School for People Living with HIV

Today, the community of people living with HIV (PLWH) in Kazakhstan is actively developing – the voice of community can now be heard at all levels, up to the Ministry of Health and the Parliament.

An important role in achieving this progress belongs to the events for potential activists organized by the Kazakhstan Union of PLWH together with AFEW Kazakhstan. One of them is a series of workshops called “School for People Living with HIV”. Such workshops are aimed at developing the community of PLWH to scale up the advocacy to promote their rights and interests and ensure care and support for PLWH at the local and national levels. They are organized with financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria within the project “Building Foundation for Sustainable HIV Response in Kazakhstan”. Yagdar Turekhanov, Program Advisor at AFEW Kazakhstan, told about the progress achieved.

 

Yagdar, what is the School for PLWH and how was it established?

The first workshop of the School for PLWH was held in November 2018 and brought together over 50 PLWH from all over the country. They were “newbies” – most of them just recently learned about their HIV status and did not have any experience of working in HIV organizations. People were enrolled after a competitive selection by motivation letters. It was a basic workshop where the participants learned about HIV, its treatment, and the role of civil society. They also received support in accepting their HIV status, bolstered their self-esteem and confidence. Following the first workshop, 25 most active participants who demonstrated their leadership skills, were selected. The goal of those workshops was to train a young generation of activists and to mobilize the regions to make the PLWH community of Kazakhstan act in a more targeted and coordinated way.

How would you describe the profile of the school participants?

Most trainees of the school are people who earlier had an experience of participating in similar activities, mobilized their peers and established local NGOs, making a significant contribution to the promotion of PLWH rights, reduction of the ART prices, etc.

What is the situation with PLWH rights in Kazakhstan?

The situation is different, and currently it greatly depends on separate individuals – friendly specialists, doctors, police officers, and workers of penitentiary facilities – as well as on the bravery and knowledge of the activists. Where such people are not numerous, the situation with observing the PLWH rights is disastrous.

What should a person do in case if his or her rights are violated?

Be brave enough to talk about it. File the case. Make a precedent. For this purpose, the person may ask more experienced community members and friendly lawyers for help.

Since 2019, Kazakhstan started using the ‘test and treat’ strategy. What does it mean?

For Kazakhstan, this approach, first of all, means breaking the stereotypes, challenging the traditional perceptions and the wide-spread myths about ART. It means fighting the “bonuses schemes”, when people take therapy only to get some incentives, but not because they see the linkage between ART and better quality of life. It includes working with health professionals, who can formally observe the protocols, but in some indirect ways, with their intonations, phrases, or even directly make their patients understand that they do not believe in what they do. E.g., they can often say something like “According to the new rules, I have to prescribe therapy to you, but you can refuse, all the more so because you have pretty good test results and those drugs are chemical anyway” or “I realize that you want to give birth to a child, but still you have to think twice as your husband has HIV and even if he does not transmit the virus to you – what will be the future of your child?” We try to change this kind of approach.

Is there a place for innovations in the PLWH community of Kazakhstan?

The active part of PLWH community is, of course, open to innovations – they are ready to introduce new approaches as soon as they learn about them or come up with them. Most of the general population are kind, empathetic people who are totally unaware of the modern scientific achievements in terms of HIV prevention and treatment. They are afraid for themselves and for their loved ones, thinking that HIV is a death sentence. Many people still think that HIV is transmitted through household contacts (“I know that HIV is not transmitted through air or touch, but just in case I would better protect my children from contacts with HIV-infected people”). It looks like this situation can only be changed by young people who are in their nature more open to new things, more tolerant and less prejudiced. Efforts aimed at young people, primarily at the students of medical colleges and universities, with the involvement of PLWH community, can gradually change the status quo. By the way, it is already happening – slowly but surely.

Will there be any workshops in future? Who will be able to participate in them?

Funding of such activities is currently very doubtful – donors gradually lose their interest to Kazakhstan, while attracting government funding is so far rather challenging. However, PLWH community is looking for new opportunities. Apart from the Schools for PLWH, PLWH camping events are held on a regular basis, where people more and more often pay for their own participation. Information about such events is shared through HIV NGOs, AIDS centers, social networks and messengers. The priority is given to “novices”. More experienced PLWH community members can try on the role of trainers after passing a competitive selection.

 

 

 

 

 

EECA INTERACT 2019

We are pleased to announce that, on the 18-19th November 2019, the first EECA INTERACT Workshop 2019 will take place in Almaty, Kazakhstan.

The EECA INTERACT 2019 Workshop builds scientific research capacity while simultaneously strengthening clinical, prevention, and research networks across the Eastern Europe and Central Asia (EECA) region. EECA INTERACT 2019 is an abstract-driven workshop focusing on factors unique to the region’s HIV, TB, and hepatitis epidemics. Bringing young and bright researchers together with top scientists, clinicians, and policymakers, EECA INTERACT 2019 aims to ignite a conversation that will build a stronger scientific base to serve the region and connect to the world.

EECA is the only region in the world where the HIV epidemic continues to rise rapidly. UNAIDS estimates point to a 57% increase in annual new HIV infections between 2010 and 2015.1 The World Health Organization has warned of a sharp rise in rate of HIV and tuberculosis coinfection, which poses a real threat to progress.2 Significant barriers to prevention and treatment services remain for people living with and affected by HIV, TB, and hepatitis across the region. For example, although the HIV epidemic in EECA is concentrated predominantly among key populations, particularly among people who inject drugs, coverage of harm-reduction and other prevention programs is insufficient to reduce new infections. The region urgently needs more effective strategies of prevention, treatment, and care and support that are tailored to the particular circumstances of individual countries.

The Amsterdam Institute of Global Health and Development (AIGHD) has over a decade of experience delivering in-country workshops and conferences that bring young researchers and established international experts together to share original research and state-of-the-art reviews on a wide range of topics. AIGHD has co-hosted the INTEREST Conference (the International Workshop on HIV Treatment, Pathogenesis, and Prevention Research in Resource-limited Settings) since its inception in 2007. The conference has grown from a small workshop to a full conference of more than 500 attendees each year.

Building on these proven results, AIGHD will collaborate closely with AFEW International and the AFEW network (AFEW) for EECA INTERACT 2019. AFEW’s deep roots and experience in the region offer a way to build sustainability into the new workshop, placing priority on local contributions. The EECA INTERACT 2019 will bring scientists, clinicians, members of civil society, and government officials together to tackle topics facing individual countries while building capacity and strengthening research and clinical networks. The two-day conference will focus on topics that are specifically relevant to EECA and dive deeply into particularities of the host country Kazakhstan, showcasing its successes, remaining challenges and responses.

The workshop objectives are:

  • To provide cutting-edge knowledge in the fields of epidemiology (modelling), treatment, pathogenesis, and prevention of HIV, TB, and viral hepatitis as well as chronic conditions;
  • To exchange ideas on providing and supporting HIV testing services and clinical care provision to adults, adolescents, and children living with HIV to achieve 90-90-90 goals;
  • To foster new research interactions among leading investigators and those who represent the potential future scientific leadership for health care and research in the region;
  • To build research and clinical capacity across EECA.

We invite researchers from EECA to submit their abstracts in the workshop. Selected abstracts will get free registration. Please find here more information.
Interested parties who do not have abstracts, but also wish to attend the event, can fill in an application form that will be considered by the committee. Please find here more information.

The deadline for all applications is September 20, 2019.

EECA INTERACT 2019 is organized by AFEW International, Amsterdam Institute of Global Health & Development (AIGHD), AFEW Kazakhstan and the Kazakh Scientific Center of Dermatology and Infectious Diseases.

EECA INTERACT 2019 is sponsored by Johnson & Johnson and Aidsfonds.

If you have any further questions, please contact Helena_Arntz@AFEW.nl.

 

 

Rehabilitation in a Dutch Way: Learning to Take Responsibility for Yourself and for Others

Author: Olesya Kravchuk, AFEW International

The ferry boat brings people to the island Texel in the Netherlands several times per day. Just a few minutes’ walk from the ferry stop there are several cosy houses. Near one of the houses, there is a hedge, behind which there are three goats. They are not afraid of visitors, and immediately come up to you and check you out. Residents of the house clean its territory and cook dinner. It is the usual Dutch routine, but the atmosphere is somehow different…

For more than 40 years already de Skuul Foundation (Stichting de Skuul) has been working on the island. It is an independent institution that specialises in assisting in the rehabilitation of people who take drugs. They also help those who have alcohol and gambling addictions.

“The fact that our residents are on the island creates a special atmosphere. In this way, they stay in a neutral environment,” says Aglaia Westra who works as a therapist at the Foundation. She has been working here for six years. “There are usually 16 residents who live here, and they live in a mini-society. They form the groups of eight people, and everyone has a task for every day. Someone, for example, goes to buy food, someone cleans the territory, and someone cooks food. That is how they learn to take responsibility for themselves and for others.”

The main thing is not to lose touch with reality

The clients of the Foundation come here after the referral of their general practitioner. De Skuul is financed via the insurance companies, local government and business representatives. In order to get into the rehabilitation programme, you need to go through the detox programme already at home. The first four weeks of their stay in De Skuul, its residents stay only on the island. After four weeks you can (and even have to) go home for the weekend. Foundation employees say that it is very important not to lose touch with reality. During the rehabilitation programme, its participants work with a psychotherapist. They also have visiting teachers who teach them singing, drawing and other crafts. The programme starts every day at 9 am and lasts until five in the evening. In the evening, the Foundation’s residents live their normal lives: they jog, read and walk by at the Wadden Sea that surrounds the island.

There are also rules here: violence and cruelty, drugs and alcohol, and mobile phones are prohibited. It is necessary to respect others and to be present during all activities within the rehabilitation programme. Violation of these rules leads to the end of rehabilitation.

“We have group sessions. Usually, it starts with one person is talking, and it becomes more like a monologue,” tells Aglaya. “We believe that everyone builds their own way while experiencing their own feelings and emotions. We use the principle of self-help and trust residents in how they lead their lives and what they do in their free time. The most important thing is that we teach responsibility. It is like a kindergarten, where you can try everything and learn again.”

The period after rehabilitation is harder than the period before it

The Foundation’s clients say that they came here to get acquainted with themselves again and to get away from their addiction. They say only good things about the rehabilitation programme. The hardest part starts when you return back home.

“I came here only yesterday,” says Linda from the Netherlands (the name is changed) with the tears in her eyes. “This is not my first rehabilitation programme, and I very much hope that this programme will help me. Working with yourself during the rehabilitation period is not that hard. Then you follow the same pattern at home. Later though it comes the time when you go back to your old habits. I think it very important to combine treatment with reality, and de Skuul is doing this.”

Every year about 50 people are being treated in the Foundation. On average, de Skuul accepts one new person per week. Each resident stays in the programme on average for 3-6 months. Each resident himself decides when his rehabilitation ends. After the programme, if necessary, ex-residents can always call Foundation employees and ask for help. Every six weeks, former residents come to the Foundation if they want to share their experiences and hear the stories of others.

Treatment based on commitment and not punishment

The rehabilitation centre Kentra24 in the city of Sint-Oedenrode in the Dutch province of Brabant is located in an old monastery. On the windows here, there is old religious stained glass, and in the inner monastery courtyard you can meet your new friends. Young people between the ages of 12 and 24 years old who cannot control their stimulants or gambling addiction have their rehabilitation here. The rehabilitation programme includes preventive, outpatient, clinical and online assistance. At the same time here there can be 40 clients for whom about 80 employees provide services. Not all customers in the centre spend nights here, some only have a daily programme. Both boys and girls are undergoing rehabilitation.

“Most of our clients are in the centre voluntarily, but sometimes someone comes after a court decision,” says Judith who works in the centre. “We want the parents of young people who have treatment with us to be also involved in the rehabilitation process. But those adolescents who are already over 18 decide themselves how much they want to involve their parents.”

There are four groups of clients in the centre. The first group is those who undergo a detox, and all the other groups are undergoing rehabilitation. Young clients of the centre have four phases of rehabilitation: zero phase is the most strict one, the third phase is the one during which there is more freedom. For example, during the zero phase it is impossible to leave the territory of the centre, but in the third phase this can already be earned as a reward. Moving to the next phase is possible by showing good behaviour and progress in the rehabilitation process. Usually, the clients stay in the centre for 3-4 months.

“Our treatment is based on commitment and not punishment. Each of our clients has his own goal and is working towards achieving this goal,” continues Judith. “If the goal is achieved, the client gets the reward. For instance, this can be some additional time online, or purchase of the new bike, or visit of the parents with a favourite pet, or additional phone call, and much more.”

Not to have an addiction is already a success

Each of those clients who stay in the centre overnight has their own private room, where other clients are not allowed. For communication, there is a joint living room with a kitchen, where clients prepare their own food. The rehabilitation programme also includes sports at the local gym, creative workshops, work on various projects, setting goals for the week and homework. There are rules: customers cannot freely use their phones or computers.

“I decided to come here because I realised that my life was going all wrong,” says 20-year-old Jan (the name is changed). “Because I used drugs, I started to close up and drifted away from my parents and my younger sister. It feels like I lost three years of my life. After the rehabilitation programme I plan to finish school, start working and living independently. It is my goal.”

The staff of the centre understands that after the rehabilitation programme some of their clients will still use drugs or alcohol and they are loyal to this.

“After all, the main thing is not to stop taking drugs, but to know why you are doing this,” says centre employee Steve. “If there is such understanding and after the programme a person will take drugs or alcohol sometimes, and not have an addiction – this is already a success.”

United Nations and World Leaders Condemned for Failure on Drug Policy, Health and Human Rights

Wednesday 1 May,  2019, Porto

As the 26th International Harm Reduction Conference comes to a close, hundreds of health professionals, academics, drug policy and human rights experts, frontline workers and people who use drugs released a statement calling on world leaders to urgently address the health and human rights crisis among people who use drugs.

Signatory NGOs shed light on the alarming public health emergency faced by people who use drugs. Between 2009 and 2015, the number of drug-related deaths rose by a worrying 60%. In 2015 alone, this culminated in a total of 450,000 deaths – an estimated 50 deaths every hour. The target to halve the incidence of HIV among people who inject drugs by 2015, set eight years ago, was spectacularly missed by 80%, and HIV prevalence increased by one third among people who inject drugs over the same period. Furthermore, globally, six in ten people who use drugs are living with hepatitis C, while 168,000 people who use drugs were reported to have died of an overdose in 2015 alone.

These health harms are preventable. The evidence, presented at the Conference this week, shows that harm reduction and human rights-centred drug policies can save lives, prevent the spread of HIV and hepatitis C, and promote the dignity and empowerment of people who use drugs. But this requires leadership from both governments and the UN.

Naomi Burke-Shyne, Executive Director of Harm Reduction International (HRI), said: ‘The evidence for harm reduction is indisputable. It is nothing short of disgraceful that governments continue to fail to support and invest in health services for some of the most marginalised people‘.

The joint NGO statement also expresses serious concerns over the ability of the UN Office of Drugs and Crime (UNODC) to adequately lead the UN response on this issue. By its very mandate and construction, the UNODC remains more attuned to the law enforcement response to drugs. As a result, UNODC leadership has consistently failed to unequivocally champion harm reduction, human rights and decriminalisation,and has lost further creditability with repeated silence in the face of egregious human rights violations. Today, people who use drugs continue to be victims of incarceration, compulsory detention, denial of access to healthcare, corporal punishment, institutionalised violence, stigma and discriminations, and – in the most extreme cases – extrajudicial killings.

In response to the vacuum of political leadership, NGOs conveying in Porto have called for global leadership to protect the human rights of a ‘population under attack’ and demanded that these unacceptable human rights abuses to come to an end.

Ann Fordham, Executive Director of the International Drug Policy Consortium (IDPC), stated: ‘With just over ten years left for countries to meet their global commitment to champion health, reduce inequalities, and provide access to justice for all, as enshrined in the UN’s Sustainable Development Goals, there has never been a more urgent need to strengthen political leadership at all levels. Faced with the current crisis, complacency can no longer be tolerated’. 

Source: https://idpc.net/

Increased Access to Healthcare Facilities for Pregnant Women who Use Drugs in Kyrgyzstan

A total of 8,392 people living with HIV (PLHIV) were registered in the Kyrgyz Republic on 1 July 2018. Transmission of HIV is connected to drug use. Recently, sexual transmission has become a popular mode of transmission as well. While the total registered injecting HIV cases have decreased by almost 30% over the past nine years (2008-2017), the incidence of drug use in certain regions of Kyrgyzstan remains high. Moreover, the number of new HIV cases among women increased by almost 10% over the past nine years (2008-2017).

In Kyrgyzstan, women who use drugs still have limited access to obstetrics-gynaecology services and often face stigma and discrimination from the medical staff. With a lack of knowledge among doctors on how to best support and treat pregnant women with substance dependence, women were sent to abortion clinics even after the acceptable period for termination of pregnancy. In general, it was not known that women who use drugs could get healthy children. Women who use drugs themselves were also afraid to be denied medical care when doctors would find out they used drugs.

A working group composed of the Kyrgyz community-led organisation (CBO) Asteria and representatives of the Ministry of Health, National Centre of the mother and child protection, National Narcology Centre, and State Institute of postgraduate education and a specialist on evidence for medicine was set up and coordinated by AFEW Kyrgyzstan.  A new clinical protocol was developed reflecting the needs of women who use drugs under the guidance of these women themselves. The clinical protocol Care in pregnancy, childbirth and the puerperium for women who use psychoactive substances was developed and approved as a Clinical Guideline by Kyrgyz Ministry of Health in January of 2017.

Medical staff in Kyrgyzstan was subsequently trained on implementation of the guideline. A representative of the Kyrgyz State Medical Institute for post-graduates reported that the knowledge of the doctors increased by 80% after trainings have been carried out. So far, 100 staff of the medical Institute and gynaecologists at the primary health care and maternity hospitals of Bishkek and Osh have been trained.  The implementation of the clinical guideline is under control of the Ministry of Health of Kyrgyz Republic. Stigma and discrimination from health care providers and policymakers against women who use drugs have decreased significantly. Service providers now understand better that proper care during pregnancy for all is a chance for improving the health of mother and child.

“I used drugs for 10 years, was detained several times, was released, and lived without documents. Then I joined the Opioid Substitution Therapy (OST) programme, restored my documents, got a job, got married. When I applied for medical services when I was pregnant, the doctor insisted on an abortion, saying that the child would be born inferior. I gave birth; the child is healthy, now he is 2 years old and 7 months”.

L. PF Podruga, Osh, a client of a community centre for women who use drugs

With the support of the Bridging the Gaps programme, it was possible to integrate harm reduction with sexual reproductive health and rights for women who use drugs. Sustainability of the guideline’s implementation has been secured thanks to the inclusion in the National Medical Institute of Postgraduate Education and the World Health Organisation’s Compendium of good practices in the health sector response to HIV in the WHO European Region. AFEW-Kyrgyzstan closely monitors the implementation of the guideline.

Pain Relief: Ukraine is on the Way to Legalizing Medical Marijuana

Authors: Yuliana Skibitskaya, Yana Kazmirenko, Ukraine

Ukraine may become the 14th European country to allow the use of medical cannabis. Activists are looking forward to the next move – drug policy liberalization.

Ukraine has taken the path of legalizing medical cannabis. In two months, a petition registered on the Ukrainian parliament’s website has collected 25,000 signatures, which makes it mandatory for MPs to review it. According to the petition’s authors, about two million Ukrainian citizens currently have no access to this effective therapy, which can help people with cancer, war veterans and patients in palliative care. Ulana Suprun, acting minister of health of Ukraine, also supports the legalization of medical marijuana. She says that the “rational” use of cannabis for medical purposes is legitimate. It is expected to be made available in pharmacies by prescription.

The draft law may be considered in May-June

The civil society movement for legalizing medical marijuana is led by the NGO 100% Life, the Ukrainian Association of Medical Cannabis, and 16 other civil society organizations.

On 20 March 2019, the relevant parliamentary committee considered the petition but failed to support it as there was no quorum at the session. MPs appealed to the Cabinet of Ministers with a suggestion to amend the current list of narcotic substances, which prohibits the use of cannabis in Ukraine for medical and research purposes. Cannabis would still be considered a narcotic drug but would be allowed for medical use.

“The Human Rights Committee supported the petition. Now MPs have a free hand, they can register a draft law based on the petition,” says one of the authors and leader of 100% Life, Dmitry Sherembey. “There is a group of MPs which supports us. We expect that in May-July the draft law may be registered and considered by the current parliament.” (In autumn Ukraine will hold parliamentary elections – note of editor).

Another author of the petition, Gennadiy Shabas, who heads the Ukrainian Association of Medical Cannabis, says the law should clearly define the rules of using cannabis for medical and research purposes in order to avoid any risks.

Medical marijuana may be used in HIV treatment

There have long been attempts to legalize medical marijuana in Ukraine, but significant progress was achieved only last year when the Ministry of Health openly supported civil society activists. For several years in a row, Cannabis Marches of Freedom have been held in Kyiv, with participants calling on the government to legalize cannabis.

Medical marijuana helps patients with cancer and Alzheimer’s disease, but can also be used for HIV therapy. Apart from the fact that medical cannabis relieves pain, scientists have discovered that people living with HIV who smoke marijuana have higher CD4 counts and lower viral load compared to patients who do not use this kind of therapy. Cannabinoids also help to tolerate opioids, which are often prescribed to AIDS patients. Marijuana prolongs the pain-alleviating effect, improves appetite and prevents tolerance and addiction to “hard” drugs.

Dmitry Sherembey explains that marijuana removes pain syndrome so that the body can direct its resources not at overcoming pain, but at fighting infection. Thus, cannabis not only makes life easier for patients, but it also improves their prognosis for fighting the disease, especially in the case of cancer.

“For instance, even if doctors gave a patient only three months, his prognosis may be improved by up to three years,” he says.

Legalization to reduce stigma

Velta Parkhomenko, the coordinator of the Ukrainian Union of People Who Use Drugs and manager of the NGO Eney Club, thinks that amending legal regulations on the use of medical cannabis is an important step for Ukraine in general, and especially for the community of people who use drugs.

“Legalization of medical cannabis will allow us to accelerate the process of humanizing drug policy. We are convinced that the fewer myths and stereotypes there are around psychoactive substances, the simpler it will be for us to talk about the problems of people who use drugs,” says Velta.

Another argument she offers is that legalizing medical marijuana will reduce stigma and discrimination and reaffirm the widely-recognised fact that drug dependence is not a crime but a chronic, recurring disease.

The activist hopes that the process will not stop with medical cannabis. The next logical steps should be to humanize drug policy, amend the table of maximum allowed quantities of narcotic drugs, and introduce changes in legislation.

Medical marijuana does not alter awareness and does not affect mental states

Medical marijuana is a medicine based on the active components contained in cannabis. The truth is that not all cannabinoids have a narcotic effect. That is why medical marijuana, as opposed to other types of marijuana, does not alter awareness or affect mental states. It may be administered in different ways, such as traditional smoking as well as pills, oils and other pharmaceutical forms.

Today, medical cannabis is mainly brought to Ukraine from neighbouring Poland, where it is sold in pharmacies. However, at present importing cannabinoid-containing medicines to Ukraine is equivalent to drug trafficking.

The ‘Vienna Consensus’ Stifles Progress on UN Drug Policy

The International Drug Policy Consortium (IDPC), a global network of more than 180 NGOs that come together to promote drug policies that are based on human rights, human security, social inclusion and public health, express our disappointment with, and concerns about, the Ministerial Declaration ‘Strengthening our actions at the national, regional and international levels to accelerate the implementation of our joint commitments to address and counter the world drug problem’, adopted today in Vienna by the United Nations.

While we acknowledge that the statement represents limited progress in some areas, we regret that it repeats the mistakes of the past and was negotiated in the absence of a genuine and honest evaluation of the past decade, since the adoption of the 2009 Political Declaration and Action Plan on Drugs.

In the lead up to this Ministerial Segment, IDPC called repeatedly on Member States to formally and honestly evaluate progress made towards the overarching goal, in the 2009 Political Declaration, to significantly reduce or eliminate the illicit drug market, as well as in the implementation of the UNGASS Outcome Document. Unfortunately, a formal and comprehensive review of the past decade of drug policies was not conducted by governments or the UNODC. The lack of appetite for a formal review illustrates the fact that governments are still unable to accept that decades of attempting to eradicate the global illicit drug market through punitive and repressive measures have failed.

In the void left by the lack of such a review, IDPC produced a civil society ‘shadow report’ titled Taking stock: A decade of drug policy which clearly demonstrates the impossibility of credibly claiming any progress made to date, given that the illicit drug market is larger and more robust than ever before, while drug-related and devastating policy harms are on the rise. Ten years ago, the previous UNODC Executive Director, Mr. Costa had already referred to the ‘unintended negative consequences’ of drug control as part of the previous 10-year review – that paper is unfortunately as relevant today as it was ten years ago.

Ahead of the 2019 Ministerial Segment, the IDPC network had developed four policy recommendations which remain relevant for our assessment of the Ministerial Declaration adopted today.

Read full statement in English here.

Source: www.idpc.net

People who Use Drugs Deserve Love, Respect and Support

Author: Grana Ziia, AFEW-Kyrgyzstan

Sergey Bessonov from Bishkek is the head of the organization that protects the rights of people who use drugs (PWUD) – “Harm Reduction Network Association” (HRNA). Sergey himself used drugs in the past. However, he admits that everyone has the right to make his own choice whether to stop using drugs or not.

Now Sergey dedicates his life to the community of people who use drugs. In his interview with AFEW-Kyrgyzstan, Sergey is talking about the challenges of the community of people who use drugs in Kyrgyzstan, drug policy and his future plans. Below are some of Sergey’s thoughts in direct speech.

About the desire to be heard

For a long time, the problem of drug use was solved by using strict bans: prisons, fines, and information that PWUDs are no longer members of our society, that they are somehow bad, dangerous… I myself know a lot of people who died from the overdose, I saw people who spent most of their lives in prisons for using soft drugs. These people were left without work, housing and the possibility to live the life they wanted to.

Now in Kyrgyzstan, the government started to understand that a progressive drug policy cannot be built without a community. However, it is very important for us that the community participation in the development of programs was not just for show. We want our opinion to be respected, considered and trusted. We need the possibility of professional growth.

About the professional growth

The project “Bridging the Gaps: Health and Rights for Key Populations” (BtG) started to help us a few years ago. Over the past two years, this project gave people from the community the possibility to take part in trainings on negotiation skills, legal monitoring by the community, analysis of regulatory legal acts.

These trainings helped us to develop some of our skills. Using this knowledge, people from our community started to develop their own organisations, participate in working groups with governmental representatives and implement advocacy programs.

About the new drug policy

Last year, our country started talking about changes in criminal and administrative codes. Governmental representatives finally understood that sending people who use drugs to prison instead of rehabilitation and harm reduction programs is ineffective and cruel.

During the analyses of new regulatory acts that HRNA conducted with the support of the BtG project and AFEW-Kyrgyzstan, we found some negative changes. For example, new amendments, which now started to work, increased the fine for carrying and possession of drugs twice. The new fine is unaffordable, which means that people will again be imprisoned. Now we are negotiating with international and state structures, with other NGOs and explaining to them why this novelty needs to be revised.

BtG also provided us with an opportunity to conduct focus groups among PWUDs. We found out that not all people are aware of the new laws. This creates extortion and corruption. Now we are constantly monitoring new cases of detention of drug users and support people who use drugs.

About the alternative to prisons

According to the new offense code of Kyrgyzstan, alternative punishment that is called probation is provided for people who use drugs and who have committed any kind of offense. Therefore, now a person has an opportunity to avoid prison.

The initiative itself is very good and we now have a lot of work for its successful implementation. We have already come to the agreement with several probation services and they are letting us know if a person who uses drugs came to them.

HRNA also plans to work with judges to explain that we should punish people only for offenses, not for using drugs. People in our country still have many stereotypes towards people who use drugs. These stereotypes can influence judges’ decisions about sending a drug user to prison or probation.

About the needs of the community

People who use drugs almost always remain alone. Parents turn away from them, doctors reject to help, friends betray them, mass media use offensive words, police suspect them in all crimes. Sometimes we become the only home and friend for each other. With our examples, we show that people who use drugs deserve love and respect.

To help our community to be strong and united, the BtG project is supporting our dialogue platform. Thanks to this, we can meet, discuss and stay united. I feel that the community is getting stronger and more confident with years passing by.

Together we build a liberal healthy future in Kyrgyzstan, where every person can get help and fulfill their potential.

AFEW-Kyrgyzstan Uses the Experience of Foreign Colleagues

216 adolescents were registered for using psychoactive substances in 2017, according to the Narcology Center in Bishkek. Representatives of the police services in Bishkek stated that there is also a high possibility that 1,031 teenagers, who were registered for committing different offences in 2018, had an experience of using psychoactive substances or are at a high risk of starting to do so. However, this data does not show the real situation. In Kyrgyzstan, there are still no complete official data on the exact number of adolescents who use psychoactive substances.

This is related to several factors. One of them is that the drug policy of the country is still strict and aimed to punish. Parents and children who face the problem of using psychoactive substances are afraid of getting help from medical specialists because the doctors will add teenager’s name to the special database. In the future, being in this database will not allow this teenager to be enrolled at the university or to get a high-paid job.

Another issue is that the country is lacking ways to support such adolescents. There is also a lack of a comprehensive program for the prevention of drug use among teenagers. The combination of all these factors does not allow the country’s specialists to work effectively with adolescents and to carry out preventive work.

Bridging the Gaps: health and rights of key populations (BtG) project, implemented by AFEW-Kyrgyzstan, intends to apply international experience to help adolescents who use psychoactive substances in Kyrgyzstan. BtG has regional exchange platforms, where specialists from EECA can share with each other their experience concerning harm reduction and rehabilitation issues. It helps the project to meet contemporary challenges. AFEW-Kyrgyzstan is aiming at creating a multifunctional mechanism that will help adolescents who use psychoactive substances and a professional system for preventive teenagers from using it.

The protocol is approved by the Ministry of Health

The clinical protocol ‘Mental and behavioural disorders due to the usage of new psychoactive substances among children and adolescents’ was developed with the support of AFEW-Kyrgyzstan and approved by the Ministry of Health in 2017. Professional narcologists and members of the community of people who use psychoactive drugs and other specialists developed the protocol.

“The developed clinical protocol gives the recommendations to emergency medical doctors, toxicologists, family doctors, resuscitators, psychiatrists and narcologists,” says Elmira Kaliyeva, a participant of the working group that developed the protocol.

Having developed the protocol, AFEW-Kyrgyzstan began trainings for narcologists, doctors of family medicine centres, teachers of the Kyrgyz State Medical Institute for post graduates and juvenile inspectors in Bishkek and Osh.

Working for the future

The representatives of the UN Children’s Fund (UNICEF) got interested in the protocol too and the BtG work and approached AFEW-Kyrgyzstan with a proposal to teach doctors in remote areas of Bishkek to work with this protocol. The proposal of UNICEF gave the opportunity to expand the circle of specialists familiar with the protocol. In addition, this cooperation will allow AFEW-Kyrgyzstan to be confident that all the work done in the framework of the BtG project will continue in the country for many years.

Waiting for the city hall’s help

Establishing cooperation with government partners to ensure stable and long-term support for adolescents who use drugs was the next task of the project. In June 2018, within BtG project, AFEW-Kyrgyzstan supported a round table organized by the city administration for the presentation of the Comprehensive City Program Prevention of Juvenile Offenses for 2018-2020.

Deputies promised to consider the proposed Comprehensive City Program which also includes recommendations that were listed in the developed clinical protocol. The adoption of the program will allow to create a cross-sectorial system of cooperation in the country, where the various departments can work together and redirect children who use psychoactive substances to help them as efficiently as possible.

Opening a centre for teenagers

The round table also became a platform for discussing the urgent need of opening a specialized centre to support children and adolescents who use psychoactive substances.

“We are in favour of building a modern centre that is capable of providing quality support to adolescents and is able to give parents verified and necessary information. This centre will become a model for working with adolescents from a key group as well as an educational and methodological centre for social pedagogues, juvenile inspectors and psychologists,” says Natalya Shumskaya, head of AFEW-Kyrgyzstan.

Taking into consideration that Kyrgyzstan’s culture is very traditional, there is a common misconception that people who use psychoactive substances are not good members of the society. This stigma leads to several issues. For example, teenagers are scared to talk with someone about the use of psychoactive substances. They are afraid of being expelled from the school or being suspected in crimes only due to their experience of using psychoactive substances.

“The center is also going to work on increasing the level of acceptance of psychoactive substances use among the society. This will lead to more effective support from the side of adults and to less risky behavior of adolescents as they got all proper information they need. It is the first step that can lead to final abstinence,” says Chinara Imankulova, manager of BtG project in AFEW-Kyrgyzstan.

AFEW-Kyrgyzstan specialists already developed a project of such centre. The centre will also work with those who have never used psychoactive substances and with children who are in high risk of starting using them. The prevention work will include helping teenagers to organize their leisure activity and to give them information that usage of psychoactive substances is not shameful, however it is important to ask yourself whether you are aware of the risks and if you really want to do so, to find solid information and to ask for help of professionals.

Creating the centre and the approval of the Comprehensive City Program will help thousands of teenagers to make healthy choices for a happy life.

Under 16 and Above: Protecting the Rights of Adolescents and Preventing HIV

Author: Yana Kazmirenko, Ukraine

Shortage of HIV prevention programmes for young people was one of the key topics discussed at the 22nd International AIDS Conference (AIDS 2018). At the conference, AFEW-Ukraine presented its best practices in HIV response among young people. Since 2012, it has been supporting the initiatives aimed at most-at-risk adolescents within the Bridging the Gaps: Health and Rights for Key Populations project funded by the Dutch Ministry of Foreign Affairs.

Gaps analysis

Over the course of project implementation, social welfare centres for adolescents who use psychoactive substances were established in Kharkiv, Poltava, Kropyvnytskyi and Chernivtsi and a rehabilitation day care centre for such young people was opened in Chernivtsi. In 2017 only, over 12 hundred adolescents received 21,290 services in those four cities.

Olena Voskresenska, Director of AFEW-Ukraine, recalls that when the project just started, a gap analysis was conducted. It turned out that there were a lot of programmes for adults who use drugs, while few donors were supporting similar activities for adolescents. It was considered that this population does not make a considerable contribution to the HIV epidemic. Thus, both most-at-risk adolescents and generally schoolchildren and students of vocational training centres remained out of focus.

“Of all the countries involved in Bridging the Gaps project, Ukraine is unique in terms of the activities implemented for under-age drug users. We work with non-injecting drug users trying to prevent them from switching to injecting drugs,” says Olena.

Children do not use drugs

One of the main achievements of AFEW-Ukraine is developing a tool to monitor the violations of human rights of most-at-risk adolescents. Questionnaires are used to collect data on adolescents’ rights violations, providing urgent response and legal support. Iryna Nerubaieva, AFEW-Ukraine Project Manager, thinks that in the Ukrainian society there is a strong belief: children cannot use drugs and they do not use them.

“This community is invisible and unheard. Most often, adolescents do not know about their rights, do not know that they have any rights or how these rights are to be protected,” says Iryna.

Adolescents – mostly high schoolers and students of vocational training centres – are brought to the community centres by their friends. Often they are referred by social welfare institutions, departments of juvenile services and even police.

Currently, AFEW-Ukraine works in four cities of Ukraine: Kharkiv, Chernivtsi, Kropyvnytskyi and Poltava. Besides, thanks to the cooperation with Alliance for Public Health, since 2017 the activities for adolescents, including monitoring of human rights violations, have been conducted in five more cities of Ukraine.

Testing as a prevention tool

At the conference, Yevheniia Kuvshynova, Executive Director of Convictus Ukraine, implementing partner of AFEW-Ukraine and Alliance for Public Health, told about the Voice of Adolescents project, which covers 717 adolescents.

The Underage, Overlooked: Improving Access to Integrated HIV Services for Adolescents Most at Risk in Ukraine project is aimed at teenagers who use drugs and live in small towns and villages in seven regions of Ukraine. Adolescents from Kyiv attend the Street Power youth club. In this club, teenagers who use psychoactive substances and practice risky injecting and sexual behaviours can watch films, play computer games and receive social support.

According to Yevheniia, most of them use non-injecting drugs and HIV testing for them is rather a prevention tool. So far, no HIV cases have been detected. Adolescents are tested for hepatitis C and B as well as sexually transmitted infections.

For many years, Convictus has been working with adults who inject drugs providing services to 11 thousand people. Working with adolescents is different: they are tested only starting from 14 years of age, with a social worker and a doctor involved.

“One of our priorities is building a network and a map of services, so that adolescents could go to any organization of the network and receive services from our partners. If a person coming to us needs more in-depth support, we provide such support and also help him or her with clothes as we maintain a clothing bank,” tells Yevheniia.

Convictus is planning to develop a School of Leadership and a sexual health programme for girls, which are to close more gaps in the system of HIV prevention among most-at-risk adolescents in Ukraine.