We Need to Talk about Chemsex!

Gay people, sex and drugs are a taboo in Russia. Despite the fact that those topics are usually not discussed, chemsex is gaining pace in the society.

Maksim Malyshev, Social Work Coordinator at the Andrey Rylkov Foundation, told AFEW International about the problem of chemsex, the rudiments of harm reduction in Russia and the mental health of people engaged in chemsex.

How widespread is chemsex in Russia?

It is a difficult question as so far there have been no studies on the prevalence of chemsex in Russia. Based on my personal observations, I can say that it exists and gains popularity over the time. Firstly, it is a global trend. Secondly, drugs are easily available in Russia through the dark net. Thirdly, discrimination and stigmatization of the vulnerable communities, in particular LGBT people, lead to the growing pressure on the community members, so they are more tempted to get isolated and engage in new destructive experiments.

Is chemsex a problem of big cities or does it also exist in smaller towns?

Mainly, it is a problem of metropolises – Moscow, St. Petersburg, maybe Ekaterinburg, Rostov and Krasnodar. It is important to understand that big cities are the centres of the gay community. Gay people from all over the country come to such cities because it is easier for them, they are not so stigmatized, there are more opportunities and a bigger community there.

Why is chemsex mainly the problem of gay community?

Of course, sex and drugs exist not only in the gay community, but also in heterosexual and transgender communities. However, I as well as many other experts in this sphere stick to the classical concept of chemsex and associate it specifically with the gay community. This community is affected by all the factors, to which chemsex can be related. I mean minority stress, stigmatization, and peculiarities of self-identification (where sex is an important element). In transgender communities, there are also drugs and sex, and for many transgender sex workers drugs are the way to survive, respond to their personal problems, depression, etc. This is only my personal opinion, of course, and I cannot speak for those communities.

What are the key issues caused by chemsex?

There are four key issues: HIV and sexually transmitted infections, mental health, the problem of choice and violence and loneliness.

When people engage in chemsex, their sexual activity intensifies, substances enhance their libido and endurance, leading to the growth in the number of sexual intercourses and partners, while their ability to control the important things goes down. People do not use condoms, their sex becomes more traumatic, their sensitivity threshold is reduced, while the level of energy and aggression goes up, which altogether leads to the higher risks of HIV and other infections.

Talking about the mental health problems, it should be mentioned that after chemsex people feel lonely and exhausted. In Russia and Europe, people engaged in chemsex use the substances, which have a negative influence on their mental health, so that it is more difficult for them to be mentally stable. They grow addicted, so when people stop taking substances, usual sex feels dull to them. The situation is aggravated with the repressive drug policy and fear of people to draw the attention of police and criminals, becoming the target for blackmailing.

Are harm reduction services available to people engaged in chemsex in Russia?

Now, we only have some rudiments of such services in Russia. For instance, Andrey Rylkov Foundation which was recognized as a foreign agent, implements outreach activities at the techno parties for gay people. We distribute condoms, lubricants and test people for HIV. Besides, we organize self-help groups for people affected by chemsex. Such groups meet on a regular basis. We also focus our efforts on providing psychological support to people affected by chemsex. AFEW International really helped us by supporting the project allowing our outreach workers to visit techno events. We procured condoms and lubricants within the ESF grant. This grant gave a big impulse to develop our activities.

I know another Russian organization, which opened an NA group for the gay community members. Those are all the services available for now. That is why our foundation together with Parni Plus NGO submitted a joint proposal to the Elton John AIDS Foundation to develop our project aimed at the gay community in the context of chemsex.

What services are to be developed in your opinion?

Now an interesting survey is carried out in the gay community, with the community members telling about their problems, ways to resolve them and share their preferences. Hopefully, we will soon see its results.

As for my personal perspective, I think that more efforts should be definitely aimed at the gay identity, so that people can identify as gay, so that they can open up. It is important for people to accept themselves, come out to their family and friends, and build contact with them. Lack of self-identification is a vital reason why people engage in chemsex. However, it is not possible to implement such activities in Russia as they fall under the concept of gay propaganda.

There should also be a bigger focus on harm reduction services. What we can do now – outreach visits to saunas and apartments to meet the community members – is not enough. It would be good to have a needle and syringe programme. However, many event organizers are afraid to implement such measures as they can draw the attention of police.

I also think that it is important to open rehabilitation centres for people affected by chemsex. Today there are no places where we can refer those people! Even if they are ready to pay for the services. All the rehabs are aimed just at people who use drugs, where there is no tolerance to the LGBT community members.

Still, are you able to create some printed or online materials under such circumstances?

Yes, there are some things that the activists do. For example, a comic book on chemsex has been published. It will be distributed in clubs. There is also an anonymous website, where LGBT community members can find the information on harm reduction and rehabilitation.

What was your biggest impression lately?

There was one case, which startled me not so long ago. There was a guy, who came to our foundation with his story. Some people he met invited him to have sex in a park after using some mephedrone. When he came there, he saw that his new “friends” had wristbands and a club. They took him to some strange venue, where there was a corpse lying. The guy was frightened and managed to escape somehow. He told us that afterwards he was ready to call the police and file a complaint against those men. But then he was too afraid. He was afraid that the police would not believe him, afraid that he would be arrested for using drugs, afraid that he would lose his job, would be registered with the police and would become a victim of jokes because of his sexual orientation.

I really hope that one day this situation will change. What we are doing now is a step into the future.

 

 

 

The Knowledge Not Available Before

In 2018, AFEW Kyrgyzstan started training the doctors of family health centres and maternity clinics in providing assistance to the pregnant women who use psychoactive substances (PAS) within the project “Bridging the Gaps: Health and Rights for Key Populations”.

Fear of judgment

According to the assessment held in 2014 within the project supported by the Global Fund to Fight AIDS, TB and Malaria, the number of people who inject drugs in the country was 25,000 people, 12% of them being women. Besides, another study showed a rapid growth in the number of pregnant women with HIV.

Women who use drugs usually seek medical assistance less frequently than men. The reason for it is their fear of judgment and discrimination, fear to lose their children. In 2016, AFEW Kyrgyzstan and a group of experts with support of the project “Bridging the GapsHealth and Rights for Key Populations” developed an action plan for women who use psychoactive substances to provide comprehensive and timely support to such women. In the beginning, guidelines for doctors and nurses were developed called “Management of Pregnancy, Labour and Postpartum Period in Women Who Use Psychoactive Substances”. Besides, AFEW Kyrgyzstan together with experts and community members organized workshops for the doctors of family health centres and maternity clinics in Bishkek and Osh and introduced a training module in the post-graduate education of health workers. Monitoring of the knowledge using such guidelines allowed identifying a big gap in the level of knowledge between the doctors from Bishkek and Osh. There can be various reasons for such situation, but the decision taken as a result of the monitoring was to support the activities of a multidisciplinary team led by the Podruga Charitable Foundation to provide quality training to the health workers in Osh. Such team was created with support of AFEW Kyrgyzstan and the project “Bridging the GapsHealth and Rights for Key Populations”.

Fighting stigma and discrimination

Since March 2018, the multidisciplinary team trained 72 doctors in all family health centres and maternity clinics in Osh. According to Irina who is a social worker at Podruga Charitable Foundation and the project coordinator, when most health workers come to the workshops, they lack trust. They say: “We do not have any female patients who use drugs, and even if there are some, why do we need to treat them – they can be just sent somewhere, and that’s it”. “Usually, women do not tell doctors that they use drugs, they are afraid to say that they have HIV”, says Irina. “As for the doctors, they do not pay attention to it. However, pregnant women living with HIV require a special approach to avoid possible complications and to make sure that mothers-to-be are not afraid to seek medical assistance and get tested. The truth is, though, that after the training most of them change their point of view”.

Before start, all the training participants fill in questionnaires. The results are not so brilliant – the average score is 5-7 correct answers out of 20. After they complete the training, the results are much better: most health workers have not more than one incorrect answer or make no mistakes at all. “I am very happy that after the workshops doctors at least start noticing that there are women who use PAS among their patients. Now, if an HIV-positive woman or a woman who uses PAS comes to them, they often call me or the trainers, we look at her case and try to help every woman. That’s how lives are saved”, smiles Irina.

To a great extent, the training is effective due to the fact that doctors with extensive experience are part of the multidisciplinary team. Each of the trainers is a role model and a real expert. Thanks to the trainers’ reputation, the participants are more willing to listen to them and agree with them. That is how the ice of misunderstanding and ill treatment is broken.

Gradual improvement

It should be noted that the project helps the health workers to work not only with pregnant women. Nadezhda Sharonova, Director of Podruga Charitable Foundation, says that now it is easier for their organization to find friendly specialists and women who use PAS do not have to fight hard to receive health care as more doctors are now willing to help the patients and treat them better.

“Once a woman came to me, she started crying and said that a cleaner told all other patients of the maternity clinic about her HIV positive status, so nobody wanted to talk to her, people turned their backs on her and the doctors were rude and neglectful”, tells Irina. She says that such cases are less frequent now. Irina recognizes that through one-time training it is not possible to ruin all the fears and stereotypes, which have been building up for many years, but it can at least considerably improve the situation. In our work, the phrase “improve the situation” means better lives of women and children that can be saved with this new knowledge.

Drug Decriminalisation Across the World

How can we end the war on drug users? Ask the jurisdictions worldwide that have decriminalised drug use!

A new web-tool launched today shows that 49 countries and jurisdictions across the world have adopted some form of decriminalisation for drug use and possession for personal use. Experts say the number of jurisdictions turning to this policy option is likely to increase in the coming years.

Drug Decriminalisation Across the World’, an interactive map developed by Talking Drugs, Release and the International Drug Policy Consortium (IDPC), offers an overview of the different decriminalisation models – and their level of effectiveness – adopted all over the world.

Twenty-nine countries (or 49 jurisdictions) have adopted this approach in recognition that the criminalisation of people who use drugs is a failed policy, disproportionately targeting people living in poverty, people of colour and young people, and causing untold damage.

When effectively implemented, decriminalisation can contribute to improved health, social and economic outcomes for people who use drugs and their communities, as well as reduced criminal justice spending and recidivism. Further, there is no evidence that drug use increases under this model – or that it would decrease if criminalised. Decriminalisation is not a ‘soft’ policy option – it is the smart approach to reducing harms for individuals and society.

The major harms caused by the so-called ‘war on drugs’ have now been widely recognised: one in five people incarcerated for drug offences globally; more than half a million preventable deaths by overdose, HIV, hepatitis C and tuberculosis in 2016 alone; and severe human rights violations including arbitrary detentions, executions and extrajudicial killings. While this horrific situation is getting worse each year, the scale of the illicit drug market and prevalence of drug use continue to soar – at least according to the UN Office on Drugs and Crime’s latest global overview from 2019.

Niamh Eastwood, Executive Director of Release (the UK centre of expertise on drugs and drugs law), said: “What we really wanted to show here is the number and diversity of existing decriminalisation models adopted all over the world, and what the real impact is on the ground in terms of health, human rights, criminal justice and social justice outcomes”.

Ann Fordham, Executive Director of IDPC (a global network of non-government organisations that specialise in issues related to illegal drug production and use), said: “In Portugal, decriminalisation has significantly reduced health risks and harms. But that’s not the case everywhere. In Russia and Mexico, ill-designed models have exacerbated incarceration rates and social exclusion. When designing decriminalisation models, governments have to carefully review the evidence of what does and doesn’t work to ensure success”.

Imani Robinson, Editor of TalkingDrugs (online platforms dedicated to providing unique news and analysis on drug policy, harm reduction and related issues around the world), said: “The most useful element of this interactive map is that it highlights the impact of decriminalisation for communities on the ground. Many models enable the liberation of people who use drugs through a broad commitment to greater health and social gains overall and an emphasis on the provision of harm reduction education and services; others do not garner the same results. Smart drug policy is not decriminalisation by any means necessary, it is decriminalisation done right.”

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.

New UNAIDS Strategic Information Hub for Eastern Europe and Central Asia

UNAIDS Strategic Information Hub for Eastern Europe and Central Asia (UNAIDS SI Hub) has been launched on the Internet.

The purpose of this resource is to provide an online one-stop-shop for data, publications and strategic information about HIV (and related health issues) in EECA. It is publicly accessible to anyone online, but it aims to make information accessible and easy to find for specialists and policymakers working on HIV in governmental, non-governmental organizations and partners across EECA.

The address of the hub is http://eecahub.unaids.org/ and it’s managed by UNAIDS RST  in Moscow, with support from UNAIDS HQ. It currently features HIV data from the latest GAM reports, as well as published reports and presentations related to HIV in EECA. It’s possible to access the country-specific data and reports as well as reports and publications from the various menus. By selecting “data” and “factsheets”, you can generate and print Regional and Country factsheets as PDFs as well access as epidemiology slides with global and regional statistics.

The hub works in two official UN languages – English and Russian, but most of the publications will only be available in the language they are produced (and not translated into other languages by UNAIDS).

For contribution to the UNAIDS SI Hub please send your suggestions, data, publications and other materials to eecasihub@unaids.org.

HIV in prison is not a death sentence

Nowadays Kyrgyzstan is recognized as one of the most advanced countries in the world in regards to delivery of the harm reduction and HIV care and treatment programs in prisons (details here).

At the moment here, in the penitentiaries, there are 5 active programs: syringe exchange program, methadone maintenance treatment program, rehabilitation program “Atlantis”, Center for Rehabilitation and Social Adaptation “Clean zone” and “Start Plus” program.

Dina Masalimova, AFEW-Kyrgyzstan program manager, explained what kind of work is done in this field in the country, and which significant results have already been achieved.

Dina, could you please describe the programs for inmates? What do they look like?

A pilot program on needle and syringe exchange was introduced in Kyrgyzstan in 2002, in one of the prisons with a modest reach of 50 people. A year later the program was expanded to 3 prisons, and then several more. Today there are 14 syringe exchange stations (SES) in the penitentiary system. They work in all the prisons except for the facility for underage convicts. Also, syringe exchange services are provided in the 2 largest detention centers. An actual number of SES clients in 2018 amounted to over 1300 people. They received syringes either in person, or through a secondary exchange conducted by volunteers. Aside from the sterile injection equipment you can also find other protection items at the stations – alcohol wipes, condoms; and HIV blood tests are done here too. Those clients that would like to decrease or fully stop the injecting drug use are forwarded to the methadone maintenance treatment stations.

The methadone maintenance treatment program was started in the country’s prisons over 10 years ago – in 2008.  Today there are already 9 stations in the penitentiaries, and the number of clients is over 350. These programs are conducted by the State Penitentiary Service with the support of the Global Fund To Fight Aids, Tuberculosis And Malaria, as well as Center for Disease Control (CDC).

Aside from the harm reduction programs there is a program aimed at the full withdrawal from drug use in prisons. In a number of places the  “Atlantis” program based on the famous model “12 steps” is active. The program graduates can serve their remaining sentence time in the Center for Rehabilitation and Social Adaptation “Clean zone”. “Clean” means that it’s free from drugs. There is a full-scale program of rehabilitation and preparation for sober life outside of prison there.

Over the past 5 years we also were active in delivering services directly to inmates. For instance, our consultants have supported prisons’ health system by providing peer-to-peer consultations and HIV testing, as well as supported inmates before and after their release from prison. For a long time this program has been implemented with the support of USAID. Soon it will be continued thanks to the financial and technical support of ICAP (international program by Columbia University’s Mailman School of Public Health).

How are these programs created, and who delivers them?

As a rule, these programs are created based on the actual needs of the most vulnerable groups of prisoners – people living with HIV and/or using drugs. And these programs are also delivered by the representatives of these communities.

We approach the program in a flexible way and always try to improve it so that it remains relevant. For example, one of our recent additions to the program is working with the convicts that were rejected by the prison subculture. Due to the unspoken prison rules this group of prisoners has the lowest level of access to medical and social support and faces a high level of stigma and discrimination from the other convicts, and often also from the prison staff.

Could you share some results of these programs?

All the programs currently active in the country are aimed at reaching the ambitious goal 90-90-90.  Now almost all inmates in prison are being tested for HIV “at the entrance”, and a vast majority of people living with HIV are formally in treatment. Why “formally”? The viral load indicators show that quite a few of inmates don’t use it. In prisons there are a lot of myths about HIV and antiretroviral therapy, and during in-person conversations many patients admit that they simply throw medicines away. Because of that, the main goal of our project is to increase the number of convicts who live with HIV with undetectable virus load.
Over the years we achieved great results. For instance, in prison #31 the number of people who are adherent and have a suppressed virus load has grown from 15% to 68%, and in prison #16 – from 33% to 66% in the past three years. We are especially proud of two prisons – #2 and #47, where we’ve already reached the second and third “90”.

All these programs are mainly targeting male convicts. Are there any special programs for female inmates, for pregnant women?

In Kyrgyz prisons there are only 10 female inmates living with HIV. However, it is also important to consider their needs while planning measures in response to HIV-epidemic. We approach work in female prisons quite reverently and are trying to make sure our programs are gender-sensitive.  In one prison there was a women self-help group focusing on gender violence prevention. Also we partner with NGO “Asteria”, which runs a women’s center supported by AFEW-Kyrgyzstan and open for women released from prison. Many of the center’s clients are former inmates, and the help and support program includes temporary lodging, provision of food and hygiene packages, peer consulting on HIV, sexual and reproductive health and rights (SRHR) and opioid substitution treatment (OST), as well as provides access to gynecological services.

What is the prisoners’ attitude towards such programs?

Inmates perceive this program in a very positive way. Slowly but surely our team managed to win their trust and involve them into the dialogue about their health. It’s important to understand that health is far from the first priority for a person in prison. Unfortunately, current conditions of prisons make basic survival the main priority, and HIV is perceived as a far removed problem for many of them. Our peer consultants have their own experience of living with HIV in a prison, so they can show by their own example how one could solve upcoming problems.

Could you name the main current problem for prisoners with HIV in Kyrgyzstan?

One of the main problems is the lack of medical staff in the penitentiary system. In a number of large prisons in the country there are no doctors with higher medical degree. All the work on supporting prisoners’ health is put on the shoulders of a small team of paramedics. Of course, very often they have no time or knowledge needed to perform quality work on supporting inmates with HIV. We also try to help in such cases. For example, in prison #16 there was no doctor for a whole year, and our organization set up weekly visits of a doctor from the Republican AIDS center in order to support the patients.

It is often said that many prisoners don’t trust prison staff, including health workers…

Yes, it’s a separate and quite serious problem, and the consequence of it is the unwillingness of prison inmates to follow doctors’ recommendations. Our consultants serve as a certain “bridge”, which helps to build trust-based relationships between doctors and patients. For instance, with the patients’ agreement they take the results of viral load and cd-4 tests and thoroughly explain their meaning to the patients, e.g. the influence of the therapy on those indicators etc. We try to find individual approach to everyone. For many people the possibility to have a family and healthy children when they reach undetectable viral load becomes the best motivation for treatment.

It seems that peer-to-peer consulting is a really life-saving tool when it comes to fighting for the health of prisoners living with HIV, isn’t it?

Александр Certainly! We have so many stories that prove it. For instance, the story of Alexander. He learned about his positive HIV-status in 2013. His prison mates gave him a clear verdict that he would die soon. Needless to say, he was in great shock. He didn’t have any access to information, and doctors didn’t explain much. On the verge of desperation he started to use more drugs. He looked at the people with positive HIV-status around him, and they were dying one after another. He also waited for his turn.
In 2016 peer consultants from the Action against HIV project started to come to the prison. One of them – Evgeniy – really impressed him. He was living with HIV himself, but he didn’t look like he was dying at all, quite the contrary. During one conversation with a peer consultant Alexander got more information than in the previous 3 years of his life with positive HIV-status. At that moment he told himself: “Enough. I choose life”. He started treatment and quite soon reached undetectable viral load.

Mass media as partners in counteracting HIV/AIDS epidemic

Mass media play a major role in fighting for human rights, especially when it comes to population groups vulnerable to HIV. Through the wide media coverage of successful human rights defence cases implemented by community and civil society, the government can see that the community of People Living with HIV (PLHIV) and people vulnerable to HIV can and should be an equal partner and an ally in fighting HIV/AIDS epidemic.

This helps with forming a positive image of PLHIV and representatives of other key populations in the society, decreases stigma and discrimination, raises their self-esteem and self-significance and gives motivation for further activities and professional growth.

Thanks to the coverage of successful practices in mass media, a large number of PLHIV, people who use drugs (PWUD) and representatives of other vulnerable groups gain opportunity to get basic human rights knowledge, action plans and tools, which allow them to solve problems related to violation of human rights due to HIV in their own regions independently.

Liudmila Vins, project manager of LUNa Social Support Centre, legal adviser of Interregional Center for Human Rights in Yekaterinburg, has applied to the Emergency Support Fund for key populations in EECA for a grant. The goal of her project is to change the legal environment and public opinion towards people living with HIV and representatives of groups vulnerable to HIV through mass media.

Liudmila, what is the core of your project?

Our way of working is as follows – our lawyer together with partners, street lawyers from the regions, collects successful legal practices and strategically important cases, prepares the gathered materials for media publications, provides a legal evaluation and an algorithm for solving the problem. An info manger writes articles based on the cases for mass media and our own media resources, passes information about these cases to journalists through mailing lists, social media, and connects media and people featured in the cases in order to prepare further materials.

Could you tell us about the intermediate project results?

Yes, the project has substantially helped us to develop the informational part of our work and also gave a start to a new project of educating Russian NGOs on working with media. We found 17 cases, which resulted in 33 publications. Each case contained a story of at least one person – the leading story character, and at least 2 more people connected to the story, close relatives of the leading character. In total 51 people were featured in the stories.

Please share the most interesting and remarkable moments of the project.

The most remarkable example of support within this project is Olga’s story (the name is changed). We published it on our website.

Local journalists quickly noticed this material; they immediately reacted and published a number of articles about the fact that a woman in detention facility doesn’t receive treatment for HIV-infection. The news travelled fast: one journalist made a lot of requests to government agencies and received a positive decision from government officials. The result was that this woman received medication the same day.

You started your social support activities for vulnerable groups in 2009. How have the statistics changed since then?

At that time harm reduction programs were developing actively. However, the issue of defending the rights of PWUD was still unresolved, so starting from 2012 I began to develop street lawyers programming in Yekaterinburg. The need for this kind of support is very high now. In 2012 legal assistance was given to 100 people per year, and there was one street lawyer. Currently we work with 5 street lawyers, and we give this kind of support to people on a regular basis.

Who are the street lawyers?

These are people from the key populations community who are taught the basics of human rights defense. So, they can provide basic support with human rights defense, and then, if necessary, pass on cases to professional lawyers.

What is the attitude of the key populations’ representatives towards your activities?

We have a good connection with our target group, they are happy to receive our support. However, there are certain difficulties. For example, a person can disappear for a period of time while being under our supervision. Then (s) he appears again in a month, and we have to start from the beginning.

Why do you think it is so important to involve representative of key populations in such work?

Almost all of our staff members except for two are people from the key populations/PWUD community. I have been in remission for a long time myself. I think that a different approach is simply not effective. Nobody can truly understand PWUD as well as a person who has gone through it too, and most importantly, who was able to overcome it and solve a problematic situation successfully.

When people are doing something for the society, they often have an ideal example of such society in mind. Do you have one?

I don’t have examples of an ideal situation in any country. There are drawbacks everywhere. When it comes to talking about the approach to working with PWUD in Russia, I reply that there’s simple no such work. Those few NGOs that provide harm reduction programs, can’t reach all the PWUD to the full extent. For me the ideal situation is when the system of social support is developed in the country, there are harm reduction programs, access to quality treatment, and there is no stigma and discrimination within the society.

The project is supported by the Elton John AIDS Foundation.

Support. Do not punish!

In June 2019, dozens of cities in the EECA region hosted the campaign «Support. Do not punish». Activists took to the streets to publicly protest against repressive drug policies.

This action, which is held annually all over the world, is a great chance to once again draw attention to this unresolved problem. How it was in the EECA region in 2019 you can read here.

Plans for 2020

Are you part of a collective, network or organisation advocating for drug policies that prioritise health and human rights? Are you planning to join the 2020 Support. Don’t Punish Global Day of Action and have an outstanding plan to build momentum? If your answer is “yes” then this call for applications might be for you!

Through this call, the Support. Don’t Punish campaign aims to identify and support local partners (up to 7) with funding of between USD 2,000 – 4,000 for strategic, creative and collaborative projects building up to the 2020 Global Day of Action that advance drug policy reform, bolster harm reduction and build bridges with/within/between communities disproportionately affected by the “war on drugs” (e.g. people who use drugs, farmers of crops deemed illicit, youth, ethnic minorities, LGBTQ+, among many others).

You can apply for the grant here.

What is “Support. Do not punish”?

Support. Don’t Punish is a global grassroots-centred initiative in support of harm reduction and drug policies that prioritise public health and human rights. The campaign seeks to put harm reduction on the political agenda by strengthening the mobilisation capacity of affected communities and their allies, opening dialogue with policy makers, and raising awareness among the media and the public.

The campaign’s yearly high point is the Global Day of Action, which takes place on, or around, 26th June (the International Day Against Drug Abuse and Illicit Trafficking). Historically, this date has been used by governments to showcase their drug control “achievements” in coercive terms. The campaign’s Global Day of Action seeks to reclaim and shift that day’s narrative. And so, every year, an increasing number of  activists in dozens of cities all over the world join this unique and multifaceted show of force for reform and harm reduction.

The Support. Don’t Punish campaign aligns with the following key messages

  • The drug control system is broken and in need of reform
  • People who use drugs should no longer be criminalised
  • People involved in the drug trade at low levels, especially those involved for reasons of subsistence or coercion, should not face harsh or disproportionate punishments
  • The death penalty should never be imposed for drug offences
  • Drug policy should focus on health, well-being and harm reduction
  • Drug policy budgets need rebalancing to ensure health and harm reduction-based responses are adequately financed.