Voices from the East

AFEW International is actively advocating for the needs to sexual and reproductive health and rights (SRHR) of the EECA region at the international arena.

On 11th March AFEW International on behalf of the partnership ‘Voices from the East’ has submitted a proposal to the Dutch Ministry of Foreign Affairs under the Policy Framework for Strengthening Civil Society for 2021-2025, Grant Instrument SRHR Partnership Fund. Under the leadership of AFEW International, the Voices from the East Partnership brought together 11 strong advocacy and service-oriented organisations and networks to improve access to SRHR for women and youth of Key Population (KP) groups and transgender people:

AFEW International; Eurasian Harm Reduction Association (EHRA); ECOM – Eurasian Coalition On Health, Rights, Gender And Sexual Diversity; Eurasian Union Of Adolescents And Youth Teenergizer; Eurasian Women’s Network On Aids (EWNA); Sex Workers Rights’ Advocacy Network (SWAN); Eurasian Network Of People Who Use Drugs (ENPUD); Dance4life; AFEW-Ukraine; AFEW-Kyrgyzstan; AFEW Kazakhstan.

The partnership plans to work with over 150 local partner organizations from across Easter Europe and Central Asia, advocating for SRHR of women and young people from key populations (living with HIV, sex workers, using drugs, LGBT, in prison) and transgender people as integral part of the Universal Health Coverage (UHC). Through capacity strengthening and mobilizing local communities of key populations the Partnership will work towards evidence-based community-led advocacy for access to high quality, inclusive, stigma-free, integrated and gender transformative SRHR services.

We will know the results of this application in the end of May 2020.

The Dutch Government Policy Framework for Strengthening Civil Society is focused on the West-Africa/Sahel, Horn of Africa, and Middle East and North Africa (MENA) regions. The Voices from the East Partnership is asking for attention to the continued health crisis in the EECA region, being the only region in the world with a growing AIDS epidemic.

Women in prison: mental health and well-being – a guide for prison staff

People in prison have a disproportionately high rate of poor mental health, and research shows these rates are even higher for women in prison. While primary care remains the responsibility of healthcare professionals, frontline prison staff play an important role in protecting and addressing mental health needs of women in prison.

Penal Reform International (PRI), in partnership with the Prison Reform Trust (PRT), has published a guide for prison and probation staff to help them understand how prison life can affect a person’s mental health, with a focus on women. The guide aims to break down the stigma and discrimination attached to poor mental health, especially for women in prison.

This guide is written to help understand how life in prison can affect a person’s mental health, with a focus on women. It describes how to recognise the signs of poor mental health and how best to respond. It also includes a checklist based on international human rights standards aimed to help with the implementation of key aspects of prison reform and advocacy initiatives in line with international standards and norms.

Published with the support of Better Community Business Network (BCBN) and the Eleanor Rathbone Charitable Trust.

Find the guidelines here – PRI-Women-in-prison-and-mental-well-being.

How to help migrants?

According to UNAIDS (www.unaids.org)[1], Russia has the second highest number of labour migrants in the world after the USA. Rostov region is one of the areas where this number is constantly growing. One of the reasons is its geographical position – Rostov region has the biggest borderline with Ukraine. Due to this fact as well as certain developments related to the armed conflict in Donetsk and Lugansk regions, many migrants from Ukraine with different statuses are coming to Rostov region, in addition to the labour migrants from Central Asia.

Are there any special services for migrants in Rostov-on-Don? How is HIV prevention implemented among migrants? Where can migrants seek help without endangering themselves? AFEW International asked these questions to Vyacheslav Tsunik, President of Rostov-on-Don Regional NGO “KOVCHEG – AntiAIDS” and Manager of the Project “HIV Prevention and HIV Services for Migrants in Rostov-on-Don”.

Significant financial support to carry out surveys and provide services to migrants within this project was provided by AFEW International, which, in particular, facilitated coordination with the Central Asian organisations to provide effective support to migrants when they leave their countries of origin and come to Russia.

For reference

Labour migrants are one of the populations most vulnerable to HIV in the world, which is explained by a number of factors. The data of numerous studies show that people coming from the Central Asia have a very low knowledge of infectious diseases: HIV/AIDS, hepatitis B and C. The situation is further aggravated with the low social and economic status of the migrants from Central Asia and the neighbouring countries, lack of access to health services, low level of social support and high prevalence of depression caused by such people living away from their families. High isolation of this social group often leads to HIV transmission inside this community, in particular through contacts with female sex workers, who come from the same countries.

Vyacheslav, how accessible is health care for the labour migrants in Rostov-on-Don?

Health care is provided to the labour migrants who officially live in Russia, in particular in Rostov region, based on their insurance certificates, which they buy when registering their patents. Without certificates, people can access health care on a paid basis, while emergency care if a person’s life is under threat in cases of heart attacks, strokes, catastrophes or accidents is provided to everyone, even with no documents, free of charge and is covered by the state.

How well informed are labour migrants about the problem of HIV?

Surveys among the labour migrants showed that they are not well informed about HIV. In our opinion, the reason is lack of preventive information provided to them in educational institutions in their home countries and when they come to work in Russia.

Do migrants practice any risky behaviours?

In fact, the prevalence of risky behaviours among migrants is approximately the same as among all young people. If we talk about the migrants who come from Asia, e.g. from Tajikistan and Uzbekistan, they have less risky behaviour due to their national customs and traditions. They mostly socialize with their fellow countrymen and they also have respect to older people and certain traditions, which restrict their risky behaviours. As for people from Ukraine and Moldova, they are closer to us, Russians, in terms of their culture and so the situation among them is similar to ours. There are young people who practice high-risk behaviour in terms of HIV. Mainly, they represent key populations. Their share in the total number of migrants is not so big, but they exist and some of them are clients of our organisation. They are not ready to quit their behaviour models.

Are there any differences in the behaviours of HIV-positive and HIV-negative migrants?

There is really a difference in the behaviours of migrants with HIV and those who do not have HIV.

Migrants living with HIV are a closed group. They are not ready to talk about their disease with their family members or their countrymen. Usually, they seek help in HIV organisations only in life-threatening situations or sometimes when they need to stock up their ARVs if there is a danger of treatment interruption.

In Russia, if migrants test positive for HIV, they cannot access free antiretroviral (ARV) therapy as they are foreign citizens. How is this issue resolved?

The situation with supply of ARVs is regulated by relevant provisions. In Russia, government covers ARV therapy only for the citizens. That is why migrants are not able to access free treatment as they are not Russian citizens. However, our organisation has contacts with community organisations in a number of neighbouring countries. We can help people who come to us and assist them is getting support services and ARVs from the countries of their origin.

Currently you are implementing the project “HIV Prevention and HIV Services for Migrants in Rostov-on-Don”. Please tell us more about it.

The goal of our project is to slow down the transmission of HIV through raising the awareness of HIV among migrants and creating services aimed at HIV prevention in migrant populations.

What do we do? Firstly, we train peer consultants from among migrants. Secondly, we provide medical and social support to HIV-positive migrants, giving them access to health services. Thirdly, we have meetings and negotiations with the representatives of diasporas concerning implementation of the prevention tools among migrants in Rostov region and coordinate service provision with the NGOs in the countries of origin of those people who seek our help.

Our organisation, “KOVCHEG – AntiAIDS”, is a community-based organisation of people living with HIV, representatives of vulnerable populations, PLWH, sex workers, LGBT and migrants. For instance, with our current project we trained a peer consultant from the migrant community. This is a woman from Ukraine living with HIV. Another peer consultant that we have, who works with people who use drugs, is also a citizen of Ukraine. Besides, when we carried out a survey among migrants, we had a volunteer supporting us – Ravshan from Uzbekistan – who is a student of a university in Rostov region.

Within the project for migrants, we organized the process to deliver HIV services. In particular, we have rapid testing, pre- and post-test counselling, if necessary provision of ARVs from our reserve stock, medical assays and support in receiving consultations from infectious disease doctors, tests for immune status and viral load, prescription of medications and treatment monitoring. We also inform migrants about the existing legal opportunities to acquire Russian citizenship with HIV status and facilitate people with HIV in obtaining temporary residence permits and Russian citizenship.

How and where do you share information about the services available?

Migrants can access our informational leaflets in the places, which they visit, such as the migration departments, health institutions, which issue the required health certificates to them, pre-deportation detention centres, and higher educational institutions we cooperate with. We use QR codes, allowing migrants to download any information on their smartphones and use it when necessary. As a result, it brings clients to our consultants, who can provide them with any additional information needed.

Name one of your most important recent activities?

Recently, we appealed to the Public Monitoring Commission and asked it to help us access the migrants in pre-deportation detention centres. The Public Monitoring Commission sent an official request to the Ministry of Internal Affairs. We visited the detention centres, met with the migrants living with HIV who stayed there and agreed with the administration of such centres that we would have further access to such migrants living with HIV. We are planning to seek financial opportunities for people living with HIV to receive consultations from infectious disease doctors, get tested for their immune status and viral load and access ARVs for the period of their stay in such institutions. Besides, we are working on developing an appeal to the government officials about the need to provide this category of people with HIV treatment at the expense of the state.

[1]Migrant populations and HIV/AIDS: the development and implementation of programmes: theory, methodology and practice / UNAIDS, UNESCO.

What should be a Primary Care?

In 2019 Anke van Dam, executive director of AFEW International, became a member of advisory board of European Forum for Primary Care (EFPC) to bring knowledge and vast expertise about the EECA region and a great network of contacts with organizations, institutes, agencies and professionals to the EFPC.

Which level does primary care (PC) in the EECA region have nowadays and how to improve that Prof. Jan De Maeseneer, Former Chair of European European Forum for Primary Care, professor emeritus at Ghent University, talked to AFEW International.

Jan, what are the features of a strong primary care (PC)?

We can speak of a strong primary care system when primary care is accessible for a large range of problems, coordinates care on a continuous basis, provides a broad range of health care services in partnership with informal care givers and operates with supportive governance structures, with appropriate financial resources and investments in the development of the primary care workforce. Effective primary care not only prevents diseases at early stages, but also stimulates people to take up healthier life-styles. Overall health is considered within primary care in a more holistic matter, paying attention not only to biomedical and mental health needs, but also to other causes of ill health, such as social determinants (e.g. housing conditions, employment). This makes primary care more person- centred than disease-centred.

PC of which country/region is the most developed nowadays?

Mostly it’s Europe. The countries with relatively strong primary care are Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, some regions in Spain and Belgium, and the United Kingdom. Especially I like the examples of Denmark, Estonia, and Finland. These countries have «primary care zones». They look at the population 100-200 000 people and try to install a PC system at that level. That enables give a high degree of participation of all stakeholders. At that scale cooperation is easy, and there is an oversight of population’s health needs, to be addressed. The scale is not too big but big enough to have a “critical mass” for effective intervention for different kinds of problems.

And what about the EECA region?

A good primary care needs democracy. Unfortunately, the former “Semashko” Soviet Union healthcare system (HCS) with policlinics, lacking family physicians, and with doctors that earn very little money don’t allow to set up a good PC. I appreciate the development of Kazakhstan – recently they rediscovered the importance of family physicians. Also, I was very surprised by Kyrgiz Republic. Last year I had the opportunity to lecture for 5th year medical students in Bishkek. In discussion on patients’ stories, they demonstrated a high commitment and patient-centeredness, and excellent skills in clinical decision making. EFPC is trying now to help countries in the EECA region to establish better inter-professional training for primary care, using primary care practices in local communities

It’s important for countries in the region to work together and to build their own PC systems. In Eastern Europe Estonia and Lithuania are doing well. Belarus is not the best example, because of the political situation. It is difficult to combine strong primary care with political dictatorship. In Russia I see some nice things. In Saint Petersburg, for example, there are good departments of family medicine with person-centered approach. But it’s still a difficult country. Good PC is possible only in countries with freedom of speech, human rights, democracy and respect for diversity.

Why good PC is especially important for people living with HIV?

Usually in countries of the EECA region if a person has one of 3 diseases – HIV, TB or Hep, most of the health care resources focus on them. There is no general comprehensive, integrated Primary Care.

PC functions very well when you integrate the care and treatment for those diseases in the broader primary health care system (HCS) as World Health Assembly has clearly stated in resolution 62.12 (in 2009). In Africa I met people who had, for example, 5 diseases, so they had 5 different vertical programs of treatment and 5 different doctors who even didn’t speak with each other. Wise HCS is when you integrate these 5 approaches into one, because, for example, diabetes can be easily an (indirect) consequence of HIV treatment.

Is there a difference between European and the EECA region’s approaches in treatment of HIV+ people?

In western countries HIV/AIDS patients are patients like all the others, they are treated in PC. When primary care providers have problems, they refer patients to the secondary care. Such approach also avoids stigmatizing of people, because when they are treated differently, are included in a separate program, there is a huge risk of stigma. Also, the integrated approach is more cost effective.

How to change people’s minds, also doctors’, towards people with HIV?

Well, first of all, you need to retrain family physicians and other primary care providers. In Russia doctors have limited, if any, training in patient-doctor communication, are not familiar with a human rights approach. For example, in the undergraduate training in my university (Ghent University), there are 55 hours of practicing doctor-patient communications with videotaping, simulated and real patients. Also, it’s necessary to train a sufficient number of family physicians for Primary Care: this requires 3 years of full-time post-graduate training, with specific programs and standards. Besides, it’s important to inform and educate population.

People should understand that every person deserves our respect, and we shouldn’t stigmatize others because they have certain diseases. It’s an open culture in a country, and it is a responsibility of the government and civil society.

What is the goal of EFPC in the region?

EFPC has several goals everywhere, including the EECA region. They are:

– to provide a one-stop information hub and building a substantial collection of information and data over time;

– to guide the development of innovative interventions based on the principles of equity, access, quality, person- and people centeredness, cost-effectiveness, innovation and sustainability.

– to connect four groups of interested parties: patients, citizens and civil society organizations.

– to share communication and information;

– to establish networking and training.

Today we have a good contact with countries from the region, people join our meetings. On the 27 September 2020, we will have a big conference in Ljubljana and in the future possibly also a conference in Central Asia. We want to create a regional platform for exchanging experiences. We hope to bring together health care providers and governments so they can learn from each other how to organize service that reflects people needs.

 

 

 

 

AFEW International and ICAP at Columbia University to improve HIV services in prisons in Kyrgyzstan and Tajikistan

In 2020, AFEW and ICAP at Columbia University will partner to implement «Technical Assistance to Central Asian National HIV Programs to Achieve and Sustain HIV Epidemic Control under the President’s Emergency Plan for AIDS Relief (PEPFAR)» in Kyrgyzstan and Tajikistan, a project funded by PEPFAR through the US Centers for Disease Control and Prevention (CDC). In Kyrgyzstan the project will be implemented by AFEW Kyrgyzstan; in Tajikistan, by NGO SPIN Plus with technical support of AFEW Kazakhstan.

With this project, the partners will strive to reach two important goals:

1) improving the 90-90-90 targets for people who inject drugs (PWID) and people living with HIV (PLHIV) in prisons in Kyrgyzstan and Tajikistan, using new technologies and services;

2) facilitating and improving collaboration between general public health care facilities and health care services within the penitentiary system, ensuring continuity of HIV-related services to people being released from prisons.

AFEW International will be the lead agency working with its in-country AFEW partners and local partners to implement this project in Kyrgyzstan and Tajikistan,” said Daria Alekseeva, Program Director of AFEW International. “We have a proven track record and evidence that working as a regional EECA network has encouraged the exchange of context-specific approaches that help to find appropriate local solutions and models of best practice. We combine local Central Asian knowledge and expertise, exchanging this within the wider EECA region, as well as the added advantage of an international, Netherlands-based Secretariat, contributing to international expertise and innovation. AFEW International – together with AFEW Kyrgyzstan and AFEW Kazakhstan, which will provide technical support to activities in Tajikistan – will aggregate lessons learned from ICAP’s previous work in Kazakhstan and combine those lessons with the methodological approach gained through the past experience of working in prisons in Central Asia to produce practical guidelines and training modules. AFEW International will look for possibilities to pilot this model in Kyrgyzstan and Tajikistan, where political and technical conditions may allow.”

“People living with HIV in prisons are less likely to be on antiretroviral therapy (ART) when compared to general population. They are also less likely to adhere to the prescribed treatment regimen and, therefore, are often viremic,” said Anna Deryabina, ICAP Regional Director for Central Asia. “Lower ART initiation and viral load suppression rates among prisoners are due to many factors, including structural factors, such as lack of trained health care personnel in prisons and limited adherence support and treatment monitoring. Also, lack of coordination between general and prison-based health care services and fragmented service delivery systems lead to many people living with HIV being lost to follow-up and discontinuing treatment after being released from prisons. ICAP has been very effective in improving the quality of HIV services provided to people living with HIV treatment facilities outside of prisons. We really hope that AFEW’s deep knowledge and understanding of subcultures and norms inside the prisons, as well as their experience working with the prison-based health care systems will allow this project to effectively improve the quality of services and HIV outcomes for people living with HIV in prisons.”

“AFEW-Kyrgyzstan is pleased to launch this joint project with ICAP. Under the Project, our organization will be responsible for the implementation of the component to achieve the 90-90-90 goal in the penitentiary system,” said Dina Masalimova, AFEW-Kyrgyzstan Programs Manager. “We plan to work in almost all large prisons in Chui Oblast. Our activities will be aimed at expanding HIV testing coverage with the provision of quality pre- and post-test peer counseling, motivation to start therapy, and adherence development. In addition, we will focus on ensuring that people do not stop their treatment even after release.”

This project is very important to maintaining an effective response to the HIV infection in the country, as 5-10% of all PLHIV in the country are in the prison system. With the high turnover of the prison population, this number can be easily multiplied by half per year.

“We are happy to work in a team with such a highly professional organization as ICAP,” said Masalimova. “It is planned that ICAP specialists will be responsible for medical aspects of providing assistance to PLHIV, and our organization will take over the community element and peer-to-peer support.”

In Kyrgyzstan, AFEW-KG will recruit and train a team of peer navigators representing each layer of the prison sub-population (with a special focus on prison outcasts and pre-release prisoners) in order to identify those who practice risky behaviors and haven’t been tested for HIV in the past six months. AFEW-KG will work with newly identified PLHIV to motivate them to start antiretroviral therapy and take all of the necessary tests. The peer consultants will work as liaisons between patients and prison doctors to ensure that patients are prescribed ART, are adherent to treatment, and that relationships between prison doctors and patients are built on mutual trust.

In addition, AFEW-KG will provide a series of counseling sessions for at least 200 prisoners who are PWID on the benefits of starting methadone-assisted treatment (MAT) and dispelling the myths related to the therapy.

“We believe that this collaboration will yield excellent results and that by the end of 2020 we will be able to see tangible progress on each of the 90-90-90 goals in prisons,” said Masalimova.

 

Russian NGOs adopt the experiences of the Netherlands

How do Dutch NGOs fundraise? What are alternative financing models? How to look for sustainable sources of income for NGOs through corporations, private donors, and through social entrepreneurship?

For answers to these and other questions, representatives of Russian NGOs went to the Netherlands. They took part in a study tour organized from 10 to 12 February in Amsterdam by AFEW International. A study tour for representatives of Russian NGOs was held as part of the EU-Russia Civil Forum and the program “Bridging the gaps the Gaps: Health and Rights for Key Populations”.

Representatives of such organizations as Aidsfonds, Mainline, De Regenboog Groep, Dance4Life, as well as the Amsterdam Dinner Foundation shared their experience with the participants.

Nowadays traditional methods no longer satisfy the needs of Russian NGOs, which face great difficulties in obtaining international institutional funding and whose needs cannot be covered by available domestic funds. Thus, alternative funding may lead to less dependence on traditional institutional donors.

The purpose of this study tour was to become familiar with alternative financing models. Participants learned about the new experience of Dutch NGOs and gained knowledge on 7 financing models that do not involve receiving funds from institutional donors.

We Need to Talk about Chemsex!

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

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

How widespread is chemsex in Russia?

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

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

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

Why is chemsex mainly the problem of gay community?

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

What are the key issues caused by chemsex?

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

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

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

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

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

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

What services are to be developed in your opinion?

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

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

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

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

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

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

What was your biggest impression lately?

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

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

 

 

 

The Knowledge Not Available Before

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

Fear of judgment

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

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

Fighting stigma and discrimination

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

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

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

Gradual improvement

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

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

Drug Decriminalisation Across the World

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

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

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

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

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

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

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

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

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

I Love Every Minute of My Life

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

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

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

How I learned about my status

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

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

Through suicidal attempts to the new life

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

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

I am happy!

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

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

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

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