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.

HIV on AIDS 2018: Global Extent, Impact and the Way Forward

The issues of stigma, discrimination and human rights violations were broadly discussed during the AIDS 2018 conference which was held in Amsterdam, Netherlands in July 2018. The conference sessions explored the political, economic and sociological manifestations of HIV related stigma, discrimination and human rights violations on the global level articulated by the civil society.

Global Network of People living with HIV presented their report on HIV stigma and discrimination in the world of work which included findings from people living with HIV (PLHIV) stigma index. The report was written based on the information provided by 13 country teams who implemented the PLHIV Stigma Index.

Stigma index as a tool

Addressing stigma-affected people living with HIV is a global priority. Stigma, defined as “the co‐occurrence of labeling, stereotyping, separation, status loss, and discrimination in a context in which power is exercised,” has a negative impact on the health of PLHIV and contributes to the psychosocial stress, coercion and violence, job loss, and social exclusion. PLHIV, gay men and other men who have sex with other men (MSM), transgender individuals, sex workers, and people who use drugs (PWUD) – often referred to as key populations – are at the intersection of HIV‐related stigma and prejudice against their identities, occupations or behaviors that are often exacerbating their experiences of stigma and discrimination.

The PLHIV stigma index provides the evidence on stigma and discrimination that has been essential for informing HIV policy, PLHIV rights advocacy efforts, and stigma‐reduction interventions.  Stigma index is a research tool by which PLHIV capture data on their experiences of stigma and discrimination. As of November 2017, more than 100,000 PLHIV had been interviewed in over 50 languages by 2 000 trained PLHIV interviewers.

Stigma is complex

Stigma and discrimination remain a significant HIV risk factor for the key populations all over the world and mostly for people living with HIV as stigma directly and negatively affects health outcomes. At the International AIDS 2018 Conference, the participants reviewed new developments in the effort to combat stigma and discrimination, report results from researches and analyses of interventions and effective anti-stigma programs. The implications of the studies were discussed as they relate to the development of ongoing efforts to reduce HIV-related stigma and discrimination around the globe.

The construction of stigma is complex. Therefore, anti-stigma interventions must take this into account. Stefan Baral, M.D., Johns Hopkins University, presented a cross-country analysis of intersectional stigma among MSM, including perceived stigma, enacted stigma, and anticipated stigma related to family, community, and the health system.

As national AIDS programs and the international community grow efforts to implement plans for the universal access to HIV prevention, treatment, care and support, participants of the AIDS response should work together to overcome the main obstacles to achieving this goal.

MSM with depression have higher risk of stigma

Expressions of stigma in this analysis included a broad range of behaviors, such as family exclusion, rejection by friends, family gossip, verbal harassment, being afraid in public, being afraid to seek care, avoiding seeking care, poor treatment by health care workers, health care worker gossip, police not providing protection, blackmail, and even physical harm. Harassment and gossip were noted as important forms of enacted stigma that must be addressed, and intersecting identities were found to raise the risk of experiencing high stigma. MSM with depression, for example, had a higher risk of being stigmatized. These intersecting identities represent a critical target for all types of stigma reduction, particularly anticipated health care stigma.

In many countries and communities, HIV stigma and subsequent discrimination can lead to the same devastating effects as the disease itself: a break with a spouse and/or family, social ostracism, loss of work and property, exclusion from school, denial of medical services, lack of care, support, and violence. These consequences or the fear of them mean that people will not be very willing to be tested for HIV, disclose their HIV status to others, or seek treatment, care and support.

Students will Attend the Annual Conference with a Discount

The annual STD x HIV x Sex Congress organized by AIDSfonds in the Beurs van Berlage in Amsterdam, the Netherlands, this year will take place on 23 November. AFEW International gladly offers students the chance to attend the Congress for 15 euros, which is a fraction of the regular ticket price. We invite you to take part in the congress if you are a student interested in issues related to HIV/AIDS and sexual and reproductive health and rights.

About 500 professionals from various institutions such as Dutch Ministry of Foreign Affairs, Amsterdam Municipal Health Service, Public Health Ministry, national and international NGOs and research institutions take part in the Congress in Amsterdam. These professionals are committed to ending AIDS and decreasing STD infections. The Congress is also a place to learn about community-based development and new research findings and technologies. Congress tickets can be bought between 11 October and 16 November online.

The student discount is made possible by AFEW International. AFEW is a network of civil society organisations working in the Eastern European and Central Asian (EECA) region. With AFEW International’s secretariat based in Amsterdam and country-offices in Kazakhstan, Kyrgzystan, Tajikistan and Ukraine, AFEW strives to promote health and increased access to prevention, treatment and care for public health concerns such as HIV, TB, viral hepatitis and sexual reproductive health and rights. At the STD x HIV x Sex Congress, AFEW is hosting an art expo and a workshop that brings students and professionals together to discuss the future of the work field.

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.

UN High-Level Meeting on Tuberculosis: People should be the Centre of the Fight

New York, 26 September 2018

The challenge of tuberculosis (TB) is faced worldwide, including across all of Europe and Central Asia. 1.6 million people died of the disease in 2017, and Heads of State are meeting today to discuss the matter at the UN General Assembly. TB kills more people each year than HIV and malaria combined. As one of the top ten leading causes of death TB deserves the highest political attention.

“I call on leaders of the world to commit to ending TB in their countries by allocating the necessary resources in their health budget, and involve us, civil society and communities in helping to reach the unacceptable 36% of people with TB who are still missed by health systems every year,” says Yuliya Chorna, the Executive Director of the TB Europe Coalition (TBEC).

Traditionally, people in many countries of the European region have been treated in hospitals for long periods from six months to two years. Patients have to suffer not only the burden and toxicity of a long-term treatment with heavy antibiotics but also being apart from their families, jobs and social lives.

“TB patients are no longer infectious by at most two weeks after they start and receive effective treatment. It is ridiculous that many programmes still isolate people from society for many months. No wonder people are afraid to seek a diagnosis. TB care has to be designed for and with people,” says Ksenia Shchenina, a former TB patient from Russia and Board Member of TBEC.

While European Heads of States are noticeable by their absence at the meeting, the WHO Europe region continues to be a hotspot for the spread of the multi-drug resistant (MDR) form of TB. Conservatism in the way TB is being treated in Europe and the lack of involvement of civil society and communities in TB care, who play a vital role for treatment adherence, has led to terrible figures in Eastern Europe and Central Asia. Too many countries report rates of around 30% of new cases being multi-drug resistant. Furthermore, worldwide only 25% of people with drug-resistant TB are on treatment.

Yet we still don’t have the right tools to fight TB. Our leaders have not allocated the right amount of funds to develop new vaccines, diagnostics, and treatment. We continue to have an astonishing annual $1.3 billion gap in Research & Development for TB.

“While the European Union congratulates itself on allocating on average less than €30 million per year to TB research initiatives in the last four years, it should think of reorienting its priority setting in health research to a needs-driven approach. Our taxpayers’ money should go to funding priorities neglected by the private sector,” says Fanny Voitzwinkler, Chair of the TBEC Board.

The UN High-Level Meeting on TB held on 26 September 2018 is a time for action and unity. We need changes if we want to stop the millions of preventable deaths caused by TB. Civil society can contribute greatly to effective people-centred care, it wants to be involved and will be watching to make sure the commitments made by world leaders at the HLM will be put into practice.

Source: TB Europe Coalition

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.

AFEW on AIDS 2018: Cases and Efforts to Spotlight Eastern Europe and Central Asia

Author: Olesya Kravchuk, AFEW International

AFEW International and AFEW Network have organised and supported numerous activities within 22nd International AIDS Conference AIDS 2018. AFEW joined many initiatives by other organisations and networks and presented successful cases of work in Eastern Europe and Central Asia (EECA). Find some highlights below.

Together with EECA regional networks and committed advocates, AFEW has put great effort into making sure that the AIDS crisis and related public health concerns in EECA were featured in the conference program. Each plenary session of the AIDS 2018 had a speaker from the region and lots of sessions addressed the challenges in stopping new HIV and TB cases in the EECA countries. AFEW also supported Russian-speaking delegates to the Conference and helped with translation to and from Russian during AIDS 2018. More than 35 sessions were translated into Russian. A team of 25 dedicated Russian and English-speaking volunteers was recruited, trained and coordinated by AFEW International. These volunteers have provided language support during the conference and at the events organised by AFEW.

AFEW has also contributed with financial and technical support to the EECA networking zone ActivEast which was one of the busiest zones in the Global Village with more than 50 sessions during the conference led by community leaders.

Besides, AFEW International helped Amsterdam Youth Force by providing it with fiscal and administrative support, technical assistance and financial means to bring young volunteers to the conference. 35 young people from different countries of EECA have travelled to Amsterdam by bus from Kyiv and have worked at youth-focused events of the Global Village.

A migrant from Tajikistan came to talk

AFEW’s Leadership workshop ‘Migration in Eastern Europe and Central Asia: Access to healthcare for all?’ presented information about migrants in EECA, and labor migrants from Tajikistan in particular. Findings from a needs assessment survey of labour migrants among people who use drugs in Kyrgyzstan and Tajikistan were presented.

A labor migrant from Tajikistan Zebo Alimahmadova came to Amsterdam to tell about her migration experience to Russia. Working in Saint-Petersburg, Zebo got to know that she was HIV-positive. Even though it was difficult for her, she found strength to go back to her home country with her children and get the proper treatment. Now she has a job and feels support from her three kids and AFEW-Tajikistan.

Coping with shrinking space

Shrinking space of civil society in the EECA region was also an important topic during many events of the Conference. AFEW’s director of programme Janine Wildschut led an active discussion on the strategies for coping with shrinking space for the civil society and shared AFEW’s techniques in the EECA networking zone in the Global Village.

“In EECA, we have observed a diminishing space for civil society organisations, perhaps best exampled by the ‘Foreign Agent Law’ in the Russian Federation. The shrinking civil society space threatens the effectiveness of the response to HIV and other public health issues, particularly as it pertains to the health and rights of key populations,” says Janine Wildschut.

The report on the coping strategies amongst resilient harm reduction organisations and community networks in the context of shrinking space for civil society in Eastern Europe and Central Asia can be read and downloaded here.

Martine de Schutter Fund donors meeting

Martine de Schutter Scholarship Fund event was organised during the AIDS 2018 to bring together the donors of the Fund and the scholars and give them an opportunity to meet the family of Martine. The Fund established by AFEW raised 130.000 EUR to cover the additional scholarships of the EECA applicants to come to Amsterdam for the AIDS Conference. It was an emotional gathering, with gratitude expresses by the scholars for an opportunity to come to the conference – for many for the first time in their lives. AFEW’s executive director Anke van Dam said that AFEW has an intention to continue fundraising for the Fund to further support EECA delegates for international scientific meetings and conferences.

Martine de Schutter was a strong Dutch advocate for human rights and had a passion to Eastern Europe and Central Asia. Her last trip was to AIDS 2014 Conference in Melbourne on the MH17 plane that was shot down and crashed.

EECA ministers showed their political will

Within AIDS 2018, AFEW took part in Ministers and civil society dialogue meeting, organized by the World Health Organization Regional Office for Europe and UNAIDS, in cooperation with the Government of the Netherlands. Ministers of health and senior policy-makers from 10 countries in EECA were introduced to the civil society organisations’ representatives during the meeting. The participants exchanged their experiences and the results of their national AIDS responses with a view to adapting them and scaling them up across the region. They discussed the Fast-Track priorities for achieving the 90–90–90 targets. EECA government representatives reaffirmed their political commitment to scale up national HIV responses during a ministerial policy dialogue on HIV, which was held on the eve of the International AIDS Conference in Amsterdam, Netherlands.

Hermitage dinner as the climax of Culture Initiative events

AFEW established International Cultural Initiative – a platform to complement AFEW’s consolidated track record in advocacy, education and outreach campaigns on matters of public health in the EECA region. The artistic work put forward by our six artists-in-residence, who came from EECA countries, was showcased at a variety of cultural institutions of the city of Amsterdam between May and July 2018. During the AIDS Conference, art-pieces were accessible to the general public in the Global Village.

The special Dialogue Dinner was the climax of AFEW’s cultural activities, taking place in the Hermitage Amsterdam Museum. We hosted an evening with dialogues about the EECA region, while savouring food and art from the region. 60 invitees representing policy makers, researchers, NGOs, foundations and international development specialists focusing on public health in the EECA region attended the dinner.

Chasing the virus together

AFEW Network members were actively participating in the EECA Campaign “Chase the virus not people!” that was launched at AIDS 2018 by the region’s community networks. EECA regional networks joined forces in response to the current situation to urge the world to overcome discrimination and the stigmatisation of key populations. AFEW International joined the campaign and was also one of its organisers.

“It was very important for us to join this campaign because this is the first campaign in which all regional networks united their efforts to draw attention to the problems of key population groups. AFEW is also against the backdrop of the catastrophic situation with the HIV/AIDS epidemic in EECA,” says Daria Alexeeva, EECA at AIDS2018 project manager at AFEW International. “Being actively present in six countries of the region, we realize how important it is to unite our efforts with other networks to achieve the common goal.”

AIDS 2018: Prison Corner and Harm Reduction Networking Zone Activities

More than 5 000 people, including famous actress Charlize Theron, visited the prison corner in Harm Reduction Networking Zone (HRNZ) located in the Global Village at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam. During five days, visitors could stop by, have a delicious cup of coffee made by former prisoners and participate in a programme with interactive debates, interviews, and presentations. Prisoners are usually a forgotten group since very few organisations pay attention to this vulnerable group of people. Taking into consideration that in many countries the issue of HIV/AIDS in prison is very sensitive and that the implementation of programs in prisons can hibernate or even fail, a pragmatic step-by-step guide for prison authorities and civil sector actors is now being developed by European Monitoring Centre for Drugs and Drug Addiction and European Centre for Disease Prevention and Control.

The executive director of AFEW International Anke van Dam stressed on the necessity of working in prisons in Eastern Europe and Central Asia (EECA). Health protection in prisons is a serious public health issue. Even though international law recognises the right of everyone, including people deprived of their liberty, in practice, many prisoners receive healthcare of a lower standard to the one available outside of the prison, if they receive treatment at all. In Eastern Europe and Central Asia, the unbearable circumstances and lack of coherency within the penal systems of the regions exists. AFEW recognizes the importance of people living within prisons receiving the same healthcare and life opportunities during and after their stay in prison. Together with prison authorities, AFEW is in constantly implementing prison health projects that seek collaboration with organisations working in prison. To introduce the region where AFEW is actively represented, Anke van Dam gave a book Invisible Lives: HIV on the Fringes of Society to Monica Beg, Chief of HIV/AIDS Section and Global Coordinator for HIV/AIDS at United Nations. Stories from the representatives of key populations from Tajikistan and Ukraine are depicted in the book.

AFEW expresses a big gratitude to our prison corner partners: The Council of Europe Pompidou Group, Asian Harm Reduction Network, International Corrections & Prison Association, Health Through Walls and UNODC.

Ukrainian success with the monitoring instrument

During the session about engaging young people who use drugs in Ukraine in the HIV and human rights response, AFEW-Ukraine presented the developments achieved during ‘Bridging the Gaps: Health and Rights for Key Populations’ and PITCH projects, supported by the Ministry of Foreign Affairs of the Netherlands.

AFEW-Ukraine’s manager Irina Nerubayeva presented the instrument for monitoring violations of human rights of adolescents using drugs in Ukraine, that has been used for a year among the partners in four regions of Ukraine. ‘Bridging the Gaps’ project partner – social worker from Kharkiv NGO Blago Alina Khokhlova – told about challenges and results of using the instrument and emphasized the importance of her organisation in developing effective advocacy programs in the city. Youth activist Daria Kopyevskayskaya from Kropyvnitsky (NGO Return to Life) emphasized the role that young people play in delivering information to their peers about rights.

Legal expert Vita Musatenko presented the most typical cases that were identified in the process of monitoring and advised what social workers can do to provide adequate response and help to a young person. Evgenia Kuvshinova from NGO Convictus told about her work with young people who use drugs in Kyiv at the Street Power Club where young clients receive a range of services, including testing for HIV, sexually transmitted diseases, hepatitis. There they also engage in educational activities and are trained as leaders.

From harm reduction programmes to methadone therapy

The session on HIV prevention, treatment, and care in the countries of the former Soviet Union allowed to learn about challenges and achievements of prison programmes from various countries of the former Soviet Union and receive information from government officials and NGOs. The head of the Medical Department of Kyrgyz Penitentiary Service Nazgul Soltobekova told about the system of HIV prevention and treatment in Kyrgyz prisons. She also shared the country’s successful experience in providing comprehensive services for people who use drugs in penitentiary facilities – from harm reduction programmes to methadone substitution therapy.

Konstantine Turashvili from the medical department of the Ministry of Corrections of Georgia told about HIV programmes in Georgian prisons and the country’s successes in hepatitis elimination programmes. Both speakers emphasized the importance of cooperation with community-based organisations that provide effective counseling services for inmates and help to ensure continuity of care of those released from detention facilities. This topic was further followed by Natalia Rudokvas from Kazakh NGO “Answer” who shared the experience of her NGO’s work with HIV positive inmates. Ikrom Ibragimov from AFEW-Tajikistan shared his experience of cooperation with the penitentiary system and told how NGO can build the capacity of prison staff in HIV, TB, and other related issues.

Being an expert in prison health, AFEW will continue advocating for HIV, TB and hepatitis C prevention and treatment programs for prisoners in EECA. We are promoting essential elements like harm reduction, including needle and syringe programmes, and opioid substitution therapy. Transitional client management that prepares prisoners for release and ensures linkage to follow-up after release is a valuable variant of client management that meets many of (ex)prisoners’ needs.

‘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.

‘Bridging the Gaps’ in Georgian Provinces

Gocha lives in a small town of Telavi

Author: Irma Kakhurashvili, Georgia

Gocha and Nikoloz are clients of ‘Bridging the Gaps: Health and Rights for Key Populations’ project in Georgia.

Art therapy works

Gocha lives in the hottest region of Georgia – Kakheti – in a small town of Telavi. He is a client of a Rehabilitation Centre in Gremi village. There he receives support to overcome his alcohol and substance use problems.

The Rehabilitation Centre for drug users run by Tanadgoma is the first and only stationary rehabilitation centre in the country offering free services to its clients. Since it was founded, over 25 clients received help free of charge there. In the Centre, clients can get social, psychological and health services. The Centre applies twelve-step recovery programme. Besides, it offers art therapy classes and even runs a ceramic workshop. The instructors working in the Centre were trained in a Ukraine-based rehab.

As many of his friends, Gocha used to smoke “harmless weed” since he was a schoolboy. Soon enough, he found himself among people who were eager to use other drugs as well. At first, he was curious to experiment with substances, but during the heroin boom in Georgia – when it could be purchased even in the Kakheti villages – the situation changed. If Gocha was lacking money to buy drugs, he had enough to get some alcohol. Gocha’s family knew about his problems. His parents told him that he would find himself in a trouble, but it did not help. After the government introduced stricter rules for drug dealers and users, Gocha switched to the homemade drugs.

He first came to the Tanadgoma Rehabilitation Centre two years ago. Gocha took part in the twelve-step recovery programme, attended counselling sessions and art therapy classes. Currently, the man is in remission, but sometimes he comes back to the Centre seeking services. He says that sometimes he drinks alcohol. Georgia is the motherland of wine, so it is hard to quit alcohol.

“I do not know what would happen to me if not for this project. Now working with clay and ceramics is the biggest joy for me. There is a radio set in the workshop and I can work all night long, listening to music. I have a lot of creative insights and the process of work is very important for me. When I draw sketches, I think of nothing else. My negative thoughts go away,” he tells.

Gocha does not know if he will be able to quit drugs and alcohol for good. There are no guarantees, but at least now he understands how to reduce the harm he does to his health. Gocha finds his support in knowing that if he goes home and has a relapse again, he can always come back to the Centre or contact harm reduction programmes.

Sometimes small tours are organized for the clients of the Centre. This region of Georgia is famous for its historical sights and beautiful nature.

“Sounds of the river calm me down. There I can think about my life. I spent 11 years behind the bars and I have many regrets… Now there are a lot of pharmacy drugs in Georgia, many people need psychosocial support… I do not understand why the government does not want to implement rehabilitation and employment programmes instead of the repressive drug policies. It does not want to be responsible for such people as me. So far, the Centre is the only place where someone cares about my mental health,” says Gocha.

He has two dreams: to equip the Rehabilitation Centre with exercise equipment for its clients to stay fit so that they are able to start a family.

“I want my empty house in Telavi to be full of child laughter and hope. I want to live a normal life,” says Gocha.

Drug use changed my life

Nikoloz is a former police officer

Nikoloz is 45 years old. He is a former police officer. His professional career ended up when he was arrested for drug use and sentenced to seven years of imprisonment. Before that day, he had no problems.

“I was 18 when my friend and I tried drugs for the first time. Little by little, I got used to drugs. My brother also did drugs, but I was afraid to tell him. I felt uncomfortable to talk about it with my family. Then I studied law, started working in police and that is when I got really “hooked.” I had powerful relatives, so I felt safe, but after eight years of active drug use I was locked up,” remembers Nikoloz.

Seven years in prison were a dreadful, lost period of his life. Then it was easy to get drugs in closed settings and Nikoloz used this opportunity. However, one case of severe overdose, when he almost died, made him rethink this situation. After he got back home, all his social connections were lost.

“Then I thought that it was enough, I had to stop. Even now, I hate drugs with all my heart. I fight them and fight myself. Last year I had a relapse. Therefore, I had to enrol into a substitution therapy programme and receive treatment in a clinic,” confesses Nikoloz.

He feels sorry because drugs changed his life but says that if years ago he had access to harm reduction programmes, he would definitely enrol in them. Back then, he knew little about reducing the risks of drug use.

“I had no strength or desire to quit drugs, but I would surely use them in a safer way, for example decreasing the frequency of injections. I would be able to control my life and health and would avoid overdose and hepatitis C. Drugs will always be there. Non-medical use of drugs is bad for everybody – the individual and the society – so protection of public health requires protection of drug users’ health. For that purpose, drug users should be integrated into the society and not isolated,” says Nikoloz.

In jail, Nikoloz got acquainted with people working for Tanadgoma, who offered different services to the inmates, in particular, psychological support, which was very important for him.

After Nikoloz was released, he went to a social bureau in Tbilisi. Tea Chakhrakia, working for Tanadgoma, helped him to re-issue his documents. Besides, people from Tanadgoma helped him to get a job with Akhali Gza NGO providing harm reduction services to people who use drugs. Since then, Nikoloz has been working as a social worker there. For him, his job is not only his responsibility, but also his real family, where he is loved and respected, and such love and respect are mutual.

Nikoloz is convinced that harm reduction services are more effective than incarceration. The best approach to resolve drug-related problems is to work with people who use drugs and not punish them.

“In our country, drug policy is based on some Utopian ideas because the government thinks that the drug use may be eradicated. In Georgia, criminal justice is the only method to solve the problems of injecting drug use. Drug use is treated as a criminal offence, though there is a strong evidence proving that repressive drug policies are ineffective and prevent access of people who use drugs to health services,” says Nikoloz.

Nikoloz is happy to share his experience with junior outreach workers. He works with clients, motivating them to get tested, helps them to prepare all the required documents, develops support plans, and tells people about safer drug use methods.

“I am really grateful to the project for the job that I have, which helps me feel that people need me. I received help one day, and now I can help others, sharing my experience with them. My clients are people who use drugs. Many of them use drugs only to overcome their withdrawal syndrome. They are the ones who really need support. I want them to understand what is waiting for them ahead,” he says.

Nikoloz says that with support of harm reduction experts many good things may be done for people who have already lost any hope. That is why it is important to implement the projects, which meet the specific needs of vulnerable populations.

“I am glad that in prison I met people who saw my potential and believed in me,” he says.

About the project

Bridging the Gaps: Health and Rights for Key Populations‘ is an international project implemented in 16 countries of the world to improve the health and protect the rights of vulnerable populations. In Georgia, the project was launched in September 2012. Its main goal is protecting human rights of drug users by changing social attitudes and government policies and improving the quality of services delivered and access to them.

In Georgia, the project is implemented by Bemoni Public Union and Tanadgoma Centre for Information and Counselling on Reproductive Health. Bemoni provides services in the social bureau based in Telavi (Kakheti), and Tanadgoma – in the social bureau based in Tbilisi. Besides, in 2015 Tanadgoma opened a Rehabilitation Centre for people who use drugs in the Gremi village, Kakheti.

In 2012-2017, over four thousand people who use drugs received 17,321 medical, psychological, social and legal services within the project.