Defending the interests of transgender community

Living in society and being a victim of all kinds of violence is unfortunately becoming the norm for transgender people in Ukraine. Stigma and discrimination, as well as police violence at times, restrict transgender people’s access to the law enforcement system and to quality medical services.

Igor Medvid, Coordinator of the Ukrainian organization HPLGBT and a grantee of the Emergency Support Fund for Key Populations in EECA, told AFEW International about the problems that transgender people face in the country, as well as about the ways of solving them.

For reference:

HPLGBT is a public self-organization of transgender people, which has been representing interests of transgender (trans) community in Ukraine for 6 years. HPLGBT is a membership association of a national scope that works in favor of high-risk groups for HIV infection, particularly, transgender people.

Igor, HPLGBT has done some research on transgender people. Could you tell us a little about it?

We are confident that advocating for the rights and interests of key populations is not possible without a thorough study of the situation.

When conducting research, not only we discover the issues that might be hidden from service-providing organizations, but also develop key recommendations for decision makers and service providers.

In 2019, through community efforts, we conducted a monitoring of human rights observance in relation to transgender women involved in sex work. As a result, we put together Alternative report on implementation of the convention on the elimination of all forms of discrimination against women. This report was implemented with the support of the Emergency Support Fund for Key Populations in Eastern Europe and Central Asia region, and it describes 61 cases of the rights violation of trans people, including information on the most common human rights violations. We also studied the specifics of chemical sex and the problems faced by people who practice it.

We hope that the Secretariat of the Commissioner for Human Rights of the Supreme Council of Ukraine will soon include all our recommendations on reforming and humanizing the policies into their annual report. Such actions will help us in advocacy.

In addition to this, we are sending the recommendations to all those who are forming national HIV programs, in order to include important services for transgender people, and we hope that the programs will be changing in accordance with the expectations and needs of those for whom they are implemented.

Financing for non-profit organizations in the EECA region sometimes leaves much to be desired. How do you survive in such conditions?

Our main source of income is small grants, which we get intermittently, therefore, unfortunately, our organization most often operates on a situational basis. However, even with the limited means of small grants, we manage to do a lot in strengthening the voice of transgender people. Our work is based on human rights and freedoms, and when planning activities, we try to focus on studying situations with the groups of trans people that are most in need of help. Our main key population groups are transgender sex workers or transgender people who practice chemical sex. Such groups face multiple stigmatization due to their deliberate involvement in sex work, their gender identity, sexual orientation, HIV status, and drug use.

Even though funding is declining, there are still opportunities for receiving money. We approached the Emergency Support Fund several times, and thanks to its grants, we were able to survive during this difficult time. We also transferred our skills to the community, and now the MSM community of sex workers, including those who practice chemical sex, has begun the process of mobilizing and helping each other. We help them with this by providing multilateral support, including technical assistance.

What are your future plans?

As for advocacy goals and objectives, we plan to continue to participate in increasing access to HIV testing, treatment and prevention, including AIDS prevention through interventions focused on commitment, support and care. We plan to promote interventions to suppress HIV replication as a result of ART (viral suppression), as well as participate in the promotion of sexual and reproductive health rights.

What is your most memorable case?

Recently, I was greatly shocked by the incident of rape, robbery and torture of a transgender person in the Zhytomyr region. Six malefactors, one of whom the trans person had met on a dating site, tortured him/her for a long time: having handcuffed the victim, they beat him/her up, threatened with a knife, cut off the clothes and raped him/her. However, the worst thing is that instead of investigating the attack as a hate crime, the police qualified it only as “robbery,” thereby causing the outrage from human rights defenders. We are deeply convinced of the homophobic/transphobic motive of this incident.

What difficulties do you encounter in your work?

The biggest difficulties arise due to the fact that nowadays there are no effective mechanisms for protecting the rights of transgender people in Ukraine. Investigations of crimes like the one I described are not adequate and exclude hate motives. Unfortunately, the Action Plan for the implementation of the National Human Rights Strategy has not been properly implemented.

Also, there is still no direct mention in the list of the Ukrainian Ministry of Health that transgender people are a key population group in the context of HIV. And, of course, the package of services that is provided in HIV prevention programs does not always meet the needs of transgender people. Especially if these people are representatives of sub-groups.

How do community members feel about your activity?

Differently. There are those who are grateful to us and often help the organization. Especially those who have already received help from us, and we have met their expectations.

But there are also those who are dissatisfied. For example, HPLGBT members and I often hear things like: “If you didn’t stick out, nobody would touch us,” or for example, “We were not touched, but now, because of your gay prides, we expect constant attacks by thugs (gopniks) or skin-heads.”

Once again this proves that people have little understanding of the fact that visibility is one of the most important components in protecting and expanding the rights not only of transgender people, but also of all other key population groups. We should make more efforts to educate and inform the public about the importance of visibility for diverse communities, to strengthen the voice of stigmatized and discriminated groups and, overall, to build an open and strong society.

Labour migrants in Russia and their needs

Author: Chamid Sulchan

Labour migrants in Russia unfortunately still have lack of access to health services. They also face a lot of barriers to a normal life from government and society in common.

Daniel Kashnitsky, a junior researcher at the Higher School of Economics on direction on labour migration and HIV positive migrants living in Russia, told AFEW International about migrants’ medical insurance, collaboration with Russian authorities and some hopes for the better future.

Which difficulties do labour migrants from Central Asia face in Russia?

It depends on a country where these migrants come from. People from Kazakhstan and Kyrgyzstan feel a bit better in Russia, because those countries are part of the Eurasian Economic Union. Citizens of those countries do not need to apply for a residence permit nor for the permit to work. They can just come and only need to have an official registration in the place where they live. To get this document might become a barrier for some people, because not all the landlords are ready to provide them with an official registration.

Also, some migrants are eligible to apply for the state medical insurance. Migrants from Belarus, Armenia, Kyrgyzstan and Kazakhstan have been eligible to have one since three years ago, however TB and HIV services are not included in this state medical insurance.

But there are countries, such as Uzbekistan and Tajikistan, who are not part of the Eurasian Economic Union. Migrants from there have to apply for work permits, and they have to reapply every year. They also have to pay a special tax every month, which is a really heavy burden considering the low wages. It’s a large part of their income, so it affects them enormously.

Also, migrants can face some other issues. For example, in the Russian Federal law number 38 there is a paragraph saying that if a foreign citizen is identified with HIV or TB he/she needs to be deported from the country. If one is identified with HIV and it is known by the migration authorities, they will include the migrant’s name in their database. Since deportation is quite expensive, migrants often remain in Russia undocumented. But if once you leave Russia, you will be banned to re-enter. There is a small part of undocumented migrants who had been caught and they are kept in those detention centres. Other migrants live in hiding and keep working, doing black jobs. Some of them get ART in NGOs and private clinics, however a large part of them do not have access to health services, they just keep living as their CD4 level goes down, and some of them they just end up in the emergency care. Unfortunately, we cannot estimate the figures, because the undocumented migrants are not in the state statistics or the patient file data.

What are the factors that influence a lack of access to health services for labour migrants? Probably language barriers, or something else?

Speaking the same language is important of course, because talking about health and body is quite intimate. People prefer to not only speak in their native language, but also to speak to a person who understands them, their social determinants of health, the culture.

Some migrants from Central Asia explained me why they prefer to go to clinics where people of their culture work. One of the reasons was that migrant doctors better understand socio-economic circumstances of migrants’ experiences in Russia. For example, they tend not to prescribe expensive medicines, because they know that migrants cannot afford them. One of the biggest barriers is discrimination in clinics and state institutions. Migrants from Central Asia are often exposed to it.

Unfortunately, migrants can be a reason of rising HIV epidemic in their countries, don’t they?

True. The migration of Central Asia is predominantly male, 80% of the migrants from Central Asia are young males from 20 – 50 years old. They are mostly seasonal migrants. They go to Russia for 10-11 months a year, then they go back to their home country for one or two months. This is the only time when they get to see their wives, children, and other relatives. A lot of them have sexual intercourse in Russia (sometimes not safe), with sex workers, or just with female from their communities.

How do migrants from countries like Tajikistan, Uzbekistan get health insurance in Russia?

They don’t have access to state insurance. But one of the requirements when applying for a work permit, is to have bought a private healthcare insurance. They can buy it from one of the private insurance companies. And it is a very basic insurance scheme, that costs about 50 euros per year. It is meant to show the authorities that one is formally secured, but in fact it does not improve with access to health care. These minimal insurance packages provide almost nothing more than just free emergency care which is still provided free of charge to anyone physically residing in Russia. If you have broken your leg or if you have any other acute situation, you will receive emergency care as it is accessible to anyone in Russia. But if you need any further treatment, then you need to pay. And in most cases the basic private insurance will not help you. Of course, you can buy a more expensive one, that would include everything, but most of migrants cannot afford it.

What have you and your organization done to address the issue of labour migrants having a lack of access to health services?

Firs of all, me and my colleagues created a regional expert group on migration health in our region. It’s an informal network of civil society experts. We are trying to collect arguments and convince policy makers to lift the residence ban for HIV positive foreign migrants in Russia. We are trying to bring evidence to decision-makers that the HIV residence ban only aggravates the epidemiologic situation. It creates negative consequences for the migrants as they can spread the virus even further to the community. It affects a lot of people as they spread it in their home country. We have been in dialogue with the Russian authorities about this, but it is a long process to create this enabling atmosphere and to actually make it happen.

So, it’s hard to collaborate with the Russian authorities, isn’t it?

Yes, because the Russian authorities are little sensitive now to what civil society is claiming. You need to have very strong argument, create a supportive environment and change the public opinion. We are working with the journalists. We helped to create lot of publications on migrants with HIV living in Russia. We work with civil society organizations and we train them. Our partner organizations have direct services for migrants, at least in Moscow, St. Petersburg. Yekaterinburg and Rostov-on-don and some other large Russian cities that attract them labour migrants.

Some limited services for migrants do exist where they can get tested for HIV, where they can have consultations. But it is difficult to provide sustainable provision of ART, and this is a large problem as most of the migrants cannot afford therapy.

Today the Russian government seems reluctant to introduce any serious changes. On one hand, the authorities understand that Russian economy would not survive without migrants. So, they try to keep migrants low profile. They do not encourage migrants to raise their voices, to create trade unions or other grassroots movements. Migrants do not have access to social entitlements, not only healthcare but to pension funds and other security funds.

What do you think should be done by the Russian government to improve the access to health services for migrants from Central Asia?

The first thing Russia needs to do, is to liberalize its HIV legislation. This is very important, because once HIV-positive migrants are not stuck in Russia, then they can travel back and forth, at least they can receive ART from their home country. Secondly, Russia needs to allocate funding for NGOs that work with the migrants, to test them and provide psychosocial support. Third, anyone who resides in Russia and contributes to the Russian economy, should get access to the Russian healthcare, including HIV and TB services. The healthcare needs to change and include all the people who actually live and work in Russia. There is a human right aspect here, but also an epidemiological aspect: if you don’t want the diseases to spread further, you need to provide basic access to services.

Do you see an opportunity that the situation will be changed in the future?

Well, I stay positive because there are some developments in the region of East Europe and Central Asia such as, for example, Kyrgyzstan and Kazakhstan having accessed to the Eurasian Economic Union. It was a major breakthrough, when member countries signed a health insurance agreement to cover their citizens when they migrate within the Union. In terms of access to HIV and TB care, it really has remained unchanged for 25 years, because when they adopted these policies, Russia did not have this severe HIV growth that it has now, it was only starting back then.

Nowadays we try to tell the authorities: it is not that you have to pay for the migrants and their health insurance, but just start with decriminalizing them, liberate migrants from this constant fear of being deported of residing in illegality and being constantly subject to rights violation. This is really important if Russia ultimately wants to be create decent life conditions for all people who live and work in the country.

 

 

We do our best to provide services

Ivan Anoshkin, coordinator of the street social work of NGO “Project April” (Tolyatti, Russia) talks about harm reduction activities of his organization at COVID-19 time.

For reference:

“Project April’ works in harm reduction. The main key groups are people who inject drugs and sex workers, but with changes on the drug scene and the emergence of different stimulants and salts, the organization got new client groups, particularly people practicing Chemsex. The organization employs 18 people and also has a large number of volunteers. “Project April” is recognized in Russia as a foreign agent.

Difficulties caused by COVID-19

Before the spread of the COVID-19 and the lockdown related to it, we used to receive our clients at our office every weekday. Anyone could come to get a consultation, HIV test or a harm reduction kit. We have always tried to provide the conditions for talking with our clients in a warm, comfortable atmosphere. Once the self-isolation regime was first introduced in Tolyatti in March, we had to completely close our office. However, seeing that after a few weeks it became clear that this regime could be extended over and over again, we decided that as a social organization, we cannot interrupt our activities indefinitely. Since then, one of the employees is in the office every working day to insure the provision of our regular services “on the spot”. Yet evidently, it is no longer possible for us to invite our clients to chat with them over a cup of tea, for the sake of their and our safety. Therefore, we are trying to provide our services at entrance.

Our work is largely focused on outreach and street work and in the current situation, this has had to be significantly reduced as well. For example, our employee went to a gay club every week where she developed trust relations with its visitors and maintained contacts with the community. With everything closed, this channel of communication is lost and this could negatively affect our current and potential clients. Finally, another significant obstacle that limits our activities during the crisis is a fear to cause more troubles to our clients by attracting unnecessary police attention to them.

Innovations

Under these circumstances, we have partially switched our activities to online. We are holding our work meetings on Skype. The visits we would do to rehabilitation centres every 1-2 months, we have also temporarily transferred to online. We agreed with administration of these centers to pre-deliver them brochures and HIV self-tests, and to organise our seminar via Skype afterwards. This way, patients have an opportunity to get tested and to get immediate information and support, even in these dark times.

What is more, to our clients we started to send and deliver harm reduction kits, HIV self–tests, and, if necessary, packages with basic products and goods. Basically, we already know places where our clients continue to gather. So we deliver our kits and packages there directly, based on their precise needs. For our employees, volunteers and active participants who continue to work, we purchase masks, gloves and disinfectants.

In times of crisis like this, our clients have more demand for social and psychological support as well. For this purpose, we have a service taxi that allows our employees to come to clients to provide social assistance and products of first necessity. And if necessary, we also deliver ARV therapy to clients, with their written agreement.

Certainly, due to the self-isolation regime and the hostile atmosphere in general, the number of new clients decreases, but not as significantly as we had feared. When you have already been working with harm reduction for this many years, the members of community know you. And we should also not underestimate the power of the word of mouth, that stays efficient at all times. Even now, newcomers visit our office at the recommendation of our clients.

What’s next?

This crisis has shown us how important it is to keep in touch with our clients not only live, but online as well. This way we stay in permanent contact. Hence, in the future we are hoping to have a possibility to hire a person whose work will be devoted only to managing social media and maintaining contact with our client through messengers on a regular basis.

We also really hope to offer some financial compensation to our employees, who continue to “work in the field” at their own peril and risk, especially as some of them – as I do – have a fairly low CD4 level.

The potential impact of the COVID-19 on tuberculosis in high-burden countries

Length of quarantine, movement restrictions and disruption of TB services could spell disaster for hundreds of thousands at risk.

A modeling analysis released by the Stop TB Partnership shows that under a three-month lockdown and a protracted 10-month restoration of services, the world could see an additional 6.3 million cases of TB between 2020 and 2025 and an additional 1.4 million TB deaths during that same period.
The new study was commissioned by the Stop TB Partnership in collaboration with the Imperial College, Avenir Health and Johns Hopkins University, and was supported by USAID. The modeling was constructed on assumptions drawn from a rapid assessment done by The Stop TB Partnership on the impact of the COVID-19 pandemic and related measures on the TB response in 20 high-burden TB countries—representing 54% of the global TB burden.

The modeling focused on three high burden countries—India, Kenya, and Ukraine—and extrapolated estimates from those countries to create global estimates of the impact of COVID-19 on TB.

According to the new study, with a three-month lockdown and a protracted 10-month restoration of services, global TB incidence and deaths in 2021 would increase to levels last seen in between 2013 and 2016 respectively, implying a setback of at least five to eight years in the fight against TB.

To minimize the impact of the COVID-19 pandemic on TB, save millions of lives and get the world back on track in achieving the UNGA targets, national governments need to take immediate measures that ensure the continuity of TB diagnostic, treatment and prevention services during the lockdown period and undertake a massive catch-up effort to actively diagnose, trace, treat and prevent TB.

At our own risk. EECA’s reponse to COVID-19.

Yuri Avdeev, Chairman of the Board of the Chelyabinsk City Public Organization “Independent Research Center “There is an opinion”, Russia

For your information:

The independent research center “There is an opinion” has been working in the field of prevention of socially dangerous diseases and research of various aspects of social life since 2000. The Center works to reduce the spread of socially dangerous diseases, such as HIV infection, tuberculosis and sexually transmitted infections; provides assistance in overcoming psychological and communication problems (difficulties in communication, self-confidence); assistance in disclosing personal qualities, self-fulfillment of personality; socio-psychological, informational assistance to people living with HIV and TB, as well as their significant environment.

At present, the “There is an opinion” centre is the largest operator of rapid HIV testing in the Urals. Every year 19,000 residents of the Chelyabinsk Region and its border areas become clients of the programme. The main target groups are men who have sex with men (MSM), transgender people (TG), people who use drugs (PWUD) and the general population.

Difficulties caused by the virus

For five years our organization has been working in the context of HIV prevention with MSM/TG. Weekly on Fridays, two teams of specialists (psychologist + nurse) worked in two nightclubs for LGBT people, carrying out rapid HIV testing, pre- and post-test counseling, distributing prevention information materials, condoms and lubricants, and accompanying identified clients to be registered with the AIDS Center. Due to the announcement of the self-isolation regime, nightclubs are closed, so we are no longer able to continue our normal work at their base. The testing room is also closed.

Unfortunately, this situation paralyzed the work of our organization and most of the activities were stopped. Many people go online, but we should understood that online counselling, for example, will not replace HIV testing and the issuance of condoms and lubricants.

Innovations

On April 7th, at our own risk, we reopened the testing room in the evening, because we received a request from clients for testing and obtaining condoms and lubricants. The cooperation with the AIDS Center helped us to do this. In addition, today we are delivering ARVT drugs for HIV+ patients in Chelyabinsk, including MSM. We have received special passes for being in the city.

We have noticed that those who receive ART at home are even happy about it, because now they do not have to take a ticket and wait in line. However, nightclub visitors are not very happy with these innovations, but the most motivated members of the community themselves come to the testing room to receive HIV prevention and testing.

In our work we try to follow all the necessary recommendations of the regional Government: the reception is held by appointment; social distance is respected; precautions are taken – specialists work with masks, gloves and glasses, the client is given a mask; surfaces are wiped with a disinfector; washing of the room takes place every 2 hours.

Of course, statistics for our activities have fallen. Whereas we used to serve up to an average of 100 MSM/TG per month, now the number has dropped by almost 5 times.

What’s next?

Today we are thinking about self-testing. We only work with blood tests, and today it is not the most convenient option. So we’re negotiating with donors to buy saliva tests.

EECA’s reponse to COVID-19

Alexander Chebin, project coordinator at the Regional Public Foundation “New Life”, Yekaterinburg, Russia.

For reference

“New Life” Foundation has been working in Yekaterinburg in the field of AIDS prevention and control, assistance to different categories of population since 2011. The key groups are (ex) prisoners, migrants, drug users, sex workers, people affected by HIV, tuberculosis, hepatitis.

Difficulties due to the virus

Currently, we have suspended our activities on fast HIV and hepatitis outreach testing, activities in rehabilitation centers, penal inspections, police departments, federal enforcement agency system and other organizations.

Since the introduction of the country’s self-isolation regime, representatives of our key groups have found themselves in new realities – for example, their level of anxiety has significantly increased, including with regard to treatment and care. Also we have received many requests for psychological support. Due to changing economic circumstances, people have developed a lot of fears – they are afraid of losing their jobs and uncertainty in the future. We have already analyzed our work during 2 weeks of self-isolation. The number of requests through the means of communication increased several times. Our employees conduct consultations, provide psychological support and accompany participants “by phone”, through various messengers. This is especially important for people released from prisons, who do not have the skills to apply to government agencies using Internet resources.

Innovations

Fortunately, in a pandemic, our work does not stop. However, due to the virus and quarantine measures, we had to go online and interact with our participants remotely, through communications channels.

Due to the new rules of patient’s admission, the management of the AIDS Centre decided to involve volunteers to help in the delivery of life-saving antiretroviral therapy. Thus, since March 30, our employees have been actively involved in this process. Our two staff members take calls and consult people on how to register delivery. With the help of the Foundation’s car with a driver health workers are delivered to clients. Also, 3 employees and 1 “New Life”s volunteer drive their cars to deliver ARV therapy.

In addition, the Foundation does not stop providing legal and social assistance to people, doing it remotely. Also, we accompany people released from prison to medical organizations, help to deliver food packages, clothes. In case of emergency, one of our employees collects the kits for participants at our drop-in centre and delivers them to their homes with all necessary security measures.

In the future, we plan to go back to the way we used to work, assess and reflect on our experience in the pandemic and perhaps make adjustments to some aspects of our work.

 

ICPCovid-HIV study

As the Covid-19 containment measures ramp up around the world, different countries implement different strategies, and health systems are overwhelmed to varying degrees. Generating high-quality evidence on the impact of Covid-19 and related measures on both the quality of life and the management of HIV in different settings, will help provide guidance for decision-making and better preparedness in case of future pandemics.

In this light, researchers based at the University of Antwerp (Belgium) have designed a small study in collaboration with Sensoa and EATG to investigate the impact of the Covid-19 pandemic on HIV care and the well-being of persons living with HIV (PLHIV).

Aims of the ICPCovid-HIV study:

1. To identify possible consequences of the ongoing Covid-19 pandemic on the quality of life of PLHIV

2. To assess access of PLHIV to healthcare services and HIV treatment

3. To compare the impact of different Covid-19 containment measures in different countries on the quality of life and management among PLHIV

4. To identify associations between specific antiretroviral regimens and Covid-19 incidence and/or Covid-19 clinical outcomes

More information – here. 

Response of AFEW Kyrgyzstan to COVID-19

COVID-19 rapidly spreading around the world requires urgent and decisive actions. AFEW Kyrgyzstan quickly responded to the emerging threat and prepared the support measures, which can help the key populations in this challenging time. Natalia Shumskaya, director of AFEW Kyrgyzstan, told AFEW International about them.

Social bureau for women living with HIV

The social bureau for women living with HIV offering peer support services as well as consultations of psychologists and social workers continues its operation during the lockdown. Before the state of emergency was announced, most people living with HIV (PLWH) in the city received Antiretroviral therapy (ARVs) for up to three months. If people were not able to come and pick up their medications, the social worker brought them to their homes. However, PLWH still need ARVs, so every day a representative of our organization brings such medications to two or three addresses using an official vehicle of the AIDS centre.

Nutritional support

About one-third of PLWH in Kyrgyzstan live in poverty. People who used to earn money for their living with odd jobs are now left without any sources of income and have urgent needs in food products, hygiene items, diapers for their babies and mobile charge cards to stay connected. Every day, the psychologist from the AIDS Centre gives calls to women living with HIV and provides them with psychological support. If people need food, the psychologist gives them contact details of the Bishkek district headquarters for them to receive humanitarian aid. We have sent a request to the Red Crescent Society of Kyrgyzstan asking them to allocate food packages for 40 women living with HIV.

In community centres for women with substance abuse problems, there was also a need in masks, disinfectants and food packages, so we procured all the needed materials to comply with the infection control measures from our project budget.

Psychological support

Three psychologists of our organization continue providing psychological support over the phone and using WhatsApp. Mostly they are contacted by women with severe anxiety, panic attacks or those who faced domestic violence. Some women have relatives with mental health problems. Besides, we received phone calls from young people with drug abuse problems.

Young people help!

There is a volunteer headquarters launched in the youth centre together with the National Agency for Youth and Physical Culture. People working at the organization and other city residents make donations to a special account to procure food products for those in need. Our Champions for Life from the Dance4life programme signed up as volunteers and deliver the humanitarian aid.

For prisoners

We procured and provided to the National Law Enforcement Service two thousand masks, 850 kg of bleach, and 50 bottles of antiseptics for the prisoners.   Besides, we developed leaflets for prisoners and prisons staff. Soon brochures will be published and distributed among the prisons.

We are currently carrying out negotiations with different donors and I hope that in the nearest future we will be able to raise more funds to support the National Law Enforcement Service.   We are waiting for the response from the German Agency for International Cooperation (GIZ) concerning our project proposal on carrying out training sessions for prisoners and non-medical personnel working in prisons on COVID-19 and on procuring soap and laundry detergent for prisoners.

Due to the physical contact being impossible, our peer consultant (PLWH) provides support to the prisoners living with HIV remotely, through phone calls.

For reference

As of today, there are 144 confirmed cases of COVID-19 and one registered death in Kyrgyzstan.

Since March 25, the government declared the state of emergency. A curfew has been introduced, so people are not allowed to leave their homes after 8 p.m. In the daytime, there can be only three reasons to go outside: to a supermarket, pharmacy or to visit a doctor provided that the person has an itinerary sheet. Public transport and taxi services are closed.

AFEW International signed “Civil Society Statement on COVID-19 and People who use Drugs”

INPUD, in collaboration with International Drug Policy Consortium and Harm Reduction International, developed a statement ‘In the time of COVID-19: Civil Society Statement on COVID-19 and People who use Drugs’.

Organizations are asking for the international community, including international donors, to act immediately to ensure, through policy guidelines and financial and political support, that national, regional and global responses to the pandemic respect the fundamental rights of all.

The deadline for sign on is Monday, 6 April, by noon (12:00 – London time).

To  sign the statement, please use this link.

The statement

In the time of COVID-19: Civil Society Statement on COVID-19 and People who use Drugs

We, as community and civil society organisations working in drug policy reform and harm reduction, urge the international community to take proactive and coordinated action to protect the health and human rights of people who use drugs in light of the COVID-19 crisis.COVID-19 infection does not discriminate, but magnifies existing social, economic and political inequities. People who use drugs are particularly vulnerable due to criminalisation and stigma and often experience underlying health conditions, higher rates of poverty, unemployment and homelessness, as well as a lack of access to vital resources – putting them at greater risk of infection. The crisis must be an occasion to rethink the function of punishment, to reform the system and to work towards ending the war on drugs. If we are to ‘flatten the curve’, the health of the most marginalised in society must also be protected as an urgent priority.

In times of crisis, uncertainty and upheaval it is imperative that human rights act as an anchor point. Careful and vigilant attention must be paid to non-discriminatory access to health care, human dignity and transparency. Multiple governments emphasise that we are fighting a ‘war’, the use of such terminology justifying a militarised approach that allows for the suspension of rights and freedoms. History shows that extraordinary powers are routinely deployed against the most persecuted in society, who risk being scapegoated in the name of infection control. As states of emergency are declared, the international community must urge caution on the creation of a ‘new normal’ where States derogate from their obligation to serve and protect all persons.

Failure to effectively steer and manage the COVID-19 response will have disastrous consequences. The international community, including international donors, must act immediately to ensure, through policy guidelines and financial and political support, that national, regional and global responses to this pandemic take the needs of people who use drugs into account and respect the fundamental rights of all. We therefore suggest the following recommendations:

1. Protect the right to health: During times such as these, governments have an obligation to ensure that a public health crisis does not become a human rights crisis due to lack of access to adequate health care. In the wake of COVID-19, however, there is great concern that harm reduction services are being closed, not adapting sufficiently rapidly to changing legal and health contexts and that essential resources will be diverted to the COVID-19 response at the expense of equally life-saving work. Inappropriate and restrictive regulations banning or limiting take-home doses and other supplies make complying with lockdowns and social distancing rules extremely difficult. Harm reduction workers report unease about scarcity of resources, lack of coherent policies and programme guidelines on COVID-19, and potential disruptions to global supply chains of essential medicines and equipment, including methadone, buprenorphine, naloxone, needles and syringes, disinfectant, masks and gloves.

The international community must act swiftly to ensure States meet their international obligations to protect the right to life and health. This can be done by issuing strong political statements and clear and comprehensive technical guidance, building on WHO and UNODC  guidelines and national COVID-10 regulations, which unequivocally calls to:

– Declare harm reduction programmes as life-saving services that must stay open. The closure of harm  reduction centres would deprive service users from accessing life-saving interventions and would ultimately lead to over-crowding of centres that remain open, increasing risk of infection.
– Immediately amend restrictive legal and regulatory policies that ban or limit take-home doses due to fear of diversion and that restrict the provision of take-home naloxone to prevent overdoses.
– Enhance service accessibility, develop and implement safety and hygiene protocols and coordinate efforts within the health system to allow for the effective distribution of resources.
– Recognise harm reduction workers as critical healthcare workers so that they can access government stocks of protective clothing.
– Protect and expand the operation of low-threshold services, including outreach, as well as provide housing and shelter for those facing housing insecurity.
– Adequately fund harm reduction services, particularly low-threshold services.

2. Ensure safe supply: Border closures and travel bans around the world will impact the future supply of unregulated substances such as heroin and cocaine. This will have a range of repercussions, including an increase in demand for opiate substitution therapy (OST). Of particular concern is that synthetic drugs such as fentanyl, which are easier to produce and transport, could replace bulkier substances such as heroin, the corollary of this being an exponential increase in overdose deaths.

In light of the above, international and regional bodies must work with member states to:

– Monitor trends of illicit drug markets to provide a rapid response to dangerous and emerging trends, such as increased risk of overdose deaths.
– Ensure increased access to OST to respond to changes in drug supply, through accelerated and flexible entry procedures.
– Deprioritise the enforcement of supply-side control in order to retain some stability in illicit drug markets and prevent market saturation with synthetic drugs.
– Respond to potential disruptions in the production of methadone and buprenorphine and step in when early signs of issues with supply chain management are detected.

3. Protect the right to be free from arbitrary detention: The COVID-19 crisis has spotlighted the public health dangers of overcrowding in prison and detention facilities which are traditional hotbeds for infectious diseases. According to UN data, at least 470,000 persons are incarcerated worldwide for drug use and possession only, while an additional 1.7 million people are incarcerated for other drug offences, many of which are non-violent. In addition, across East and South-east Asia, hundreds of thousands of people who use drugs are detained in compulsory drug detention facilities, with tens of thousands more detained in private drug treatment centres, often against their will, across Asia and Latin America. In such contexts, COVID-19 prevention measures, such as physical distancing, cannot be implemented effectively. Further restrictions on family visits and supervised releases increase isolation and stress during a time of fear, leading to an increase in violence, riots and assault.

The UN High Commissioner for Human Rights has urged governments to reduce the number of people in detention, particularly those without sufficient legal basis. In view of this, the international community must ensure States take action to:

– Decriminalise drug use and possession for personal use as promoted by the UN system and outlined in the UN Common Position on Drugs.
– Reduce the prison population through early release, pardons, amnesties and non-coercive alternatives to incarceration for people detained for drug-related non-violent offences, particularly those on remand, and those most-at-risk individuals, including people living with HIV, TB and COPD, as well as older people.
– Immediately release people who use drugs from compulsory drug detention centres and from private drug treatment centres that apply coercive measures, including involuntary detention.

4. Protect civil and political liberties: Many governments, as part of COVID-19 containment measures, are restricting civil liberties in unprecedented ways, through mass surveillance, including tracking mobile phone data, restricting movement and banning public assembly. Authorities such as police and army personnel are permitted to stop anyone on the street, increasing the chance of hostile interactions with people who use drugs, particularly when they need to purchase drugs or travel for health appointments. The potential misuse of personal data, particularly when it comes to criminalised populations, is of acute concern.

In a joint statement, UN experts have urged States, in accordance with the Siracusa Principles, to exert caution when applying COVID-19 related measures and restrictions that may impinge on human rights, as well as to limit their duration and subject them to regular review. Based on this, we urge the international community to:

– Ensure that emergency declarations and broader extraordinary powers granted under COVID-19 responses are not used to target specific populations or deployed to silence and repress human rights defenders.
– Establish rights-based legal safeguards to govern the appropriate use and handling of personal data to  protect privacy and confidentiality.
– Ensure that exorbitant fines and imprisonment should only be used as a last resort and personal circumstances taken into account, in the event of breaches to protective measures.

5. Protect community and civil society organisations: The COVID-19 pandemic has showed the critical role of communities in the response, as they can react quickly and reach those who are otherwise unreachable, easing the burden on the healthcare system. Furthermore, communities play important watchdog functions when it comes to government transparency and accountability. UN and donor agencies must act to:

– Protect human rights defenders, communities and civil society organisations during this crucial time, by highlighting their critical role in public statements and in their interaction with governments.
– Ensure governments do not impose disproportionate restrictions or obstructions on the work of community  and civil society organisations.
– Establish mechanisms for monitoring human rights compliance, with a particular focus on populations whose rights are commonly violated.

Global problems such as the COVID-19 pandemic require global solutions. We urge the international community to take urgent action to ensure the inherent rights and dignity of people who use drugs are respected and defended in the time of COVID-19. The pandemic has laid bare the failures within our societies. Undoubtedly a serious challenge, COVID-19 must not be exploited by governments to suspend basic rights and freedoms indefinitely, but be a wake-up call to change and repair a broken system that has been overly focused on the punishment of people who use drugs, a policy that is now exacerbating the dangers of COVID-19. The failed war on drugs must end, and health and political systems must be reformed to ensure the health and wellbeing of all.

#Strongertogether. The EU’s response to the coronavirus pandemic in the Eastern Partnership

As part of its global response to the coronavirus outbreak, the European Commission is mobilising an emergency support package for Armenia, Azerbaijan, Belarus, Georgia, the Republic of Moldova, and Ukraine: €140 million for immediate needs; up to €700 million for the short and medium term to support the social and economic recovery of the region.

Responding to immediate needs includes:

  • Support to the health sector (€30 million)
  • Working with the WHO to supply medical devices and personal equipment such as ventilators, laboratory kits, masks, goggles, gowns, and safety suits.
  • Training medical and laboratory staff, and raising awareness across the six countries.

 

  • Support for the most vulnerable groups in society (€11.3 million)
  • Grants of up to €60,000 to civil society organisations to respond to immediate needs, such as supporting local schools with distance learning – already available through the EU’s regional “Rapid Response Mechanism”.
  • Launch of the “Eastern Partnership Solidarity Programme” to target the most affected parts of the populations, with sub-grants to smaller, local organisations.

Limiting the social and economic impact

Working closely with International Financial Institutions (IFIs) and financing institutions from EU Member States to provide a coordinated European response as TEAM EUROPE:

  1. New €100 million support programme to help SMEs, including self-employed and others to easily access credit and boost their businesses after the crisis.
  2. €200 million of existing credit lines and grants to SMEs in local currency through the EU4Business Initiative.
  3. €500 million available for the EU’s Neighbourhood through the EU’s major de-risking instrument, the European Fund for Sustainable Development (EFSD) to rapidly provide liquidity across the region.

What is the EU already doing for the Eastern Partnership to face the coronavirus emergency?

Armenia

  • Over 3,000 vulnerable households, with elderly people and people with disabilities and large families in Shirak, Tavush and Lori regions will receive humanitarian aid packages thanks to the support of the European Union.

Azerbaijan

  • With EU funds, the Ganja Vocational Education and Training school will purchase equipment machinery to produce masks for the Ganja area.

Belarus

  • Thanks to EU cross-border cooperation projects linking communities in Belarus, Ukraine and Poland, emergency medical services such as ambulances and respirators are available in the hospitals to help doctors fight against the coronavirus pandemic.

Georgia

  • A Georgian producer of medical textiles has produced 40,000 medical gowns within a week after he was able to purchase 12 additional sewing machines thanks to a micro-grant provided by the EU.

Republic of Moldova

  • EU projects in Moldova are already working to provide protection sets such as gloves and masks for vulnerable people and medical staff, as well as sterilizers for equipment across the country.

Ukraine

  • The EU supports the building of community resilience through assistance to vulnerable people, transition to online education, fighting disinformation and strengthening cultural diversity and creativity online.

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