Monitoring of HIV-related stigma and discrimination

The ways in which HIV-related stigma and discrimination are manifested and experienced are complex and varied. Many different measures from different perspectives are currently used to monitor HIV-related stigma and discrimination.

To better understand the status of HIV-related stigma and discrimination and progress towards their elimination, support advocacy for addressing HIV-related stigma and discrimination and highlight data gaps, UNAIDS is coordinating the development of summary measures of HIV-related stigma and discrimination. Please see the concept note for more background information.
Starting on 19 August 2019 for a period of three weeks, various elements of the draft measures will be discussed. A few key questions will guide the moderated discussion each week. Inputs and recommendations from each week will be shared at the start of the following week and used to inform the next element of the measures to be discussed.
To participate in the consultation please read more information here.

Through the 2016 Political Declaration on HIV and AIDS, the global community committed to eliminating HIV-related stigma and discrimination by 2020 “for the equal enjoyment of all human rights and equal participation in civil, political, social, economic and cultural life, without prejudice, stigma or discrimination of any kind” of people living with, at risk of and affected by HIV.
The proposal is to develop one summary measure of HIV-related stigma and discrimination and four accompanying summary measures of stigma and discrimination experienced by sex workers, gay men and other men who have sex with men, people who inject drugs and transgender people related to factors other than HIV. This will make it possible to capture the diverse forms of stigma and discrimination that may be experienced by key populations most affected by HIV that may not be directly due to HIV but that have important impact on the HIV response.

This virtual consultation aims to encourage broad participation, particularly of people living with and affected by HIV, gay men and other men who have sex with men, transgender people, young people, sex workers, people who use drugs and women, from all regions. Contributions through this consultation will be used to inform the development of the measure(s) and ensure they are people-centered, reflecting the lived experiences and realities of people, and meaningful to inform programmatic action.
A summary of inputs and recommendations from the consultation will be shared in September 2019. 

Facts abour EECA region

HIV epidemic status in Eastern Europe and Central Asia (UNAIDS, 2017)

Since the start of the epidemic:
• Over 76 million HIV-infected patients registered
• 35.0 million people died of AIDS-related illnesses
• The number of people living with HIV was 36.7 million, of which 2.1 million were children under the age of 15.
• 20.9 million people (28%) living with HIV received treatment
• 76% of pregnant women living with HIV had access to treatment to prevent transmission of the virus to the fetus
• In 2017, 1.8 million new HIV infections were reported worldwide.

Have you already registered your abstracts for the EECA INTERACT 2019 workshop?

Attention! Selected abstracts will get free registration. Please find here more information. 

New collaboration of AFEW International

We are happy to announce that AFEW International represented by executive director Anke Van Dam became a consultant of an international project “Optimizing HIV prevention portfolios targeting people who inject drugs using dynamic economic modeling” awarded with NIH grant.

As one of the significant contributors AFEW International will act as a liaison to the key networks, organizations, and partners in the countries in the region of Eastern Europe and Central Asia. We will help the project team access data and the best level expertise for undertaking modeling in EECA. As well as we will provide consultations and feedback on the modeling process in the EECA region.

The overarching aim of the project “Optimizing HIV prevention portfolios targeting people who inject drugs using dynamic economic modeling” is to optimize HIV prevention strategies for people who inject drugs (PWID) in 108 countries worldwide using dynamic economic modeling based on multiple large data sources.

The project will:

1) Develop an epidemic model to estimate the impact of HIV prevention portfolios among PWID for every country with available HIV prevalence data among PWID (108 countries), based on data from multiple large systematic reviews.

2) Externally validate the model in 9 key countries with the highest numbers of HIV-positive PWID (including Russia and Ukraine)

3) Develop a user-friendly and web-based multi-platform portal for dissemination of the epidemic economic model and associated data.

The research team of the project consists of:

Natasha Martin, DPhil, Associate Professor, a leading economic infectious disease modeler (University of California);

Steffanie Strathdee, PhD, Professor and a leading epidemiologist focusing on HIV among PWID with 500 publications;

Javier Cepeda, PhD, Assistant Professor, an economic modeler with expertise in cost data collection among PWID;

Peter Vickerman, DPhil, Professor, a leading modeler of HIV transmission among high-risk groups including PWID, MSM and FSWs (the University of Bristol);

Louisa Degenhardt, PhD, Professor, an epidemiologist with over a decade of experience in conducting global systematic reviews on IDU and health harms among PWID (the University of New South Wales);

Sarah Larney, PhD (the UNSW team).

 

Tbilisi Pride: Conference and Non-Festive March

A priest together with a thousand of other people attacks the participants of the campaign organized by LGBT activists on May 17, 2013. Photo by Radio Svoboda

Author: Yana Kazmirenko, Ukraine

In June, Tbilisi will host a Pride Week completed by the March of Dignity. The aspiration of the LGBTI community to speak out about their rights has already caused threats from the side of radical groups. On June 18-23, LGBTI activists will make another attempt to hold Tbilisi Pride, expecting about 1,500 participants. They do not announce the exact date of the event to prevent radicals from hindering the march and intimidating the participants.

Sandro Bregadze, leader of the Georgian March movement, said that he will not allow holding a gay march in Tbilisi and threatened to punish all those who will be protecting the LGBTI activists, including law enforcers. In addition to the radical groups, the Georgian Orthodox Church is also traditionally against the Tbilisi Pride. All attempts of the LGBTI community to organise any public events have always faced their counteractions. Thus, the Georgian Orthodox Church has announced that May 17, marking the International Day Against Homophobia and Transphobia, is the Family Day and holds a festive parade on this day. In 2013, an LGBTI rally turned into a fight.

There is a variety of activities planned to be held within Tbilisi Pride 2019, including an international conference to discuss the challenges and the best practices in protecting the rights of LGBTI community in Georgia and in the region, the importance of visibility and the impact of prides on the situation of queer people. The topic of HIV transmission and prevention will be brought up during the panel discussion “Right to health and the problems of LGBTI people accessing health services.”

“The Tbilisi Pride mission is not limited to fighting for our rights. The Pride Week is also aimed at raising public recognition and mobilizing the LGBTI community. Our slogans are addressed to the government, to the society and to the community,” says Mariam Kvaratskhelia, co-organizer of Tbilisi Pride.

The pride will be concluded with a March of Dignity, which will not take a festive shape since queers have little to celebrate in Georgia today.

On the eve of Tbilisi Pride, its organizers issued a statement, directly saying that the state authorities use LGBTI people as a cover. The authors say that they are not going to hide and live double lives.

The statement reads, “Violence is committed against us in our families, in schools, on the street and at work. We are attacked at home and expelled from families. They’re killing us! As a result of such hate and aggression, our sisters and brothers have to seek asylum in other places. (…) We are concerned about the poverty, unemployment, occupation and social inequality in Georgia. We are used as scapegoats to draw people’s attention away from the important social problems everyone should care about!”

Mariam hopes that after the Pride Week the community will be better mobilized.

“We already see many community members going public. Some of them agreed to become heroes of our videos, others will come to the Tbilisi Pride. Every year, the number of our supporters grows. We show to the government that there are many of us, that we are strong and that we have to be taken into account,” sums up Kvaratskhelia.

In Georgia, most LGBTI people have to hide their orientation, as they are afraid of facing violence from the side of their families and being judged by the church.

‘Bridging the Gaps’ in Georgian Provinces

Gocha lives in a small town of Telavi

Author: Irma Kakhurashvili, Georgia

Gocha and Nikoloz are clients of ‘Bridging the Gaps: Health and Rights for Key Populations’ project in Georgia.

Art therapy works

Gocha lives in the hottest region of Georgia – Kakheti – in a small town of Telavi. He is a client of a Rehabilitation Centre in Gremi village. There he receives support to overcome his alcohol and substance use problems.

The Rehabilitation Centre for drug users run by Tanadgoma is the first and only stationary rehabilitation centre in the country offering free services to its clients. Since it was founded, over 25 clients received help free of charge there. In the Centre, clients can get social, psychological and health services. The Centre applies twelve-step recovery programme. Besides, it offers art therapy classes and even runs a ceramic workshop. The instructors working in the Centre were trained in a Ukraine-based rehab.

As many of his friends, Gocha used to smoke “harmless weed” since he was a schoolboy. Soon enough, he found himself among people who were eager to use other drugs as well. At first, he was curious to experiment with substances, but during the heroin boom in Georgia – when it could be purchased even in the Kakheti villages – the situation changed. If Gocha was lacking money to buy drugs, he had enough to get some alcohol. Gocha’s family knew about his problems. His parents told him that he would find himself in a trouble, but it did not help. After the government introduced stricter rules for drug dealers and users, Gocha switched to the homemade drugs.

He first came to the Tanadgoma Rehabilitation Centre two years ago. Gocha took part in the twelve-step recovery programme, attended counselling sessions and art therapy classes. Currently, the man is in remission, but sometimes he comes back to the Centre seeking services. He says that sometimes he drinks alcohol. Georgia is the motherland of wine, so it is hard to quit alcohol.

“I do not know what would happen to me if not for this project. Now working with clay and ceramics is the biggest joy for me. There is a radio set in the workshop and I can work all night long, listening to music. I have a lot of creative insights and the process of work is very important for me. When I draw sketches, I think of nothing else. My negative thoughts go away,” he tells.

Gocha does not know if he will be able to quit drugs and alcohol for good. There are no guarantees, but at least now he understands how to reduce the harm he does to his health. Gocha finds his support in knowing that if he goes home and has a relapse again, he can always come back to the Centre or contact harm reduction programmes.

Sometimes small tours are organized for the clients of the Centre. This region of Georgia is famous for its historical sights and beautiful nature.

“Sounds of the river calm me down. There I can think about my life. I spent 11 years behind the bars and I have many regrets… Now there are a lot of pharmacy drugs in Georgia, many people need psychosocial support… I do not understand why the government does not want to implement rehabilitation and employment programmes instead of the repressive drug policies. It does not want to be responsible for such people as me. So far, the Centre is the only place where someone cares about my mental health,” says Gocha.

He has two dreams: to equip the Rehabilitation Centre with exercise equipment for its clients to stay fit so that they are able to start a family.

“I want my empty house in Telavi to be full of child laughter and hope. I want to live a normal life,” says Gocha.

Drug use changed my life

Nikoloz is a former police officer

Nikoloz is 45 years old. He is a former police officer. His professional career ended up when he was arrested for drug use and sentenced to seven years of imprisonment. Before that day, he had no problems.

“I was 18 when my friend and I tried drugs for the first time. Little by little, I got used to drugs. My brother also did drugs, but I was afraid to tell him. I felt uncomfortable to talk about it with my family. Then I studied law, started working in police and that is when I got really “hooked.” I had powerful relatives, so I felt safe, but after eight years of active drug use I was locked up,” remembers Nikoloz.

Seven years in prison were a dreadful, lost period of his life. Then it was easy to get drugs in closed settings and Nikoloz used this opportunity. However, one case of severe overdose, when he almost died, made him rethink this situation. After he got back home, all his social connections were lost.

“Then I thought that it was enough, I had to stop. Even now, I hate drugs with all my heart. I fight them and fight myself. Last year I had a relapse. Therefore, I had to enrol into a substitution therapy programme and receive treatment in a clinic,” confesses Nikoloz.

He feels sorry because drugs changed his life but says that if years ago he had access to harm reduction programmes, he would definitely enrol in them. Back then, he knew little about reducing the risks of drug use.

“I had no strength or desire to quit drugs, but I would surely use them in a safer way, for example decreasing the frequency of injections. I would be able to control my life and health and would avoid overdose and hepatitis C. Drugs will always be there. Non-medical use of drugs is bad for everybody – the individual and the society – so protection of public health requires protection of drug users’ health. For that purpose, drug users should be integrated into the society and not isolated,” says Nikoloz.

In jail, Nikoloz got acquainted with people working for Tanadgoma, who offered different services to the inmates, in particular, psychological support, which was very important for him.

After Nikoloz was released, he went to a social bureau in Tbilisi. Tea Chakhrakia, working for Tanadgoma, helped him to re-issue his documents. Besides, people from Tanadgoma helped him to get a job with Akhali Gza NGO providing harm reduction services to people who use drugs. Since then, Nikoloz has been working as a social worker there. For him, his job is not only his responsibility, but also his real family, where he is loved and respected, and such love and respect are mutual.

Nikoloz is convinced that harm reduction services are more effective than incarceration. The best approach to resolve drug-related problems is to work with people who use drugs and not punish them.

“In our country, drug policy is based on some Utopian ideas because the government thinks that the drug use may be eradicated. In Georgia, criminal justice is the only method to solve the problems of injecting drug use. Drug use is treated as a criminal offence, though there is a strong evidence proving that repressive drug policies are ineffective and prevent access of people who use drugs to health services,” says Nikoloz.

Nikoloz is happy to share his experience with junior outreach workers. He works with clients, motivating them to get tested, helps them to prepare all the required documents, develops support plans, and tells people about safer drug use methods.

“I am really grateful to the project for the job that I have, which helps me feel that people need me. I received help one day, and now I can help others, sharing my experience with them. My clients are people who use drugs. Many of them use drugs only to overcome their withdrawal syndrome. They are the ones who really need support. I want them to understand what is waiting for them ahead,” he says.

Nikoloz says that with support of harm reduction experts many good things may be done for people who have already lost any hope. That is why it is important to implement the projects, which meet the specific needs of vulnerable populations.

“I am glad that in prison I met people who saw my potential and believed in me,” he says.

About the project

Bridging the Gaps: Health and Rights for Key Populations‘ is an international project implemented in 16 countries of the world to improve the health and protect the rights of vulnerable populations. In Georgia, the project was launched in September 2012. Its main goal is protecting human rights of drug users by changing social attitudes and government policies and improving the quality of services delivered and access to them.

In Georgia, the project is implemented by Bemoni Public Union and Tanadgoma Centre for Information and Counselling on Reproductive Health. Bemoni provides services in the social bureau based in Telavi (Kakheti), and Tanadgoma – in the social bureau based in Tbilisi. Besides, in 2015 Tanadgoma opened a Rehabilitation Centre for people who use drugs in the Gremi village, Kakheti.

In 2012-2017, over four thousand people who use drugs received 17,321 medical, psychological, social and legal services within the project.

Study of Sex Workers’ Behaviour in Georgia

Author: Irma Kakhurashvili, Georgia

Gabriela, a 40-year-old sex worker from Tbilisi has not been tested for HIV since 2016. She is convinced that she does not have HIV. She also thinks that she knows everything about this virus. However, when asked if HIV is transmitted by mosquitoes, she says ‘yes’. In July, Gabriela is going to the bustling resort city of Batumi to earn some extra money.

“I do not think that I will get tested for HIV anytime soon as I have got a lot of work and do not have free time. Besides, from Batumi I plan to relocate to Turkey,” says the woman.

Gabriela did not participate in the recent research conducted in two cities of Georgia – Tbilisi and Batumi – to study risky and safe behaviours of sex workers.

No major changes

The Tanadgoma Centre for Information and Counselling on Reproductive Health is the first Georgian organization, which has been studying the HIV transmission among sex workers since 2002. The recent study held in 2017 covered 350 women: 200 from Tbilisi and 150 from Batumi. The goal of the researchers was to determine the prevalence of HIV, hepatitis C, gonorrhoea and syphilis among people involved in sex work. Besides, they were able to analyse the key risks associated with HIV and to collect valuable information for advocacy and policy development. The research study was conducted with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Curatio International Foundation and the Infectious Diseases, AIDS and Clinical Immunology Research Centre.

The study confirmed that 85% of women in Tbilisi and 97.3% in Batumi know about the existence of HIV/AIDS, but only 11.5% of respondents in Tbilisi and 23.4% in Batumi gave correct answers to questions about the HIV transmission. For example, some respondents like Gabriela did not know that HIV is not transmitted through the bites of mosquitoes. In general, the respondents from Tbilisi were less aware of HIV if compared to the ones from Batumi.

Georgian researchers say that there have not been major changes in the study outcomes since 2012. For instance, most women mention condoms as the main measure of protection against HIV.

The study results showed that the indicators of condom use during most recent sexual intercourse with a commercial partner have not changed in the recent 10 years (over 90% in both cities). However, sex workers rarely use condoms with their regular clients.

“I do not use condoms with my regular clients to show that I trust them, but I definitely use them with other clients. I have to suffer offences because of this, but I know that it is a sure way to protect your health,” says Gabriela.

Sex work in Georgia is illegal and often police will confiscate condoms if they decide that a woman could be doing sex work.

Sex-workers and drugs

The research study showed that sex workers are well aware of HIV transmission when sharing needles and syringes. Besides, the recent study showed some interesting results concerning drug use. The share of sex-workers who used non-injecting drugs in the last 12 months was 11% in Tbilisi and 20% in Batumi. The most widely used non-injecting drugs were sleeping pills and sedatives in Tbilisi and marijuana in Batumi.

As for the injecting drugs, 1.5% of respondents in Tbilisi and 3.3% in Batumi injected drugs in the recent 12 months The respondents used ‘vint’, ‘jeff’ and amphetamines in Tbilisi and heroin in Batumi.

“Before, we did not have such data for sex-workers,” says Nino Tsereteli, researcher and head of Tanadgoma.

Women are getting out of sight

Gabriela says that she does not inject drugs but takes some pills. The woman has no problem to buy them in a pharmacy and uses substances at least once a week.

“The issue of drugs became relevant to this key population as well. We have been working with sex-workers for 20 years in five cities in Georgia and cover 3,000 people with our services annually. As for HIV/AIDS, during the period when we conducted the study only three women in Tbilisi were diagnosed with HIV. What is bad is that sometimes as soon as a woman learns that she has HIV, she is getting out of our sight and we do not know where she is and if she continues working with clients,” says Nino Tsereteli.

Gabriela promises that in September she will get tested for HIV with the help of Tanadgoma. She is not going to change her lifestyle, but she wants to know if everything is all right with her health. In Tanadgoma, she will get recommendations not only about HIV because, according to Nino Tsereteli, another problem of sex workers in Georgia is violence. Sex workers do not always know how they can organize themselves to protect their rights, health and lives. In Tanadgoma, they can get knowledge and support of professional lawyers.

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.

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.

GeNPUD is Allowed Official Registration

A landmark judgment allowing an official registration of Georgian Network of People Who Use Drugs for Human Drug Policy (GeNPUD) was delivered on March 26, 2018, by Tbilisi City Court Judge Tamar Chuniashvili.

The lawsuit was prepared on behalf of GeNPUD after the network was refused official state registration as stated in LEPL National Agency of Public Registry’s decision. The rejection of registration was based on the “name issue.” Public Registry references the law which says that the name of GeNPUD (any kind of drug users’ organizing assembly) seemed to be an attempt “to put the illegal activities in the legal framework” and is misleading the entire society. GeNPUD is disagreeing saying that this is the violation of the community’s fundamental rights guaranteed by the Constitution and the European Convention.

Within the lawsuit and during the Court hearing among legal arguments versus the Public Registry, Strasbourg Court’s judgments solid arguments as well as factual circumstances that demonstrated the importance of the network activities in the process of human rights protection, harm reduction services’ effective delivery to the targeted groups, liberalization of the drug policy, formation of effective health system and in overall all for public benefit were presented.

GeNPUD believes that Tbilisi City Court’s judgment would be an important step in the protection of the communities’ rights and interests not only at the local level but at the international scene and it will become the new window of opportunities to fight for health and the fundamental rights of the community members. It is believed that this judgment will further strengthen the democratic values on the way of establishing the effective drug policy.

Source: Drug Policy Georgia