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!”

 

 

Prospects for cooperation in the health sector in Uzbekistan

On January 10, 2020, AFEW International, represented by Anke van Dam, Executive Director, and Daria Alexeeva, Program Director, met with Ambassador of Uzbekistan in Benelux countries Dilier Hakimov.

AFEW International is considering possibilities to implement two projects in Uzbekistan. The first one is to develop and improve the quality of HIV testing and prevention services for key populations and support people living with HIV.

The second project, entitled “Strengthening civil society in inclusive health care in Uzbekistan”, is currently under consideration by the European Commission and is on the reserve list of projects.

At the end of the meeting, the parties agreed on a schedule for the AFEW International delegation to visit Tashkent on 15-16 January 2020. AFEW International’s team will have negotiations with the Republican AIDS Center, as well as with representatives of some international organizations, which may act as donors for the implementation of projects of the non-governmental organization in Uzbekistan.

AFEW International already has experience in working in Uzbekistan: the organization supported several projects in the country through ESF, as well as was involved in preparations for the AIDS2018 conference. In addition, representatives from Uzbekistan participated in AFEW International’s community based research education project.

Help Here and Now

“If you can help someone Here and Now, you should do it without postponing it or thinking what other people can do,” says Ekatherina Rusakova, Director of Sverdlovsk Regional Charitable Organization “Malaxit” supporting people in difficult life situations. “If every one of us helps at least one person, maybe it will drive changes in the society.”

To support these words, Malaxit implements the project “Social and legal support of people who use drugs in Yekaterinburg” with financing and support of the Emergency Support Fund for Key Populations in Eastern Europe and Central Asia (EECA).

Ekaterina how does your organization help people who use drugs in Yekaterinburg?

Ekatherina Rusakova, Director of Sverdlovsk Regional Charitable Organization “Malachite”

Mainly we provide social and legal support to clients to eliminate regulatory and discriminatory barriers, help them to get fair court decisions and access to free rehabilitation. Besides, we provide our clients with referrals to healthcare and social support institutions of the city. Our social worker makes outreach visits to families with small children. He provides consultations on HIV and treatment, helps clients to make appointments with specialists, assists them in re-issuing documents and receiving temporary registration in the city as clients are not able to receive medical or social services without registration.

Why did you decide to apply to the Emergency Support Fund for Key Populations in EECA?

We applied to the Emergency Support Fund because the situation of PUD in our city is difficult. Many people still do not recognize that substance use is a disease. However, this condition needs comprehensive treatment, including medical assistance, psychological and social support. Moreover, efforts should be aimed not only at the person using substances, but also at such person’s family as substance abuse is a systematic, family disease.

Of course, current situation contributes to the growth of HIV and other socially significant diseases (tuberculosis), while people who use drugs remain outsiders and the society prefers not to notice them. However, it is not possible to solve this problem pretending that it does not exist, after all sooner or later it will manifest itself and, most likely, in a very negative way. That is why, in our opinion, enough attention should be paid to secondary prevention and working with the “risk groups”.

What case from your practice do you remember best of all?

Andrey, a representative of the Rehabilitation Center, Dmitriy Kadeikin, consultant, and a social worker of the project, after a lawsuit in Revda, Sverdlovsk Region

That’s a story of one of our clients. Andrey came to our project when he learned about it from his friends. Back then, there was an investigation against him based on part 2 of article 228 of the Russian Criminal Code. Our staff members signed a social support agreement with him, drafted procedural requests and collected all the necessary documents. Social worker of the project acted as a community advocate in court. A person from the rehab also took part in the court hearings. As a result of our joint efforts, Andrey got a suspended sentence with a course of rehabilitation.

What does the society think about your work?

It depends: some people support us, some don’t and it’s fine! All people cannot think the same and have the same “view of the world”. We are all different, with various views, values, attitudes, and that’s the beauty of human beings – in their differences…

Have you ever faced any challenges working with the key populations?

Speaking about the members of key populations, our target groups, they are all positive about our activities, they trust our staff members and our experience. We mostly see challenges related to new psychoactive substances, which our clients still use. That is why they can have unpredicted behaviours, treatment interruptions, etc.

How does engagement of the key populations in your activities help you in your work?

I think that when implementing such projects it is very important to engage members of the key populations. Without such engagement, it is not possible to reach PUD, who are a very closed target group, especially considering that in this group there is a very low level of trust to people.

Your example of a perfect society.

I don’t think I could give you an example of a perfect society. I tend to be realistic when looking at things, not losing myself to illusions. I do not like it when people say that somewhere there is a perfect country and a perfect society, where everything is fine, which we should strive to achieve. There are some pitfalls everywhere. It is important to realize that there are good things everywhere and we need to learn to notice and appreciate them. I am sure that we have to always start with ourselves and you can of course feel offended and be angry at our country and our authorities, but it does not bring any results. Speaking about a specific country with the approach to working with key populations that I like, for me it’s Portugal.

The project is supported by the Elton John AIDS Foundation.

 

What does good collaboration between municipalities and NGOs mean?

AFEW International (The Netherlands) was a technical partner in the Fast-Track HIV/TB Cities Project, which was implemented between 2017-2019. The main goal of the project was to develop efficient and sustainable city models of HIV/TB responses that would allow to reduce AIDS and TB mortalities in five project cities; Almaty (Kazakhstan), Balti (Moldova), Odesa (Ukraine), Sofia (Bulgaria), and Tbilisi (Georgia).

AFEW International with expertise on increasing access to health services for HIV, TB and viral hepatitis for key populations, is well-connected to Dutch health care providers. Within the Fast-Track HIV/TB Cities Project, videos were made to feature professionals working for municipalities, consultancies and NGOs, law enforcement agencies in the Netherlands and on an international level. What good collaboration between municipalities and NGOs means, why service-delivery for sex workers, People Who Use Drugs and LGBTQI is funded by the dutch municipality, and how this is organized? Answers on these questions are in this video.