We Fight, We Hide or We Unite

We Fight, We Hide or We Unite: coping strategies amongst resilient harm reduction organisations and community networks in the context of shrinking space for civil society in Eastern Europe and Central Asia

The title of this report, ‘We Fight, We Hide or We Unite’, reflects the survival strategies we identified amongst resilient harm reduction non-governmental organisations and community networks of people who use drugs (PWUD) in Eastern Europe and Central Asia (EECA). This assessment forms a part of the regional approach of the AFEW Network within the ‘Bridging the Gaps: health and rights of key populations’ programme, financed by the Ministry of Foreign Affairs of The Netherlands. This report presents the primary findings from the assessment, ‘Shrinking Space for Civil Society Organisations in Eastern Europe and Central Asia’, conducted between June and September 2017 at the international level by AFEW International and at the regional level.

We provide a detailed description of the overall study purpose, methodology, background and context regarding the shrinking civil society space and the coping strategies of HIV and PWUD CSOs working under these circumstances. The results of this assessment will be used to develop ideas and strategies on how to cope with the local contexts of the shrinking civil society space. In this way, it will contribute to the survival of CSOs and improving the current situation. This assessment represents the first step in the development of this focus within the AFEW Network’s regional approach within the ‘Bridging the Gaps’ programme. It will be followed by an analysis of existing gaps in the support necessary for specific interventions and initiatives to support specific coping strategies; the development of pilot projects on advocacy, service delivery or capacity building; and the continuous monitoring of results.

The full version of the report is available here.

Share Experience and Adopt New Ideas: Kyrgyzstan Heading to AIDS 2018

Author: Olga Ochneva, Kyrgyzstan

22nd AIDS Conference AIDS 2018 is an event which is particularly important for the countries of Eastern Europe and Central Asia – the region where the HIV epidemic is still growing. Representatives of governmental, non-governmental and community-based organizations from Kyrgyzstan were active in submitting applications and abstracts as well as looking for support to participate in the conference. We spoke to some of the delegates heading to AIDS 2018 and asked them how they are going to present their country at the conference. We also talked about their expectations for this major international event in the area of HIV.

Experience of preventing gender-based violence in HIV response

For three years, civil society organizations in Kyrgyzstan have been working to prevent violence against women who use drugs: 213 women attended individual sessions. They were screened for the exposure to violence, received detailed information on this issue, together with a counsellor developed safety plans, strengthened social support, and determined their goals to resolve the issues of violence and HIV.

Tatyana Musagalieva

Asteria NGO was one of the organizations implementing the Wings of Hope project to prevent gender-based violence, and Tatyana Musagalieva as a representative of this organization will present the efficiency of this rapid intervention at AIDS 2018.

“We would like to share our experience and demonstrate that this intervention is effective: it helps women to be open for medical, social services and harm reduction programs and reduces the HIV risks. I hope that the results of our work will prove the importance of preventing gender-based violence and its linkage to the risks of HIV.”

Sex-work: challenges and solutions

Ulan Tursunbayev

The needs of Kyrgyz sex-workers will be presented at AIDS 2018 by Ulukman Daryger NGO, which received support from AFEW International to carry out community-driven research.

“We are preparing a poster to present the results of our research study. We make a focus on two most pressing challenges – HIV testing and economic adaptation after sex-work,” says Ulan Tursunbayev, Director of Ulukman Daryger NGO. “After completion of the study, we have already started making first steps to resolve the issues we identified. Now we are getting prepared to submit a funding proposal within the national social contracting mechanism. There are intentions to finance a program to socialize women in difficult life circumstances from the local budget. That is why at the conference, apart from our research results, we will also present our vision of how to resolve this problem.”

Young people are going to AIDS 2018 to gain knowledge

Renata Bayazitova

The only organization in the country working with young people who use drugs will also be prominently present at the conference. Renata Bayazitova, Project Coordinator of the Ganesha NGO will deliver a poster presentation to show the results of the assessment of services for young female drug users.

“I will present the country situation in terms of the number, quality and effectiveness of the services for young female drug users offered by governmental and non-governmental organizations. This assessment was carried out by the community and showed major gender and age-related gaps. I hope that participation in the conference will help me get new information, learn practical ways to adjust services to our young people, and share the experience with other youth organizations.”

Treatment is a priority

Margarita Sabirova

Prosvet Charity Fund will represent the Kyrgyz organizations working with people living with HIV (PLWH) at AIDS 2018. The Fund provides consultations on adherence to antiretroviral therapy as well as legal and psychological counselling, navigates clients to various services, offers support in rehabilitation and reintegration in the society, and strives for better quality of the services for PLWH.

“My expectations from the conference are to get information about the new methods of HIV/AIDS treatment based on the latest achievements of modern medicine,” says Margarita Sabirova, the psychologist of the Prosvet Charity Fund. “It would be good to learn about the experience of other countries in terms of the interaction of civil society sector with governmental agencies, to see the contribution of different governments to the activities of civil society organizations and their response to HIV.”

Sixteen delegates supported by AFEWKyrgyzstan

Natalya Shumskaya

Thanks to the support of donors (Dutch Ministry of Foreign Affairs, USAID, GIZ, UN Women, WHO), AFEW-Kyrgyzstan was able to support 16 delegates providing them with an opportunity to attend the conference. Those are representatives of AIDS centres, municipal bodies, healthcare coordinators, researchers, community leaders of key populations and AFEW-Kyrgyzstan staff members.

“The delegates will present the experience of AFEW Network in strengthening community monitoring and community involvement in service delivery will tell about the HIV prevention, treatment, care and support in Kyrgyz prisons. There will be poster presentations dedicated to the country’s experience in economic empowerment of women vulnerable to HIV as well as HIV prevention through opioid substitution therapy. I will speak about the assessment of opportunities of female leaders of the community of people who use drugs and their impact on the access to and quality of HIV programs,” tells Natalya Shumskaya, director of AFEW‑Kyrgyzstan. “Participation in AIDS 2018 is a unique opportunity for all of us to get acquainted with the best practices in HIV diagnostics, prevention, treatment and care as well as present our own experience. Kyrgyzstan has an extensive experience as our country has implemented innovative HIV prevention approaches both in public health care and in penal institutions.”

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

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

Author: Olga Ochneva, Kyrgyzstan

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

Testing is an integral part of prevention

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

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

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

Social benefits for children living with HIV

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

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

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

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

Support and training in the summer camp

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

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

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

Findings from a needs assessment survey of labour migrants among people who use drugs in the pilot regions of Kyrgyzstan and Tajikistan

Findings from a needs assessment survey of labour migrants among people who use drugs in the pilot regions of Kyrgyzstan and Tajikistan

30 November 2017

Financial support for this survey was provided through the budget of the project ‘Bridging the Gaps: Health and rights for key populations 2.0’, funded by the Ministry of Foreign Affairs of the Netherlands. Additional financing agreements with AFEW International as of 1 July 2017 and with the UNAIDS country office in Tajikistan as of 31 July 2017 helped finance the survey.

Our analysis points to a set of problems related to information, as well as social, legal and education issues. People who use drugs face these same problems whilst planning, remaining in and returning from periods of labour migration. A lack of finances and social vulnerability represented key problems faced by migrants when planning their labour migration. A lack of finances hampers access among people who use drugs to complete medical examinations through primary healthcare facilities, HIV testing and TB diagnosis in order to obtain the necessary certificates, including those from HIV centres, drug rehabilitation centres and TB control institutions.

The full version of the report is available here.

Coalition of Communities of Kyrgyzstan: “We United to Strengthen the Voices”

The Coalition of Four Communities is developing a media campaign to eradicate hate and stigma speech

Author: Olga Ochneva, Kyrgyzstan

Community organizations are often not cooperative: each one deals with specific problems and has its own approaches to work. Nevertheless, the Coalition of Four Communities: people who use drugs (PUD), sex-workers (SW), people living with HIV (PLHIV), lesbians, gays, bisexuals and transgender people (LGBT) is developing and gaining strength in Kyrgyzstan. Consolidation began three years ago without any financial support. The goal is to make the participation of communities in solving the problems of their groups meaningful, to fight against HIV, to reduce stigma and discrimination. Below we discussed the experience of interaction, successes and plans with the representatives of the Coalition.

Four years ago, our interlocutors could not even dream of uniting all groups vulnerable to HIV.

“I said three years ago, that organisations for people who use drugs can only unite with a group of PLHIV, and probably with sex-workers organisation. The representatives of our group often have experience of imprisonment and would never join the LGBT community,” says Sergey Bessonov, leader of the IDU community organization Harm Reduction Network Association. “At the meeting earlier this year, 99% of my employees agreed to work with convicted men who have sex with men. This is the result of the gradual and systematic work on the consolidation of our groups, which we have been carrying out in recent years. People start looking at each other differently.”

The true spirit of unity

The groups began to unite in 2015, when women who use drugs (Asteria), sex-workers (Tais Plus) and the LGBT community (Labrys) took part in presenting an alternative report on the situation with all three groups at the 60th session of the CEDAW Committee on the Elimination of Discrimination against Women in Geneva. According to the members of the Coalition, they sensed the real spirit of unity during the election of a representative from the community to the governmental Coordinating Council for Public Health.

“As community organizations, we have mobilized to promote our candidate as an alternative to a candidate from AIDS-service organizations, since we have different approaches to work. Spontaneously, within two hours we managed to organize 47% of the votes,” recalls the director of the organization for women who use drugs Irena Ermolaeva. “Then the community of PLHIV and men who used drugs joined us. Although our candidate did not win, we understood that we are stronger standing together than alone, understood the real power of consolidation and were inspired by it.”

Similar problems in groups

The first activity of the Coalition was the development and submission of two project applications. At this time, a large regional network announced grants for the development of consortiums of communities. According to the representatives of the Coalition, the focus of their applications was on maintaining tolerance among groups as the basis for the future work. The Coalition has not received support but did not stop a joint activity. In 2017, the Coalition together with the Office of the Ombudsman conducted monitoring: they monitored the rights of all four communities. Later the organizations united to conduct a media campaign to eradicate hate speech and a language of hatred.

“Initially, the campaign had to be focused on the LGBT community. At the joint meeting last summer we decided to include all our communities in the campaign,” says Nazik Abylgazieva, the LGBT representative of the Labrys organization. “We made a video with famous people of the country who spoke about our problems. Our message has been heard: during three days, the video was viewed by more than 150 thousand people.”

50 representatives of different communities took part in a joint training, recalls the psychologist of the PLHIV-organization Prosvet Margarita Sabirova, and the team-building process was seen. People overcame external and internal discrimination. It became clear that groups had similar problems.

Involvement on a short notice

Now the Coalition includes seven community organizations representing women, men and young people who use drugs, PLHIV, sex-workers and the LGBT community. The Coalition is considering two more candidates. The association is not officially registered and is currently developing its strategic plan.

“Memorandums, agreements and the formal creation of consortiums do not solve the problem. If we understand each other and trust our partners, there is no need to register it legally since we are ready to help each other on a short notice, ready to get involved, to support,” claims Sergey Bessonov. “Together we already submitted several applications for our Coalition. The first joint project is aimed at bringing our communities closer together. We develop the three-year strategy of our Coalition and determine how we will interact to promote common interests.”

The Coalition received Global Fund project this year. Due to cuts of funding, it was decided to leave only one network that would work for all the groups instead of four separate national networks of communities. In the framework of this activity, communities monitor and advocate to improve the quality and access to HIV programs as well as receive technical assistance to increase community capacity and solidarity.

The needs of women living with HIV/AIDS in the Kyrgyz Republic

Community-based participatory research report “The needs of women living with HIV/AIDS in the Kyrgyz Republic”

Women and girls with HIV infection are culturally, socially, biologically and economically more vulnerable than men. The lack of reliable statistics, misconceptions about HIV transmission routes, stigma and discrimination on the part of society lead to the fact that HIV-positive women face many problems.

For several years in the Kyrgyz Republic, there has been a trend towards increased sexual transmission of HIV. The most vulnerable groups, along with injecting drug users (IDU), are women. HIV infection affects a whole range of problems – psychological, social and spiritual. Women, living in the conditions of “traditional culture”, are in a more difficult situation; gender inequality, which exists in the initial ethno-cultural environment, strengthens their social and economic problems. Women in particular, whose HIV status creates obstacles for the realization of basic needs, are particularly vulnerable in this regard, and therefore it has a negative impact on their quality of life. At present, services for HIV positive people (HPP) in the Kyrgyz Republic are universal, not taking into account the gender, which often limits access to legal, social, psychological and medical support for women living with HIV (WLH).

Despite the urgency of the problem, in the Kyrgyz Republic there was no systematic study conducted to reveal the needs of WLH, identifying factors that affect the quality of their lives and the barriers to obtaining services.

Read the research here.

Civil Society of Kyrgyzstan in the Fight for Availability and Affordability of Medicines

Director of the Partner Network Association Aibar Sultangaziev

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan is gradually switching to state drug provision system. Some of the tuberculosis medicine will be purchased out of the budgetary funds this year, and some of the antiretroviral (ARV) medicines – starting from the next year. Respective financial resources are planned to be allocated in the budget. At the same time, the question regarding the national legislation remains. A number of important documents is currently under the review. We discussed how these documents consider patients’ needs as well as the results of the analysis regarding the availability of medicines for HIV, hepatitis C and tuberculosis treatment with Aibar Sultangaziev, the representative of public council at the Ministry of Health and the Director of the Partner Network Association.

– Your organization and you personally are actively researching medicine availability and affordability. What are your successes so far?

– We started our work in 2009 with the issue of intellectual property. A respective study was conducted and, on the basis of the facts of high cost on brand medicines used for hepatitis C treatment, we advocated for the amendments to the Patent Law. In 2015, the Law was adopted; it also included the flexible provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). Due to this, it became possible to bring more generic medicine into the country. To date, seven medicines have been registered. We keep the cost of hepatitis C treatment at the lowest level in the region: from 615 US dollars for a 12-week course.

Back then, the legislation lagged far behind the needs. We developed an intra-organizational strategy for ensuring the availability of medicines and started to work in several directions. In 2014, we approved the clinical guidelines for the treatment of hepatitis C that became a clinical protocol in 2016 that included a full range of medicine available within the country. Hepatitis C treatment was added to the State Program on HIV/AIDS, and from 2018 onwards, 150 people living with HIV (PLHIV) will receive it free of charge annually. We participated in the revision of protocols on HIV treatment, and now they include modern and inexpensive medicine, such as dolutegravir, darunavir, rilpivirine.

– The Essential Drugs List (EDL) is currently undergoing a revision. It is an important document related to the availability and affordability of medicines and holding public procurement. Did you participate in its elaboration?

“For the availability and affordability of hepatitis C treatment!” Campaign on amendments to the Patent Law

– In 2015, we conducted a study on five diseases: HIV, tuberculosis, hepatitis C, oncological diseases, conditions after transplantation, and found out what medicines for their treatment were registered in the country or included to the EDL and clinical protocols. We identified the differences between the WHO recommendations and the situation in the country, and then submitted a List of necessary medicines to the Ministry of Health (MoH). All of them were added to the EDL and will be approved soon after several amendments to the Law on Circulation of Medicines are introduced. By the way, the Law provides a List of medicines that can be imported and used in the country without registration. This List is used for socially significant diseases, and, as part of the working group of the MoH, we are currently working to determine the procedure for its formation.

– Will it allow the pharmacological companies not to register medicine in Kyrgyzstan?

– Registration is needed. However, in cases when the government urgently needs medicines that are not available on the market, it will be possible to legalize them by the decision of the commission without registration. Of course, there are criteria: medicine must be of high quality, prequalified by the WHO, etc. This list already exists. Last year in November, together with UNDP, (the organization manages grants of the Global Fund in the country – author’s remark), we submitted a list of 12 essential tuberculosis and antiretroviral medicines for the Ministry of Health to consider the possibility of importing them. This is a matter of political will and one commission’s meeting, but there has been no progress with the documents yet. That is why we are preparing a new regulation so that another commission could formalize it via a new procedure.

– Does it mean that practically all conditions for public procurement are in place?

Activists’ campaign to support the amendments to the Patent Law allowing the import of generic medicines to the country

– A lot has been done but the risks still remain. We have to make every effort to regulate the process by autumn. The point is that this year the state’s responsibility is to purchase 10% of second-line tuberculosis medicines, none of which has yet been registered in the country. In 2019, the state should purchase 20% of the required amount of ARV medicines, and in 2020 the share will increase up to 30%. Not all pharmacological companies enter the national small market, and those that do, inflate prices. We are determined to promote the possibility of medicine purchase through international mechanisms. For example, if Kyrgyzstan purchases medicines through UNICEF, one can expect a 5-7-fold decrease of the cost since UNICEF places a single long-term order that covers several countries with the medicine producers.

– What other plans do you have and what is the ultimate goal of your work?

– We carry out constant monitoring of procurement. Price regulation remains one of the priority tasks. We want people to have unhindered access to inexpensive and effective treatment, and the state to provide medicines for socially significant diseases.

Persecution and Activism of Sex Workers in Kyrgyzstan

Author: Olga Ochneva, Kyrgyzstan

For almost a year and a half, law enforcement agencies have been persecuting sex workers in Kyrgyzstan. During this period, the number of sex workers receiving HIV prevention services in some regions of the country reduced twice. Civil society organisations registered more than 450 cases of sex workers’ rights violations by the police every year.

Extortion, detentions, and threats

In 2017, 81% of all reports of abuse and human rights violations submitted to the Shah-Aiym Sex Workers Network were complaints against police officers on extortion. Shah-Aiym documents such cases with the support of Soros Foundation-Kyrgyzstan and street lawyers of public associations all over Kyrgyzstan within the framework of the Global Fund via Soros Foundation-Kyrgyzstan. Both sources recorded 475 cases of sex workers’ rights violations by law enforcement agencies in 2016 and 459 cases in 2017. Most often, those are cases of extortion, arbitrary detention, threats, blackmailing, pressure and degrading treatment.

“The wave of mass raids started in mid-2016 when City Directorate of Internal Affairs in Bishkek announced that it was going to “clean the city by getting rid of prostitution.” They even asked local people to conduct night raids, make photos of sex workers and pass such photos on to the policemen,” tells Shahnas Islamova, head of NGO Tais Plus. “At first, press service of the Chief Directorate of Internal Affairs was reporting detentions, not even hesitating or not understanding that they were, in fact, announcing unlawful acts of the law enforcement agencies.”

In Kyrgyzstan, sex work is decriminalized, which means that it is neither an administrative nor a criminal offense. To punish sex workers, law enforcers use other provisions of the Administrative Offences Code. Most often, sex workers are detained for alleged disorderly conduct or petty crimes.

“Sex workers try to avoid court proceedings: they buy off. There are some cases when law enforcers know what a girl does to earn her living and start blackmailing her. They threaten to take photos of the girls, tell their relatives about their occupation or take them to a police station, so the girls agree to pay: the standard charge is up to 1,000 soms ($15),” tells Alina (the name is changed), a street lawyer of a civil society organization. “If girls try to defend their rights, law enforcers find other ways to detain them: they draft reports of disorderly conduct or failure to obtain registration. Those who have bad luck or are not able to buy off may be arrested for three to five days.”

According to Alina, many sex workers have gone underground: they often change their rented apartments and phone numbers. Such situation in some regions of the country hinders the access of NGOs to sex workers to conduct HIV prevention interventions: distribute condoms, offer testing, conduct awareness-raising activities, and consultations.

“Since the start of the “purge”, our organization has been monitoring the dynamics in the coverage of sex workers with prevention programmes in Bishkek,” says the head of Tais Plus NGO. “In a year and a half, the coverage has reduced twice, and in the second quarter of 2017 the actual indicator went down to 39% of the planned coverage.”

Activism in the challenging environment

Mass raids of 2016-2017 echoed almost in every region of the country. Groups of people who explained their actions with the “religious motives and interests of the society” helped law enforcers in their “fight” against sex workers. As the end of 2017 approached, things calmed down: sex workers got used to the new conditions, while the pressure from the side of police weakened a bit and the mass raids ended. However, “police marks” stipulating sex workers paying money to the law enforcers for the so-called “protection” and “permit to work” are still there.

“Currently, in most cases pimps are the ones to keep contact with police, while there are almost no girls who work on their own,” says Nadezhda Sharonova, director of the Podruga Charitable Foundation about the situation in Osh. “Recently, our street lawyer has been more and more often reporting complaints of sex workers against their pimps who beat and blackmail the girls.”

Despite the fact that civil society organizations in Kyrgyzstan offer legal support, sex workers rarely report their offenders. Representative of the Tais Plus NGO thinks that this fact is easy to explain: to go through all the legal prosecution process, one needs boldness and strength as well as certain savings – not to cover the legal expenses, but to be able not to work for a while and keep out of the law enforcers’ sight.

At the same time, the sex workers movement is growing and becoming stronger. The Shah-Aiym Network unites sex workers in Kyrgyzstan, Tajikistan, Russia. The network documents human rights violations and provides support to the victims of human rights violations, actively protects the interests of sex workers’ community and publicly campaigns against violence towards sex workers. The network ensures conditions for strengthening activists’ capacity to claim and defend their rights.

“We have seen cases when sex workers defend themselves,” says Shahnas Islamova. “For instance, at the court hearings on administrative offenses some sex workers now openly say that they are engaged into sex work and do not violate any laws, while the police has violated the law when detaining them. As a result, such sex workers have left the courtroom free from any accusations.”

Bridging the Gaps in Clinical Guideline to Care in Pregnancy for Women Using Psychoactive Substances

All the regions of Kyrgyzstan already received the developed clinical guideline

The estimate number of people who use injected drugs (PWID) in Kyrgyzstan is about 25,000 people. Many of these people are women. Such is the data from the research that was conducted within the framework of the Global Fund’s grant in 2013.

Applying recommendations in practice

In 2016, Public Fund (PF) Asteria, a community based organisation that protects rights of women who use drugs in Kyrgyzstan, applied to AFEW-Kyrgyzstan seeking for a help in developing a clinical guideline to care in pregnancy for women who use drugs. Within the framework of the project Bridging the Gaps: health and rights for key populations, AFEW-Kyrgyzstan decided to support this initiative as there were no modern standards for working with women who use drugs in the country before. A working group that included an expert in narcology, an obstetrician-gynecologist, an expert in evidence-based medicine, and a representative of the community of women who use drugs was created. In January 2017, the clinical guideline “Care in pregnancy, childbirth and the puerperium for women who use psychoactive substances” was approved by the order of the Ministry of Health and became mandatory for doctors’ use.

“When the guideline was approved, we realized that it is not enough to simply distribute it among the doctors. It was necessary to organize a comprehensive training for the family doctors, obstetrician-gynecologists and other specialists so that they could not only apply the developed recommendations in practice, but also share their experience with their colleagues,” said Chinara Imankulova, project manager of the Bridging the Gaps: health and rights of key populations at AFEW-Kyrgyzstan.

In April 2017, trainings were organized for the teachers of Kyrgyz State Medical Institute for postgraduate students. The manuals for teachers with presentations have been developed so that in the future trained teachers could deliver reliable information to the course participants. This approach gives an opportunity to train all healthcare professionals in the country and provides them with an access to the protocol.

In August 2017, trainings were offered to obstetrician-gynecologists of the centers of family medicine and obstetrical institutions. During the trainings, specialists got acquainted with the latest research in this field, studied the peculiarities of pregnancy, prenatal and postnatal period of women, who use drugs, as well as ways to avoid or minimize the risks of drug exposure to women and children.

“Two or three years ago, when our pregnant women who use drugs visited doctors, they were afraid that doctors would force them to have an abortion. In September 2017, our client Victoria, who at that time was on methadone therapy, visited the obstetrician-gynecologist. Victoria gave birth to a healthy girl, and doctors treated Victoria and her child very well. Moreover, the doctor even helped Victoria to get methadone so she could spend enough time in the hospital for rehabilitation after the childbirth,” said Tatiana Musagalieva, a representative of PF Asteria.

Women should not be discriminated

During the trainings, 100 specialists who are working in the republic of Kyrgyzstan were trained. Doctors from the regional centers were also invited for the training. It is very important to provide access to quality medical services for women who use drugs in the rural areas. Doctors also learned to get rid of their stigma towards women who use drugs and always treat them with respect. A class on stigma and discrimination was taught by women from the community of drug users. They told the participants of the training their stories, talked about how difficult it was when doctors refused to treat them or insulted them. This part was useful in reducing stigma and discrimination among doctors, in showing them that women who use drugs are just like the others.

“Before the training I met several pregnant women who use drugs. To be honest, I was not sure that they could give birth to healthy children. Having received the clinical protocol, and with the knowledge I have got in the training, I realized that these women should not be discriminated. I learned about scientific recommendations for conducting pregnancy in the situations that cannot do harm to either mother or child. This helped me a lot,” said the participant of the training, obstetrician-gynecologist Kaliyeva Burul.

All the regions of the republic already received the developed clinical guideline. Doctors who have been trained, share their experiences with their colleagues and help women who use drugs to safely plan their pregnancies and give births to healthy children. AFEW-Kyrgyzstan continues to monitor the work of specialists who have been trained, and monitors if all health specialists have access to the guideline. In the future, AFEW-Kyrgyzstan will continue to work on improving the quality of life of people who use drugs, and will monitor the usage of this protocol by doctors.

In Kyrgyzstan, Fines for Drug-Related Offences will Grow 30-Fold

Street lawyers of the Ranar Foundation provide legal counselling to people who use drugs

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan has adopted new legislation on drug-related crimes. Amendments have been introduced into a number of national legal codes within the broad judiciary reform in the country. The amendments will come into force starting from 2019. Initiators of the reform declare the ideas of humanisation and decriminalisation, but the practitioners and the community expect an opposite outcome.

Unaffordable fines or imprisonment

Aybek (the name is changed) has recently been released from jail. He spent three years behind the bars for 3.5 grams of hashish, which he bought for his own use.

“In 2014, Aybek was caught with drugs and was told to pay a fine of 30,000 Kyrgyz Soms (375 euros) and was let go. Soon, he was seized again for a similar offence. The fine was left in force and in addition, Aybek was sentenced to three years of imprisonment,” the street lawyer of the Ranar Foundation Denis Kucheryaviyis telling. “Now Aybek lives in our social dormitory. He has no passport and he has no job. During his years in prison, he was able to pay only 30% of the fine. He has been told he cannot get his passport unless he pays the whole sum. How can he find a job with no documents? Recently, we learned that he was put on a wanted list due to his failure to pay the fine, so now he faces the threat of imprisonment again.”

According to the Criminal Code currently in force, possession of drugs with no intent to sell in big amounts exceeding one gram for heroin and three grams for hashish is now punished with a fine of 250 to 650 euros or with imprisonment for a term of up to five years. In the new Criminal Code, the fines will be increased up to 3,250-3,750 euros.

“There will be a huge increase in fines. The minimum fine will be 3,250 euros. Will a person injecting drugs be able to pay such a sum at least once in his life?” asks Sergey Bessonov, Executive Director of the Harm Reduction Network Association. “An alternative to paying the fine is deprivation of liberty for up to five years, though the fine will not “disappear” completely and will only move to another category of 1,250-1,750 euros. Now Aybek does not know how to pay 375 euros, and starting from 2019 people will be released after years in prison with fines, which will be 3-5 times higher.”

Humanisation or criminalisation

Fines for the small amounts of drugs (up to 1 gram of heroin and up to 3 grams of hashish) will also be increased. The administrative fine will grow 30-fold: from 12-25 euros to 370-750 euros.

Sergey Bessonov: “We need alternative punitive measures and effective treatment programmes”

“The punishment for the small amounts of drugs will be toughened in the Code of Administrative Offences depending on the number of similar offences during a year. For the first offence, the fine will amount to 2,000 Kyrgyz Soms (23 euros); for the second offence, an administrative arrest for five days will be applied; for the third offence, the fine will amount to 650 euros. In the new Code of Offences, the punishment will not be toughened and there will be no criminal record. Probably this is what the humanisation is about,” assumes Sergey Bessonov. “However, if we look at the practice, most people are seized with the amount of heroin 1.2 -1.5 g which is considered to be a big amount and falls under provisions of the Criminal Code. After the fines are increased, there is a probability that the number of people seized with small amounts of drugs will be growing. The worst thing is that violation of the Code of Offences may also lead to the imprisonment in case if the fine is not paid on time. A person will have two months to pay 370 euros. After this term, the fine will be doubled and the payment period will be extended by one more month. After this month is over, if the fine is still not paid, article 351 of the Criminal Code will come into force meaning from 2.5 to 5 years of imprisonment.”

Currently, Sergey Bessonov and the lawyers of his organisation desperately fight not only for Aybek to stay free, but also to change the legislative amendments proposed. They are due to come into force in one year so there is still a chance to collect evidence that such amendments will lead to the criminalisation of people who use drugs.

“Introducing heavy fines may lead to the growth of corruption practices and increase in the number of prison population, which will have a negative impact on the national budget. Now we are making attempts to show the evidence of all the risks to people developing the new codes,” says Sergey Bessonov. “We need alternative punitive measures and effective treatment programmes. Members of the community were not able to take part in the development of the new codes, but we hope that our voices will be heard. We are doing our best at the national level and we also plan to tell about the recent developments in the drug policy to the international community at AIDS 2018 Conference.”