Our goal is to help adolescents become stronger

For several years, International Charitable Foundation “AIDS Foundation East-West” (AFEW-Ukraine), a partner of AFEW International in Ukraine, has been successfully implementing programs aimed at working with adolescents who use psychoactive substances. This activity results in hundreds of strong and self-confident adolescents who change their lives and lives of people around them for the better.

Anastasia Shebardina, AFEW-Ukraine Senior Project Manager, told AFEW International how it all began and how her organization managed to mobilize the community of adolescents who use drugs through Bridging the Gaps program.

Why does Ukraine pay particular attention to working with youth?

Back in 2012, when Bridging the Gaps (BtG) program just started in Ukraine, we understood that most of the projects in our country are aimed at working with adult drug users. There was nothing like this for young people, and this is why we focused our work on adolescents who use psychoactive substances.

What is the peculiarity of your approach to working with youth?

Our work can be divided into 3 different directions. The first one is the so-called low-threshold services, when an adolescent can apply for a particular service one or more times through the project. For example, he/she can be tested for HIV, get contacts of organizations where he/she can get help. As a rule, such an adolescent is not ready for systematic work and drastic changes. The second direction is working with adolescents who come with a specific request for help, requiring a comprehensive solution. For example, often these young people may have problems in educational institutions, difficulties with documents etc. We invite an adolescent to join a case management program in one of the youth friendly centers. In total, there are 4 such centers under the BtG program in Ukraine. They are located in Kropyvnytskyi, Poltava, Kharkiv and Chernivtsi. Case management in these centers is designed for a period of 3 to 6 months. But if youngsters have a need to get help longer, we extend the program for a longer period.

The third area is rehabilitation programs for adolescents who are willing to change and want to reduce or completely stop drug use. One of such programs has already been working in Chernivtsi for a long time; it is designed for six months. This is a structured program, within which an adolescent gets several obligations – he/she needs to come to the center regularly, participate in group events, and so on. Recently, we started a similar rehabilitation program in Kharkiv.

What difficulties did you encounter at the start?

At first, we were not sure whether public organizations in Ukraine would be able to work with youth without having official permissions from parents and governmental bodies. However, having analyzed Ukrainian legislation, we realized that it didn’t have a clear regulation on how to work with adolescents or any kinds of restrictions.

There were also difficulties of a different nature: firstly, since young people rarely use injecting drugs, they almost never turn to harm reduction programs for services, so accessing this group was complicated. As for rehabilitation programs, they also could not reach young people, as they are primarily designed to work with adult drug users and do not take into account the peculiarities of working with adolescents. Participation of adolescents in such rehabilitation programs could do more harm than good.

At first, it was hard, because public organizations had mainly worked with adult drug users and needed to learn the peculiarities of working with adolescents from scratch.

However, the biggest difficulty was working with parents. The fact is that most often an adolescent who has problems in life and who practices risky behavior, does not have good contact with the parents. Therefore, it was difficult to expect that adults would behave actively and participate in our activities when a complicated situation arose. Some are very busy, some just don’t want to come to the centers, some believe that parents should not help children solve their problems with risky behavior, and this is the job of state institutions. They simply do not understand that in many cases it is working with parents that really helps to correct the situation.

What has changed over 8 years in the field of working with youth?

Young people got noticed – this is the main change! People making youth-related decisions locally have become more loyal to them, more open to dialogue. Programs to counteract the spread of drugs and prevent HIV that are being developed at the local regional level have started targeting adolescents as a separate group. The attitude of specialists towards youth is gradually changing, they began to understand how important it is to have special programs for the younger generation. For instance, we began to receive much more requests from other organizations. Educational institutions and services that work actively with adolescents redirect to us those who have problems with the use of psychoactive substances.

What is the goal of our activity?

Our goal is to help teens reach their goals. Of course, we would like adolescents to change their behavior to a safer one so that they stop using psychoactive substances. But it’s important to understand what adolescents come with initially. Most often they come with a question that is not directly related to drug use. And our experience shows that when these issues are resolved, they also change their behavior in relation to the use of psychoactive substances. Various unresolved situations in life lead to risky behavior: self-doubt, conflicts, difficulties, somatic diseases, failures. Therefore, in relation to young people it is so important to work with the problem as a whole. Also, you need to work with what is important for adolescents, and not what we, adults, think would be better for them. Any social programs should work that way. The more tools we give people to deal with difficulties, the easier it is for them to change the situation in other areas of life. We give an adolescent the resources to become stronger. But of course, we also educate young people about overdoses, safe sex and drug use.

You have a special program for working with youth leaders. What is it like?

A few years ago, it seemed to us that adolescents were not very interested in public activities. It was difficult for us to find an active adolescent who publicly talked about his/her problems and problems of the social group. Therefore, we started to actively explore various opportunities for attracting youth. Thus, we began to search for our most active clients, trained them, and involved in the organization of events. In 2018, we gave them an opportunity to create their own projects and started to issue grants for leadership initiatives. We were telling the participants how to create projects, set indicators, implement activities and write reports. In the end, we invited them to create their own small projects, where they will do everything from beginning to end by themselves – write a plan, report, implement. The first year was difficult, but since last year we noticed that this direction has become the most effective in our work on mobilizing community and attracting leaders. The bottom line is that when you give adolescents the opportunity to be responsible for something, when they feel that this is their own project, then they change a lot.

Which projects in the leaders’ program were most remarkable?

All projects are interesting in their own way. Personally, I really noted an online magazine in Chernivtsi. It was called “This magazine is as good as the son of mother’s friend”. It contained articles on completely different topics, the youngsters interviewed representatives of the police, doctors, etc. Adolescents were reading this magazine, commenting online. Many of them, having read the articles in the magazine, would come to our program.

There was also an interesting project on creation of a cinema club. Adolescents selected films by themselves, organized shows, handed out tickets. One could only enter the club by completing a special task. This gaming element was especially attractive for young people.

I should say that before this project, many adolescents came to us with a certain caution, because they were usually brought by parents or the police. After the leaders’ project, we noticed that it was the leaders who became the first contact point for such adolescents. Thus, the leaders were peer consultants. Since 2018, we have supported 9 projects like that. In 2020 there will be a continuation of the project.

How exactly do teenagers change during their participation in such projects?

When we conducted a focus group with leaders, we heard that thanks to the project, someone changed their relationship with parents, it became easier for someone to express their point of view, to analyze problems without quarrels. Someone said that he plans to continue studying professions, some saw that projects can really help, some stopped spending all their free time on the street. The youngsters really changed for the better.

I remember that one of the participants even started working as a social worker in another organization. This is a very significant indicator, because it means that he evaluated social activities in such a way that he himself wanted to do it. He saw the value of helping others, changing lives. I also noticed that adolescents are pleased to conduct various trainings and seminars on their own, they feel they are the owners of unique knowledge and are proud of it. In schools, they are no longer afraid to go to the blackboard. Teachers sometimes ask us what we did with an adolescent that resulted in him starting to raise his hand in class. We just developed his self-confidence.

In September you plan to host the MARA Youth Conference. What is special about this event?

The MARA 2020 Conference – Most-At-Risk Adolescents – will be the second. We conducted the first one in 2015 at the end of the first phase of Bridging the Gaps project. This is a conference on the well-being and health of adolescents. It is not limited to any key groups, but it is important to note that this is the only conference in Ukraine that focuses on the adolescents at risk. We have created a working group of representatives from various organizations, and together we choose which topics are interesting for discussion, who should be invited as speakers. Last time the conference was opened by adolescents themselves – in order to do that, they had gone through a training in public speaking beforehand. This year we will strengthen this component: the conference will have a separate section where adolescents will participate on equal terms with adult specialists.

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.

AFEW-Kyrgyzstan Opened a Youth Centre in Bishkek

Author: Grana Ziia, AFEW-Kyrgyzstan

On March 19, the ground floor of the Palace of Sports in Bishkek was crowded: teenagers, civil servants, representatives of the city hall and non-governmental organisations, social workers of district administrations and AFEW-Kyrgyzstan team all gathered together for the opening ceremony of a new youth centre.

In the spacious hall, decorated with felt paintings and bright red wallpapers, the Deputy Director of the State Agency for Youth Affairs, Physical Culture and Sports Mirlan Parkhanov welcomes all the guests. He says that this centre was opened last year to organise events and conferences for young people.

– Now, with the support of AFEW-Kyrgyzstan, a teenage centre is opened here. A psychologist and a social worker are now working here. They will organise free counselling for adolescents and their parents, organise useful leisure activities for young people, those who wish can join sport clubs and do other extracurricular activities, – Mr. Parkhanov is saying and inviting all guests for a tour around the centre.

The most important thing is to have trust from children

Guests are entering the interactive room. Judging by the interest with which they take pictures there, they like this room very much. Inside there is a dozen of bright fashionable beanbags, a shelf with board games and brochures about health, family planning, and drug use prevention. On the walls, there are posters with the rules of the centre and announcements of various competitions and grants for young people. There is a computer, a projector and a big screen for teenagers in the corner of the room.

Another room is a room for the staff of the centre and individual consultations of adolescents with a psychologist, social workers and other specialists. It is cosy here. There are also felt paintings and framed carpet, cookies on the table, and a few pillows on the sofa.

– We tried to create the most relaxed atmosphere here so that the children can trust us. I hope it worked out! – says the psychologist of the centre Margarita.

A place for useful leisure and development

After the tour, the guests gather in the conference room again. AFEW-Kyrgyzstan manager Chinara Imankulova begins the presentation of the services of the youth centre and talks about the idea of opening the centre.

– Last year, with the support of the Central Asia Drug Action Programme (CADAP), AFEW-Kyrgyzstan conducted a study on the prevalence of psychoactive substances usage among adolescents in Kyrgyzstan. The data obtained showed that it was time to begin working on prevention. Thus, this centre appeared. We want all teenagers to come here, and not just those who use psychoactive substances or are in a difficult life situation. Here, teenagers will have a safe space to relax, to talk to their peers and get professional support, – says Chinara.

The psychologist and social worker of the centre add that this form of work with adolescents is the most effective. When children come from different groups, they communicate with each other, share interests and help each other. Therefore, no one feels deprived and lonely.

Joined efforts are needed

In her presentation, Chinara is saying that the centre will also function to increase the capacity of psychologists, social workers and pedagogues, doctors and juvenile inspectors. Guests perceive the news with enthusiasm, because, according to them, there is a need for constant professional growth.

The guests of the event are also saying that Bishkek needs such a centre for a long time. They also talk about the problems they face in their practice. After the discussion, they develop a plan of cooperation with the centre: how to guide children, how to interest them, how to organise training sessions.

Employees of professional lyceums are saying that they are ready to hold master classes for teenagers; representatives of the city hall promise to help with the transportation for outdoor events; the department of physical culture and sports is ready to engage teenagers from the centre in free sports activities. After all, only with joined efforts, we can build a healthy future.

AFEW-Kyrgyzstan Uses the Experience of Foreign Colleagues

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

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

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

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

The protocol is approved by the Ministry of Health

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

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

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

Working for the future

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

Waiting for the city hall’s help

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

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

Opening a centre for teenagers

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

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

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

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

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

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

Svetlana Izambaeva: “Uncovering the Topic of HIV, We Talk About Violence and Bullying”

Author: Olesya Kravchuk, AFEW International

Svetlana Izambaeva was one of the first women living with HIV in Russia who was brave enough to open her face. Now Svetlana supports other people living with HIV. In summer 2018, Svetlana Izambaeva’s Non-Profit Charitable Foundation held a gathering of adolescents living with HIV with the financial support of AFEW International and other donors. We talked with Svetlana to ask her what was interesting about this gathering in Georgia and why, when we talk about HIV, we also “uncover” other topics.

– Svetlana, could you please tell us how the idea of having a summer gathering was born? Who was able to take part in it?

– It started with our desire to support adolescents living with HIV in Kazan. Later those boys and girls, who had been participating in such meetings for five years, offered to hold a meeting with adolescents from other cities and countries. Several adolescents from Kazan dreamt about going to the seaside. Thus, those adolescents’ dream gave birth to our project #vseprosto (#itseasy). Before, we held one- or three-day workshops in the cities of Tatarstan, Ufa, Nizhny Novgorod, and Irkutsk.

We made a decision on the venue and started sharing information about the event through social media and AIDS centres. The response was immediate. We heard both from mothers of children living with HIV and from adolescents living with HIV. Every person who wanted to attend our event had to fill in a questionnaire based on which we selected the participants. An important eligibility criterion was the awareness of adolescent of his or her HIV status. This year, the meeting in Georgia brought together adolescents aged 11 years old and above from six countries – Russia, Ukraine, Armenia, Georgia, Belarus, and Kazakhstan – and nine cities of Russia – Vladivostok, Irkutsk, Ekaterinburg, Nizhny Novgorod, Kazan, Orenburg, Rostov, St. Petersburg, and Moscow.

– How was this gathering different from a traditional summer camp for children?

– Our gathering was more than a camp. We had full immersion into the topic of HIV, including all medical and psychological issues. Interactive games and quests help us to reinforce the theory. We raise the questions related to feelings, emotions, and experiences, explore guilt, resentment and pain, acceptance of diagnosis and empowerment. An important factor is that we offer many games on HIV – while playing, adolescents learn about the immune system and realize why they need to take pills strictly in accordance with their schedule. For some adolescents, this is the first time when they meet other boys and girls with HIV. At the gathering, we openly talk about HIV for ten days, which allows “recognizing” and accepting one’s diagnosis.

– What was your biggest insight during this gathering? Where there any good or maybe bad surprises for you?

– Each gathering has its own story and each one of them is special. Every time, we sit down with the team of trainers and prepare new exercises and new quest games for the adolescents. What is surprising is the depth of feelings and the extent of trust and openness among the adolescents living with HIV. They are all ready to work on their problems but not all of them are willing to do it in a group. From the very first day, we offer individual sessions with psychologists. Besides, one of the insights was that when we uncover the topic of HIV, we bring up deeper topics, such as violence, bullying, and reliance on parents. Parents or guardians may be a negative factor. There was a case when the guardian was not ready to work together all day long and also in the evening. We pay a lot of attention to building knowledge, but information is presented in the format of games and our participants have fun. Though it is just a five-minute walk to the seaside, our priority is keeping up with our agenda and the knowledge to be gained by the adolescents and their parents or guardians.

– What challenges did you encounter when planning the event and how did you cope with them?

– The main challenge was raising funds. We needed money to cover accommodation and meals for the participants, pay the trainers (though three times we did not pay either to trainers or to the logistics provider), to buy stationery, gifts, T-shirts and caps. It was important to have at least five trainers for 30 participants as we had both general activities and small group sessions. We had to find sponsors to cover our costs, and it was not easy. Besides, at our gathering we started training people who would like to conduct similar activities in their regions.

– Why is this event important? Have you achieved the goals that you wanted to achieve?

– This event is important for every adolescent – that is what they say in their comments and follow-up questionnaires. The changes happening with every boy and girl may be tracked through the diagnostic drawings that they do in the first and last days of the event. On the first day, when they are asked what they feel, think and want to do when they hear the word “HIV”, they draw scary images and write “pain, guilt, fear, do not want to talk about it.” On the last day, when answering the same question, they depict strength, confidence, freedom, easiness and desire to support their peers. The event is also important because after it they will not stop taking their therapy and will adhere to treatment. We already see the results of their blood assays. Our event is also aimed at the prevention of suicide attempts and depression.

Do you plan arranging similar events in future?

– We have already organized and held four gatherings: in 2017 – in Sochi and St. Petersburg, in 2018 – in Ureki (Georgia) and Vladivostok (Russia). We have piloted the programme, trained the trainers and we plan to launch such gatherings in Russia and open centres for adolescents in Irkutsk, Kazan, and Krasnodar region. Next year, we plan to conduct first-level training for new participants in each of the territorial units, hold a gathering in Irkutsk at the Baikal Lake and then – an international event in Armenia. Besides, we would like to hold a meeting and workshop in Moscow suburbs for a team of leaders from all our gatherings.