Needs and gaps in treatment and rehabilitation for people who use drugs in selected countries of EECA

Report on the needs and gaps in treatment and rehabilitation for people who use drugs in selected countries of EECA

This report presents the results of an assessment on the availability of and access to treatment and rehabilitation services for people who use drugs (PWUD) in selected countries of the Eastern European and Central Asian (EECA) region. It was carried out through a regional approach developed by the AFEW Network within the programme ‘Bridging the Gaps: health and rights for key populations. Phase 2’, fi­nanced by the Ministry of Foreign Affairs of the Netherlands.

The assessment focused primarily on the topics of rehabilitation and human rights. AFEW International was responsible for information at the international level, whilst regional level assessments focused on EECA countries where the AFEW Network implements the project amongst PWUD, namely, Georgia, the Kyrgyz Republic, the Russian Federation and Ukraine. We expect the results of this assessment will be used to improve the current situation with access to treatment and rehabilitation services for PWUD in the EECA region, particularly in those countries in which the AFEW Network works. Findings from this analysis of existing gaps, this assessment represents the fi­rst step to developing rehabilitation services and human rights under the AFEW regional approach. Furthermore, the ­findings will inform the development of pilot projects on advocacy, service delivery or capacity building and the continuous monitoring of results.

The full version of the report is available here.

AFEW’s Chair of the Board Jeffrey Lazarus Steps Down

Jeffrey Lazarus

After three years as Chair of AFEW International’s Board, Professor Jeffrey Lazarus has stepped down on 1 June 2018. Many positive dynamic changes happened during his tenure. AFEW gained financial stability, renewed its board with community members, increased gender equity and cemented its position as a leading NGO in Eastern Europe and Central Asia (EECA).

Jeffrey Lazarus joined AFEW right after its re-organisation into a network with members in five EECA countries. AFEW was still negotiating the second phase of ‘Bridging the Gaps: health and rights for key populations’ project, which ultimately ensured financial sustainability for five years.

“Jeff Lazarus changed many things with regards to our Board. During these three years, AFEW’s board had more meetings and more involvement. During Jeff’s chairmanship, our organisation has gone through many important changes. We changed the location of our office in Amsterdam, our name, our logo and our statutes. These were all basic requirements to prepare AFEW for the future, for the next level in our work. Thanks to Jeff, we have got more visibility and more connections,” says AFEW International’s executive director Anke van Dam.

During his three years, Jeff provided needed input into AFEW’s strategies to improving access to health services – including hepatitis C – for key populations at risk.

Jeffrey V. Lazarus continues as an associated researcher at ISGlobal, Hospital Clínic, University of Barcelona and an affiliate professor at CHIP, Rigshospitalet, the University of Copenhagen, a WHO Collaborating Centre on HIV and Viral Hepatitis and will take on new duties as the first Vice-Chair of the EASL International Liver Foundation

“When I was at World Health Organisation a decade ago, the AIDS Foundation East-West (that now became AFEW International) was one of our most important non-governmental partners. I never imagined that one day I would become Chair of the Board and help shepherd in a new era where AFEW International solidified its leading role as an organisation working for the improved health of the most marginalised and vulnerable populations in Eastern Europe and Central Asia,” says Jeffrey Lazarus.

AFEW International wishes Jeffrey Lazarus all the best in his important work to improve the health and quality of life of marginalised populations.

Expert: Polygamy Increases the Risk of the HIV Spread in Tajikistan

Author: Nargis Khamrabaeva, Tajikistan

Polygamy is one of the main factors contributing to the rapid spread of HIV in Tajikistan. This is stated in the research of the Tajik network of women living with HIV. In 2018, this network in cooperation with the public fund Your Choice conducted a review of the legal environment in relation to HIV.

Protection of rights regardless of the status

In Tajikistan, polygamy is officially prohibited and is punishable by a fine of two years of correctional labour. However, as the religious influence on the society increases, many men have several wives. The second and subsequent marriages are not registered but are consecrated by a mullah and normally wives do not live in one house.

“The committee on the elimination of discrimination against women called on Tajikistan to ensure the protection of women’s rights in existing polygamous and religious marriages regardless of their registration status,” says Larisa Aleksandrova who represents the public fund Your Choice and acts as a gender and legal consultant of the research.

According to the expert, polygamy has negative consequences in relation to HIV. First of all, in sexual relations women in Tajikistan usually do not have the right to make a decision to use condoms. Women are not able to counteract the unsafe pattern of men’s intimate behavior. According to the statistics on HIV, programmes promoting safe sexual behavior and family planning are not successful. They also do not have impact on men and youth.

Undisclosed  information is a threat to unofficial wives

Larisa Aleksandrova says that another problem is that men living with HIV prohibit their wives to go to the hospital for treatment.

Larisa Aleksandrova, representative of the public fund Your Choice, gender and legal consultant of the research

“One of the reasons why men have such behavior is the fear of public disclosure of their HIV status. Another reason is additional expenses on the treatment of the spouse, who usually is being financially taken care of by the husband. In many cases, such behavior led to the death of women,” tells the expert.

Besides that, polygamous men living with HIV infect all their spouses. During consultations in the AIDS Centre, they often choose not to tell that they have several wives because polygamy is a criminal offence. Therefore, undisclosed information becomes a threat to the lives of unofficial wives. They simply will not know about their status and will not be able to receive the treatment.

“Polygamy is a major risk for the spread of HIV. In 2017, in the town of Nurek a lawyer defended the interests of a woman who contracted HIV from her husband. She demanded compensation for moral and material damage due to the transmission of HIV. The investigation showed that the woman’s husband had a second wife who had died of tuberculosis. After that, according to the Muslim traditions, the man got remarried for the third time. He was seen together with his new spouse in the AIDS Center in Nurek where both of them were receiving antiretroviral therapy. It is possible that the third wife already was HIV-positive as well”, tells Larisa Aleksandrova.

This is not an individual incident. When interviewing women living with HIV, some respondents said that their husbands had second wives, and in most cases, they found out about it when they got to know about their positive HIV status.

 

Mother-to-Child Transmission of HIV in Kyrgyzstan is Minimal

Now about half of the money allocated by Kyrgyzstan for the HIV component goes to the procurement of test kits for pregnant women

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan is getting prepared to receive a certificate to confirm elimination of mother-to-child transmission of HIV. In the last five years, over 95% of pregnant women were covered with prevention projects, while the new cases of vertical HIV transmission are now at the level of 2%.

Testing is an integral part of prevention

Since 2007, all pregnant women have been tested for HIV when registered in maternity care. In case of a positive result, the woman is registered with HIV treatment facilities and receives consultations on the need of antiretroviral treatment (ART).

“A good, easy-to-understand consultation leads to the woman giving her voluntary consent to the therapy initiation. There are rare cases when women refuse treatment due to the lack of knowledge or religious beliefs, but most often – due to their self-stigmatization. The share of such refusals is now less than 2%,” says Erkin Tostokov, physician working at the Prevention Unit of the Republican AIDS Centre. “There are some cases when a woman is first seen by the doctor only when she delivers her baby. For such women, we do rapid HIV testing in the maternity clinics and, if HIV is confirmed, we hand out ART drugs right there. We update our clinical protocols in line with the most recent WHO guidelines and train our doctors on a regular basis.”

Children born to HIV-positive mothers go through several stages of examination: early diagnostics to identify if the foetus is infected intra uterine; then within 4-6 weeks doctors have to exclude HIV transmission during the delivery; and the last test allows detecting the HIV status of the infant after the breastfeeding is completed. Children receive preventive ARV therapy depending on their risk level and receive monthly social benefits during the whole period until final confirmation/non-confirmation of the diagnosis (up to 18 months).

Social benefits for children living with HIV

Elena learned that she had HIV in 2011. In a while, the woman found out that she was pregnant. Back then, she was in a difficult situation: no job, no place to live, and no money. The woman felt lost because of her HIV status.

“The doctor prescribed ART and I started taking the pills, though before I refused to take the therapy because of my allergy,” Elena recalls. “When my daughter was born, she received preventive therapy for two months. When my girl was 18 months, the doctors did the last test and took her off the register as she was perfectly healthy. However, I was still scared and took her for HIV testing until she was four years old.”

Now about half of the money allocated by the state for the HIV component goes to the procurement of test kits for pregnant women. The government provides social benefits for children living with HIV and free breast milk substitutes.

“In the recent 7-8 years, our programmes to prevent mother-to-child transmission of HIV achieved a big progress: the share of such transmission was reduced from nine to one percent,” says Aybek Bekbolotov, Deputy Director of the Republican AIDS Centre. “To a great extent, this result was achieved through the efforts of doctors working in general and maternity clinics. Now there is almost no pregnant woman whom we miss. All maternity clinics have been provided with rapid HIV tests and ART drugs. We received a strong support from UNICEF. They provided training to doctors, supported the launch of early diagnostics in newborns and rapid testing in maternity clinics. Now they help us to get prepared to receive the certificate of having eliminated mother-to-child transmission of HIV. A country can get such a certificate provided that the rate of vertical transmission is less than 2% and if over 95% of pregnant women have been covered with prevention programmes in the recent two years. There are certain requirements to indicators and procedures to calculate such data, and now we are working on meeting them.”

Support and training in the summer camp

Currently, there are 478 children with HIV registered in care, 464 of them receive treatment. Every year, summer camps are held for children living with HIV with UNICEF support. This year, this event will be brought to the international level for the first time.

“In July, there will be a one-week summer camp for children, parents, doctors and social workers from Kyrgyzstan, Kazakhstan, Tajikistan, Uzbekistan, and Turkmenistan. There will be trainers from the UK, Ukraine, Russia, Germany, Spain, the Netherlands, and Italy,” tells Aybek Bekbolotov. “The camp will include several parallel events: a forum for adolescents living with HIV and their parents, workshop for pediatric medical staff and training for psychologists and social workers.”

Medical and social workers will be trained to work with children living with HIV, while children and their parents will develop support and leadership skills and are expected to form a new community.

Georgian Youth for Music and Harm Reduction

For the first time in the history of Georgian music festivals, a team of volunteers delivered harm reduction services 24 hours a day during 4GB festival

Author: Irma Kakhurashvili, Georgia

4GB is an annual electronic music festival which has been held in Georgia since 2011. The festival is dedicated to the memory of DJ Giorgi Bakanidze – one of the Georgian club music pioneers. This year, 4GB was held in an abandoned Cosmic Constructions Centre near the Saguramo village. Apart from the high-quality lineup, sound systems and headliners performing on stage, 4GB festival had another prominent feature – for the first time in the history of Georgian music festivals, a team of volunteers delivered harm reduction services 24 hours a day. Mandala – Harm Reduction youth project team members did their best to make sure that more than one hundred participants of the festival stay healthy. Thanks to this project, drug and alcohol intoxication, overdoses and other risky situations were brought to naught.

Information as weapons

Information about the new project first appeared in social networks. Several days before opening of the festival, organizers announced that due to the growing number of drug-related deaths (last month, seven young people died in Georgia – author’s note) they decided to protect their guests and music lovers with the help of Mandala – Harm Reduction.

With the financial support of Doctors of the World (France), 20 young volunteers, who received harm reduction training, were engaged in the project.

“Last month, several young people died of drugs, and we thought that in such circumstances our initiative will be very timely. We still remember the last-year GEM FEST, where 22-year-old Natia Tavartkiladze died of drug intoxication in Anaklia. Therefore, our goal was to give all people, especially young ones, objective information about health, drug use and personal safety,” says Temur Khatiashvili, Project Coordinator.

20 young volunteers, who received harm reduction training, were engaged in the project

According to Temur, the awareness-raising materials distributed at the festival were specially developed for young people – pocket-size brochures with the original design, which used simple language to describe a number of popular club drugs, their potential harms, and universal overdose prevention and safety rules. The brochure included a matrix showing the compatibility of different low- and high-risk drugs and a map of the festival territory marking the tent offering harm reduction services. In the friendly atmosphere of the tent, all interested people could receive consultations, get free condoms, drinking water and hematogen (nutrition bar that is often considered to be a medicinal product and is used to treat or prevent low blood levels of iron and vitamin B12 – editor’s note).

Project to be continued

The 4GB festival had a happy end. Participants of the Mandala – Harm Reduction project coordinated their efforts with the ambulance team, which they contacted over the radio in case of need.

The 4GB organizers welcomed Mandala – Harm Reduction as it clearly demonstrated that such project is important for thousands of people who are brought together by such large-scale music event. Participants of the festival were also positive about the project.

21-year-old Tamar Ninua thinks that today electronic music is the fastest growing youth culture in the world, and such projects are especially important for people who may use drugs, not being fully conscious of the consequences of their unsafe behaviours. In such cases, access to timely assistance is very important.

“Despite of the high health risk, people still use various substances. The festival is not an exception. The efforts of Mandala volunteers helped to mitigate the risks. Many young people lose self-control in the euphoria of the festival. The Mandala volunteers, who were easy to recognize as they were wearing kind of a uniform, were moving around in an organized way and were promptly responding to any cases who might need help,” says Tamar.

The project initiators are optimistic and say that in the nearest future the idea of festival-based harm reduction will be extended to cover all the music events in Georgia. They hope that they will receive support not only from different harm reduction charities but also from the mayors’ offices.

It is not that easy

In the nearest future the idea of festival-based harm reduction will be extended to cover all the music events in Georgia

“We will try to improve this project and will learn to overcome the barriers that we face. E.g., festival organizers said that we could by no means hand out syringes. They said that young people might see it as an incentive for using drugs. However, we insisted until the end that this service is necessary. Besides, they were against the distribution of naloxone but we were able to prove that having a highly effective medication to deal with overdoses is vital,” told Mariam Ubilava, project volunteer and coordinator.

According to Mariam, the project is aimed at preserving the health of each festival participant, at mitigating the negative consequences of substance use and achieving behaviour changes.

“We noticed one more problem. When some young people saw us, they were more eager to practice risky behaviours, hoping for our help. Thus, they reduced their own responsibility, shifting it on us. That is why we will have to think how to prevent it from happening in future and find a balance,” says Mariam.

Such projects as Mandala – Harm Reduction are widely implemented at various music events all over the world, such as Amsterdam Open Air, Lollapalooza Paris, Tomorrowland, etc.

AFEW’s Statement: Do not Abandon the HIV-Fighters in Russia

It is urgently needed to continue working in Russia on the prevention and treatment of HIV. Now that the health situation in Russia is becoming critical, solidarity with the Russians and Russian non-governmental organizations (NGOs) is more necessary than ever. Policymakers, international donors and aid organizations must focus on what is still possible to combat HIV.

One million HIV infections

Russia has the highest number of new HIV infections in Eastern Europe and Central Asia. In January 2016, the number of people living with HIV exceeded the limit of one million. It is estimated that there are still 500,000 more people who do not know their diagnosis. Within this group, it is mainly the injecting drug users who contract HIV. This is the case with no less than 54% of the new HIV infections. Just like sex workers and lesbians, homosexual men, bisexuals and transgenders (LGBTs), this risk group faces stigmatization and discrimination that prevents from treatment and care.

Pragmatism works

NGOs are crucial to contain the HIV epidemic in Russia. It has been proven worldwide that this is successful. With the Dutch approach applied, no new HIV infections among drug users are added in the Netherlands. Among sex workers, there are now even fewer sexually transmitted diseases than among the students. A pragmatic and tolerant policy works everywhere.

Strengthening the capacity of local NGOs enables them to reach the groups that they work for and provide access to HIV care. Communication between local government and NGOs also gives drug users, sex workers and LGBT people a voice in developing a joint fight against the HIV epidemic.

Not easy

Unfortunately, Russian legislation against NGOs does not make it easy to come to a constructive approach. But it is possible. There are strong, knowledgeable and motivated organizations that stand up and provide care and assistance with limited financial resources. They need (financial) support and solidarity, because in almost no other Eastern European country international support for HIV control has been reduced so far. Moreover, after about 17 years of providing support in Eastern Europe and Central Asia, AFEW Network has learned that one should always continue to point out to the Russian authorities their responsibilities and the importance of NGOs.

Continue with HIV control

If we continue to only observe from a distance, the already difficult situation in Russia will deteriorate even further, with disastrous consequences for global health. We should not let this happen. There are numerous specialists who have the required knowledge and local authorities who simply want the best for their citizens. We therefore continue to focus on conducting dialogue and supporting grass roots organizations in Russia. For example, in February 2018 a delegation from Russia came to the Netherlands to learn how the government can give subsidies to NGOs. From trust building with the local Russian government and from humanity and pragmatism, much is still possible. It is with this in mind that we call on policy-makers, donors and aid organizations not to abandon the Russian HIV-fighters.

Integrated Care Centre in Almaty – a Home for Everybody

Three months ago, the building hosting the centre – a three-story cottage – seemed huge and empty. Now it is filled with voices

Author: Marina Maximova, Kazakhstan

A month ago, the first Integrated Care Centre for people in difficult life circumstances, called Revenge, was opened in Almaty, Kazakhstan. The centre was established at the initiative of the community of people living with HIV.

Invisible People

People living with HIV (PLWH), people who use drugs (PUD), those who are released from places of confinement… Those people are often left behind and ignored. They are invisible, pinned to the wall of despair, with a trail of problems that remain unresolved for years, not believing that there is a light at the end of the tunnel. Now they know where they can find help. Where they will be understood and will not be neglected. Now the address 14A Omarov Street, Almaty is well known to many people. They pass it on to each other, realizing that for someone it might be the last hope.

“The centre was opened by the community, which is one of the factors attracting the potential clients. Here people can stay overnight or even live for a while until they are able to resolve their most pressing problems. The main thing is that here they are able to get a temporary registration, which is the main barrier in re-issuing the documents, getting “registered” with a healthcare facility, etc. The centre is a unique initiative and its launch was very well timed,” tells Roman Dudnik, Executive Director of AFEW Kazakhstan.

AFEW Kazakhstan supported the idea of opening the Revenge Centre within the Project “Fast-track HIV/TB responses among key populations in cities of Eastern Europe and Central Asia.” Among other initiators – activists of the Kazakhstan Network of Women Living with HIV and the Revenge Social Support Fund.

I reached the lowest point of my life

Director of the newly established centre Yelena Bilokon knows about the lives of people who practice risky behaviours not by hearsay. She was using drugs, lived in the street and has been living with HIV for 22 years. Rehabilitation centres inspired her to start a new free life. She got acquainted with the rehab clients within her community activities. When she saw the premises, the joint work, the support people provided to each other and their enlightened faces, she felt that she wanted to open her own centre.

Timurtau centre was her first success. It is a crisis centre for families called My Home, which provides assistance to many women and their children who are in trouble. The Almaty project is more large-scale.

“We have clients who have not been able to access antiretroviral treatment (ART) and, thus, to reduce their viral load and even go through medical examinations for three years or more. What can we say about migrants if even our citizens cannot receive these services? The same story is with tuberculosis patients who are left without social benefits, which they are entitled to. People are not even able to find jobs. As for children, when they get into crisis situations with their parents, they also need help, sometimes even more than adults,” says Yelena Bilokon, Director of the Kazakhstan Network of Women Living with HIV.

Up to 40 calls a day

In the centre, telephones are ringing all day long. Many people need help. The centre, in fact, is also in need of help. Kitchenware, clothes, bed linen, furniture, food… All these things are brought by good people. There was a call for help in social networks – and a lot of people responded.

Three months ago, the building hosting the centre – a three-story cottage – seemed huge and empty. Now it is filled with voices. 25 people were tested for HIV with rapid tests, 17 found jobs, 11 were examined for hepatitis and tuberculosis. It is not just statistics. Every number symbolises the struggle for someone’s health and life. Every day.

“Opening of such centre offering integrated services for vulnerable populations is an important event for our city. All the crisis centres, which existed before, had their own profiles and worked only with certain populations. People who need help cannot always find a centre offering the necessary services quickly. The Revenge Centre helps everybody,” says Alfia Denebayeva, Deputy Chief Physician of the Almaty AIDS Centre.

Workshops on case management, outreach work, stigma and discrimination delivered by medical professionals and civil society leaders help the centre clients to become volunteers. Recently a youth and adolescent club was opened in the centre, with many guests coming for the opening ceremony. In fact, they are not called guests here – those are our friends and allies, and their number is growing day by day.

Drug Policy Reform in Georgia – Any Reason for Optimism – Part II

Author: Irma Kakhurashvili, Georgia

Thanks to the harm reduction and methadone programmes, the rate of HIV transmission among injecting drug users went down in 2011-2017. We decided to find out who facilitated implementation of those programmes, fighting for people’s lives.

Implementing harm reduction programmes, changing attitudes towards drug users and protecting their rights was possible, in particular, thanks to the incredible efforts and commitment of civil society organizations. Thus, the Georgian Harm Reduction Network was founded in 2006, bringing together 27 organizations. In 2008, the Network had 9 service delivery sites all over the country. Starting from July 2013, 14 service delivery sites have been operating in 11 Georgian cities. Such sites offer free services to people who use drugs: testing, clean syringes, counselling, legal support, case management, etc. In 2017, 30,000 people who use drugs received at least one service offered by the Georgian Harm Reduction Network.

“Considering current repressive drug policies, it is not easy to bring a person who injects drugs to a service delivery site. That is why in cooperation with the community of drug users and various NGOs we offer our services not only in our centres but also in the places convenient for drug users. Besides, the Georgian Harm Reduction Network has six mobile clinics, which deliver services in 65 cities of Georgia. They do testing not only among drug users but also among the general population,” tells Maka Gogia, Director of the Georgian Harm Reduction Network.

Hoping for the expertise of civil society organizations

Since 2013, with support of the Global Fund, the Network was able to mobilize the communities of drug users in response to the epidemics of hepatitis C and HIV. The first self-organizations – Hepa Plus and New Vector – became the champions in fighting for the rights of drug users. The community of drug users was the first to speak against the practice of compulsory drug testing, informing the drug users that they may refuse to undergo such testing run by law enforcement agencies. Apart from the fact that this procedure is rather humiliating, it also costs a lot of money to the country. According to 2015 data, GEL 15 million (about EUR 4.7 million) were spent for drug testing.

The Georgian Harm Reduction Network hopes that after the Global Fund leaves the country and cuts the funding of harm reduction programmes, the government will rely on the experience of civil society organizations. Taking into account the coverage and the positive impact of such programmes in terms of reducing the spread of risky behaviours and preventing new cases of HIV and hepatitis, international experts strongly recommend increasing the state funding allocated for such programmes to cover more people who need such services.

Another problem that drug users in Georgia face – difficulties in receiving medical aid in case of overdose, despite the fact that overdose is one of the main causes of deaths among drug users. Regulation of the Ministry of Health, which was in force since 2000, did not allow ambulances to take patients with drug overdoses to inpatient hospital units before the arrival of patrol police. Besides, taking into account that in Georgia drug use is a criminal offence, drug users tried to hide any cases of overdose and even in critical circumstances refused to call an ambulance. According to the survey held by the Georgian Harm Reduction Network in 2013, 26.7% of drug users aged 30-35 years old had an experience of overdose, 42.1% were present when another person had an overdose and only 15.80% of them called an ambulance.

A big success of civil society organizations and human rights activists was the ban on notification of police by healthcare workers in case of overdoses in 2014.

“We do not have the exact statistics, but changes in the laws reduced the number of deaths. However, it is only a minor improvement comparing to what the government should do to humanize the drug policy,” says Konstantin Labartkava, Chairman of the Network of People who Use Drugs in Georgia (GeNPUD).

One of the most effective response measures to overdoses is naloxone, but in Georgia, this medicine can only be bought in pharmacies by prescriptions. On numerous occasions, various NGOs requested the Ministry of Health to increase the accessibility of naloxone, but there still have been no changes in this regard.

Activism against the repressive system

Despite all changes, the Georgian drug policy remains inhumane. For example, a person who has four ecstasy pills may receive a stricter punishment than a person who commits a murder or a rape. Lack of reintegration programmes for ex-prisoners does not allow them to find a job, renew their social connections or receive an adequate psychosocial support.

“My dependence is 16 years old. I have spent over three years in prison for drug use and almost died of the abstinence syndrome. My family fell apart. After I got out of jail, I have been looking for a job for a long time, but in vain. Nobody wanted to give me a job when they learned that I had a criminal record… Several times police took me for drug testing, right from the street and from my own yard, where I was having a walk with my small son… Four times, I received drug treatment, I did my best but as there is no psychosocial rehabilitation in Georgia, it all went wrong. If I had no support of my friends from the New Vector NGO, this drug policy would totally ruin my life. Now I am a social worker and I help other drug users to fight for their rights and their health. I think that the repressions which ruined so many lives should end!” says Giorgi M., former drug user, 38 years old.

That is why activists and the community advocate for the decriminalization of the drug use. They are not ready to accept a compromise and call on the government to use more humane approaches to drug users and amend the existing legislation.

The court supported decriminalization

Two years ago, the central avenue of the Georgian capital – Tbilisi – became the epicentre of protest demonstrations. The protesters called on the authorities to change the repressive drug policies; new coalitions were founded; campaigns were initiated through mass media. The activism of civil society organizations, including self-organisations of drug users, gradually started bringing its result. The Prime Minister, Giorgi Kvirkashvili appealed to the Parliament calling for drug policy liberalization. On 16 June 2017, members of the Parliament supported the draft law developed by the Ministry of Justice, stating that 70 grams of dry cannabis and 140 grams of raw cannabis were considered as small amounts of the substance, the purchase and possession of which leads only to administrative responsibility.

In December 2017, the Constitutional Court of Georgia supported decriminalization of cannabis. It decided that bringing up criminal proceedings for the use of cannabis was against the Constitution and banned such practice. Georgian people said that this court decree was revolutionary.

Striving to accelerate the progress in changing the laws and establish a humane drug policy, experts and civil society activists founded the National Drug Policy Platform. Over 40 participants of the Platform were involved in the development of a draft law, stipulating decriminalization of all types of drugs in adequate quantities and the development of harm reduction and psychosocial rehabilitation programmes. The draft law is based on the international expertise and is supported by such reputable organizations as UNAIDS, the Global Commission on Drug Policy and the International Drug Policy Consortium. The Portugal model was used as the best practice as it allowed reducing the number of people with drug dependence, significantly decrease the growth of new HIV cases and deaths caused by drug overdoses.

“None of the countries which made their laws more liberal observed the growth of drug use. Decriminalization surely does not mean encouragement of the drug use,” says David Otiashvili, Director of the Alternative Georgia NGO.

Alternative drug law

Recently, consideration of the draft law registered by the Platform in the Parliament in July 2017 was postponed for two months. The reason of such delay was the lack of consensus among the clergy, MPs and the Ministry of Internal Affairs.

It appeared that the Ministry of Justice developed an alternative draft law on the amounts of narcotic substances. This draft law defines the amounts of only six substances (amphetamine, desomorphine, MDMA, LSD, ephedrone, and methamphetamine) and reduces the small amounts of two substances (heroin and methadone).

According to the civil society activists, such amendments are fragmentary and do not resolve the existing problems. They say that the draft law developed by the Ministry of Justice ignores many injustices and systematic issues in the drug policy.

Drug Policy Reform in Georgia – Any Reason for Optimism – Part I

Author: Irma Kakhurashvili, Georgia

The Georgian drug policy calls for radical changes. Currently, it is aimed at the strict punishment of drug users and their isolation from the society. Data of the 2016 Council of Europe report show that every third prisoner in Georgia is convicted for drug-related crimes. However, such repressive approaches do not make people quit drugs. In prisons, people suffer from the abstinence syndrome and lose their health as well as years of their lives. Authorities think that the prison “cures” people, but according to the research studies by Human Rights Education and Monitoring Centre (EMC), 89% of drug users go back to drugs after they are released. The rest of them return to their drug using habits within 11 months.

According to the Georgian Ministry of Corrections and Probation, support of people convicted for drug-related crimes costs the government up to GEL 40 million (or about EUR 12.5 million) a year, while the Ministry of Health spends only GEL 4 million (or about EUR 1.25 million) on drug treatment and rehabilitation, including substitution therapy, which is 10 times less.

At the same time, the government spends more money to identify and arrest drug users than to treat and rehabilitate them. Prison stay of one person convicted for drug-related crimes costs the state GEL 12 thousand (about EUR 3.8 thousand) a year, while treatment of one person costs only GEL 2.2 thousand (about EUR 690) a year, which is 5.5 times less.

Many people agree with the fact that the Georgian drug policy does not stand up to criticism. Apparently, the government also agrees with it – the governing party Georgian Dream wrote about the need of drug policy liberalization in its pre-election programme in 2012, but in fact, there have been no major changes in the situation. Humanizing draft laws are lost in the parliamentary labyrinths, leaving no trace, and the statistics on the number of injecting drug users grows – in the recent seven years it went up from 40,000 to 52,500 people (data of Bemoni NGO and Curatio International Foundation).

Georgia could become a part of drug-trafficking transit chain

In Georgian history, the use of cannabis as a narcotic drug is first mentioned in the XIII century – the king of Georgia Lasha-Giorgi sometimes used it. However, none of the historical sources mentions Georgia as a producer of drugs, though, considering its geographical location, there has always been a risk of the country becoming a part of the drug-trafficking transit chain. It happened in the 90s, when drugs were coming from Afghanistan and Central Asia to Europe. Part of such drugs remained in Georgia, which increased drug use in the country.

In this period, police was the main agency responsible for countering drugs, with punishment considered as the most effective method of “help.” Though drug users were able to access voluntary treatment, there was no integrated, people-centred and human rights-based prevention and rehabilitation system. Escalation of drug use was caused by social, political and economic developments in the country – the war in Abkhazia, aggravating the criminal situation, corruption, economic collapse, crisis of values in the society and unemployment.

The 90s were also associated with the onset of the HIV epidemic. The first case of HIV in Georgia was registered in 1989. Now the estimated number of people living with HIV in the country is about 12,000 people. About 5,000 of them are aware of their HIV status.

Regional centres and counselling rooms

For many years, injecting drug use was the main route of HIV transmission. That is why drug use gradually turned out to be not only a social and criminal issue, but also a health issue.

Since 1997, led by the Public Health Department, the Scientific Research Institute of Narcology started implementation of the State Drug Abuse Prevention Programme. However, most resources allocated for the programme were used to cover drug tests. The average of just GEL 250-200 thousand a year, and since 2005 – GEL 50 thousand a year were used to cover other areas of activities. For example, a network of drug services was created – 10 regional drug centres and 21 regional drug counselling rooms.

As the year 2000 approached, the drug laws did not change, but the first harm reduction programmes were already implemented. A number of non-governmental organizations started “field” work to exchange syringes for drug users. It was a difficult job as social workers had to overcome the resistance of police, on the one hand, and gain the trust of drug users, on the other hand.

On 5 December 2002, the Georgian Parliament adopted a law on drugs, psychotropic substances, precursors and drug treatment, which came into force in March 2003. The main principle defining the new laws was the maximum restriction of the purchase and use of drugs, while recognizing drug users as people who need treatment. The new law defined obligations of the government to drug users – it had to provide drug users with expertise, diagnostics, treatment and rehabilitation. However, due to the economic crisis, it was impossible within the state programme.

Heterosexual route of transmission is leading

According to the Scientific Research Institute of Narcology, the number of officially registered drug users grew nine-fold from 1990 to 2004. By the end of 2004, 24,000 people were officially registered as drug users. However, according to the estimates, the real number of people who use drugs is much higher – 200-240 thousand, including 80-90 thousand of people who inject drugs.

In 2003, Georgia received a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria and started to successfully fight communicable diseases. As a result, Georgia became the only country in Eastern Europe and among post-Soviet states with an absolute accessibility of antiretroviral drugs for people with HIV/AIDS. All people who need treatment and who are citizens of Georgia can access it. At the same time, the country started implementing a methadone programme, which has been supported from the state budget since 2008. Currently, over 9,000 people participate in the programme (7 sites in Tbilisi and 9 – in other regions).

Thanks to the harm reduction and methadone programmes, the rate of HIV transmission among injecting drug users went down in 2011-2017. Today, the biggest route of HIV transmission is heterosexual – 45.2%, while injecting drug use accounts for 41.6% of new HIV cases.

In the second part of our article, we will tell about the role of civil society organizations and activists in the promotion of harm reduction programmes and drug policy changes.

AIDS 2018: Ukraine is Looking for Expertise and Technologies

Author: Yana Kazmirenko, Ukraine

At AIDS 2018 to be held in Amsterdam, Ukraine will be the focus of attention. It is one of the leading countries in terms of HIV transmission, with half of people living with HIV not knowing their status and the war in the east of the country combined with hundreds of thousands of migrants contributing to the aggravation of the situation with HIV. Our article highlights what expectations representatives of Ukraine have from AIDS 2018 and what experiences they are ready to share.

Olena Voskresenska, Director of AFEW-Ukraine

Expectations from AIDS 2018

I hope that the conference will help to draw attention to the region of Eastern Europe and Central Asia, in particular to Ukraine. Our country is interested in the experience of countries, which have a social contracting mechanism for non-governmental organisations because NGOs currently play a key role in the delivery of services to the populations most vulnerable to HIV and the support that comes from the governmental budget to these services will be most relevant for Ukraine after withdrawal of the Global Fund.

Opportunities of the conference

AFEW-Ukraine plans to learn about the promising models of work with our target populations, primarily aimed at young people. We are going to share our experience of working with adolescents who use drugs.

This year we have been able to support our partners from the regions of Ukraine, including programme clients and community members, who will take part in the conference. Using the experience of other countries, through joint efforts we will improve our activities in Ukraine.

Vira Varyga, Chair of the Board of Positive Women NGO, leader of the self-help group for HIV-positive women, Kyianka+

Expectations from AIDS 2018

This will be my first time to participate in a conference of such level. We will share the experience of the self-help group for HIV-positive women, Kyianka+, where we provide services to women living with HIV, helping them to accept their status and overcome stigma.

The model that we apply is patented in the Netherlands. It is based on personal development and leadership. The woman not only accepts her own status, she also helps others and is involved in the life of the group, in the advocacy and representation of the community interests.

Opportunities of the conference

We would like to learn about the new methods of work with women, about prevention, treatment and diagnostics. We hope that the participants will appreciate our social theatre, where the mime performance and direction are the products of creative activities of the Kyianka+ members.

At the conference, we will also offer some hand-made items produced by our activists for sale. The money we earn will be used to support the women who are hospitalized and do not have resources to pay for their treatment.

Nataliia Isaieva, Director of All-Ukrainian Charitable Organization, Legalife-Ukraine

Expectations from AIDS 2018

Taking part in the Amsterdam conference, I plan to achieve two goals: first, study the experience of countries from which the Global Fund has withdrawn. In Ukraine, there is an alarming trend: the Global Fund withdrawal leads to the collapse of the health care system to vulnerable populations’ support. For instance, we lack friendly gynaecologists. Sex workers cannot go to public clinics as they hide vital information about their occupation and therefore they will not receive adequate treatment.

The second question, which is very important for us, are the increased restrictions of working conditions. Commercial sex services and human trafficking are more and more undesirable linked with each other and this often is leading to serious consequences for the sex-workers. USA adopted SESTA-FOSTA legislation, which intends to curb sex trafficking but has as a consequence that it prohibits offering sex services via internet. Such laws make it impossible for sex workers to look for their clients online so they are forced to go back on the streets, risking their lives and health. The “crackdown” trend is typical not only for the United States, so we need to offer a joint strategy to confront such “crackdown” policies.

Igor Medvid, HPLGBT coordinator, involved in social activism since 2004

Expectations from AIDS 2018

At the conference in Amsterdam, I will present a thesis based on the findings of “The study of behaviours of transgender persons and their needs for HIV prevention services in Ukraine.” We interviewed 438 people and currently, it is the biggest study in Eastern Europe and Central Asia. The study showed that the HIV prevalence among transgender persons is up to 21%. 91% of transgender persons provided sex services at least once. At the same time, the level of condom use is extremely low – 69% of respondents did not use condoms during the last intercourse. This study allowed us getting statistical data and receiving a Global Fund grant. Without the support of AFEW we would not be able to conduct the study.

Now we are opening a regional office, launching a site, making efforts to increase the visibility of transgender people. Before the end of this year, we would like to introduce a member of our population to the Country Coordinating Mechanism.

Another objective that I have for the conference is to learn as much as I can about the cross-cutting activities because transgender people fall into three groups: MSM, sex workers, and people who inject drugs.

Aleksandr Mogylka, Director of the Compas day care centre for adolescents who practise risky behaviours (division of the Blago Kharkiv Charitable Foundation)

AIDS 2018 is…

…a global-scale event, which can be compared to the major film festivals, air and motor shows. The only difference is that at the conference apart from successes and achievements we will also be talking about the ways to overcome challenges. It is good to watch films, drive cars and feel proud of the achievements in aircraft or spacecraft engineering when you are healthy.

The problem of HIV/AIDS may not be resolved only by fighting the virus. It may be resolved by changing the attitude to this issue and by changing people’s attitudes to themselves. Many countries have already taken such steps and reduced the risk of development of the epidemic.

Opportunities of the conference

We would like to learn about the best practices in fighting HIV and to share the experience of our organization in involving law enforcement agencies in HIV prevention among most-at-risk adolescents.

A police reform has been implemented in Ukraine and adolescents now see the police as something new and interesting. Our objective was to unite the resources of NGOs and police to prevent the use of drugs, which often lead to experiments in sexual relations. Building trust relations between adolescents and police contributed to the formation of a city mechanism to refer adolescents to the network of partner organizations formed at the initiative of the Foundation.

Unconventional formats of cooperation between the police and civil society organizations can help to change the behaviours of adolescents.

Natalia Bezeleva, Executive Director, Svitanok Donetsk Charitable Organization

AIDS 2018 is…

…an opportunity to show yourself to the world and access the best international practices. In 2010, Svitanok received the Red Ribbon Award, which is the Oscar of health care. We received it for our work with children. The award was given to us at the opening of the conference when Bill Clinton delivered his speech and the singer Annie Lennox presented her foundation. It was a great success both for our organization and for Ukraine.

Expectations from the conference

At the conference, people will be asking me questions about the situation in the east of Ukraine. We have a lot to be proud of: in two years, we restored the ruined laboratories, AIDS centre and services. For the first time ever, a regional HIV/AIDS and tuberculosis programme was adopted and funded. Now we also have a roadmap for the transition period, when donors will withdraw from the country and all services will be funded by the government.

As a social worker and an internally displaced person, I am interested in the topic of gender in terms of what impact the situation of women has on the epidemic of HIV/AIDS.