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

Author: Olesya Kravchuk, AFEW International

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

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

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

The main thing is not to lose touch with reality

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

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

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

The period after rehabilitation is harder than the period before it

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

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

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

Treatment based on commitment and not punishment

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

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

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

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

Not to have an addiction is already a success

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

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

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

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

Uzbekistan Eliminates Vertical HIV Transmission

Evgeniya Korotkova from Ishonch va Hayot NGO, photo from the personal archive

Author: Inna Gavrilova, Ukraine

The rate of mother-to-child HIV transmission in the Republic of Uzbekistan is approaching the zero mark. In 2017, only 11 cases of such transmission were documented or 0.3% of all the HIV cases registered.

“Such trend has been observed for several years already,” says Evgeniya Korotkova from Ishonch va Hayot NGO, which has been advocating for the rights of women and children from the families affected by HIV/AIDS epidemic in Uzbekistan. “It gives me confidence that in the nearest two years our country will be able to get well prepared, do its best at the national level to successfully go through the procedure to validate the elimination of mother-to-child HIV transmission and to become the fourth country in Eastern Europe and Central Asia to receive an elimination validation certificate from the World Health Organization (WHO).”

According to Korotkova, WHO validation of the elimination of vertical HIV transmission is a rather lengthy and complicated process, but in the recent seven years, patients’ groups and civil society organizations were able to gain support from the government, which is also interested in healthy newborns who would get a good start in their lives. Only the joint efforts of civil society activists and government allowed fighting stigma and discrimination – which are the main obstacle on the way to 90-90-90 targets – in an effective and comprehensive way. It is not enough to just find all the people living with HIV (PLWH), the task is to convince them not to be afraid of their diagnosis and take the therapy.

“Stigma and discrimination remain serious obstacles on the way to HIV prevention, prevention of mother-to-child HIV transmission, expansion of HIV testing as well as enhanced access and adherence to HIV care and support,” said Evgeniya Korotkova. “The government committed to take over the procurement of all antiretroviral (ARV) drugs by 2021 to make sure all people who need treatment have access to it. At the same time, it is important for PLWH to be willing to take ARV drugs and adhere to treatment, despite stigma and discrimination, which is still present today in health institutions and in the society as a whole. We help our doctors and actively work with PLWH to ensure their adherence to ART.”

It bears reminding that the WHO officially validated the elimination of mother-to-child HIV transmission in three countries of Eastern Europe and Central Asia: Belarus, Armenia and Moldova.

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.

AFEW International Releases Report on Its Activities for AIDS 2018 Conference

AFEW Network (AFEW)  has a long history of working to link the “east” with the “west” so when the decision was made to hold the 22nd International AIDS conference (AIDS 2018) in Amsterdam, the city that is home to AFEW International, the secretariat of AFEW Network, it was clear that AFEW could have an important role in leveraging the conference to bring global attention to the crisis situation in Eastern Europe and Central Asia (EECA). Starting from 2016, with the support of the Dutch Ministry of Foreign Affairs (MoFA), various strategies (fostering linking, learning and dialogue; developing creative solutions to unresolved challenges; influencing leaders, policymakers and donors; addressing stigma, discrimination and criminalization of people affected by HIV) were undertaken as to empower communities from the EECA to take part in AIDS 2018.

Leading up to and during AIDS 2018, AFEW International engaged in a range of activities to promote EECA at the conference and to promote the conference in EECA. An independent evaluator examined the impact of the implemented activities and factors that contributed to the successes and analyzed the challenges. In the report, you can read what were the key activities and lesson learned.

The short version of the report can be read here.

The full version of the report can be read here.

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.

The development of Community Advisory Councils in Tajikistan

Newly detected HIV cases in Tajikistan increased by 25% in 2010. Key populations most affected by HIV are people who use drugs (13.5%), gay men or other men who have sex with men (2.7%) and sex workers (3.5%). There is a growing concern that the prevalent pathway of HIV transmission has been radically changed from injecting drugs to sexual transmission. Moreover, HIV is also found more among migrants. This group often does not have knowledge of HIV prevention tools or has no access to health care services. Partners of migrants are now getting HIV as well. The fact that more women live with HIV also risks an increase in mother-to-child transmission.

In 2018, AFEW-Tajikistan expanded its NGO testing services for females who use drugs, sexual partners of people who use drugs (PUD), female prisoners and women living with HIV. With the aim of increased inclusion of people who use the services, Key Population Advisory Councils (KPACs) were established in four cities in Tajikistan: Bokhtar, Dushanbe, Khujand and Kulob. The KPACs represented people living with HIV, sex workers and people who use drugs. Per city, the KPAC consists of four members who serve a term of two years. These members bring recommendations forward and involve the service beneficiaries more closely.

The Tajikistan network of Women Living with HIV (TNW+) started mentoring the KPACs and introduced evaluation tools for people who use the services. While the members of the councils are changing a lot and regular training among members of the current KPACs is still desired, the councils now have a patient-complaint procedure. The concept of “being asked for feedback on your service” is new to Tajikistan and is showing results. In 2018, 85% of all total complaints received were positively resolved. The councils received training and have become convinced of the belief that they could change not only their lives but also society. Apart from monitoring tasks, the members of the councils also offer support on paralegal counselling and peer-to-peer education.

“A woman who used drugs gave birth to a baby. The Drug Treatment Service of Bokhtar has people show up and get their methadone before noon. Sometimes this woman was late because of all the duties with  a baby. Therefore, she sought help in a civil society organisation, which contacted the administration of the methadone site. Now the centre is open until 2 pm, and the woman I mentioned before can get her methadone easier.” 

Takhmina Khaidarova, TNW+

The expansion of service delivery for Civil Society Organisations in Tajikistan has led to a bigger coverage of services for key populations. People who use the services are now taking part in the development of services, planning and implementation of activities and the evaluation of provided services. It has also led to an improvement in providing services with longer opening hours, shorter waiting times in health facilities and friendlier attitudes of medical staff. Besides, TNW+ is linked to the daily reality of the people who use the services. The government considers civil society accountable for monitoring the services, providing feedback and seeing changes.

By integrating TNW+ and service beneficiaries into a system of service delivery, both the community network and the service beneficiaries are strengthened. This leads to more gender-sensitive services for female PUD, (ex)-prisoners and sexual partners of PUD.

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

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

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

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

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

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

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

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

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

Authors: Yuliana Skibitskaya, Yana Kazmirenko, Ukraine

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

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

The draft law may be considered in May-June

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

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

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

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

Medical marijuana may be used in HIV treatment

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

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

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

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

Legalization to reduce stigma

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

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

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

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

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

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

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

Daria Alexeeva: “The Majority of Applications to the Emergency Support Fund Come from Russia”

Author: Olesya Kravchuk, AFEW International

Starting from December 2018, organisations from 10 countries in Eastern Europe and Central Asia can receive small grants with a maximum amount of €5,000 per grant. AFEW International and Aidsfonds started awarding emergency grants in the framework of the Emergency Support Fund for Key Populations (ESF). The activities of the Fund are financed by the Elton John AIDS Foundation and Aidsfonds. With these small grants AFEW International and Aidsfonds support organisations representing key populations in surviving in difficult situations which they face due to legal barriers, stigma and discrimination, financial challenges and political restrictions. Support is given to organisations carrying out activities that ensure access to HIV prevention, treatment and/or services for key populations, or projects protecting the human rights of key populations. The total funds available in the Emergency Support Fund is equivalent of the 750,000 pound sterling.

Today we are talking with AFEW International’s program manager Daria Alexeeva about the first results of ESF’s work, and what it takes to be awarded the small grant.

– What are the first results of Emergency Support Fund’s work?

– During this first phase, our main tasks were to set up the grant application process, the selection procedure and the infrastructure for receiving and qualifying applications. All three aspects were ready by December 1, 2018. The invitation to apply for a grant from the ESF was spread widely in the networks of AFEW, Aidsfonds and the members of the Advisory Board. In December 2018 AFEW International has established a system to administer grants to applicants. On January 4th the first meeting of the Operational Team took place to review first applications. Since December 1, 2018 we received 96 applications, of which 42 (44%) were approved for grants. The total committed amount by the end of March 2019 was Euro 235.000.

– What countries are applying to the Fund the most?

– The majority of applications came from Russia. We received 45 applications from the Russian Federation and awarded 22 applications. The next most active country was Tajikistan with 15 applications, and 7 being awarded. The third one was Ukraine with 16 applications, 5 of which were awarded.

– What problems do organisations address the most?

– More than half of the awarded grants are targeting people living with HIV (PLHIV) – 55%. One third of all awarded grants went to the projects which provide support to communities of LGBTI, and one third – to communities of men having sex with men (MSM). One third of the awarded grants support projects for people using drugs (PUDs). The equal amount of the awarded grants – 21% – supports projects for sex workers and vulnerable women.

– How does the Fund help to solve the problems organisations have?

– We are helping with a broad range of emergencies. We have several goals within the Fund. The first one is contributing to decline in the annual number of new HIV infections in Eastern Europe and Central Asia (EECA). The second goal is increasing access of everyone who is living with HIV in the EECA region to treatment. The third goal is full funding of the AIDS response in EECA.

Thus, we are funding activities, which contribute to these goals. Among the grants we awarded are projects aimed at the provision of harm reduction services, HIV testing and referrals for the treatment for difficult to reach populations (MSM, LGBTI). We have funded repairing mobile units for outreach work, purchasing milk formula to secure stock for HIV positive women. We support project working for disabled PLHIV making sure they are able to adhere to their treatment regimens, and projects which help prisoners getting access to testing and treatment, and to adhere to their treatment after they are released from prisons. Besides, there are projects organising trainings of the medical staff with the goal to form a tolerant attitude towards key populations, for instance, transgender people, in order to improve access and quality to health services and antiretroviral treatment. We also support advocacy activities to raise awareness of the needs of the key population and to call for the funding increase, for instance, provide legal support to cases of rights violation in prisons to generate evidence for advocacy. There are much more issues we support that are aligned within our three goals that I have mentioned before.

– What type of applications is being rejected by the Fund?

– Some of the projects are one-off events which are not carefully thought through from the sustainability point of view. For instance, conducting training for outreach workers without creating a system to support their work in the future. Besides, there are projects which are contributing to solving a real emergency situation. Some of the proposals are just weakly written. In all cases, we provide feedback and advice on how to improve the proposal if an applicant decides to submit again.

– What are ESF’s plans for the future? How many projects do you plan to support in 2019 and in the years afterwards?

– We plan to support at least 100 applications and maybe even more in the period till the end of 2020. We will continue supporting applications until the total funds that are available will be exhausted. We might be done in the middle of 2020 already. The amount of grants to be awarded depends on the size of the requested funds. In some cases, we allow a grant up to 10,000 euro, in particular when the project is contributing to solving situations which concern bigger groups of key populations or when the project is contributing to generating the evidence needed for developing prevention programs and advocacy towards national or local governments. When the emergency situation cannot be solved with 5,000 euro – then the bigger amount is awarded as well. We foresee a little fewer approved grants in the second quarter of 2019. By the way, there will be a summer break in the reviewing of applications from 8th July till 16th August due to holidays.