Labour migrants in Russia and their needs

Author: Chamid Sulchan

Labour migrants in Russia unfortunately still have lack of access to health services. They also face a lot of barriers to a normal life from government and society in common.

Daniel Kashnitsky, a junior researcher at the Higher School of Economics on direction on labour migration and HIV positive migrants living in Russia, told AFEW International about migrants’ medical insurance, collaboration with Russian authorities and some hopes for the better future.

Which difficulties do labour migrants from Central Asia face in Russia?

It depends on a country where these migrants come from. People from Kazakhstan and Kyrgyzstan feel a bit better in Russia, because those countries are part of the Eurasian Economic Union. Citizens of those countries do not need to apply for a residence permit nor for the permit to work. They can just come and only need to have an official registration in the place where they live. To get this document might become a barrier for some people, because not all the landlords are ready to provide them with an official registration.

Also, some migrants are eligible to apply for the state medical insurance. Migrants from Belarus, Armenia, Kyrgyzstan and Kazakhstan have been eligible to have one since three years ago, however TB and HIV services are not included in this state medical insurance.

But there are countries, such as Uzbekistan and Tajikistan, who are not part of the Eurasian Economic Union. Migrants from there have to apply for work permits, and they have to reapply every year. They also have to pay a special tax every month, which is a really heavy burden considering the low wages. It’s a large part of their income, so it affects them enormously.

Also, migrants can face some other issues. For example, in the Russian Federal law number 38 there is a paragraph saying that if a foreign citizen is identified with HIV or TB he/she needs to be deported from the country. If one is identified with HIV and it is known by the migration authorities, they will include the migrant’s name in their database. Since deportation is quite expensive, migrants often remain in Russia undocumented. But if once you leave Russia, you will be banned to re-enter. There is a small part of undocumented migrants who had been caught and they are kept in those detention centres. Other migrants live in hiding and keep working, doing black jobs. Some of them get ART in NGOs and private clinics, however a large part of them do not have access to health services, they just keep living as their CD4 level goes down, and some of them they just end up in the emergency care. Unfortunately, we cannot estimate the figures, because the undocumented migrants are not in the state statistics or the patient file data.

What are the factors that influence a lack of access to health services for labour migrants? Probably language barriers, or something else?

Speaking the same language is important of course, because talking about health and body is quite intimate. People prefer to not only speak in their native language, but also to speak to a person who understands them, their social determinants of health, the culture.

Some migrants from Central Asia explained me why they prefer to go to clinics where people of their culture work. One of the reasons was that migrant doctors better understand socio-economic circumstances of migrants’ experiences in Russia. For example, they tend not to prescribe expensive medicines, because they know that migrants cannot afford them. One of the biggest barriers is discrimination in clinics and state institutions. Migrants from Central Asia are often exposed to it.

Unfortunately, migrants can be a reason of rising HIV epidemic in their countries, don’t they?

True. The migration of Central Asia is predominantly male, 80% of the migrants from Central Asia are young males from 20 – 50 years old. They are mostly seasonal migrants. They go to Russia for 10-11 months a year, then they go back to their home country for one or two months. This is the only time when they get to see their wives, children, and other relatives. A lot of them have sexual intercourse in Russia (sometimes not safe), with sex workers, or just with female from their communities.

How do migrants from countries like Tajikistan, Uzbekistan get health insurance in Russia?

They don’t have access to state insurance. But one of the requirements when applying for a work permit, is to have bought a private healthcare insurance. They can buy it from one of the private insurance companies. And it is a very basic insurance scheme, that costs about 50 euros per year. It is meant to show the authorities that one is formally secured, but in fact it does not improve with access to health care. These minimal insurance packages provide almost nothing more than just free emergency care which is still provided free of charge to anyone physically residing in Russia. If you have broken your leg or if you have any other acute situation, you will receive emergency care as it is accessible to anyone in Russia. But if you need any further treatment, then you need to pay. And in most cases the basic private insurance will not help you. Of course, you can buy a more expensive one, that would include everything, but most of migrants cannot afford it.

What have you and your organization done to address the issue of labour migrants having a lack of access to health services?

Firs of all, me and my colleagues created a regional expert group on migration health in our region. It’s an informal network of civil society experts. We are trying to collect arguments and convince policy makers to lift the residence ban for HIV positive foreign migrants in Russia. We are trying to bring evidence to decision-makers that the HIV residence ban only aggravates the epidemiologic situation. It creates negative consequences for the migrants as they can spread the virus even further to the community. It affects a lot of people as they spread it in their home country. We have been in dialogue with the Russian authorities about this, but it is a long process to create this enabling atmosphere and to actually make it happen.

So, it’s hard to collaborate with the Russian authorities, isn’t it?

Yes, because the Russian authorities are little sensitive now to what civil society is claiming. You need to have very strong argument, create a supportive environment and change the public opinion. We are working with the journalists. We helped to create lot of publications on migrants with HIV living in Russia. We work with civil society organizations and we train them. Our partner organizations have direct services for migrants, at least in Moscow, St. Petersburg. Yekaterinburg and Rostov-on-don and some other large Russian cities that attract them labour migrants.

Some limited services for migrants do exist where they can get tested for HIV, where they can have consultations. But it is difficult to provide sustainable provision of ART, and this is a large problem as most of the migrants cannot afford therapy.

Today the Russian government seems reluctant to introduce any serious changes. On one hand, the authorities understand that Russian economy would not survive without migrants. So, they try to keep migrants low profile. They do not encourage migrants to raise their voices, to create trade unions or other grassroots movements. Migrants do not have access to social entitlements, not only healthcare but to pension funds and other security funds.

What do you think should be done by the Russian government to improve the access to health services for migrants from Central Asia?

The first thing Russia needs to do, is to liberalize its HIV legislation. This is very important, because once HIV-positive migrants are not stuck in Russia, then they can travel back and forth, at least they can receive ART from their home country. Secondly, Russia needs to allocate funding for NGOs that work with the migrants, to test them and provide psychosocial support. Third, anyone who resides in Russia and contributes to the Russian economy, should get access to the Russian healthcare, including HIV and TB services. The healthcare needs to change and include all the people who actually live and work in Russia. There is a human right aspect here, but also an epidemiological aspect: if you don’t want the diseases to spread further, you need to provide basic access to services.

Do you see an opportunity that the situation will be changed in the future?

Well, I stay positive because there are some developments in the region of East Europe and Central Asia such as, for example, Kyrgyzstan and Kazakhstan having accessed to the Eurasian Economic Union. It was a major breakthrough, when member countries signed a health insurance agreement to cover their citizens when they migrate within the Union. In terms of access to HIV and TB care, it really has remained unchanged for 25 years, because when they adopted these policies, Russia did not have this severe HIV growth that it has now, it was only starting back then.

Nowadays we try to tell the authorities: it is not that you have to pay for the migrants and their health insurance, but just start with decriminalizing them, liberate migrants from this constant fear of being deported of residing in illegality and being constantly subject to rights violation. This is really important if Russia ultimately wants to be create decent life conditions for all people who live and work in the country.

 

 

Safety measures for sex workers

Enji Shagieva, Secretary of the Russian Sex Workers’ Forum, about the Forum’s activities at COVID-19 time. 

For reference:

The Russian Sex Workers’ Forum (SW Forum) is an association which includes people with experience of sex work, active sex workers, their partners, assistants and allies. The SW Forum is a platform for constructive communication between sex workers to discuss and develop common strategies to protect health and well-being of sex workers; to provide access to evidence-based HIV/STI prevention programs; to combat violence against sex workers by clients, police and third parties; to change public opinion about sex workers and sex work for the better by the state and society (destigmatization); to waive fines for sex work; to ensure sex workers’ full access to justice; and to strengthen and develop the sex worker community and mobilize sex workers and their supporters to join forces in the above directions.

Difficulties caused by the virus

Russia has always been a difficult country for SWs, transpeople and migrants, and due to the consequences of COVID-19 the situation got even worst.

As demand for sex services has fallen sharply and the risks of COVID-19 infection have increased, some sex workers have stopped working. It is no longer easy to reach this key group since sex workers are less likely to work on the street and more likely to stay in rooms that are not accessible. Many sex workers are losing contact. Some sex workers continue to provide sex services and put themselves at risk of infection. In addition, they are at increased risk of becoming victims of crime or falling prey to police raids, and thus falling prey to police brutality. Due to the epidemic, crimes against sex workers – robbery, theft, beating, fraud, threats, blackmail, extortion – have multiplied.

Due to the quarantine, some sex workers cannot return to their homes and some are left without means of subsistence and housing. It is especially difficult for migrants to return to their homes. They have to live in one small apartment for several people, which multiplies the risk of infection with coronavirus.

Organizations working with SWs have cancelled outreach visits to places where SWs still continue their activities, at their own risk. HIV testing and the distribution of condoms have been stopped. Sex workers still need condoms, as well as protective masks, antiseptics and wet wipes, and some need food and financial means.

There are also certain problems that sex workers’ clients may also be carriers of coronavirus and break quarantine, putting sex workers at risk of infection.

Due to quarantine, HIV positive sex workers have no access to ARV therapy. Due to lack of money, inability to pay rent, hormone treatment, condoms and lubricants, someone went to work online, on webcams. But it is also difficult there, because high income requires a large number of online customers. Beginners don’t have them. And because of the influx of new people, those who have long been earning on the webcam, began to earn less.

Innovations

Because of the Coronavirus pandemic, there has been an increased emphasis in the community on prevention education and protection against coronavirus. Through social networks, special groups, personal profiles, chat rooms and groups of various messengers, the forum informs SWs about what measures to take to minimize the risks of infection, both during everydayl life and during the provision of sex services. We have sent out several special documents with visual content to prevent coronavirus infection. In addition, volunteers and employees of some projects cooperating with the SW Forum purchased personal protective equipment (masks and antiseptics) and distributed it to sex workers using their own funds. Information was also distributed among sex workers on how to quickly make their own protective masks and antiseptics.

We are constantly working with the media, organising interviews with sex workers about the problems associated with the pandemic, how they comply with safety measures and what safety measures clients require.

A lawyer of the SW Forum has developed a memo on receiving social benefits from the government for families with children and the unemployed. Sex workers are encouraged to apply for social benefits if they fall into the privileged category of citizens.

We keep SWs informed about the pandemic news, new risks, prevention measures and risks of administrative penalties. At the request of one SW from St. Petersburg, the info manager of the SW Forum informed the special services that a citizen who violated the quarantine applied for services. Thus, the SW Forum helps sex workers to demonstrate their active position and combat the spread of coronavirus.

Today, the SW Forum is attempting to obtain operational funding to provide financial assistance to those SW who are particularly affected by the Coronavirus, as well as food packages or temporary accommodation.

 

 

 

At our own risk. EECA’s reponse to COVID-19.

Yuri Avdeev, Chairman of the Board of the Chelyabinsk City Public Organization “Independent Research Center “There is an opinion”, Russia

For your information:

The independent research center “There is an opinion” has been working in the field of prevention of socially dangerous diseases and research of various aspects of social life since 2000. The Center works to reduce the spread of socially dangerous diseases, such as HIV infection, tuberculosis and sexually transmitted infections; provides assistance in overcoming psychological and communication problems (difficulties in communication, self-confidence); assistance in disclosing personal qualities, self-fulfillment of personality; socio-psychological, informational assistance to people living with HIV and TB, as well as their significant environment.

At present, the “There is an opinion” centre is the largest operator of rapid HIV testing in the Urals. Every year 19,000 residents of the Chelyabinsk Region and its border areas become clients of the programme. The main target groups are men who have sex with men (MSM), transgender people (TG), people who use drugs (PWUD) and the general population.

Difficulties caused by the virus

For five years our organization has been working in the context of HIV prevention with MSM/TG. Weekly on Fridays, two teams of specialists (psychologist + nurse) worked in two nightclubs for LGBT people, carrying out rapid HIV testing, pre- and post-test counseling, distributing prevention information materials, condoms and lubricants, and accompanying identified clients to be registered with the AIDS Center. Due to the announcement of the self-isolation regime, nightclubs are closed, so we are no longer able to continue our normal work at their base. The testing room is also closed.

Unfortunately, this situation paralyzed the work of our organization and most of the activities were stopped. Many people go online, but we should understood that online counselling, for example, will not replace HIV testing and the issuance of condoms and lubricants.

Innovations

On April 7th, at our own risk, we reopened the testing room in the evening, because we received a request from clients for testing and obtaining condoms and lubricants. The cooperation with the AIDS Center helped us to do this. In addition, today we are delivering ARVT drugs for HIV+ patients in Chelyabinsk, including MSM. We have received special passes for being in the city.

We have noticed that those who receive ART at home are even happy about it, because now they do not have to take a ticket and wait in line. However, nightclub visitors are not very happy with these innovations, but the most motivated members of the community themselves come to the testing room to receive HIV prevention and testing.

In our work we try to follow all the necessary recommendations of the regional Government: the reception is held by appointment; social distance is respected; precautions are taken – specialists work with masks, gloves and glasses, the client is given a mask; surfaces are wiped with a disinfector; washing of the room takes place every 2 hours.

Of course, statistics for our activities have fallen. Whereas we used to serve up to an average of 100 MSM/TG per month, now the number has dropped by almost 5 times.

What’s next?

Today we are thinking about self-testing. We only work with blood tests, and today it is not the most convenient option. So we’re negotiating with donors to buy saliva tests.

EECA’s reponse to COVID-19

Alexander Chebin, project coordinator at the Regional Public Foundation “New Life”, Yekaterinburg, Russia.

For reference

“New Life” Foundation has been working in Yekaterinburg in the field of AIDS prevention and control, assistance to different categories of population since 2011. The key groups are (ex) prisoners, migrants, drug users, sex workers, people affected by HIV, tuberculosis, hepatitis.

Difficulties due to the virus

Currently, we have suspended our activities on fast HIV and hepatitis outreach testing, activities in rehabilitation centers, penal inspections, police departments, federal enforcement agency system and other organizations.

Since the introduction of the country’s self-isolation regime, representatives of our key groups have found themselves in new realities – for example, their level of anxiety has significantly increased, including with regard to treatment and care. Also we have received many requests for psychological support. Due to changing economic circumstances, people have developed a lot of fears – they are afraid of losing their jobs and uncertainty in the future. We have already analyzed our work during 2 weeks of self-isolation. The number of requests through the means of communication increased several times. Our employees conduct consultations, provide psychological support and accompany participants “by phone”, through various messengers. This is especially important for people released from prisons, who do not have the skills to apply to government agencies using Internet resources.

Innovations

Fortunately, in a pandemic, our work does not stop. However, due to the virus and quarantine measures, we had to go online and interact with our participants remotely, through communications channels.

Due to the new rules of patient’s admission, the management of the AIDS Centre decided to involve volunteers to help in the delivery of life-saving antiretroviral therapy. Thus, since March 30, our employees have been actively involved in this process. Our two staff members take calls and consult people on how to register delivery. With the help of the Foundation’s car with a driver health workers are delivered to clients. Also, 3 employees and 1 “New Life”s volunteer drive their cars to deliver ARV therapy.

In addition, the Foundation does not stop providing legal and social assistance to people, doing it remotely. Also, we accompany people released from prison to medical organizations, help to deliver food packages, clothes. In case of emergency, one of our employees collects the kits for participants at our drop-in centre and delivers them to their homes with all necessary security measures.

In the future, we plan to go back to the way we used to work, assess and reflect on our experience in the pandemic and perhaps make adjustments to some aspects of our work.

 

AFEW International, AFEW Kyrgyzstan and IOM Tajikistan launched a project for Tajik migrants

Tajikistan is a country marked by a high level of labour migration due to a lack of work in the country. According to official figures, in 2019 more than 500.000 Tajiks left the country for working abroad. The majority works in Russia, where there is a high prevalence of HIV. The proportion of the Tajik migrants among new registered HIV cases in Tajikistan increased  from 10.1 percent in 2014 to 18.8 percent in 2018. Also, little is known about migration of key populations, such as people who use drugs and men who have sex with men (MSM), and their behavior in using health services while working abroad.

To enhance Tajik migrants’ access to HIV services, particularly key populations, IOM Tajikistan together with AFEW International and AFEW Kyrgyzstan launched the project “Improving migrants’ access to HIV services in Tajikistan” in 2019.

What are the goals of this project and how will it change migrants’ lives? Rukhshona Kurbonova, National Professional Officer, Sub-Regional Coordinator on Migration Health for Central Asian countries, talked to AFEW International.

Rukhshona, why it is important to work with migrants?

Migrant workers significantly contribute to the economy of the countries of origin and countries of destination, but are often left out when it comes to health programming. The majority of the Tajik migrants is involved in low skilled jobs, even if they have a good education. The prerequisite for good performance – even for low skilled work – is good health; therefore, both countries of origin and destination benefit from healthy migrants. However, migrants can be stressed by facing a new environment, culture, language, and they are often exposed to poor working and living conditions in the receiving country. This all can put their health at risk. This all circumstances put their health at risk and make migrants vulnerable.

Additionally, since the majority of Tajik migrants are young men from rural areas, where strong social control is part of the traditional patriarchal society, getting into a big metropolis with different norms and morals can impact their sexual behaviour. A difference in social control, little knowledge about prevention of sexually transmitted infections and HIV, alcohol consumption and drug use, and casual sex all play into migrants’ vulnerability to Sexual Transmitted Infections (STIs) and HIV. Therefore, it is important to address their health needs and raise awareness. Integrating migrants into national health programmes and strategies is part of the agenda of the Universal Health Coverage approach promoted by the WHO and other UN organizations including IOM.

The project “Improving migrants’ access to HIV services in Tajikistan” aims to enhance Tajik migrants’ access to HIV services, particularly among key populations. How do you plan to reach this goal and which tools will you use?

The project is composed of two parts: The first part is working in the field with returned migrants in Kulob to raise awareness on safe migration and promoting health seeking behaviour relating STIs and HIV through peer networks. The second part is a regional working meeting with the participation of officials and HIV service NGOs from the Russian Federation, Kazakhstan, Kyrgyzstan and Tajikistan to discuss the essential HIV related package of services for migrants from Central Asia, as recommended by the World Health Organisation.

For the fieldwork in Kulob, IOM will partner with the local NGO “Nakukor”, which has strong experience in working with different groups of migrants. Jointly, they will promote the peer-to-peer approach and hire outreach workers among representatives from the key populations. In addition, within this project supported by AFEW International, IOM will provide free access to HIV tests and survey key populations among migrants to map their sexual behavior and refer them to HIV testing when needed. A legal consultant and venereologists will conduct information sessions for migrants on safe migration and prevention of STIs and HIV. Thanks to the project, two new brochures on safe migration and prevention of STIs and HIV will be developed for migrants. To ensure the sustainability of the project, IOM implements all activities jointly with relevant governments stakeholders – the Tajik Ministry of Labour, Migration and Employment, the Republican Healthy Lifestyle Promotion Center and the Republican AIDS Control Center of the Tajik Ministry of Health and Social Protection.

How long does IOM Tajikistan work with migrants?

IOM Tajikistan has been working on migrants’ health since 2005 and implemented projects on the prevention of STIs, HIV and TB among outbound and inbound migrants. The activities of the Migration Health Unit at IOM Tajikistan are covering the four main pillars needed to ensure the health of migrants holistically: monitoring migrants’ health, advocacy for policy development, provision of migrant sensitive health care services and strengthening inter-country coordination, partnership and networking. IOM Tajikistan has been implementing innovative approaches to reach migrants through peer education, engagement of the diaspora, the creation of multidisciplinary teams in the districts, the publication of communication materials in different languages such as Tajik, Russian, Uzbek, Chinese, Dari, Turkish, and others and by ensuring a multisectoral approach and cross border cooperation. To improve knowledge and skills of the stakeholdres, NGOs and health workers on promoting migrants’ health, a number of educational materials, such as manuals, video clips, and documentaries, were developed and distributed. Additionally, IOM Tajikistan is experienced in providing technical support and promotes the inclusion of migrants’ health issues and concerns into health-related policy documents, such as those developed by the HIV and TB National programmes. Last but not least, we are currently contributing to the development of the National Health Strategy for 2021-2030 and the National Strategy on migration health. IOM Tajikikstan is a member of the Technical Working Group on developing new National AIDS Control Programme and National TB Control Programme for 2021-2025.

Which barriers you might face in Tajikistan and how you are going to overcome them?

Stigma and discrimination are the main barriers faced by migrants and the general population in Tajikistan in accessing HIV services. There is also a high stigma of people who are using drugs, and sexuality is also a taboo topic in society. With our peer-to-peer-approach, we want to reach out to key populations. Through the awareness-raising campaign, working with migration officials and health workers, we want to address and reduce stigma and discrimination of people living with HIV and of key populations. For a better understanding of migrants’ access to HIV services in Tajikistan, the project also has as an operational research component to explore the barriers face by migrants when coming back home.

What do you expect from the project?

The results of the project will improve our understanding of the migrants’ needs concerning HIV services. The project will also help in developing effective communication and health promotion strategies that improve the detection of HIV among the migrant population and refer them for adequate treatment.

Helena Arntz, Junior project officer of AFEW International

Public opinions about migrants, in particular key populations among migrants, are often full of prejudice and stereotyping, which leads to discrimination in the health care system. Migrant workers are in constant movement and often a long time from home, so they can have more difficulties in getting the health care they need. They receive little information about how to be safe abroad, which poses continuous threats to their health and that of their families.

AFEW International has experience with and knowledge on migration in Central Asia and Russia. AFEW International currently also manages two projects in Russian cities Rostov-on-Don and Yekaterinburg to improve healthcare for migrants living with HIV.

In this joint project with IOM Tajikistan we not only want to address the limited information available to key populations among migrants, but also gain better insight in the behavior of this specific group. As the consequences of unsafe migration are not limited to the home country, we will address the needs of migrants at a regional event in Dushanbe. We expect that this will increase cross-border cooperation between Central Asian countries and Russia to improve the needs of key populations among migrants.

 

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.

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.

 

 

 

IT’S TIME

24 of March is a World TB Day 2020.World TB Day is a big moment to sound the alarm, raise attention, and tell world leaders to follow through on their promise to diagnose and treat 40 million people with TB by 2022, as agreed at the UN High-Level Meeting (UNHLM) on TB in September 2018.

We all need to work together now on important activities to make sure that World TB Day 2020 is the biggest and most effective.

What we together can do?

  • REACH OUT
    Reach out to your political leaders (Mayors, Parliamentarians, Ministers of Health, Heads of State) to request their leadership in the fight to END TB, remind them of the commitments and targets that have to be reached by the end of 2022, and request their engagement for World TB Day. This could include making a public statement, supporting an event, introducing a motion in parliament, or committing to achieve the UNHLM country targets.
  • GET SOCIAL 
    The hashtags for this year’s World TB Day are #ItsTimetoEndTB and #WorldTBDay. Start raising awareness through social media. Share your plans with us on Twitter or Facebook.
  • MAKE IT STARRY
    Reach out to celebrities, influencers, TV personalities, and other figures to ask them to join your efforts and raise awareness or wear a red arrow pin ahead of World TB Day. Stop TB partnership has a list of national celebrities, journalists and personalities that we can share with you case by case, so don’t hesitate to get in touch with us to get their contacts.
  • TEAM UP
    Team up with local TB partners to join forces in planning major World TB Day events, public mobilizations, and other activities. Stop TB partnership have a database of partners at country level – so do not hesitate to get in touch with us to be able to identify the partners with whom you want to work for these events.

Text – http://www.stoptb.org/

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 and Aidsfonds.