Mariias Frolova: “The Most Important Thing is Working Together”

Author: Olya Kulyk, ICF “AIDS Foundation East-West” (AFEW-Ukraine)

Last year, AFEW-Ukraine gathered young activists of the project “Bridging the Gaps: Health and Rights for Key Populations” from four cities of Ukraine in a Summer Camp. One of the goals was to teach teenagers to design projects and prepare their own applications for funding. The projects created during the camp later were sent to AFEW-Ukraine’s competition of small grants.

18-year-old Mariias Frolova is a leader of the youth community centre “Compass” from the Community Organisation “Kharkiv charitable fund “Blago”. “Compass” is a centre for adolescents who use drugs. AFEW-Ukraine supports four of such centres in Ukraine. Mariias is telling about the projects of her team.

Mariias, please tell us why did you decide to create the projects for youth?

– I decided to develop projects for youth when I participated in the camp for project leaders of Bridging the Gaps project. After training, I thought that I could do something useful for myself or for other young people.

In “Compass” we often get together, play and discuss things. Our team got the idea of ​​watching films together and discussing them later. Initially, we wanted to choose educational films – about diseases, human rights and so on, so that we learn more. Then as a bonus, we added fiction films. We needed some extra equipment – a beamer, screen, and speakers.

AFEW-Ukraine supported the purchase of this equipment.

Our second project is called “QR code”. The project helps adolescents to learn more about their rights. One day our friend asked: “What would I do if I did not know about “Compass?” This made us think that not everyone knows about the centre and how cool it is, as this is the place for the adolescents to get help. We needed to inform adolescents that they can come to “Compass” while facing different situations in their lives. Now QR codes are popular. Through scanning them, you can get access to different information, so we decided to use them for informing youth about their rights and inviting them to the centre.

Who is the target audience for your projects and how do you inform about them?

– We locate our QR codes in schools and lyceums of Kharkiv. By scanning the QR code (there are six of them), adolescents are directed to the information about “Compass”, information about HIV, reproductive health, psychoactive substances and police. After reading the information, teenagers are offered to answer online questions on these topics. After passing the quest with six different topics and completing the task, participants receive an invitation to “Compass” and get a ticket to our cinema.

 Target group of the projects is youth of 14-19 years old, usually from not very rich families, often having limited access to leisure activities. Therefore, free movie screening is very attractive for them.

What are your achievements in projects implementations?

– Since October, we had 13 film screenings with 105 participants, followed by interesting in-depth discussions. 

Due to QR codes project, more people began to visit “Compass”. 64 people received invitations to come to the centre and the cinema. Some visitors to our cinema stay here for services… Since November last year, we received more than 260 answers to our online questionnaires.

QR codes and movie screening stimulate youth to learn more about HIV, drug use, reproductive health issues. Those who come to watch the movie, are also involved in discussions about safer behaviours. Social workers from the centre are invited for facilitating discussions and can immediately respond to any question or provide individual or group counselling if needed.

How did you benefit from creating and implementing projects?

– It was a great experience. After the projects I mentioned above, we developed a new one, submitted it to one big organization and won a grant that will allow us to have a gym in our centre.

I am confident that the most important thing is to work together. We can have different opinions, which can sometimes create problems, but instead of arguing we have to decide on everything together.

Research: ‘Virus Carriers’ and HIV Testing: Navigating Ukraine’s HIV Policies and Programming for Female Sex Workers

Background

There are an estimated 80,100 female sex workers (FSWs) in Ukraine, of whom 7% are living with HIV. Early HIV diagnosis continues to be a public health priority in Ukraine as only approximately 54% of people living with HIV are diagnosed nationwide. This study aims to analyse the content, context and discourse of HIV testing policies among female sex workers in Ukraine and how these policies are understood and implemented in practice.

Methods

To analyse past and current national policies, we searched the database of the Ukrainian Parliament and the Ministry of Health for relevant policy documents (e.g. legislation and orders). To analyse the day-to-day practice of those involved in the implementation of these HIV programmes, we conducted face-to-face semi-structured interviews with key stakeholders. All data were coded using deductive thematic analysis initially guided by the Policy Triangle, a framework which addresses policy content, the process of policy-making, the health policy context, actors involved in policy formulation and implementation.

Results

HIV testing policies are formed and implemented in the post-Soviet context through a vertical system of AIDS clinics, resulting in the separation of key affected populations from the rest of the health system. Successive testing policies have been strongly influenced by international donors and non-governmental organisations. Furthermore, a lack of government funding for HIV prevention created a gap that international donors and local non-governmental organisations covered to ensure the implementation of testing policies. Their role, however, had limited influence on the Ukrainian government to increase funding for prevention, including testing of FSWs. Since the early 1990s, when stigmatising and discriminatory forced/mandatory HIV testing was applied, these approaches were slowly replaced with voluntary testing, self-testing and assisted HIV testing, yet stigma was found to be a barrier among FSWs to access testing.

Conclusion

Poor governance and the fragmentation of the health system, ongoing health sector reforms, shrinking international funding, and persisting stigma towards people living with HIV and sex workers might impede the continuity and sustainability of HIV testing programmes. Local civil society may now have the opportunity to contribute to the development and further implementation of HIV testing policies in Ukraine.

Read the full version of the research here.

 

Most-at-Risk Adolescents Report Human Rights Violations in Ukraine

Ukraine has a high HIV prevalence with an estimated number of 240,000 people living with HIV in 2017. Most-at-risk adolescents (MARA) are among the most vulnerable groups of the HIV/AIDS epidemic in Ukraine. The estimated total number of MARA is 129,000 people (10-19 years old), of which 21,700 are people who inject drugs. There are yet no official statistics on the exact number of MARA, including underage people who use drugs. In Ukraine, MARA represent a very closed group. Lack of statistical data, stigma, discrimination and legal barriers make their access to HIV/Sexual Transmittable Infection (STI) services more complicated contributing to increased risks of HIV. Since 2012, AIDS Foundation East-West in Ukraine (AFEWUkraine) has an established system of services for young people who use drugs in the framework of the Bridging the Gaps programme. Social bureaus, rehabilitation centres and day-care centres in four cities are currently opened providing 21,290 services to 1,215 adolescents in Ukraine.

Experience shows that young people who use drugs are confronted with various types of violations of their rights, which are often not officially registered and publicly known. The fact that young people face stigma and discrimination forms a barrier for asking for help from health specialists. Adolescents are publicly humiliated by teachers, priests and even their parents because of the fact that they use drugs. There is also a lack of appropriate mechanisms for response and misunderstanding young drug users have about their own rights. In Chernivtsi, for instance, one of the problems is the lack of an effective mechanism for responding to suicide attempts among adolescents, especially if these attempts are related to the use of drugs. Therefore, young people who use drugs often do not report human rights violation or apply for protection. Social workers and psychologists do not feel they have relevant knowledge and tools to respond to violations.

Therefore, in 2016 AFEW-Ukraine created an instrument for monitoring human rights violations among young people who use drugs. This instrument was developed for any specialist providing help to young people who use drugs. It can be used by a wide range of organisations and specialists with some basic knowledge about human rights who worked with vulnerable children, adolescents and youth. Based on the outcomes of the monitor tool, the scale of the problem became apparent and advocacy actions on the national and local level can be adjusted. From 2017 onwards, in four Ukrainian cities – Chernivtsi, Kharkiv, Kropyvnytsky, Poltava – AFEW-Ukraine organised introductory trainings that helped specialists gain experience on how to use the tool.

“A social worker or any other professional working with people who live with HIV can defend their rights. This does not require special legal education. Specialists often do not understand that the problems faced by their clients is, in fact, the case of human rights violations that needs special attention,” says Anastasiya Shebardina, Senior Project Manager AFEW-Ukraine.

Over 100 specialists were trained on how to use the tool. Social workers, lawyers, teachers and psychologists of NGOs, representatives of the patrol police, the probation service, youth prevention services for children, social services, local departments of education and medical facilities from the referral network were among those specialists. They had the opportunity to analyse specific cases of violations of the rights of minors and in cooperation with trainers developed an action plan within each city. The tool consists of a questionnaire which is filled in on paper together with an adolescent. Based on the answers in the questionnaire, one can get an idea about the life of the adolescent. In the case of violation, adolescents are matched to a lawyer for legal assistance. An online form for registering human rights violations is filled out by social workers. This form allows to collect statistical data on the rights violations and, if necessary, a follow-up with counselling assistance. A wider range of participants who wished to learn more about the monitoring tool could do it during the educational webinar.

The tool demonstrates that documenting cases of human rights violations help service providers to recognize them and provide timely response better. The analysis of the documented cases allows to identify typical situations for each separate region or city and make advocacy actions more effective. NGOs have also established closer personal contacts with representatives of governmental agencies such as police and probation. Now they plan and implement joint activities. For more systematic future response, the instrument learns what need legal specialists and human rights organizations have to be involved in referral networks. In the long run, this instrument can become a national mechanism for civil society on improving service delivery and upholding human rights.

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.

Olena Voskresenska: “2018 Was Very Active and Diverse for AFEW-Ukraine”

Author: Olya Kulyk, ICF “AIDS Foundation East-West” (AFEW-Ukraine)

The executive director of International Charitable Foundation “AIDS Foundation East-West” (AFEW-Ukraine) Olena Voskresenska is telling about the main achievements of organisation in 2018 and its plans for 2019.

– Olena, how was the year of 2018 for AFEW-Ukraine?

– 2018 was a very active and diverse year for AFEW-Ukraine. During the last year we strengthened and expanded our work on empowering key communities, developing community leaders and facilitating the dialogue between the communities. In our work with adolescents who use drugs within the project “Bridging the gaps: health and rights for key populations”, the special focus was on developing youth leaders. In 2018, young activists from four regions of Ukraine had a chance to develop their own projects, and small grants that we provided to them allowed young people to implement youth-led projects in their regions. Through the Country Key Populations Platform, that we continue to support, we had an opportunity to learn more about the needs of different key populations – people who use drugs, sex workers, LGBT, and ex-prisoners. We also help the communities to develop communication algorithms to ensure that the voices from the most remote areas of the country are heard by the community leaders.

Besides, at the end of the year, we started the project aimed at empowering HIV-positive women in Kyiv and Cherkassy as advocates for their rights. The project was supported by the Embassy of Norway – a new donor for our organization.

– What were the three main achievements over the past year that you can determine?

– Since 2011, AFEW-Ukraine has been working with adolescents who use drugs, and I am very proud that in 2018 we managed to expand this work to small cities and rural areas of Ukraine. It was possible thanks to the project “Underage, overlooked: Improving access to Integrated HIV Services for Adolescents Most at Risk in Ukraine” that is supported by Expertise France – Initiative 5%. The project is implemented in cooperation with Alliance of Public Health, and now services for adolescents who use drugs are developed in 28 small cities of seven regions of Ukraine. Initial project research, that is now being finalized, is the first of its kind not only in Ukraine but probably in most of the countries of Eastern Europe and Central Asia (EECA).

In 2018, AFEW-Ukraine supported the development of standards on rehabilitation for the Ministry of Social Policy. I am very proud that we managed to bring together a good team of experts for working on the standards, including a representative of the community of people who use drugs. We hope that these standards will help to improve the quality of rehabilitation services in the country, based on the best international practices, human rights approach and needs of the community. We are very much looking forward to further work in this direction not only in Ukraine but also in Georgia.

2018 was also a very important year for all HIV service organisations, as it was the year of the 22nd International AIDS Conference that took place in the Netherlands. Being a part of AFEW Network, with AFEW International Secretariat in Amsterdam, we worked hard to ensure maximum involvement of EECA participants in the conference and attracting attention to our region. I am very happy that we managed to support a large delegation of AFEW-Ukraine partners, including young activist from Kropyvnytskyi, representatives of the community of people who use drugs, and HIV-positive women from Ukraine.

– What are the plans of the Foundation for 2019?

– In 2019 we will continue working with young people in Ukraine, focusing on their active involvement in decision-making processes, including monitoring of the local budgets. I hope that we will be able to expand our work to include young detainees in our projects.

Developing harm reduction friendly rehabilitation remains a priority for us, and we will stimulate the changes in current rehabilitation practices in Ukraine and Georgia with our local partners. Also, we are very much looking forward to closer working with HIV-positive women in Ukraine, disseminating the successful model of immediate intervention that was already tested in Kyiv, to Cherkasy, and potentially other regions of the country. In 2019 we are also planning to revise our strategic plan, which will define the priorities of AFEW-Ukraine’s work for the upcoming several years.

Why Ukrainian Key Communities Unite in One Platform

Author: AFEW-Ukraine

In many countries, different key populations unite. They do it for the better representation of their interests in the development of public policy. This is often the alliance within one community, and less frequently – of several communities.

Four key populations in Ukraine – ex-prisoners, LGBT, people who use drugs (PUDs), sex workers (SW) – have their own self-organizations, being at different stages of development. There are communities with great experience in advocacy and work with international donors, but there are those that are at the initial stage of development. They grow stronger with the support from more experienced activists.

“Despite growing importance of the community voice in decision-making processes related to access to health and social services, very often representatives of HIV-service organisations speak on behalf of key populations rather than community representatives. Having the voices of community directly heard leads to a situation where the actual needs of key communities are much better taken into account in programs planning and implementation”, says Olena Voskresenska, executive director of ICF “AIDS Foundation East-West” (AFEW-Ukraine).

In October 2015, during the meeting held within the framework of Tripartite cooperation between the Kingdom of the Netherlands, UNAIDS and civil society, community activists expressed the idea of creating a Platform. This Platform had to become an independent structure for sharing experience, dialogue and developing a common position and advocacy messages of several communities, as well as facilitating representation of communities in public bodies, working groups and other organizations. In addition, the Platform could contribute to collecting data on the needs of communities and raising new activists.

“My idea was to give communities the opportunity to advocate for their rights and change policies and to bring communities together to help each other. Also, it was important to allow communities to develop and mobilize themselves without external influence,” recalls Petro Polyantsev, a member of CKPP steering committee.

Creating the Platform

Initially, it was necessary to understand whether all key communities are interested in the Platform. Then the priorities of the Platform had to be identified. In 2016, the most active representatives of the LGBT, SW and PUD communities formed an initiative working group. Participants of the Tripartite cooperation initiative – UNAIDS, ICF “AIDS Foundation East-West” (AFEW-Ukraine) and LGBT Association “LIGA” (partners in the project “Bridging the Gaps: Health and rights for key populations”) – helped to organise group’s work and found the necessary funding for the Organizational Forum of the Country Key Populations Platform (CKPP).

“Today the priority for communities is to maintain access to services in the context of transition to state funding. By working together, communities can achieve much better results than by working just by themselves,” says Andrii Chernyshev, a member of CKPP steering committee.

The first CKPP Forum was held in January 2017. The main result of this event was a decision to establish the Country Platform as an association of key communities’ representatives. During the Forum, also representatives of the community of ex-prisoners joined the Platform.

CKPP was officially registered as a public association in December 2017. The Steering committee, representing all four communities, coordinates the work of the Platform. The main strategic issues are resolved during the CKPP Forums. Funding for Platform activities is provided through the selection of several grant programs managed by the organizations endorsed by the Steering Committee and an Advisory Group. As of today , the work of the Platform has been financially supported by the Ministry of Foreign Affairs of the Netherlands in the framework of the project “Bridging the Gaps: Health and rights for key populations”, UNAIDS, Eurasian Harm Reduction Association (EHRA), International Renaissance Foundation, the Embassy of the Netherlands in Ukraine. Such diverse funding model allows the Platform to remain independent and unbiased.

First steps are successful

The activities of the Platform in the last two years were mainly focused on the development of its structure, as well as the strengthening of the communities. During this period, 163 activists from 18 regions of Ukraine took part in important and interesting events and trainings, the topics of which were determined by the participants. Communities’ members developed CKPP Regulation and the CKPP Code of Ethics which regulates the basic principles of work.

In 2018, members of the Platform presented it at the XI National LGBT Conference in Ukraine and the 22nd International AIDS Conference (AIDS 2018) in the Netherlands.

“I believe in the Country Key Populations Platform. We are already seeing the results. The government is more inclined to listen to us because we gained legitimacy by joining our forces. When people are motivated to make change happen and work together, human rights will be a reality in our country, and not just words. Only together we can save our lives,” says Vielta Parkhomenko, a member of CKPP steering committee.

The researcher Anastasia Bezverkha in the recent study “Country Key Populations Platform – from better communication to stronger voice. The case study from Ukraine” highlighted the positive changes influenced by the creation and work of the Platform.

“CKPP impacted the communication between the partners in the field in a positive way. Key population leaders became more visible and new leaders emerged. In addition, CKPP serves as an important space for communication of national decision-makers with key population leaders,” summarizes Anastasia.

The IV CKPP Forum, which was held in December 2018, was focused on developing the strategies and work plans of the Platform for 2019.

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.

Chemsex and Drug Use Among MSM in Kyiv: New Challenges

Analytical community-based participatory research report based on the results of the study “Chemsex and drug use among MSM in Kyiv: new challenges”, 2017.

According to a bio-behavioral research conducted in Ukraine every two years with the support from the ICF “Alliance for Public Health”, men who have sex with men, is a group where the prevalence of HIV continues to grow. Thus, in Kyiv at the end of 2015 – the beginning of 2016, the prevalence of HIV among MSM was 15%.

According to the observations of social workers of the PO “ALLIANCE.GLOBAL”, that carries out outreach work through gay dating mobile applications, Internet web-sites, where sex workers’ ads are published, gay clubs and saunas in Kyiv, in recent years, the number of MSM who use different chemical substances in a non-injecting way (amphetamines, ecstasy, LSD, oxybutyrate, etc.) has significantly increased, which suggests that their sexual behavior becomes riskier and significantly increases the likelihood of HIV infection, viral hepatitis, and other STIs, both in terms of getting infection as well as transmitting the infection. To assess the drug scene, the risks of using chemical substances and the possible negative effects of sex under their influence in the context of the spread of HIV, viral hepatitis and other STIs, we conducted this study, the aim of which was to develop recommendations for more effective prevention of HIV infection, drug-related harm reduction and other related means and planning of specific services for subgroups of MSM who practice sex under the influence of chemical substances.

The purpose of the research is to study how the use of drugs, psychotropic substances and / or certain medications affects sexual behavior and mental health of MSM and how to minimize the risk of transmitting infections, in particular, HIV.

Read the report here.

AIDS 2018 Sidenotes: How We Tested Drugs

Experts of the centre testing a tablet

Author: Yana Kazmirenko, Ukraine

Saturday morning at the Schiphol airport. A conference participant from Ukraine – camera operator Igor K. – finds out that his tablets are gone. In a second, a confident man loses his heart: he becomes pale, his hands are shaking, and his eyes are full of dread. Igor has been taking methadone therapy for a few years, and for him losing his tablets can be life-changing. In Ukraine, it is not possible to receive methadone at the weekend.

Ukrainian drug users say that losing your tablets is the same as losing your passport. In both cases, you have to report to the police, where police officers issue a certificate to confirm the loss and only then a doctor would give you methadone. Igor is standing in the huge Amsterdam airport. He has three hours before his flight. It turns out that it is easier for a Ukrainian citizen to access methadone in Schiphol than back at home. After listening to Igor’s story, the doctor at the health station just prescribes him tablets for EUR 20.

Diseases are born in the streets

That was how the 22nd International AIDS Conference in Amsterdam (AIDS 2018) ended for me. After the event, it became clear that the capital city of the Netherlands had a full right to host this global forum. First of all, this right was earned because of its innovative HIV programmes, including progressive drug policies. It is not only about coffee shops where one can taste cupcakes with marijuana…

The first syringe exchange programmes, safe injection rooms and drug testing sites – those are all Dutch inventions, which were widely practised back in 1980s. This country was the first to realize that diseases are born in the streets and that nobody can tell better about the threat of HIV and ways to prevent it than drug users.

I could see it with my own eyes when I went with a study visit to the Jellinek drug testing centre with a group of journalists accredited at the conference. The building of the centre looks just the same as the neighbouring buildings. The centre has branches in Amsterdam, Utrecht, Almere, Amersfoort, Hilversum and other cities. In all of them, you can anonymously test your drugs for dangerous components.

Nightclub goers test their drugs

In 2017, over 12 thousand people tested their drugs (in 60% of cases ecstasy was tested). The centre has two tasks: monitoring of the market of club drugs and reducing the harms associated with their use.

A staff member of Jellinek says that visitors can access two types of tests: rapid test with a marker and laboratory testing, which takes a week. All kinds of things can be tested: tablets, powders, liquids, capsules or crystals. Every visitor may bring up to three samples to be tested. The price of one test in EUR 2.50.

E.g., an ecstasy tablet is first inspected, recording its colour, size, logo, acid test and comparing it to the national database with aggregated data of 30 drug testing centres from all over the country. If such tablet has already been tested (which happens in 75% of cases), the visitor is informed about its content straight away. If the tablet does not match any entry in the database, with the consent of its owner it is sent to a laboratory for further testing. The result is ready in a week. The only exception is LSD. Testing this drug is expensive, so Jellinek does partial testing not to go bankrupt.

Rapid test is the preferred option of the main drug users in the Netherlands – nightclub goers. After getting the testing results, they usually follow up with claims to the dealer who has sold them a dangerous product.

By the way, every year the Netherlands host more than a thousand musical festivals, with a mobile drug testing site operating at each of them. Such strict measures were introduced after 2014 when three visitors of a festival died after using low-quality drugs. However, using any drugs is a risk.

“People who started using drugs 5-10 years ago have to realize that now drugs may be more potent with a higher risk of overdose,” warn the experts working at the centre.

Ukraine needs changes

AIDS 2018 participant from Ukraine Anton Basenko, who is the head of the Ukrainian Union of People Who Use Drugs (PUD.Ukraine) says that establishing drug testing centres and safe injection rooms is the reason why there are no more streets covered with used syringes in Amsterdam.

In Ukraine, there are also talks about opening such drug testing centres and safe injection rooms. However, they will not appear unless the legislation changes. So far, such facilities are outlawed and people who open them may be incarcerated for running drug dens.

‘Bridging the Gaps’ through the eyes of teenagers

In 2011-2017, over eight thousand clients received 70,232 medical, psychological, social and legal services within ‘Bridging the Gaps: Health and Rights for Key Populations’ project in Ukraine. Halyna, Artem and Carl (names changed) were also clients of ‘Bridging the Gaps: Health and Rights for Key Populations’ project.

Resolving problems with the family

Halyna is 19 years old. She is a slim girl with beautiful eyes and a charming smile. Halyna was born in a small Ukrainian town bordering with Moldova. She has been living with a man she loves for a year. A month ago, they got married.

However, just two years ago, Halyna’s life was neither easy nor happy. Back then, she lived with her mother and stepfather and was a constant victim of abuse. Halyna’s stepfather did not want the girl to live with them, so was turning his wife against her own daughter. Halyna, who was still a minor, had to leave her home, find a job and make her own living. The girl started using drugs – first marijuana, then amphetamine, sometimes ecstasy or LSD. It lasted for a few months.

Once, when the girl told her mother everything. Talking about that period of her life, Halyna cannot hold her tears back.

“When I came back home, I was not quite adequate and had hysterics. Once, my stepfather called police and they took me away. They sent me to a juvenile shelter in Chernivtsi. I spent two months there. At first, it was difficult, and I wanted out of there as soon as possible, but when I went back home to my family, it was even worse. My stepfather abused me and made my mother do the same,” tells the girl.

The psychologist working in the shelter referred Halyna to the Dialogue Centre of Social and Psychological Support (New Family Foundation), implementing ‘Bridging the Gaps: Health and Rights for Key Populations’ project. Three times a week, Halyna attended counselling sessions with a psychologist and a social worker there. Besides, the girl, her mother and stepfather took part in family group conferences. The approach of family group conferences stipulates that a child may not be viewed separately from the family, so family members should be involved in solving child’s problems. Halyna says that it helped to maintain relations in her family for a while.

“Later, as my legal age was approaching, my mother and stepfather said that they did not want me to live with them. Our problems resumed, and I went back to drugs. After I turned 18, I had to move out,” tells the girl.

Despite the challenges, Halyna continued coming to the Centre for support and soon was able to quit drugs. She attended the Centre for about eight months. The girl says that for her, the Centre was a safe place and people working there helped her a lot. Halyna thinks that it is quite possible that if not for this support, she would still be using drugs.

Coming home for Mom’s birthday

Artem from Kropyvnytskyi is 22. He lives with his family – his parents, sister and grandmother. The young man says that he likes mountains, nature, rock-climbing and drugs.

When Artem was a teenager, he started taking alcohol, smoking cigarettes and then tried drugs for the first time. He confesses that he was not happy with his life and wanted to escape the reality, so he started “systematically” using drugs. Crystal meth, LSD, ecstasy and so on – he used everything except injecting drugs. It lasted for over four years.

Then his family intervened. Artem’s uncle suggested he should visit a psychologist from Lilia social bureau (NGO Return to Life). Psychologist’s counselling, awareness-raising classes, school of volunteers – all those things became part of the young man’s life.

However, just in several months he went back to drugs and had to start everything from scratch. Later, Artem spent three months in the rehabilitation centre run by the Return to Life NGO. He came back home last autumn, on his mother’s birthday.

“If it were not for this project and the social bureau, I would probably still be an active drug user. Maybe I would even end up in jail,” says Artem.

He became an active volunteer of the organization. Campaigns, workshops, summer school, working on his own project – all those things interest him and are an important part of his life. He has no desire to go back to drugs.

Drugs bring an illusion of the solution

Nineteen-year-old Carl is a second-year psychology student from the western region of Ukraine. He has parents and an older sister. Carl enjoys learning new things and likes history, especially military history. A year ago, he experienced some problems and his friends offered him a “way out” – together with them, he started using drugs.

“At first, I liked it, it felt exciting. Then I realized that drugs only bring me new problems. I grew addicted to drugs, could not communicate with people in a normal way, it interfered with my studies. When I understood that it all turns out to be a problem, I came to the Centre,” says Carl.

He heard about the Dialogue Centre a year and a half ago. Project workers regularly come to student dormitories and tell young people about HIV, drugs, safe sex, test them for HIV and hepatitis, distribute condoms.

“I lost many friends and acquaintances. Sometimes even my fellow students rejected me and called me a drug addict. I am a human, so when the society turns its back on me, it is very painful,” he recalls.

In the Centre, there was a psychologist who worked with Carl for six months. Embarrassed, Carl tells that he opened up during those counselling sessions and even cried. He says that the psychologist helped him to keep his life from going to pieces. Besides, in the Centre he could eat a meal and spend his leisure time.

“I know for sure what would happen to me if not for this Centre and this project. There was a friend of mine in the dormitory, who had a “point of no return”: he switched to hard injecting drugs, was kicked out of the dormitory and then – out of the university. It is quite probable that it would be the same with me,” says Carl.

The problems, which led the young man to drug use, are still there, but he realized that drugs do not resolve them, only bringing an illusion of solution. He is sure that every person should understand it.

About the project

‘Bridging the Gaps: Health and Rights for Key Populations’ is an international project, which was launched in Ukraine in 2011 and is aimed at protecting the human rights of drug users by changing social attitudes and government policies and improving the services they can access. The main activities are aimed at under-age drug users. Four partner organizations provide services to adolescents in four cities: Return to Life CF in Kropyvnytskyi, Public Health PRCF in Poltava, Blago CF in Kharkiv and New Family CF in Chernivtsi.

In Chernivtsi, there is a rehabilitation centre, while in other cities the services are provided through social bureaus and day care centres. The efforts are aimed at reducing the risks of drug use, re-establishing social connections and finding resources in the lives of adolescents to support them. The most important task for project workers is to make adolescents understand that in the centres they will be welcomed and will not be judged because of their drug habits.