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Ikram Ibragimov: “AFEW-Tajikistan is the Only NGO with HIV Rapid Testing Services in the Country”

Фото ИкромThe activities of AIDS Foundation East-West Tajikistan for already 15 years are directed into improving the health of key populations at higher risk of HIV infection. Last December HIV voluntary counselling and rapid testing point was opened in in the representative office of RPO AFEW-Tajikistan in the city of Qurghonteppa. Director of AFEW-Tajikistan Ikram Ibragimov tells about the achievements of the testing point and the organisation in general.

– How was the year of 2016 for AFEW-Tajikistan? What new and important things happened?

– The year was full with events. We changed the statute of the organisation, and we made the areas and directions of its activities wider. We also developed and approved the strategy of the development of the organisation for the medium term, strengthened the partnership and cooperation with governmental and non-governmental organizations in the health sector. We have our own new premises for our office. We renovated it, and have been working there for three months already. In November of the last year we elected the management of the organisation – the board, the audit committee and the director – for the years of 2017-2021. Generally speaking, I would say that 2016 was successful for us.

– Just recently you opened HIV voluntary counselling and rapid testing point in Qurghonteppa. Why did you choose this city to be the “base” for it?

– Our second office is situated in Qurghonteppa. That is why we decided to open HIV voluntary counselling and rapid testing point on the premises where key groups of population are already provided with the direct services. By the way, now we are the only NGO in the country that has such service. Besides, one of the main routes of Afghan drug traffic goes through Khatlon region and that is why drug addiction level in the region is high. People who use drugs are the main target audience for us. As a rule, donors and partners work in the capital and on the North of the country. We decided to go South.

HTC center 3– What are the first results of HIV voluntary counselling and rapid testing point?

– Starting from December, 1 and up until December, 31 there were 18 people tested for HIV: 9 men and 9 women. Thanks God, there were no new cases of HIV found. People find out about our testing point from our website, media, business-cards that we disseminate, information from the clients who visit the centre themselves. Mostly, our visitors are representatives of key populations.

– At the end of 2016 you developed a draft of multilateral agreement on cooperation in the field of prevention of socially significant diseases in Khatlon region and the provision of medical, social and legal services for vulnerable groups. What does it mean?

– This agreement means the cooperation with different organisations that provide complex services (medical-psychological, social, legal and others) to key populations on many levels. The agreement is created on the existing epidemical situation with taking into consideration the socially significant diseases in Khatlon region in Tajikistan. It is planned that 46 government and non-government organisations of the region will become the members of the agreement. We strive to create favourable conditions for the clients of our social support services, so that they can get high-quality, timely and free services of certain specialists. The service should be affordable. Therefore, this memorandum is intended to lower the difficulty of access to services for key populations, and to create a basis for the integration of various services “under one roof.” This is so-called principle of “the single window.”

– What are AFEW-Tajikistan’s plans for 2017?

– As I mentioned before, last year we agreed upon the strategy of the organisational development for 2017-2019. Therefore, all our plans are directed into reaching the quality indicators of this strategy.

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Bridging the Gaps in Women’s Hostel in Kyrgyzstan

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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.

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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.”

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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.”

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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.”

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Irina Used Drugs and Became a Social Worker

irinaIrina Starkova started to use drugs in 1980’s in Osh city in Kyrgyzstan. She tried all the drugs that were available at that time starting with opium, ephedrine and finishing with heroin. She began to use drugs with her husband who was just released from prison.

In 1983, Irina gave birth to a son. “I was happy, but even that did not stop me from drug usage. I couldn’t imagine life without drugs, – Iryna says. – In 1990, I was imprisoned for the first time. After that, I was imprisoned for three times more. In total, I was in detention for almost 11 years, and it was all for the drug use.”

Thus, her son grew up mostly without his mother. Irina’s parents were raising him up. In 2000, she was visited by a specialist from the AIDS Center. He took her blood for HIV testing, and a week later Irina got to know that she was HIV positive. At that time, she had very little information about her diagnosis. “I didn’t know how to live and was afraid of people and relatives condemn, – she remembers. – But I began to shoot up even more drugs. I thought that I will die soon because of HIV…”

Nine years ago, when she was released from prison for the last time, her mom and son got to know that Irina was HIV positive. Their reaction was very unpleasant: Irina’s son said that he did not need a mother, and that she was his shame, and her mother was afraid to live with her in the same apartment. Therefore, Irina was forced to leave to Bishkek, the capital of Kyrgyzstan.

In Bishkek she also found heroin, and it all lasted until she went to rehabilitation in NGO “Ranar” where she got helped. “I don’t use drugs for 9 years already, – she says. – In 2009, I was tested for HIV one more time and I found out that I am healthy and I have no positive status. They explained me that this was an erroneous result. I did not know whether to laugh or cry, because all these years were a nightmare for me. What would have my life been if I knew that I was not sick…”

When Irina went back to Osh, she visited women center “Podruga” (“Girlfriend” in Russian) to receive their services. “Podruga” was established to combat HIV, AIDS and STIs in the Kyrgyz Republic among vulnerable groups. The organization is also is active in HIV/AIDS advocacy and human rights. Now, for three years already, Irina is working in the organization as a social worker. She helps women who use drugs.

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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.

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Dutch Student Researched Families of People Who Use Injected Drugs in Ukraine

2007_Russia_DrugsA qualitative study “Family members of the people who inject drugs should promote the positive image of harm reduction services” was recently made by the graduate student of Vrije Universiteit Amsterdam Sandra Hagoort, and AFEW in Ukraine.

Master of Health Sciences Sandra Hagoort explored the role of the family of people who inject drugs (PWID) in the utilization of harm reduction services and how could the family stimulate those people to increase the uptake of harm reduction services in Ukraine. With the help of AFEW-Ukraine in the capital city of Kyiv, Sandra disseminated the surveys and did interviews with the family members, PWID and people who work with PWID.

Sandra chose Ukraine for her research because of the incidence and prevalence rates of HIV that are still high in EECA region. “This number is especially high among people who inject drugs which was the group I wanted to focus on, – Sandra says. – I did my study according to the conceptual model which is mainly based on the behavioural model of Andersen. Most important aspects of this model are the population characteristics and the external environment of the PWID.”

HIV is indeed an increasing problem among the PWID in Ukraine. Harm reduction is an evidence based approach which has been proven to reduce the incidence of HIV among PWID. These services are available in Ukraine, however, the uptake is low because of stigma and discrimination. To overcome this barrier, the family of the PWID might play a stimulating role to use more harm reduction services.

“You always hear about HIV in Africa, but I thought, EECA would be a different and interesting angle. I remember the interview I had in Ukraine was with the mother of someone who uses drugs, – Sandra Hagoort says. – During the interview with the mother, I realized that we forget to assist family members of people who use drugs. This was also confirmed by the social workers later on. I realized that the mother was close to despair about how to help her son.”

As a result of her studies, Sandra Hagoort found out that emotional and practical support were both provided by the families of PWID. Moreover, attitude and knowledge were important themes. Stigma towards IDUs as well as to family members of IDUs was reported. The fact that PWID who are under 18 years old are not allowed to obtain harm reduction services without parental consent was also considered as a barrier. In order to increase the uptake of harm reduction services, the communication between the PWID and their families should be improved. This can be done by family counselling in which both parties can express their needs and more support can be provided. After that, a positive attitude towards harm reduction services has to be created. The best way to do this is that family members themselves promote the positive image of harm reduction services.

Now Sandra plans to publish the results of her study in a scientific journal.

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AFEW: High Standards in Service Delivery

The new social bureau of AIDS Foundation East-West in Tajikistan attracts diverse key populations for respectful attitude, quality services and professional counselling

In 2014, AIDS Foundation East-West (AFEW) officially opened its branch office in the Khatlon region (in the city of Qurghonteppa, formerly Kurgan-Tyube). This branch office aimed to expand prevention, treatment, care and support services for key populations at high risk of acquiring HIV and other infectious diseases.

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Prior to 2014, AFEW had never provided direct healthcare, social, psychological or legal services to key populations. Instead, AFEW supported local community organisations by increasing their capacity and providing them with the skills and knowledge to offer such services. Whilst AFEW plans to continue providing technical assistance to local non-governmental organisations (NGOs), opening its own social bureau will allow AFEW to significantly increase the coverage of quality services aimed at assisting key populations.

THE HIV SITUATION AND LOCAL CONTEXT

High unemployment rates persist in Tajikistan. Official figures indicate that 2.6% of the economically active Tajik population currently have no job, whilst many Tajik migrant labourers returned home following the Russian economic crisis. According to World Bank data from 2014, one-third of Tajikistan’s population lives below the poverty line.

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In Qurghonteppa the major source of income for the locals is bazaar

Tajikistan lies along the primary transit routes of Afghan drugs making their way to Russia and eventually Europe. The Tajik–Afghan border stretches for 15 000 km, a considerable portion of which lies along rugged mountain terrain, ideal for trafficking. According to official data from 2005, officials seized 4676 kg of opiates illicitly trafficked. Since then, the volume of narcotics exported from Afghanistan has continually increased. Between 2010 and 2015, authorities seized 31 696 kg of illicit drugs.

The availability of drugs, and the high rates of poverty and unemployment in Tajikistan, relate to other demographic characteristics and statistics in the country. For example, in 2004, the estimated number of sex workers reached more than 14 000 individuals. As of 2015, unprotected sexual contact accounted for nearly 62% of all newly registered cases of HIV.

Considering these factors, AFEW chose the location of its social bureau deliberately. The Khatlon region stands as the most densely populated area in Tajikistan. According to Republican AIDS Centre data, since 2013, this region is home to the highest number of new HIV cases.

SOCIAL BUREAU STAFF

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Staff meeting at AFEW social bureau

AFEW’s head office in Dushanbe — Tajikistan’s capital — took matters related to human resources for the new social bureau quite seriously. Of primary importance, setting and maintaining high standards for the social bureau received particular focus since the facility would serve as an example for other NGOs. Today, AFEW is genuinely proud of its branch office staff given how well-known and respected they are within Qurghonteppa and the surrounding region.

Until recently, Tursunpulod Norkulov, PhD (on the right) worked as the chief physician at the Regional AIDS Centre. Today, Dr Norkulov serves as a project specialist at AFEW’s social bureau. His nurse at the AIDS Centre, Kurbongul Alimova (middle) — also a trained biologist and virologist — works as a social worker within the bureau. Clients seeking services from AFEW know both Dr Norkulov and Ms. Alimova from their work at the AIDS centre. Clients also confess to experiencing better attitudes towards those seeking services at AFEW compared to elsewhere. Each individual consultation or group meeting traditionally begins with inquiries about the client’s health, exchanging news from one’s private life and a discussion about any successes and problems the client recently experienced.

JurabekJurabek is one of the most active participants of such meetings. In the past, this 48-year-old man used drugs. He now works at AFEW as an outreach worker. Jurabek knows all of the places in town where people who use drugs typically congregate, and many of those who use drugs know him. In 2015, he reached 190 individuals through his work, 14 of whom joined the opioid substitution therapy (OST) programme.

Jurabek: ‘People who use drugs do not believe in substitution therapy, because drug dealers tell them that the state is deliberately handing out methadone in order to get rid of drug users in a year or two. But, of course, this is not true and only serves to keep their clients buying street drugs. Every time I hear this myth, I tell them my own story—that I myself was on methadone, began to feel well and have now stopped taking methadone completely.’

Alisher, another AFEW outreach worker, uses the same approach when working with people living with HIV. Many are afraid to initiate treatment for HIV, or quit soon after they start it because they lack accurate information about antiretroviral treatment.

Alisher: ‘I work with HIV-positive families, and visit them together with my wife. The AIDS centre provides us with information on those who have quit treatment. The most important elements to this work consist of trust and communication. My wife and I explain to them everything that we did not hear ourselves when we needed it: information related to the side effects of treatment, the importance of continuing treatment and so on.’

CLIENTS

Zhanna-42-SW-Kurgan_smallZhanna (42), a sex worker, divorced her husband when he found another woman when working as a migrant labourer in Russia. Finding herself alone with two young children, she became a sex worker to support herself and her family. When the opportunity arises, Zhanna also cleans houses.

She visited the social bureau initially when it opened, and continues to visit it regularly now. Here, she picks up informational brochures, takes part in information sessions and group consultations or simply comes to chat with other clients. Social worker Kurbongul regularly accompanies Zhanna during her consultations for various tests and consultations at the women’s health and infectious disease clinics. Every three months, Zhanna undergoes HIV testing.

‘I love myself and value my health,’ she said. When asked if she always uses condoms, Zhanna said that she doesn’t always with her regular clients.

She said, when she suggests that her clients use condoms, they suspect her of having a sexually transmitted infection.

Zhanna: ‘Then, I explain to them that it is for my own protection, because not all diseases have visible symptoms, including HIV.’

In future, Zhanna hopes to find a permanent job. Now, she is busy gathering the paperwork necessary to work as a kindergarten teacher.

Sharifbek-and-Bobo1Sharifbek Safarov (left) is 54 years old. He is a Master of Sport on the national wrestling team, a six-time Tajik champion and a Candidate for Master of Sport in judo. For many years, he worked as a wrestling coach. The difficult economic situation, as well as the instability resulting from the civil war in Tajikistan between 1992 and 1997 and the flow of drugs from neighbouring Afghanistan contributed to many young people, including Sharifbek, picking up heroin use.

Sharifbek: ‘For a pair of rubber galoshes, dealers doled out a half kilo of opium.’

In June 2014, Sharifbek met an outreach worker from AFEW’s branch office in the Khatlon region. After Sharifbek underwent an HIV test and screening for tuberculosis, he was offered enrolment in an OST programme.

Thanks to OST and support from social workers, Sharifbek returned to his favourite job. Today, his wrestling programme includes around 70 teenagers, for which he receives a salary from the state. In addition, his methadone dosage is gradually decreasing. With a diploma from a sports college, despite his age, Sharifbek also hopes to complete further higher education training and receive a diploma from the Sports Pedagogical Institute.

Together with his friend, Bobokhuja Badridinov (right)—who is also a client of the OST programme—they often visit AFEW’s branch office to take part in the group sessions with active drug users. In doing so, they explain the advantages of OST and the resulting positive changes to their own lives.

‘Methadone has literally saved us. We can work and feed our families. There is no need to look for drugs. It means there are fewer health risks and chances that we will get into trouble with the law.’

Shodi-MSM-Kurgan-dancer-waiter-volunteer-has-boyfriend_smallShodi (24) is a volunteer at AFEW’s social bureau. He conducts thematic mini training sessions for men who have sex with men and accompanies them to the AIDS centre and infectious diseases clinic. Nearly 20 individuals attend training sessions.

With his boyfriend, whom he met on a popular social network, Shodi regularly undergoes HIV testing. Whilst the couple has been together nearly three years, their parents remain ignorant of their relationship—they think that the two are simply good friends.

Shodi: ‘In Tajikistan, every man must marry a woman. Marriage also awaits both of us. However, this won’t be a problem for us—we will continue our relationship as always.’

In addition to his work at AFEW’s social bureau, Shodi also works as a waiter at a local cafe. When asked by his boss, Shodi performs Indian and Tajik national dances.

Whilst AFEW’s social bureau provides services to all key populations, the majority of its clients consist of people who use drugs. None of those who use drugs holds a permanent job and almost all of them served time in prison. Many clients come directly to the social bureau upon release from prison carrying AFEW’s business cards in their hands. Since September 2014, AFEW has regularly conducted training sessions for prisoners in two colonies in the Khatlon region, preparing individuals for release and reintegration into society. These activities fall within the framework of the Start Plus transitional client management programme. Currently, 26 individuals are enrolled in the programme, the main activities of which consist of AFEW informational sessions on the prevention of tuberculosis and HIV, personal hygiene and healthy lifestyles.

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Clients come to AFEW’s social bureau for consultations on HIV and other infectious diseases. Here, they may also receive legal counselling and referrals to health centres. Many individuals visit the social bureau simply to chat with each other whilst drinking tea or playing ping-pong.

safetySoon, clients may undergo HIV testing on the premises of the social bureau. In September 2015, the Tajik Ministry of Health issued an order allowing on-site testing based on an AFEW initiative. To provide HIV testing services, public organisations must offer all of the necessary testing infrastructure (i.e., a separate room, equipment and materials) and the staff must complete a relevant training programme. AFEW has already met all of the requirements, including approval from the Blood Centre to handle blood samples. To begin testing, AFEW needs to amend its statute, which is also underway.

Many clients’ primary challenge centres on their lack of employment. Whilst most clients possess only a secondary education, nearly all have hands-on construction, electrical, welding and carpentry skills and experience. Many clients are willing to work in the garden to grow their own fruit and vegetables to sell, raise poultry or rabbits or initiate small-scale production of paving stones for instance. Clients argue that such opportunities would significantly change their lifestyles, habits and behaviour.

CO-OPERATION WITH STATE AGENCIES

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Training plan with the police

AFEW’s partnership with the Ministry of Justice’s Punishment Implementation Department to increase prisoners’ awareness of HIV prevention stands as one example of successful cooperation with state agencies. In May 2015, Tajikistan’s Interior Ministry turned to AFEW with a request to organise information sessions on HIV prevention for police personnel. Accepting this request resulted in a total of 566 police officers from district stations completing a training session. Analysis of completed pre- and post-training mandatory questionnaires demonstrated a significant improvement in knowledge about HIV and the means of prevention amongst attendees. Police training will continue in 2016.

FUTURE PLANS

We may safely say that AFEW’s branch office in the Khatlon region has hit the ground running. For such a small organisation, its list of accomplishments for just two years is rather impressive. With its multiple achievements, AFEW plans to expand its work amongst and for this region’s key populations.

Abdumadzhid Saitov, AFEW social bureau’s co-ordinator: ‘As we expand, we will try to accommodate as many of the wishes of our clients. For example, we will develop a library for them towards self-education, offering interesting and educational films. Unfortunately, we cannot address all of their wishes in the nearest future—for example, creating a dormitory for our homeless clients remains a bit beyond our reach. To organise such a place, we would need significant financial resources and qualified personnel.’

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Why UNGASS matters for young people who use drugs in Ukraine

By Elena Voskrenskaya, Director AIDS Foundation East-West (AFEW) Ukraine

DSC00159Today’s youth, tomorrow’s key populations?

For many years, people who use drugs in Ukraine, especially those younger than 18 years, have been facing serious barriers that prevent them from accessing support services. The strict drug legislation, resulting from the global war on drugs, aims to punish people who use drugs rather than tackle the drug dealers. Moreover, the discriminating attitude of service providers and the lack of understanding within communities leave thousands of young people without proper treatment and care.

Care in a friendly environment

Although nowadays adults have better access to harm reduction, which is the most effective method to prevent HIV, children and adolescents who use drugs are left without this support in Ukraine. Also fear of being punished discourages young people to seek medical, legal and other services. The traditional available methods are limited to promoting immediate abstinence from drugs, in most cases with involvement of parents and schools and by informing the police. AFEW-Ukraine embraces innovative approaches. For four and a half years in four regions of Ukraine, we support services that give proper care in a friendly and encouraging environment. The aim is to support young people who use drugs in dealing with challenges and adjusting to life – no matter whether she or he stops using drugs or not. The method works because the services are based on consultations with community representatives and are aligned to the needs of young people.

‘I wanted a thrill’

The Compass Drop-In Centre in Kharkiv is one of the locations that offers services to young people. Oleksandr (17), a client of the centre, told me about his experiences: ‘I tried drugs for the first time when I was 14. Well, the very first time I was 11. I was bored, I wanted a thrill. I got in with the wrong crowd and it was normal. Then I started to suffer from paranoia and panic attacks. My dad is a policeman. But now my relatives really support me coming to the centre. I am more communicative with them now and I have more friends – I communicate more. This has a lot to do with the psychological support I have received here.’ Svitlana, another client of the Drop-In Centre, added: ‘I can’t remember being happy as a child, but I’m happy in the centre.‘

UNGASS

Maryna, psychologist in the centre in Kharkiv, explains that UNGASS is important for the people who use drugs and for the service providers: ‘If any declaration or action plan is adopted globally, it might help us in dealing with the local authorities. And when there is a certain strategy employed by a huge number of stakeholders, this will benefit initiatives for young people at the local level.’

Watch the video ‘Today’s youth, tomorrow’s key populations?’ about young people who use drugs in Ukraine

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Without the right solution for the worldwide drug challenge, we cannot stop HIV

From 19 till 21 April 2016, nearly 200 UN member states will come together to discuss the solution for the ‘world drug problem’. We spoke to Edo, whose voice will represent the voices of the drug user community during the UN General Assembly Special Session on Drugs (UNGASS).

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During UNGASS the member states hope to find a solution for the ‘world drug problem’. Will you be present at this high-level meeting in New York?

‘Yes, I’m excited that I can attend UNGASS. The meeting is quite special, because the last session on drugs was long ago, in 1998. The member states that pushed for the session are of the opinion that the world needs to reconsider the current approach, which has failed. I will be there as a member of the community of people who use drugs. In this role, I will for example speak at a side event of Amnesty International and participate in a meeting about the development of guidelines for a human rights-based approach to drug control. It is very important that the voices of the people who use drugs are heard. In Indonesia, they are systematically stigmatised and criminalised, and the implementation of the country’s policy is worse than the drugs itself. People who use drugs are the most affected population by this policy.’

You will represent a network of organisations for and by people who use drugs in Indonesia, PKNI. How did you prepare for this meeting?

‘PKNI gave input to the Civil Society Task Force in Southeast Asia, which submitted recommendations for the UNGASS outcome document. In addition, PKNI shared its concerns and ideas about the drug policy in Indonesia during a meeting with Indonesian government representatives. Civil society groups also released a statement, ‘Diplomacy or denialism?’. Our role is to monitor and be a key partner in a positive relationship, and we hope that the decisions made during UNGASS will be more legitimate and effective. Before and during the Special Session, we work together in a consortium because in this way we can make our voices louder. Over the years, the movement to end the war on drugs has been growing stronger and stronger. While we continue to fight our small battles, we must unite to ensure that no country or region is left out.’

What would be the solution to the ‘world drug problem’?

The punitive approach must end. The leaders of the world should develop a new strategy that takes into account development, public health and human rights – a humane drug policy.
‘Like Einstein said: ‘Insanity: doing the same thing over and over again and expecting different results’. Illicit drug use is placed under the health goal in the Sustainable Development Goals. To achieve the goals and to end AIDS, drug policy reforms should prioritise health and a human rights approach.’

Published on www.hivgaps.org on April 18, 2016

eecaac

AFEW’s Seminars at the 5th Eastern Europe and Central Asia AIDS Conference

eecaacAs part of AFEW’s strategy to keep the dialogue with the countries we work in and to support our local partners that implement groundbreaking projects for people who use drugs, sex workers, people living with HIV and other key populations, AFEW is organising or taking part in the following seminars during the 5th Eastern Europe and Central Asia AIDS Conference (EECAAC) in Moscow:

Bridging the Gaps: Health and Rights for Key Populations – Successes, Achievements, and Challenges
The objective of this seminar is to share the results of the “Bridging the Gaps: Health and Rights for Key Populations” programme, and the People ho Use Drugs Project in particular. We will focus on interventions developed, including: youth activities in Ukraine, e-learning and knowledge platforms in Kyrgyzstan and Tajikistan, prison activities in Georgia, and the exchange of information with other harm reduction organisations in the programme, and with other key populations

When: March 24, 11:30 – 13:00
Where: BIRYUSA Hall
Speakers/Presenters:
Janine Wildschut, Project Manager, AIDS Foundation East-West
Anke van Dam: Director, AIDS Foundation East-West
Ikrom Ibragimov: Director, Public Foundation AIDS Foundation East-West in Tajikistan

How Community Involvement in Research Leads to More Effective Interventions
presentation of research opportunities for community based organisations that work with key populations in Eastern Europe and Central Asia. By equipping community members with tools to conduct research and collect data, their capacity is increased and the research results reflect an inside perspective as to needs and priorities to design future intervention programmes

When: March 24, 13:30 – 15:00
Where: BAIKAL Hall
Speakers/Presenters:
Anke van Dam: Director, AIDS Foundation East-West
Natalya Shumskaya: Director, Public Foundation AIDS Foundation East-West in Kyrgyzstan 

Community-Based Efforts to Ensure Access to HIV Treatment
The work of the community within the project “Bridging the Gaps: Health and Rights for Key Populations”

When: March 25, 13:30 – 15:00
Where: Congress Hall 1
Speakers/Presenters: Anke van Dam: Director, AIDS Foundation East-West

Information Exchange and Cooperation between the European Union and the Countries of Eastern Europe and Central Asia Region
The main theme of this seminar is the expansion of HIV prevention and treatment services for key populations as a key element of the HIV response strategy in the EU and EECA region. Participants will become familiar with the most illustrative examples of the activities of the civil society as well as identify gaps that must be filled from the civil society’s point of view

When: March 25, 15:30 – 17:00
Where: BIRYUSA Hall
Speakers/Presenters:
Anke van Dam: Director, AIDS Foundation East-West
Olga Alexandrova: Head of the programmes and projects, East Europe & Central Asia Union of PLWH (ECUO)
Michael Krone: Executive Coordinator, AIDS Action Europe
Ljuba Böttger, Communications Coordinator, AIDS Action Europe

In addition to these, AFEW’s partners will be presenting their work with key populations.

Nadezhda Sharonova from NGO “Podruga” in Osh, Kyrgyzstan, will speak on the Specifics of Prevention and Treatment among Female Sex Workers.

When: March 25, 11:30 – 13:00
Where: PRESS ROOM

NGO “Podruga” is the only organisation in the south of Kyrgyzstan that works specifically with women who use drugs, sex workers and former prisoners.

Finally, AFEW is also involved in the key population photo exhibition “Every life matters”, jointly organised by partners of Bridging the Gaps. These are stories of six people that invite to step into their world and experience what it is like to be a drug user living with HIV in Nepal, a young gay man in Botswana, a female sex worker in Uganda, a male sex worker in Vietnam, a woman who uses drugs and a young gay man in Kyrgyzstan. The exhibition features a unique combination of photos made by these community members themselves and complementary photos that were made by award winning photographer Chris de Bode. Through their photo stories, we want to create more visibility about the challenges they encounter and the HIV risks they face.

The 5th Eastern Europe and Central Asia AIDS Conference will bring together 2500 scientists, experts, healthcare professionals, policy makers and civil society representatives who will exchange best practices and jointly strategize about how to achieve the UNAIDS target of ending the AIDS epidemic by 2030.

UNGASS

THE UNGASS OUTCOME DOCUMENT: DIPLOMACY OR DENIALISM?

CIVIL SOCIETY STATEMENT
THE UNGASS OUTCOME DOCUMENT: DIPLOMACY OR DENIALISM?

UNGASSMarch 14, 2016—We, the undersigned civil society organisations, representing drug policy expertise and affected communities worldwide, express our serious concerns about the preparations and draft Outcome Document for the UN General Assembly Special Session (UNGASS) on the “world drug problem” in April 2016.

UN Secretary General Ban Ki-moon called for the UNGASS to be a “wide-ranging and open debate that considers all options”, and an inclusive discussion was promised, taking into account the perspectives of all stakeholders, member states, UN agencies, academia and civil society. The UNGASS is a critical opportunity for an honest assessment of what is, and what is not, working in global drug control. It is an opportunity to find a new consensus that addresses the reality of the failure and negative consequences of existing policies.

The UNGASS process has failed to recognise the lack of progress achieved by international drug control over the past 50 years – substances under international control are more widely available and affordable than ever. It has failed to acknowledge the damage caused by current approaches: systemic human rights abuses, and continued use of the death penalty for drug offences; exacerbation of HIV and hepatitis C transmission; intolerably inadequate access to controlled drugs for medical purposes; 187,000 avoidable drug-related deaths each year; violence, corruption and killings perpetuated by criminal drug markets; systemic stigmatization of people who use drugs; destruction of subsistence farmers’ livelihoods by forced crop eradication; and billions of dollars of public money wasted on drug policies that demonstrably do not work.

Given the highly problematic, non-inclusive and non-transparent nature of the preparatory process, the UNGASS is now perilously close to representing a serious systemic failure of the UN system. By failing to engage in meaningful critique, new ideas or language, the UNGASS Outcome Document is at risk of becoming an expensive restatement of previous agreements and conventions. This would represent a major failing for the General Assembly – and a betrayal for the member states, UN agencies, civil society, and public who have demanded so much more.

Problems with the UNGASS preparatory process

The process has been dominated by the status quo forces of the Vienna-based UN drug control apparatus. The Commission on Narcotic Drugs (CND) and its secretariat in the UN Office on Drugs and Crime (UNODC) in Vienna were tasked with leading the preparations, instead of the UN General Assembly itself in New York. These Vienna institutions have actively sought to exclude innovative and forward-looking proposals from member states, other UN agencies, and civil society – perpetuating the same power struggles and paralysis that have hindered the Vienna debate on drug control for decades.

Many member states from the global south, notably the Caribbean and Africa, do not have permanent representation in Vienna and have been largely unable to participate in the negotiations on the Outcome Document. The General Assembly encouraged the participation of all member states in the UNGASS preparations and requested the “provision of assistance to the least developed countries” for this purpose; but no extra budgetary resources seem to have been made available. In order to ensure an “inclusive and effective preparatory process”, the CND secretariat set up a website that includes many useful contributions. However, the CND secretariat appears to use the website as a parking lot for dissenting ideas rather than promoting it as a resource for inputs in the negotiations. Finally, the negotiations have mostly taken place in closed informal meetings rather than official ‘intersessionals’ – excluding civil society participation and contributing to the lack of transparency.

These problems have been compounded by the self-imposed reliance on consensus-based decision-making in Vienna and a push from many member states to finalise the Outcome Document before it gets to the General Assembly. This means that a handful of vocal and regressive countries can block progressive language – whereas other parts of the UN system (including the General Assembly) take votes on key issues whenever needed. The notion of a global consensus on drugs is untenable: today, people face the death penalty in some countries for possessing drugs that are legally regulated in others. Consensus can be valuable, but where polarisation exists, it can result in statements that fail to capture genuine policy tensions that merit honest discussion and debate.

Problems with the draft UNGASS Outcome Document

Member states agreed to produce “a short, substantive, concise and action-oriented document” that proposes “ways to address long-standing and emerging challenges in countering the world drug problem”. Yet the draft Outcome Document is now a long way from this aspiration:

  • The current draft has sprawled to over ten pages and more than 100 paragraphs, yet includes almost no operational outcomes or actions to address the countless challenges, tensions and contradictions that exist in international drug control. Proposals that the UNGASS at least establish an expert advisory group to undertake a critical review and elaborate recommendations for modernising the system towards 20195 have so far been rejected.
  • Rather than considering “all options”, the draft simply reaffirms the current approach and is devastating in its failure to acknowledge the damage of punitive policies noted above. These costs have been highlighted repeatedly in submissions to the UNGASS from civil society, UN agencies and member states, yet the draft document claims “tangible and measurable progress”, providing no justification or explanation of what progress this refers to.
  • The current draft is not a balanced reflection of the formal UNGASS submissions and recommendations made by UN agencies. Many of these submissions explicitly call for ending the criminalization of people who use drugs, but this point has been excluded from successive drafts of the Outcome Document negotiated in Vienna demonstrating a lack of coherence across the UN family. Furthermore many inputs from the Civil Society Task Force, NGOs, member states and regional groups have also been neglected, most notably calls for the abolition
    of the death penalty for drug offences.
  • Despite explicit acknowledgement of the term ‘harm reduction’ by the General Assembly as long ago as 2001, there is no acknowledgement of the need fora harm reduction response to drug use in the draft Outcome Document. In addition, specific references to effective and life saving measures such as needle and syringe programmes, overdose prevention, and opioid substitution treatment are still under dispute. This is despite the fact that the European Union and multiple countries of Latin America and Africa have called for explicit recognition of harm reduction.
  • The draft Outcome Document reaffirms the call for “a society free of drug abuse” by 2019, a goal set by the 2009 Political Declaration. Since the 1998 UNGASS, convened under the slogan “A drug-free world, we can do it!”, drug use has in fact risen. This goal is not aspirational, it is delusional and dangerous, framing and distorting the entire policy response, prioritising the elimination of drugs above health, well-being, human rights, and the reduction of drug-related harm.
  • The draft is entirely out of sync with the realities on the ground in many countries – including the successful implementation of harm reduction programmes, a growing trend towards ending the criminalization of drug use, the exploration of regulated-market models for cannabis, the recognition of indigenous rights, as well as the social, spiritual and therapeutic uses of psychoactive plants. The reality is that globally, the outdated punitive enforcement paradigm in drug control is being challenged, reviewed, and reformed.

We call upon member states – especially those who have been shut out of the Vienna-based negotiations – to challenge the current draft of the UNGASS Outcome Document, to ensure the debate on it contents is not closed in Vienna, and to prepare statements expressing their disappointment and dissent at the UNGASS in April. We call on UN agencies, senior UN officials, academics, civil society, and networks of impacted communities to do the same. The UNGASS is a unique opportunity to take a stand and demonstrate leadership for drug policy reform, as we simply cannot continue with the same failed approach.

This statement has been made on behalf of:
[Names of signing orgs]