AFEW Tajikistan’s Offers the Range of Unique Services

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

Empowering women is the aim

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

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

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

Starting vocational training

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

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

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

AFEW Shared Techniques of Relaxation in Kyrgyzstan

The community dialogue platform gathered for the summer school last week in Kyrgyzstan. This summer school was organised within ‘Bridging the Gaps’ programme. The director of programs of AFEW International Janine Wildschut attended the school. After some days of serious work in which the community discussed struggles they face in Kyrgyzstan and how they can come up with a united voice, a training on burnout syndrome and how to prevent it was arranged.

“For many community leaders life is hectic and full of stress. First of all, they do their work with their full heart, which makes them also more sensitive for the stories and troubles of people they help. Secondly, the community members were mostly not trained as managers and leaders of NGOs, and now they are carrying this responsibility with big feeling of commitment. Besides, daily life in Kyrgyzstan for many people consists of a lot of struggle: family responsibilities, economic challenges and little time for relaxation,” Janine Wildschut shares. “This results in feelings of stress, little division of private life and work and little awareness of spending time on hobbies or personal time. Besides, within NGOs there is not much awareness of the need for staff to relax, take holiday time, have some breaks or breathing exercises. Women seem to have more pressure than men, as women are the main caretakers of the household.”

Thіs summer school gave the community members an opportunity to become more aware of stress factors. For one week they were thinking more about themselves, exchanged their worries and learned relaxation techniques.

“As I am not drinking or taking drugs at the moment, I do not know how to relax since that normally was my relaxation,” says one participant of the training who stopped to use drugs. Most of the participants of the summer school also feel that it is very important to be together during such studies since it is the only opportunity for them to gather together outside of official gatherings.

Janine Wildschut shared her experience with stress and burnout. Some of her lessons were taken as eye opener for many.

“When your system stresses up, it “tells” you to run harder, and that is the moment to stop yourself and slow down completely,” Janine said. “To have a boss that understands that this is important and supports you taking a break sometimes is also very important. As the problems around you are a fact of life, you are the only one that can change how you handle this: with stress or by contributing the best you can, but not more than you can.”

Besides, on her trip in Kyrgyzstan, AFEW’s director of programs conducted a focus group about community advocacy to see if change in this area is occurring, what is required to have a greater involvement of the community, and how the dialogue platform contributes to that. Janine also interviewed community NGOs on the situation of shrinking space for CSOs in Eastern Europe and Central Asia. The situation in Kyrgyzstan nowadays is stable. Wider coalitions are initiated and hard work is done with the government to show the invaluable work that NGOs are doing.

Join AFEW at Harm Reduction International Conference in Montréal

AFEW International is taking part in 25th Harm Reduction International Conference that will take place in Montréal, Canada next week. AFEW’s executive director Anke van Dam and program director Janine Wildschut will take part in the side event on harm reduction.

The side event ‘Future Proofing Harm Reduction’ is supported by the Dutch Funded Harm Reduction Programs – Bridging the Gaps, PITCH and the Alliance Integrated Harm Reduction Programme (AIHRP). These three alliances are represented by Aidsfonds, International HIV/AIDS Alliance, International Network of People Who Use Drugs, AFEW International, and the Mainline Foundation. The side event will take place on Monday, 15th May, 2-3.30 pm at Mansfield II, Entry hall, Centre Mont-Royal.

AFEW will be represented by the talk by AFEW International’s program director Janine Wildschut with the talk ‘Shrinking space for civil society in the EECA region’ and AFEW Kyrgyzstan’s director Natalya Shumskaya who will talk about women who use drugs in Kyrgyzstan. More detailed program of the side event can be found here.

Harm reduction goes much further than HIV prevention, and contributes significantly to the quality of life of people who use drugs and to the realization of the Sustainable Development Goals (SDG). This side event, moderated by the Dutch Ambassador for Sexual and Reproductive Health and Rights and HIV/AIDS Lambert Grijns, will share examples from the variety of grassroots harm reduction projects currently funded by the Netherlands. Current challenges in harm reduction funding beyond HIV and framing programmes within the context of the SDGs will be discussed.

The theme of this year’s Harm Reduction International Conference is ‘At the Heart of the Response’, and the programme includes presentations, panels, workshops and dialogue space sessions on innovative harm reduction services, new or ground-breaking research, effective or successful advocacy campaigns and key policy discussions or debates.

Community-based Participatory Researches are Starting

IMG_114226 applications out of 44 were selected in the small grants programme to support community-based participatory research (CBPR) projects in Eastern Europe and Central-Asia (EECA) region. The small grants fund is part of a wider programme to build the research capacity of community based organisations in EECA region and increase meaningful participation of the region at the AIDS2018.  The Dutch Ministry of Foreign Affairs provides financial support to the programme.

The supported applicants are from 10 countries of the EECA region: Ukraine, Tajikistan, Kyrgyzstan, Kazakhstan, Moldova, Belarus, Armenia, and Uzbekistan. They represent the following target groups: people who use drugs, people who live with HIV, sex workers, HIV positive women, MSM, transgender people, prisoners, and LGBT.

The total grant fund for the proposals is €230,000. “Previously we announced that the fund was €120,000, but we managed to get more funding and that is how we can afford implementing more projects,” project manager Aids2018EECA in AFEW International Daria Alexeeva is saying.

The grant winners will soon start to implement their researches in their countries. It is expected to have the results of the CBPR in the fall of 2017.

Natalya Shumskaya: “We Want to Improve Country Health System Coordinating Mechanisms”

shumskayaPublic Foundation “AIDS Foundation East-West in the Kyrgyz Republic” makes a significant contribution to public health of the country in reducing the growth rate of socially significant infections in Kyrgyzstan. The head of AFEW-Kyrgyzstan Natalya Shumskaya is telling what we should expect from the organisation in 2017, and outlines the achievements of the previous year.

 – How was the year of 2016 for AFEW-Kyrgyzstan? What do you think were your greatest successes?

– 2016 was a successful and fruitful for our organization. We managed to keep our activities on HIV prevention in the prison system, including law enforcement, prevention of HIV among women who use drugs. During the last year, 1013 women received an access to health and social services. One of the achievements was that in 2016 our organization supported the Ministry of Health of the Kyrgyz Republic in the development of the clinical protocol “Pregnancy, childbirth and the postnatal period for women who use drugs.” In December of the last year this protocol was adopted. Later, we started a very difficult project with the aim to return the patients with multidrug-resistant tuberculosis (MDR-TB) to the treatment. Since August 2016, AFEW-Kyrgyzstan together with the City Centre for Tuberculosis Control in Bishkek started a project “Joint control of tuberculosis and HIV in Kyrgyz Republic.” During five months of 2016, 17 MDR-TB patients returned for the treatment; three patients co-infected with HIV were connected to antiretroviral treatment, five patients with tuberculosis and extensively drug resistant TB (XDR-TB) had the necessary tests, and their results were given to the council for inclusion in a treatment program under the new scheme. There was organized controlled treatment at home for 28 patients. The delivery of products is done 6 days a week, except Sundays. Additionally, project case managers conduct information sessions with patients with MDR-TB and their inner social circle, monitor the side effects of anti-TB drugs, and, if necessary, deliver drugs to relieve the side effects. They also maintain regular contact with doctors. In January of 2017 we increased project staff. It was done for the full coverage of all MDR-TB patients who need to receive treatment at home and assisting them to diagnosis and friendly services. Two case managers and a social worker were hired.

– How is the work of the research department of your organization that you created two years ago?

– The Department continues to work successfully. Over the past year, the researchers conducted a qualitative study among the inmates of correctional facilities that are getting ready to be released. It was called “Prisons, injecting drugs and the environment of risk of HIV infection.” This is a continuation of the positive experience of effective cooperation of AFEW-Kyrgyzstan with medical school researchers from Yale University and the State Penitentiary Service of the Kyrgyz Republic. This study aims to describe and research the quality of the program of methadone substitution treatment in the penitentiary system of Kyrgyzstan and civil society. The recommendations based on those results will be offered to the country to optimize harm reduction programs.

– One of the main directions of your work is cooperation with the police and the prison systems. Please tell us, how is this cooperation going? What is the role of AFEW in it?

– AFEW cooperates with the Ministry of Internal Affairs for 10 years already. In 2016 our organization has provided technical support to the Ministry in carrying out monitoring visits to all the regions of the country. The aim of the visits was to control how the law enforcement officers perform the instruction on HIV prevention. In addition, we organized and conducted four trainings for the staff responsible for the official trainings and for non-governmental organizations on the reform of law enforcement agencies. It is important that the civil sector supports current reforms, and it is important that law enforcement officers assist the execution of the State Programme on HIV.

AFEW is also working with the penitentiary system of the country for more than 10 years. We work together in three areas: technical assistance and coordination, increasing the capacity of staff and providing direct services to prisoners. In 2016 we worked first in six and then in four institutions to promote the goal 90-90-90. We provided services for people who inject drugs (PIDs), told them about HIV and the ways of transmission, motivated them to pass the test for HIV. We actively worked with people living with HIV at the stages of realising of the diagnosis, preparation for therapy, start of therapy, development of adherence to treatment. One of the achievements, of course, is to extend the work on the colony-settlements. Before, prisoners there fell of HIV prevention services, as there are no medical units there, and they usually have no documents for getting help from the civilian health organizations.

– In October AFEW-Kyrgyzstan helped to sign a memorandum of cooperation of four key groups. Please, tell us what these groups are and why their teamwork is so important? How is this cooperation going now?

– Unfortunately, there is mutual stigma within the key groups. Cooperation can help to overcome barriers and build partnerships. The leaders of key groups started to work closer. They discuss new joint projects, research abstracts for AIDS2018 conference in Amsterdam. Together they will carry out activities to reduce stigma and discrimination in relation to other key groups through the mini-session, for example, PIDs for LGBT and sex workers’ organizations. Since last year, we have been inviting all the participants of memorandum for the event and, of course, they also invite us for their events.

– In February, you will host a training for the members of the Country Coordinating Committee on HIV/AIDS (CCC) project BACK UP-Health. Tell us more about it. What are other areas of your work with the CCC?

– Starting from July 2016, AFEW-Kyrgyzstan will implement the project “Harmonization and consolidation of resources to fight HIV infection and tuberculosis in Kyrgyzstan.” It will be done with the financial support of GIZ, program Back Up-Health. With this project we want to improve the coordination mechanisms in the country’s health care system. We want to involve civil society in the discussion on the reform of CCC, and we also want to increase the capacity of the Committee. In February of 2017 AFEW-Kyrgyzstan plans to host a seminar for members of the CCC to prepare the Country Request for continued funding in the state funding for 2018-2020. The following groups will take part in the seminar: members of the Committee for the preparation of applications for resource mobilization and harmonization of CCC; CCC board; members of the Advisory Working Group, which were included by the Kyrgyz Ministry of Health; national experts who work on the preparation of the request for continued funding who will directly collect information and write application; international consultant; head of the expert working group on writing requests for funding, and also key partners from the public and international sectors which may influence decisions and who expressed their readiness to provide technical assistance in the preparation of high-quality country request to the state financing from Kyrgyzstan. During the workshop, participants will act as experts and will share their knowledge and experience with each another. They will also learn how to fill the forms for the requests, will learn the new priority areas of TB and HIV, which are included in national policies and programs, will discuss and analyse the share of public funding, make mapping of the services, clients and funding. Actually, the main purpose of this seminar is to assist the CCC, experts and other stakeholders in the preparation of high-quality application. We want everyone to have one vision and one structure of the request, so that the process of approval of the CCC members is efficient and fast.

– What are AFEW-Kyrgyzstan plans for the year of 2017?

– AFEW-Kyrgyzstan spent its first three years as a local non-governmental organization. The most important achievement is that we were able to successfully implement its first strategic plan and to develop partnerships with international and donor organizations. In 2017 we will review the strategic plan of the organization. Of course, the priority for the board of the organization has been and continues to be ensuring of the stability of the organization.

Compass Centre in Kharkiv, Ukraine: when Policeman Becomes an Uncle

img_0039“I come here often,” Senior Inspector of the Juvenile Prevention Department of National Police of Kharkiv region, Ukraine, Andrii Stadnik is sitting by the table in the centre Compass of Kharkiv City Charitable Foundation Blago. He is smiling and pointing at the table. “Look, here I even have my own cup to drink from…”

Andrii Stadnik started to work in police in 1998. He says he is very happy with his job now. In Compass he meets many children who are grateful for not being send to prison, and he likes to be able to help them. The regulars of the centre even call him uncle Andrii, and this shows very good relations between people in the Ukrainian culture.

18 years old Oleksandr (Sasha) is sitting in front of Andrii, at the same table. Sasha is one of the main characters in the film that was made about the centre Compass a few years ago. Once he was detained by Andrii Stadnik and stayed under police control for some time. Now, after the client management program at Compass, Olexandr is doing much better. He even found a job as a security guard. “Now I somehow feel as Andrii’s colleague,” Sasha smiles.

“The criminal juvenile cases decreased tremendously last years, due to the approach when juvenile police is collaborating with a youth centre that offers client management. These alternative supporting ways are more constructive and more effective,” Senior Inspector of the Juvenile Prevention Department is telling us. “Previously there were 2000 cases per year, and now it is 362. The formulas of substances that circulate on the streets change so fast that young people can often not be prosecuted, but by giving youth an option and an alternative for other options, young people have less problems and also cause less problems for the society they live in.”

img_0036There are 492.000 children in the region in total. 897 families are under juvenile department control in Kharkiv region in Ukraine. The Juvenile Police checks these families, sees how they are doing, and if there are cases of child abuse, financial problems, and so on. Kharkiv Juvenile police is also inviting colleagues from other smaller cities or villages, and teaches them how to work with the Centre Compass. Through this cooperation they found out that young people from the region have difficulties with coming to the Centre since Kharkiv is too far for them. That is why now once a week a social worker of the Centre travels to the villages to counsel young people in need there.

Kharkiv City Charitable Foundation Blago has a long history of working with key populations, including people who use drugs, sex workers, men having sex with men and street children. The organisation started to work with adolescents using drugs since 2012 within the framework of “Bridging the Gaps: Health and Rights of Key Populations” project, through ICF “AIDS Foundation East-West” (AFEW-Ukraine.) Bridging the Gaps project supported the opening of the centre Compass that specifically serves vulnerable adolescents and young people, focusing on youth using drugs. The centre offers psychological counseling services, medical help, testing for HIV, hepatitis B and C. It is a daycare facility with social workers, psychologists and medical workers. The centre is providing case management services to youth using drugs, and also works with youth in prisons, and vocational schools.

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.

Map_Map

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.

khatlon

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

staff

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.

group

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

plan

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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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.

Every life matters: Key population photo exhibition at the EECAAC conference in Moscow

chris

Baby of Linara. Photo: Chris de Bode

Linara, Thuan and David invite you to step into their world and experience what it is like to be a female drug user in Kyrgyzstan, a male sex worker in Vietnam or a young gay man in Uzbekistan. 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, which will be displayed at the 5th Eastern Europe and Central Asia AIDS Conference (EECAAC), Bridging the Gaps wants to create more visibility about the challenges they encounter and the HIV risks they face.

“The doctors gave me pills for an abortion and told me my baby will be a freak. But my son is perfectly healthy.”
Linara

The spread of HIV will not be stopped and reversed without a relentless focus on key populations

Key populations (sex workers, people who use drugs, lesbian, gay, bisexual and transgender people) are hit hard and disproportionately by HIV, with a million new infections a year – that’s half the total worldwide. It is often difficult for them to have any control over the risks they face. They have to deal with a toxic mix of legal, political and social factors which can institutionalise stigma and social exclusion.

David is a young gay man from Uzbekistan. He was forced to leave his country because of his sexual orientation. As a refugee he did not have permission to work. He is now an activist for LGBT rights.

Thuan lives in Vietnam and is a male sex worker in Ho Chi Minh City. His family doesn’t know he is a sex worker. They do know he is gay.

Linara is living with her husband in Kyrgyzstan. She is 42 years old and has a long history of drug use. During her recent pregnancy she faced a lot of discrimination.

“He told my friend that homosexuals don’t get free treatment. He threatened him with criminal prosecution and imprisonment.”
David

EECAAC

The 5th Eastern Europe and Central Asia AIDS Conference (EECAAC) will take place from 23-25 March 2016 in Moscow, Russia. The 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.

When: 23-25 March 2016

Where: World Trade Center Moscow, Russia

Bridging the Gaps

The photo exhibition was developed by Bridging the Gaps. Bridging the Gaps is a joint initiative of more than 90 grassroots organisations which collaborate with four Dutch non-governmental organisations, namely Aids Fonds, Aids Foundation East-West (AFEW), Federation of Dutch Associations for the Integration of Homosexuality (COC), and Mainline, and with five global networks, which are the Global Network of People Living with HIV (GNP+), International Network of People who Use Drugs (INPUD), International Treatment Preparedness Coalition (ITPC), Global Forum of MSM and HIV (MSMGF) and Global Network of Sex Work Projects (NSWP). Together we address the human rights violations and challenges faced by sex workers, people who use drugs and lesbian, gay, bisexual and transgender people, in accessing much-needed HIV and health services.

Decriminalise drugs to meet users’ right to good health, says UN adviser

December 9, by Damien Gayle, The Guardian

pudAll drug use should be decriminalised and possession made free from the threat of lengthy prison terms, the UN’s special rapporteur on the right to health has said, criticising punitive sanctions on users.

In an open letter, Dainius Pūras throws down the gauntlet to governments with the claim that a focus on repressive drug control means they are failing to meet their treaty obligations to realise citizens’ rights to good health.

He argues that drug control policies, including punitive measures against drug users and dealers, drive many people away from health services and have led to epidemic levels of violence.

“At the root of many health-related problems faced by people who use drugs is criminalisation itself, which only drives issues and people underground and contributes to negative public and individual health outcomes,” Pūras writes.

“As a step towards the fulfilment of the right to health, drug use and possession should be decriminalised and de-penalised alongside increased investment in treatment, education and other interventions …”

The letter, dated Monday 7 December, is addressed to the executive director of the UN office on drugs and crime, Yury Fedotov, but it was mentioned to delegates at the reconvened 58th session of the Commission on Narcotic Drugs, which began on Wednesday morning in Vienna.

The commission is currently discussing the draft outcome document for the UN general assembly special session on the drug problem in April 2016, where ministers and heads of government from all member states will debate international drugs policy for the first time since 1998.

Drugs law reform groups are not hopeful of any radical outcome. But with liberal attitudes to drugs becoming more widespread across the world, including in the US, they see the session as the best opportunity in years to get their voices heard.

Pūras’s letter argues that the current framework of drug control is a major hurdle to facilitating the right to health and wellbeing. It denounces the use of the death penalty for drug offences and lethal drug law enforcement.

“Repressive responses to inter alia drug use, rural crop production and non-violent, low-level drug offences pose unnecessary risks to public health and create significant barriers to the full and effective realisation of the right to health, with a particularly devastating impact on minorities, those living in situations of rural and urban poverty, and people who use drugs,” he says.

Pointing out that drug use can lead to a range of health problems, including the spread of blood-borne diseases, Pūras calls for better access to opiates for the treatment of pain, harm reduction measures such as needle exchanges, including in prisons, and evidence-based treatment for drug addicts.

“The provision of harm reduction must not be seen as merely a policy option for states,” Pūras writes. “Rather, the provision of these programmes for people who use drugs … constitute[s] a legal obligation as part of state obligation to progressively realise the right to health.”

Steve Rolles, a senior policy analyst at the Transform Drug Policy Foundation, said the letter issued a challenge to many countries, including the UK, whose drugs laws were now being interpreted as in conflict with UN human rights treaty obligations.

“It does throw down the gauntlet to the UK government. We do still have a very punitive approach, we do still criminalise people who use drugs. The UK government is violating the right to health for many millions of people in this country. This is a very serious challenge and they will need to respond to this, which they won’t be able to do unless they change the law,” he said.