW Tajikistan staff on the development and strategies within the next years of the ‘Bridging the Gaps’ programme.

“During the focus group, opioid substitution therapy (OST) clients expressed the uniqueness of the service centre in Qurghonteppa. The biggest challenge for people is to travel every day to the OST point to pick up their methadone, since some of them live quite far and have little resources to spend on transportation,” Janine noticed. “Located nearby, AFEW branch is of big help since they can, after picking up OST, go for health checkup, self-support group or use some other support. Nowadays they are experiencing less discrimination and not such bad treatment of public health facilities because with the AFEW partner network and the AFEW referral vouchers, the attitude and climate in the health facilities in Khatlon region improved a lot. Besides, the support of social workers decreased the level of self-stigma which makes people less fearful to visit  public health services.”

The biggest challenge people still face is the lack of work and education. For that reason, AFEW Tajikistan is considering the option of starting vocational training and enterprise. These plans will be developed in collaboration with experts and micro credit organizations that are part of the partner network.

Bridging the Gaps in Women’s Hostel in Kyrgyzstan

img_0956

Leila and Sofia live in women hostel in Bishkek

Five-year-old Sofia is playing with her mother’s telephone. The girl is sitting on the floor and is listening to the music. She is switching between the songs, watching videos, and trying to find her favourite track. There are four beds in a small room. At some moment, the girl puts the phone away and asks: “Mom, what will Santa bring me?”

“What would you like, dear?” she hears from her mother, and the broad smile appears on her face. “I would like him to bring me a kitten. I will feed it with milk.”

When the girl is smiling, she has cute dimples on her cheeks. She brings a toy – plastic alphabet with the buttons. She presses the letters and repeats them. Sometimes she gets the letters wrong, and then the mother asks her to do it again.

TELLS ABOUT HIV TO NEW FRIENDS

Sofia and her forty-year-old mother Leila live in the hostel that operates in the centre of adaptation and socialization of women – injecting drug users in the public fund Asteria in Bishkek, Kyrgyzstan. Leila was recently released from prison.

img_0927

Leila is teaching Sofia an alphabet

“I do not have any relatives; I was raised in the orphanage. I got to prison when I was pregnant, and my daughter was born there,” Leila tells. “Now I work in the kitchen or wash the floors. Recently I went to Turkey, and wanted to find a job there, but I do not know Turkish language, and that is why it did not happen. By education, I am a seamstress and a pastry chef, but it is hard to find a job because I am HIV-positive. I am being asked about my diagnosis all the time, and I always have to go through medical examinations. Now I have found a job as a nursemaid, but I do not have anyone to leave my daughter with. She has to go to kindergarten, but all of them here are not free of charge. I will have to spend almost whole salary to cover the pay for kindergarten… I am currently waiting for the cash advance to pay.”

Leila says that she tells her new friends about her diagnosis, even though she does not always want to do it.

“I think, people with my disease should talk about it, and warn others as well. Now I also bring other people to get tested. I am telling them they have to do it, and that it is free of charge,” Leila says. “Of course, people treat me different when I tell them about my diagnosis. Yes, it is unpleasant, but I am happy that in this way I do something nice to others. Everybody should know such things.”

PRAYING FOR ASTERIA

Leila is worried that the hostel in Asteria can be closed. In that case, the woman can end up on the street. She does not have anywhere to go to.

“I should not be complaining; we have everything here. The main thing is the roof over your head,” the woman smiles and hugs her daughter. “I am very comfortable here. We receive medical treatment, there is a place to sleep, to do laundry. Every Sunday we go to church. In the church I always pray for this house, for people who help us here, and ask God that the organization has donors.”

img_0999

The head of Asteria Iren Ermolaeva shows the rules of the hostel

Leila says that she would like to move from the hostel in the future, but she does not have such possibility yet. She dreams of her own home, family, and work. She also wishes that the hostel will never close. People who work in Asteria have the same desire.

“We indeed often have problems with financing. Every year we do not know what to expect in the next one,” the head of the public fund Asteria Iren Ermolaeva says. “Our public fund is working since 2007, and the hostel – since 2009. We would like to have the whole range of services, but there is not enough financing these days. We know how to find the approach to women, we know how to create friendly atmosphere so that a woman would want to change her life for better herself, and we would like to use this knowledge. We feel sorry for our clients, and we would like to help them more.”

DREAMING ABOUT OWN HOUSE

Workers of Asteria also dream about purchasing the house where they will place the centre of adaptation and socialization of women – injecting drug users and the hostel. They have already found funds for the future house renovation, but cannot find money for its purchase.

“Then we would be able to have social entrepreneurship, maybe some little farm. In that way, we could at least not depend on donors in food,” the coordinator of the social services of the fund Tatiana Musagalieva is saying. “Until now, we rented all three houses for our centre.”

img_0978

Asteria workers Iren Ermolaeva (on the right) and Tatiana Musagalieva say that their organisation often has problems with financing

Thanks to “Bridging the Gaps: Health and Rights for Key Populations” project from Public Foundation “AIDS Foundation East-West in the Kyrgyz Republic”, in 2016 Asteria could support four beds in the hostel. The project also helped with medicine and warm food.

“People often come to us to eat, to do laundry,” Iren Ermolaeva says. “Around 300 women come through our centre during one year. Leila, for instance, came here after she was released from prison. She has got all the necessary services, clothes, shoes, and got medical examinations. Leila was imprisoned for five years, and, now, due to the conditions that we have, she adapts and integrates into society. In this way, she becomes more confident in herself, can find a job and build her future.”

Starting Methadone after 18 Years of Using Drugs   

IMG_269244 years old Makhmad asked for support of the social workers of “Bridging the Gaps” program implemented in Qurghoonteppa city in Tajikistan after he experienced 18 years of injecting drugs and had several ineffective attempts of stopping using them. He was seeking for some assistance in his drugs dependence treatment.

“I have heard about methadone many times, but did not believe that it can help me, even though many of my “colleagues” in the streets were telling about its positive effects. During my communication with social workers of AFEW-Tajikistan, I received all the answers to my questions. They told me everything about opioid substitution therapy (OST) and all aspects of using of methadone. I decided to try this treatment myself,”– Makhmad says.

Before entering OST program, Makhmad faced many problems in his everyday life and with his family. “Frankly, I never thought about my family and my kids. All my thoughts were about how to find drugs”, – he says. Thanks to “Bridging the Gaps” program support, Makhmad passed medical observations, got needed tests and afterwards was included in OST program that was implemented by state detox center of Qurghoonteppa.

“After some time of participation in OST program I felt positive changes. First of all, I stopped to think about how and where to find my dose of heroin. Besides, my relations with family members improved. I have also found the job. I feel myself healthy and I can say it with a confidence that everything is good in my life. When I now see people I know who are still using drugs, I explain them that methadone is something that can really help us”, – Makhmad tells.

Social workers of AFEW-Tajikistan are continuing to provide assistance to Makhmad. In return, he does some volunteering work for AFEW, and together with the social workers Makhmad is informing people who use drugs about available services within “Bridging the Gaps” program in Qurghoonteppa.

“Bridging the Gaps: Health and Rights of key populations” project is funded by the Ministry of Foreign Affairs of the Netherlands is implementing in Qurghoonteppa by AFEW-Tajikistan Branch in Khatlon region. People who use drugs or are affected by HIV epidemic can receive client management and HIV prevention services including assistance in initiation and adherence to treatment. Only in the first half of 2016, 84 PUDs were provided by AFEW-Tajikistan’s assistance to pass needed medical observations on free of charge base and 16 of them finally were included in OST program.