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.

AIDS Conference Brought me a Job in Tajikistan

Author: Nargis Hamrabaeva, Tajikistan

Fifty-year-old Zebo from a southern region of Tajikistan – Khatlon – is a former labour migrant. At the 22nd International AIDS Conference in Amsterdam (AIDS 2018), she had the courage to speak out about what she long kept in – her HIV-positive status. Zebo once again turned the attention of the international community to the fact that labour migrants are one of the populations most vulnerable to HIV.

We interviewed her in Amsterdam, right after she delivered a speech at one of the sessions dedicated to HIV in the context of labour migration.

– Zebo, why did you decide to go to Russia to earn money? Usually that is what men do.

– In 2004, after I divorced my husband, I was left alone with three small children – my elder siblings were 9 and 6 years old, and my smallest daughter was only 3 months old. I worked as a nurse at a local maternity clinic. My children grew up, with our expenses growing along the way, and my earnings were not enough to feed them all. My ex-husband had a new family and was not helping us. Many of my countrymen went abroad to earn money and support their families. I decided to do the same. That is how my children and I found our way to Saint Petersburg.

– Isn’t it difficult for a woman to be a labour migrant?

– It is very difficult. I was desperate and went to nowhere. For the first days, we slept at the railway station or in the street. Some strangers helped us, offering food or money. Once, a woman from Tajikistan, who worked in Saint Petersburg, saw us and was so kind to give shelter to my children and me. I started baking and selling pasties, earned some money. As time passed, more people were buying our pasties: I was baking and my elder daughter was selling them at the Sadovy street market. Luckily, we had many buyers. However, I had to work my fingers to the bone.

I tried to settle my personal life again as it was very hard for me to cope with all my troubles alone. I met a young man. In the beginning, everything was fine. Then I started noticing him doing some strange things. It turned out that he was a drug user. He injected drugs. I asked him to stop but it did not help. Then I decided to break up with him. Later I heard that he felt bad and his relatives took him back to his motherland. Since then, I have never heard from this man, but my HIV status always reminds me of him.

When did you first learn that you had HIV?

– In 2015, a year after I broke up with my partner. All of a sudden, I felt bad and had a fever. My relatives called an ambulance. In the hospital, they made some tests and I was diagnosed with HIV. In a month, I felt better and went back home, but six months later it happened again. I was dwindling, with my weight going down to 34 kilos. Doctors advised me to go back to my country and get treatment. Almost all my countrymen working in Saint Petersburg had to raise money to buy airline tickets for me and my children. They knew that I was severely ill but did not know the exact diagnosis. When I came home, my family knew I had HIV. They did not really welcome me back. My relatives turned their backs on me and asked me to leave our house. My mother said that I would infect everyone, told people not to eat from the same plate with me and not to shake hands with me. I remember her yelling: “Get out of the house, aidsy!” It hurt me to hear such words, especially from my own mother. Still there are kind people in this world, so a neighbour living opposite from my parent’s house offered me to stay with her. She gave me a small room in a little building. That is where I still live.

So you had to go back to square one again?

– Yes, I did. A woman I know told me about AFEW-Tajikistan office in Bokhtar. I went there and they received me well, helping with food and treatment. They also had a business workshop for the members of vulnerable populations and I was able to get a credit from a microfinance organization. I bought everything I needed to open a small sales outlet in the neighbourhood. Sometimes, when I need to go to the city, my daughter takes over my duties. Children always help and support me in everything I do. My son also assists street market vendors, bringing home 15 somoni a day (less than two US dollars – ed. note). After my speech at the Amsterdam conference, Director of AFEW-Tajikistan Ikrom Ibragimov offered me to work as a consultant in the Bokhtar office of the organization. Now I will receive a salary. I am so grateful to him and to all the members of his great team. With their support, my life is getting better.

Great! One more question about Amsterdam. What does participation in the AIDS conference mean to you?

– It is my first trip far abroad. It is also the first time I take part in such a conference. I listened to many speakers and was inspired by their stories. They were openly saying that they lived with HIV for 20-25 years, taking care of their health and living active and complete lives. It gave me strength and confidence. I was startled to learn that in many countries people living with HIV are not prosecuted and other people do not avoid them. In those several days of the conference, I received more sincere hugs and handshakes than I did since I learned about my diagnosis. Why is there such a strong stigma against people living with HIV in my country? Why do people still hold to stereotypes and are afraid of us? At one of the sessions of the Amsterdam conference, I heard a slogan: “Chase the virus, not people.” It is such a good point! 

AIDS 2018: Will Decriminalisation Resolve the Problem of HIV

Maybe one of the most important sessions at the recent 22nd International AIDS Conference AIDS 2018 held in Amsterdam was the session, which raised the question why we still fail in responding to the epidemic among people who inject drugs. Participants of the session were able to consider this problem from the different points of view: science, law enforcement and community of people who use drugs.

Methadone is good for police

For over 20 years, Professor Nick Crofts from the University of Melbourne has been working to engage police in HIV response. He considers that decriminalisation is an absolute necessity to resolve the problem.

“We fail responding to the epidemic because we have failed to enlist police as partners in the response to HIV,” he says. “Changing the situation, first of all, requires changing the role of police, which will, in turn, help bringing the marginalized communities back to the society.”

In Australia, Professor Crofts and his allies were able to convince the police that such harm reduction programmes as methadone therapy and syringe exchange may benefit police as well as the rest of the community.

“We still have not introduced harm reduction courses in police academies, have not adequately educated police and have not fostered the role of peer educators, which is important not only in the traditional environment of activists, but also in such specific group as future or current police officers. Police officers may listen only to other police officers,” says Nick Crofts with a smile.

HIV for culture change

It is essential to find police officers who support the idea of harm reduction and educate them so that they can then educate their colleagues in relevant agencies.

“Find at least one or two individuals who want to do something different! Find them and give them your support!” exclaims Professor Crofts.

HIV may be a starting point to change the culture of the police. For a start, we need to engage the police, hold joint workshops with people from civil society and police, foster gender diversity in the police (to recruit more female police officers) and, finally, include harm reduction into the programme of police academies.

However, the Professor points out that it may sound pie in the sky talking about police in some countries.

“A third of them understand harm reduction, a third can understand and another third will never understand. Our goal is to find those people who understand or can understand it and work with them until they outnumber those who will never understand harm reduction,” he says.

“Narcotic ration” for Russia

Dr. M-J Milloy, the epidemiologist from Vancouver, tells about an interesting case, which occurred in his city back in the 1990s. Back then, there was already a large needle and syringe exchange programme in Vancouver and methadone was available. The epidemic among people who use drugs had successfully been curbed, but suddenly there was an unexpected outbreak of new HIV cases. How could it happen in a city with a well-developed harm reduction programme? It was explained with the fact that people could not access the necessary services when they were incarcerated.

Epidemiologists found out that incarceration was one of the key factors increasing the risk of HIV acquisition and one in five new HIV cases in Vancouver was a result of incarceration.

At the same time, experts estimate that in Russia every hour ten people are infected with HIV, while tuberculosis is the main reason of mortality among those who live with HIV. Most of them are people who inject drugs. The country does not offer evidence-based treatment to people who use drugs, i.e. there is no methadone, which, according to a recent statement from the Russian Ministry of Foreign Affairs, is a “narcotic ration.”

Compendium of good practices in the health sector response to HIV in the WHO European Region

In response to the rapidly increasing number of new HIV infections in the WHO European Region, the action plan for the health sector response to HIV in WHO European Region was endorsed at the 66th session of the WHO Regional Committee for Europe in September 2016. From December 2017 to April 2018, the WHO Regional Office for Europe collected good practices in implementation of the action plan and compiled them in this compendium.

National health authorities, national and international experts, and civil-society organizations involved in HIV prevention, treatment and care were solicited to share their practices. The practices exemplify efforts within five target areas: HIV prevention; HIV testing and treatment; reducing AIDS-related deaths; curbing discrimination; and increasing financial sustainability of the HIV/AIDS response. This first compendium of good HIV practices in the WHO European Region includes 52 practice examples from 32 Member States. The compendium is intended as a resource for relevant stakeholders in the HIV response.

Download the compendium here.

Source: WHO Europe

AIDS 2018: Prevention Focused on Key Populations

Source: www.aids2018.org

Author: Marina Maximova, Kazakhstan

Just before the 22nd International AIDS Conference in Amsterdam AIDS 2018, a new Global AIDS Update prepared by the Joint United Nations Programme on HIV/AIDS (UNAIDS) was presented in Paris. The report shows that the HIV epidemic is still growing in the countries of Eastern Europe and Central Asia (EECA). In the recent year, the number of new HIV cases in the region has doubled.

Participants of AIDS 2018 debated a lot on the reasons of this trend. Experts explained it, in particular, with a lack of prevention programmes, especially among people who inject drugs (PWID). Today, they account for over half of the new HIV cases. That is why implementation of the innovative multilevel interventions aimed at HIV prevention in key populations is to be continued.

For several years already, the Global Health Research Center of Central Asia (GHRCCA) and the Social Intervention Group (SIG) of Columbia University have been implementing projects and evidence-based interventions aimed at HIV prevention among key populations in the region, in particular in Kazakhstan. The results and achievements of three of such projects were presented at a special session of AIDS 2018.

Good News from NOVA

Assel Terlikbayeva

Assel Terlikbayeva, GHRCCA Regional Director:

NOVA Project is the first intervention combining harm reduction services and microfinance for women in difficult life circumstances. In two years, about 500 women from vulnerable populations – sex workers and people who use drugs – developed their skills to reduce the risks of contracting HIV and other sexually transmitted infections. Women received professional training in sewing and hairdressing. The most active participants received micro loans to start their own businesses. About 82% of project participants were able to open savings accounts, and many of them did it in the NOVA Project. About 70% of project participants were qualified for non-repayable allowances to start their own businesses, while 36% of women were able to use this opportunity.

Renaissance is possible

Louisa Gilbert

Louisa Gilbert, PhD, GHRCCA Co-Director:

The Renaissance Project is an innovative HIV prevention intervention aimed at PWID couples. Project results are inspiring first of all for its participants. Here is some of the optimistic statistics: unsafe sexual behaviours among project participants and their sexual partners were reduced by 42%, hepatitis C incidence decreased by 69% and HIV incidence – by over a half in the harm reduction group as compared to the control group.

Throughout the project, there were 89 instances when Naloxone was successfully used to reverse overdoses: in 15 cases, the medication was used to deliver first aid and saved lives of the Renaissance Project participants and in 74 cases – of PWID partners and their immediate circle.

PWID choose trust

Nabila El-Bassel

Nabila El-Bassel, PhD, Executive Director of GHRCCA and SIG, Professor of Columbia University:

In the recent year, the number of PWID visiting pilot confidential counselling sites and going through HIV rapid testing has more than doubled. It is very important that the number of new HIV cases detected at such pilot sites has grown. Implementing evidence-based strategies in routine activities allowed scaling up PWID coverage with harm reduction and HIV testing services. It became possible through the Bridge Project.

Besides, the project enhanced the role of outreach workers in finding and recruiting new clients as well as the role of nurses in working with HIV-positive people. Implementing electronic data collection helps to improve tracking and monitoring of the services and referrals provided.