We listen to each other and learn

Author – Irma Kakhurashvili

In Georgia, at festivals and clubs, young women who use drugs very often experience violence, including physical and sexual abuse, which means they have unplanned pregnancies, various injuries and infections.

In order to raise awareness among young women who use drugs about reproductive health, rights and the various services they can receive, the Community-based organization “Mandala” has organized the Papaya Health Club. The project helps young women and redirects them to those organizations that provide services of the different specialists, for example, a gynaecologist.

The project was supported by the ICF “AIDS East-West Foundation” (AFEW-Ukraine) within the framework of the program “Bridging the Gaps: Health and Health for Key Populations”.

“Mandala” is the organization based on the community of young drug users in Tbilisi, the capital of Georgia. The main goal is to provide harm reduction services during music festivals, where there is always a risk of intoxication, overdose and unprotected sex. At such events, the team of volunteers is always armed with informational materials on universal safety rules related to drug use. In a friendly atmosphere, in a special tent located near the festival venues, music lovers can get a quick consultation, condoms, drinking water and test drugs for free.

The coordinator of this project is Mariam Ubilava.

– Mariam, what is the idea of “Papaya”?

– In 2018, we, representatives of the community of people who use drugs, met in a simple, informal atmosphere, opened up and discovered that we are united by similar stories, about which we often keep silence. We are ashamed to tell about them. Many of us don’t want to talk about what we use and how, about our sex life. Young women are afraid of public censure.

And then we thought that it would be great to create a confidential atmosphere in a club format where young women can gather, speak freely and share their experiences. Because when you speak openly, identify the problem, this may be the first step to solving it.

In the Club, we meet monthly, talk, listen and learn from each other, discuss pressing issues, watch films that help young women reflect on topics related to drug use, reproductive rights and services for women that they don’t get in the reality.

– What are you trying to focus on more at your meetings?

– We are sure that a young woman should know that a condom cannot protect her from all troubles. She should remember that after taking drugs, she is more at risk of becoming a victim of violence. There is a combination of drugs leading to a “blackout,” memory loss. In this state, the young woman may be stranded in psychological and physical violence.

In addition to the “traditional” problems that young women all over the world face (the negative consequences of unprotected sex, violence), there is also another problem in Georgia. In our country, due to cultural traditions, a man occupies a dominant role in society. Modern girls, trying to be “on equal terms” with men and prove that they are not weaker, often take the same dose as the male dose, regardless of the experience of use and physical factors. And the use of a dose too large for a woman can lead to intoxication or death.

– Which questions do young women most often ask?

– We noticed that for young women, questions about how to avoid unwanted sex, violence and stigma associated with their sexual behaviour are especially important. For example, in the Club there was a girl who experienced severe stress after one music festival – she took an unknown substance and did not remember her sexual experience after drinking alcohol, and was also afraid to get pregnant.

Also, young women often ask our trainers: why do we need to know our sexual and reproductive health rights? How do contraception and the use of psychoactive substances affect the body of women – for example, what happens if you take ecstasy during menstruation? Of course, the answers to these questions can be found on Google, but it is better to hear verified and more accurate information from a specialist. That’s why our seminars are important.

– Which more services do you provide to young women and how can they find you?

– At festivals, “Mandala” volunteers give out business cards and then communicate with young people in a closed group on Facebook. And our Facebook page can be found at https://www.facebook.com/dancewithmandala/.

Different clients often come to us to receive free consultations, but with the help of the Club, we were able to expand our work with young women, whom we can redirect to various NGOs and medical institutions. It is unfortunate that when we accompany the girls, we notice the indifference of doctors to young, but in fact very vulnerable patients. It is common for the country to treat the elderly politely, but with young people, this is not necessary as we see.

We are young, but we need information, sex education. We still do not know how to behave in clinics, how to draw up documents.

Although, I note that with the help of the project we also met doctors who are sensitive to the problems of women who use drugs. One gynaecologist still provides free services to Papaya girls, for which we are very grateful.

Discover your health!

In 2019 the world famous youth program Dance4Life came to Kyrgyzstan. This means that young people in the republic will now be more informed about reproductive health and healthy sexual behaviour.

One of the Dance4Life champions in Kyrgyzstan, Temirlan Irysbekov (20 y.o.), told AFEW International what this project means for him and shared interesting observations from his practice of working with adolescents.

How did you come to the Dance4Life project?

My coordinator in social organization “Red Crescent” told me about this project and offered to apply. I liked the idea because such areas as Sexual and Reproductive Health and Rights (SRHR), surfactants and HIV/AIDS are very important for society. I always wanted to help people by volunteering, conducting trainings in schools and universities, and I liked it.

What do you do for a living?

I am a part-time student at Bishkek State University, freelance programming for companies from the West. Now I work as a barista in Beeline’s office and also do an internship there as a programmer. And for the last four years, I have also been a volunteer at the “Red Crescent” in Kyrgyzstan.

What does it mean for you to be a leader, a champion of Dance4life?

In my understanding, a leader is a person who is listened to by other people, who can deliver any information beautifully and competently. At the same time, to be the Dance4life Champion is a great pride. To be the Dance4life Champion means to share information with people. This project has given me self-confidence, a motivation that drives me to help people. I can confidently support, motivate people around me.

Dance4life aims to work with young people to develop leadership and maintain reproductive health, prevent HIV and sexually transmitted infections. How do you feel about these topics in your environment? Have you and your peers been enlightened on them in school?

My friends are not well informed about the SRH content, as teachers in schools and universities do not talk about it. They don’t even know how to use contraception or how HIV is transmitted. There was a situation when I heard from friends that HIV is transmitted through saliva. I gave them a little training where I told them how HIV is actually transmitted, gave them arguments to dispel all doubts, and shared with them information about contraception.

When I was a schoolboy myself, we had only one class hour dedicated to SRH in all years. When the Red Crescent volunteers started telling us about men and women health, many became shy, turn away, and even cried. Over time, when I shared with people that it is okay to know about your health and we need to know that to protect ourselves, their points of view changed and they became interested and now they can share this knowledge with others.

Why is it important, in your opinion, to be enlightened on these topics?

During my work with various projects, I have repeatedly encountered horrific stories that could have been warned if people knew more about their health and how to keep it. At one of the medical institutions during the training we were told the story of a girl who was playing with her brother’s clothes and decided to try on his pants. At this time she noticed blood – that was a day when her first period started. At that moment, she thought she was pregnant and decided to commit suicide.

What do you remember most about Dance4Life?

At Dance4life we become not just coaches for the guys, but friends that they can trust.

One day, a guy from our team shared his problem with me: he didn’t know how to deal with alcohol addiction. He told his parents he needed money to eat or for smth else, but he actually went to the nearest store and bought himself a beer. It had been going on for a while and he didn’t know how to stop. I redirected him to a youth center with qualified psychologists. At first, I wanted to accompany him, but I realized that he should be willing to do it himself. He made me a promise to come there.

 

So many women, so many fates

 

In Tajikistan, there is an increase in the proportion of sexual transmission of HIV infection from year to year and an increase in the number of women of reproductive age among those registered with the diagnosis established for the first time. That is why in 2019 the public organization “Tajik network of women living with HIV” (TNW+) with the support of AFEW International in the framework of Bridging the Gaps project conducted a study “Key problems of sexual and reproductive health of women living with HIV in Tajikistan through the prism of human rights”.

Before the International Women’s Day on 8 March, Tahmina Khaydarova, head of TNW+ discussed with AFEW International HIV, sex, violence and gender inequality in Tajikistan.

What does sex mean for men and women in Tajikistan?

For men, sex is an opportunity to satisfy their desire, and only then is it a way of making children. For women, sex is almost always a way of making children and extending the family. As a rule, women in Tajikistan cannot talk about sex and take the initiative in sexual relations, as it is considered to be debauchery.

Generally speaking, the sexuality in Tajikistan is highly exposed to traditional gender stereotypes. It is not common here to discuss sexual relations, either in the family or in society. Some people talk about it with their partners, doctors, etc. But even if they do that that they do not really understand the meaning and significance of the concepts of “sex” and “sexual relations” and most often talk about contraception, methods of protection against unwanted pregnancy, hygiene, etc. But not more.

Does it happen because of national traditions and religion?

Yes, in many ways. However, Islam is a religion of peace and good. Islam does not talk about the abuse of women, but there are other factors that affect women’s lives. These are stereotypes, which can be connected with religion.

One of them is “a woman is obliged to take care of her husband and all members of his family, to be obedient and kind”. Therefore, girls have been brought up in a spirit of obedience since childhood. Women themselves think that men’s interests come first. One of the features of families in the republic, especially in villages, is the predominance of extended families, where several generations of adults and children live in the same house – parents, their adult sons/daughters already married, grandparents, adult sisters or brothers. As a consequence, relatives constantly interfere in the husband and wife relationship.

In the family, girls are taught to be housewives, in most cases have no education, especially in villages, and after marriage the girl becomes very dependent on her partner and family members. Without the permission of her elders and husband, a woman has no right to leave her home and receive information about sexually transmitted diseases (STDs) if she wants. A woman must stand one step behind the man in everything: in decision-making, in expressing her opinion. A woman should listen to her husband’s words, she should keep silence, this is respect. It is also rare for women to be able to decide for themselves when, how and with whom to have sex, how many children to have, etc.

At the same time, sexual violence from an intimate partner increases the risk of HIV infection. During our survey, we heard from the respondents reasoning that non-consensual sexual intercourse is a normal phenomenon, and so it should be in the family, “This is your husband: if he wants to do something then you should obey. He’s young, and that’s why you have to satisfy his desires!”

Inequality between men and women in Tajikistan is developed not only in private life, but also in public life, isn’t it?

Yes, gender inequality is one of the problems hindering sustainable development in Tajikistan. Inequality is everywhere – in access to all types of tangible and intangible resources (property, land, finance, credit, education, etc.); in decision-making in all spheres and participation in political life, and violence against women.

Why do women tolerate violence?

Because it fits within the established system of gender inequality in Tajikistan. Men provide for women, control family relations, and therefore can do, in fact, whatever they want.

But the saddest thing is that society does not sufficiently understand the importance of this problem. It is convinced that domestic violence is a private matter. It is considered that the manifestation of abuse of wife, daughter-in-law, sister, etc. or constant control over their life and behavior is not violence but a norm. At the same time, it is widely believed that a woman is to blame if her husband or his relatives use physical force against her. There are many supporters of this opinion among young people, women themselves, and especially among their mothers-in-law. Therefore, in my opinion, special attention should be drawn to solving the problems of relations between mother-in-law and daughter-in-law, the relationship to the wives of migrant workers during the period when their husbands are outside the country, early and forced marriages, etc.

Are women with HIV more vulnerable?  

Definitely! Despite the fact that very often the source of HIV infection for a woman is her husband, she is subjected to violence and discrimination by her husband and his relatives. One woman said that her husband infected her, but did not consider himself guilty. Sometimes he closed the house and left his wife without food, hungry and helpless. One day he even tied her to a pole with a rope and beat her up, and then left for two days. After this she went to her parents, where she was also discriminated.

Why are women with HIV afraid to visit doctors?

Practice shows that those who go to the AIDS centre receive quality care and many are happy with it, including me. However, the main challenges for women are when they go to other health care facilities (for surgery or dentists), including primary health care (PHC). In these facilities women living with HIV (WLHIV) are most likely to experience discrimination against themselves. During focus groups, there were a lot of situations when health care workers refused to provide medical assistance to WLHIV and disclosed their status. Most of these cases were in maternity hospitals, dental clinics and during other surgeries. Therefore, most HIV-positive women are afraid to disclose their status and do not seek services from health care institutions, including primary health care services in their place of residence.

Have you talked to these doctors? What do they say about discrimination against people living with HIV?

We haven’t interviewed the health workers. However, many women believe that the reasons are in the lack of preparedness of health workers to work with PLHIV, as well as the low level of knowledge about HIV among staff. One woman, who went to the clinic, told doctors about her status. They immediately refused her services. The woman said it was a violation of her constitutional rights. But doctors said that she was ill and they could not help her anymore. Just imagine – that’s what the doctors said!

Besides in Tajikistan there is not good medical personnel who have experience working with PLHIV. A lot of professionals are leaving our country.

Let’s imagine – a woman found out about her status, she is ready to be examined, receive treatment and do everything that doctors say. Can she face any obstacles even in this case?

An antiretroviral therapy (ART) in our country is bought from the Global Fund, so there are virtually no interruptions. If a person wants to take ART, he or she can get it at all AIDS centers. But according to WHO’s recommendations, people living with HIV are assigned to PHC services and according to these requirements a person has to get the service at home. Due to the fact that in rural areas and small towns and districts everybody practically knows each other, PLHIV are afraid of disclosing their status. So there is a possibility that they will not apply to these services locally for ART services.

How difficult is it for women to accept their status?

More often it depends on their level of awareness and education – they might not know anything about HIV or have distorted information about the virus. Because HIV does not show strong symptoms in the early stages, women think that they are not sick and that the virus does not affect them. Also, accepting a diagnosis depends on a specialist working with the woman, conducting pre-test and post-test counselling.

Do you plan to use the results of your research in future work?

At the moment, the country is developing a “National Program to combat HIV/AIDS epidemic in the Republic of Tajikistan for the period 2021-2025”, and we have joined the working group on ART treatment and prevention of stigma and discrimination against PLHIV. As part of this platform, we are actively promoting the recommendations in our report.

At the same time, the research results helped us to identify and understand a number of issues, which we have not always paid due attention to before. Therefore, we will use this information in our daily work.

You can find the research here

 

I Love Every Minute of My Life

HIV is not a verdict. It is a reason to look at your life from a different angle and get to love every moment of it.

That is exactly what Amina, the protagonist of this story who lives with HIV, did. She went through the dark side of self-tortures, reflections, and suicidal attempts to realize that every minute is precious and HIV is what helped her to become strong, independent and happy.

Amina works in the Tajikistan Network of Women Living with HIV. She found herself in this field and nowadays she is actively involved in the Antistigma project implemented within the Bridging the Gaps programme.

How I learned about my status

“In 2012, I got pregnant for the fourth time. Seven months into my pregnancy, I got tested for HIV within the routine health monitoring. Four weeks after, I was asked to come to the clinic and was told that they detected haemolysis in my blood. I got tested again. My doctor told me the result of this second test after my baby was already born.

HIV. The diagnosis sounded like a verdict. What should I do? How should I live? Where can I get accurate information? My conversations with health workers were not very informative. Nobody told me that one can live an absolutely normal life with the virus. I felt that I was alone, left somewhere in the middle of an ocean. I had my baby in my arms, my husband who injected drugs was in prison. Back then, I hoped that I could tell at least my mother about the diagnosis to make it easier for me. However, the virus drove us apart. My mother, who took care of me for all my life, turned her back on me. At the same time, my three-month-old daughter, who also had HIV, died of pneumocystis pneumonia. I hated myself so much that I even had suicidal thoughts. I took some gas oil, matches… If not for my brother, who saw me, I would have burned myself. Then I remember a handful of pills, an ambulance and another failed attempt to kill myself. I felt that I was completely alone on this dark road of life. I started losing weight and falling into depression”.

Through suicidal attempts to the new life

“Two years passed, and my suicidal thoughts started to gradually go away. I had to go on living. Throughout all this time, I kept ignoring my status, but I was searching for the information on HIV in the internet. I was not even thinking about ARVs, I was not ready for the therapy. Sometimes I did not believe that I had HIV as doctors kept telling me that HIV was a disease of sex workers.

After a while, I came to the AIDS centre with a clear intention to start ART. I passed all the required examinations and told the infectious disease doctor that I wanted to start the treatment. Six months after, I already had an undetectable viral load! I believed in myself, in my results, so I wanted to share this knowledge with all the people who found themselves in similar situations. That’s how I started working at the AIDS centre as a volunteer and later as a peer consultant”.

I am happy!

“HIV helped me to start a new life. I am happy – I help people, I am doing something good for the society working at the Tajikistan Network of Women Living with HIV. Recently, I was the coordinator of the Photo Voice project.

I want to keep people who find themselves in similar situations from repeating my mistakes. I want to protect them from unfair attitude, stigma and discrimination against PLWH as well as different conflicts, in particular based on gender.

In 2019, I gave birth to a baby. My boy is healthy. Just recently, with the help of the Photovoices project I disclosed my HIV status to my older sons.  Before that, I wanted to keep that as a secret, but after training and meetings with women within the framework of this project, I decided that I need to open my status. For me it was the scariest thing to do as I thought that they might not accept me as my mother did. However, I did not have to worry. My children hugged me and said that I am the best mother in the world. Now I’m a happy wife of my husband, whom I convinced to start opioid substitution treatment.

HIV helped me to be happy and independent! I am not afraid to say that I have HIV and I love every minute of my life!”

 

 

Study tours help the public and non-public sectors to hear and see each other

For many years, NGOs have been engaged in study tours with visits to various organizations and institutions in other countries. While experience shows that not all study tours are equally useful – sometimes practices that work well abroad are incompatible with local realities – study tours have overall proven to provide participants with new knowledge and valuable practices that can be applied.

AFEW-Ukraine, partner in the “Bridging the Gaps: Health and Rights for Key Populations” programme, has noticed that at the local level partners benefit from sharing knowledge and experiences. Whereas each organization has its own reality and experience, NGOs all work in similar conditions. Since 2016, AFEW-Ukraine is regularly involved in the organisation of study tours for representatives of public organizations and government agencies, and colleagues working in other regions of Ukraine.

For Oleksandr Mohylka, Project Coordinator at the Compass Social House (KCF “Blago”, Kharkiv) and Nataliia Zlatopolska, Project Coordinator at the Altair Youth Friendly Center (PRCF “Public Health”, Poltava) study tours in Ukraine have proven to be an inspiration for bringing about change in their organisations and for their work with adolescents using drugs.

Where?

Oleksandr: As part of the project “Bridging the Gaps” this year, two social workers and me went to the CF “New Family” in Chernivtsi and their Psychosocial support center “Dialogue”. We wanted to know about their rehab program for teens. This was important for us because we wanted to provide rehabilitation services for adolescents who use drugs.

Nataliia: We had two trips to Kropyvnytskyi and Kharkiv. In Kropyvnytskyi we visited colleagues from the Social bureau “Lily” (CF “Return to Life”) and their partners in the city. In addition to Altair employees, we included representatives of the center for vocational training education, the department of juvenile prevention and the city center for family, children and youth.

The choice of partners for the trip was not accidental. For example, the practice has shown that our clients are mainly students of vocational schools, and through direct interaction with management, it is easier to connect with this group, to make our work process systematic to reach more people and achieve positive dynamics. Juvenile prevention redirects clients to us, and we engage them in training project leaders.

In Kharkiv, we had the opportunity to get acquainted with the experience of their Compass Center. First of all, we were interested in what tools the organization uses to work with our target audience, and how their partners’ network works.

Goal

Oleksandr: We had a very tight trip. It was interesting how the rehabilitation was organized – statutes on rehabilitation, the program, orders of local authorities etc. This is what we can apply now in our everyday work. It was interesting to learn how it all began to work, why there was a need for certain documents, what mechanisms these documents regulate, what is the role of the City Coordination Mechanism. We were also interested in the interaction of the “New Family” with the Coordination Council since this is a positive experience of interaction.

Nataliia: We had a meeting with the deputy mayor of Kropyvnytskyi for humanitarian issues, a dialogue showed that the public sector in Kropyvnytskyi understands what benefits it has from working with NGOs. Project specialists proved the importance of interacting with them with the help of numbers, statistics, cases, and stories. And we took this experience forward.

We also saw how the ideas of the project clients are implemented. We saw that they are really possible to fulfil. And these are not just dreams – it is actually possible to realize the ideas of adolescents. For example, we liked the idea of ​​sketching the addresses of Telegram drug distribution channels, not on their own, but using the resources of the city.

What was learned?

Oleksandr: It was after the trip to Chernivtsi that we made a firm decision that we would do a rehabilitation program. And we realized that we should do our own program, not the same as in Chernivtsi. The drug scene and, accordingly, the behaviour of adolescents and the consequences of using drugs change. Thanks to the trip to Chernivtsi, we now better understand how to take into account the unique experience of our colleagues and to make our rehabilitation program maximally meet modern challenges. We have already presented our idea to the Coordinating Council of Kharkiv. In the new City drug program, the development and support of a rehabilitation center for youth are now registered on the basis of our Social home! We were inspired by their experience and success; we saw that this is all real in our country. Moreover, now, apart from the “Dialogue”, no one is doing rehabilitation separately for teenagers in Ukraine. We always say that in Ukraine we have the experience of a successful rehabilitation center for adolescents and that we learn from them and are ready to contribute.

Nataliia: We “brought” new work tools home – for example, a step-by-step mechanism for referral clients from our city partners (educational and law enforcement agencies, social services, etc.) to us. In Kropyvnytskyi, if one of the key partners discovers a teenager who is probably using drugs, he or she will immediately be redirected to the social bureau “Lily”. And we studied communication mechanisms, registration log and so on. We also liked the practice of the leaders’ school. In addition, we spied on the work in the organizations themselves, how employees interact and were inspired by their atmosphere.

Results

Oleksandr: Study tours with partners to colleagues from Ukraine are a very high-quality mechanism for obtaining of well-deserved trust from government bodies and our main partners – the police, social services, educational and medical institutions. Such joint actions help them understand that we are doing real things, we are doing things that government agencies are not doing because of limited resources, instructions or something else. But the main thing is that we complement their work very well. We let them know that we are ready to help and train. We noticed that upon returning, even the level of relations changed, as well as the number of redirects to the Center. At the same time, during such study tours, we ourselves see how government bodies work and what kind of help they need.

Nataliia: Study tours help the public and non-public sectors to hear and see each other. Employees of various services in different cities may have different views, but this does not prevent them from communicating and sharing experiences and thoughts. They can understand what powerful resources we have, and that we really bridge the gaps in their work, too. Previously, for example, various myths were circulating about NGOs in our city that interfere with the organization’s work. After this visit, all questions of officials were removed, and the level of mutual trust continues to grow.

With the organisation of study tours, AFEW-Ukraine thus fosters in-country processes and partnerships to reinforce results in line with Bridging the Gaps Theory of Change. The organisation contributes to deliver and advocate continuously for strengthening services and upholding human rights for adolescents who use drugs in Ukraine.

 

 

The 3rd regional autumn school in Bishkek

On October 29, AFEW partners came together in Bishkek, the capital of Kyrgyzstan, for 3 days to take part in the annual Autumn School, which is organized within the project “Bridging the Gaps: health and rights of key populations“.

The great energy of the participants and amazing nature gave a chance to everyone to enjoy the event and to discuss important issues on prevention and treatment of #HIV, harm reduction, migration, and financing in the region of Eastern Europe and Central Asia. Participants in the Autumn School included representatives of AFEW partners from Kazakhstan, Kyrgyzstan, Ukraine, Russia, and the Netherlands, sub-recipients of the project “Bridging the Gaps”, as well as other partners and experts including those from Great Britain and the USA.

Active space

The Autumn School quickly became an active space for discussion: about strategy, barriers, innovations, and partnership opportunities between the participating organizations. During the first day, participants shared updates on the “Bridging the Gaps” project and activities in their countries – Georgia, Kyrgyzstan, Ukraine, and Tajikistan. The afternoon session was devoted to a World Café, in which partners exchanged ideas and developed specific actions to overcome challenges that they often encounter in their work.

The second day was devoted to the topic “Stimulant use and chemsex”. Benjamin Collins, director of International HIV Partnership (IHP), which partners with medical and community activists across Europe and the Middle East for successful responses to HIV and viral hepatitis, joined the Autumn School in Bishkek to share his experience on chemsex . The topic of (problematic) chemsex was further elaborated in the presentations of Monty Moncrieff, Chief Executive of London Friend, a London charity working to promote the health and well-being of lesbian, gay, bisexual and trans (LGBT) people, and Daria Alexeeva, program director of AFEW International. Monty spoke about the London experience in harm reduction, while Daria presented materials of Nikolay Lyuchenkov, an infectious disease doctor and expert on sexual health issues from Russia, which were focused on trends and responses to chemsex in Russia and EECA region.

 

The third and final day of the conference was devoted to workshops on migration, rehabilitation and financial sustainability. Evgeniya Alekseeva, director of Public Health and Social Development Foundation “FOCUS-MEDIA”, presented analysis of NGOs funding situation in EECA region; Elena Zhirnova, manager of the project “Our Choice: Empowering Vulnerable Women in Kyrgyzstan” (AFEW-Kyrgyzstan) told about challenges and opportunities of social entrepreneurship in the country; and Fatima Yakupbayeva, co-founder of law firm “PRECEDENT” and publisher of the book “From Grant to Business Project”, shared auditing resources for launching a business model and recommendations on how to implement business ideas.

 

The session on migration started with a presentation by Rukhshona Kurbonova, coordinator of the Migrant Health Programs at International Organization for Migration in Tajikistan. She talked about labor migration in Central Asia, while Zulaika Esentaeva (IOM Kyrgyzstan) shared their experience on service-delivery by IOM Kyrgyzstan for vulnerable migrants.

The session on rehabilitation was devoted to building information campaigns. During the session, Marina Govorukhina, specialist on strategic communications and branding, author of the books “Communications in Public Organizations”, “Strategic Communications in Public Organizations”, demonstrated specific techniques of developing informational marketing campaigns for rehabilitation centers to the participants from Georgia, Kyrgyzstan and Ukraine.

Moreover, the School included a 2-day training for AFEW communication managers, during which participants focused on learning about storytelling and SMM in the context of NGOs.

 

 

Natalya Shumskaya, director of AFEW-Kyrgyzstan

I especially noted the session on new psychoactive substances. This topic is relevant for our country, as sexual ways of HIV transmission keep growing in Kyrgyzstan, and new psychoactive substance use impacts sexual behavior. For us it is a wonderful opportunity to take on the experience of those countries that have already faced similar problems, and elaborate effective strategies for preventative measures in our country.

The third day was remarkable due to the acute topic of sustainability of civil society organizations. We all see the tendency of decreasing donor support in our countries. That means that civil society should aim to ensure financial sustainability independently, and one of the opportunities is the development of social entrepreneurship. During this meeting we shared the experience of creating our own social enterprise – a beauty salon. I would like to especially point out the session by Fatima Yakupbayeva from the “Precedent” company. She gave us specific business-ideas, which could be developed by an NGO in order to earn money independently and further direct it to realization of our statutory goals.

The importance of this event is in sharing and exchange of experience. When the financial support for our organizations is not that high, it is important to avoid duplication of activities, and, on the other hand, to consolidate our efforts in order to realize our main strategic goals. For instance, the past regional meetings allowed us to bring good practices of working with youth at risk from Ukraine to our country. We are very grateful that we didn’t have to be the pioneers in this, but rather adapt and use their experience. Also, I think that the experience of Kyrgyzstan will be useful to some of our colleagues, and they will be able to apply it in their countries.

Monty Moncrieff MBE, Chief Executive of London Friend

It’s important for people working in the region on the same issues to have the opportunity to come together and share their knowledge and experience. It helps build the data on important topics, and enables participants to share what they’re seeing locally, as well as share tips on how to address new and emerging trends. It also helps build relationships, which spark ideas for new partnerships. Even though the internet gives us great opportunities to connect and work together online it’s difficult to get that richness of connection without bringing people together in person, and doing so for a number of days provides lots of opportunities for conversations outside the formal sessions.

We can always learn from one another, and hopefully by inviting people who have been working on issues for some time in other countries we can bring the benefit of that experience. We can share leaning about what’s worked and what hasn’t for us, and hopefully that can benefit people who are only starting to see these issues emerge locally.

Evgeniya Alekseeva, PHD in medical sciences, Director of Public Health and Social Development Foundation “FOCUS-MEDIA”

Meetings such as the Autumn School are important, because they bring together people from different countries and cities, create space for discussing acute issues and situations in our field, allow to form alliances, agree about partnerships, as well as have informal conversations and take a break from the daily routine.

At the Autumn School in Bishkek, I especially noted a very interesting session on chemsex, sessions on business projects for NGOs, and on migration. I will certainly use this knowledge further while writing proposals, developing new projects and creating new ideas.

Zarina Siyakova, program coordinator of the Tajik Network of Women Living with HIV

This meeting provided me with a great opportunity to learn more about what is happening in other countries in regards to promoting prevention and treatment of HIV. I especially noted the session on chemsex, as I hadn’t had a chance to encounter this issue before. I was particularly interested in the presentation by Monty Moncrieff, as well as the presentation of Nikolay Luchenkov from Russia on chemsex in EECA.

Also, I received answers to many questions on migration that I’m interested in, and most importantly, exchanged contacts with almost all the participants. It is well known that nowadays there is a very large stream of migrants from Tajikistan to Russia, and many of them lack information about services for migrants and d existing organizations in Russia. Now our organization will be able to refer our clients to these organizations, and we won’t lose them out of sight.

If you are interested in specific presentations of the Autumn School, please send your request to autumnschool@AFEW.nl.

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

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

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

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

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

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

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

AFEW-Ukraine supported the purchase of this equipment.

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

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

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

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

What are your achievements in projects implementations?

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

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

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

How did you benefit from creating and implementing projects?

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

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

‘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.

We Fight, We Hide or We Unite

We Fight, We Hide or We Unite: 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

The title of this report, ‘We Fight, We Hide or We Unite’, reflects the survival strategies we identified amongst resilient harm reduction non-governmental organisations and community networks of people who use drugs (PWUD) in Eastern Europe and Central Asia (EECA). This assessment forms a part of the regional approach of the AFEW Network within the ‘Bridging the Gaps: health and rights of key populations’ programme, financed by the Ministry of Foreign Affairs of The Netherlands. This report presents the primary findings from the assessment, ‘Shrinking Space for Civil Society Organisations in Eastern Europe and Central Asia’, conducted between June and September 2017 at the international level by AFEW International and at the regional level.

We provide a detailed description of the overall study purpose, methodology, background and context regarding the shrinking civil society space and the coping strategies of HIV and PWUD CSOs working under these circumstances. The results of this assessment will be used to develop ideas and strategies on how to cope with the local contexts of the shrinking civil society space. In this way, it will contribute to the survival of CSOs and improving the current situation. This assessment represents the first step in the development of this focus within the AFEW Network’s regional approach within the ‘Bridging the Gaps’ programme. It will be followed by an analysis of existing gaps in the support necessary for specific interventions and initiatives to support specific coping strategies; the development of pilot projects on advocacy, service delivery or capacity building; and the continuous monitoring of results.

The full version of the report is available here.

AFEW on AIDS 2018: Session ‘AFEW Network’s experience in strengthening community, Monitoring and involvement in service delivery: From grassroot to policy level’

What: Session ‘AFEW Network’s experience in strengthening community, Monitoring and involvement in service delivery: From grassroot to policy level’

Where: Global Village, Eastern Europe and Central Asian Networking zone

When: July 25, 2018/16:00-17:30

Important to know: Session will be in Russian, translation to English will be provided.

This session, organized by AFEW Network, will offer an opportunity to share experience in strengthening community monitoring and involvement in service delivery: from grassroot to policy level.

During the session we will talk about creating an enabling environment by building the bridge between service beneficiaries, services, policies and successful experiences in meaningful involvement of our service beneficiaries and building strong collaborations between communities of key populations and the public system.

Through exchange and panel discussion we aim to:

  • Demonstrate the double win (for both the public system AND the communities served) when communities and service beneficiaries are involved in service delivery and policy making;
  • Share strategies and best practices from the AFEW network members that use innovative methods of information through online media that hands bigger autonomy to the service beneficiaries;
  • Share strategies and best practices to form mechanisms of community monitoring.

This session is prepared and presented in the framework of the program ‘Bridging the Gaps: health and rights for Key populations’, through the regional EECA approach by AFEW International and AFEW Network.

Agenda

3 Session of 30 min each to share and discuss experiences.

Session 1: ‘Meaningful involvement of service beneficiaries in planning, designing and monitoring of services’ experiences within the AFEW Network

  1. Creation key populations’ advisory councils in Tajikistan: Dilshod Pulatov, project manager, AFEW-Tajikistan
  2. Involving adolescents in service delivery and monitoring of services in Ukraine: Daria Kopiyevska, activist, NGO “Return to Life”, Kropyvnitsky, Ukraine
  3. Initiative groups in the provincial steering committee of Kakheti region in Georgia: Davit Kazaishvili, Public Union “Bemoni”, Georgia
  4. Supporting community steered service delivery by key populations in Kazakhstan: Roman Dudnik, Executive director AFEW Kazakhstan, Rosa Oleynikova,  Director NGO “Doverie Plus”, Sergey Schetnikov,  NGO “Answer”
  5. Discussion

 

Session 2: ‘Building equal access to prevention, treatment and care for HIV’, experiences within the AFEW Network

  1. New digital approaches to support adherence to treatment in Kazakhstan: Yagdar Turekhanov, Program technical advisor, AFEW Kazakhstan
  2. On-line consultations in Tajikistan: Zarina Davlyatova, Project specialist of AFEW-Tajikistan
  3. Interactive prevention methods for working with young drug users in Ukraine: Aleksander Mohylka, NGO “Blago”, Kharkiv, Ukraine
  4. Discussion

 

Session 3: ‘Building bridges, connecting people’, experiences within the AFEW Network

  1. Community-based participatory research: Daria Alexeeva, project manager, AFEW international       
  2. Сoordination mechanisms on HIV in Kyrgyzstan: Ulan Kadyrbekov, Director, Republican AIDS center, Kyrgyzstan
  3. Key populations platform in Ukraine: Vielta Parkhomenko, Club Eney, Kyiv, Steering Committee of the Country Key Populations Platform
  4. Discussion and closing of the session