The 3rd regional autumn school in Bishkek

On October 29, AFEW partners came together in Bishkek, the capital of Kyrgyzstan, for 3 days to take part in the annual Autumn School, which is organized within the project “Bridging the Gaps: health and rights of key populations“.

The great energy of the participants and amazing nature gave a chance to everyone to enjoy the event and to discuss important issues on prevention and treatment of #HIV, harm reduction, migration, and financing in the region of Eastern Europe and Central Asia. Participants in the Autumn School included representatives of AFEW partners from Kazakhstan, Kyrgyzstan, Ukraine, Russia, and the Netherlands, sub-recipients of the project “Bridging the Gaps”, as well as other partners and experts including those from Great Britain and the USA.

Active space

The Autumn School quickly became an active space for discussion: about strategy, barriers, innovations, and partnership opportunities between the participating organizations. During the first day, participants shared updates on the “Bridging the Gaps” project and activities in their countries – Georgia, Kyrgyzstan, Ukraine, and Tajikistan. The afternoon session was devoted to a World Café, in which partners exchanged ideas and developed specific actions to overcome challenges that they often encounter in their work.

The second day was devoted to the topic “Stimulant use and chemsex”. Benjamin Collins, director of International HIV Partnership (IHP), which partners with medical and community activists across Europe and the Middle East for successful responses to HIV and viral hepatitis, joined the Autumn School in Bishkek to share his experience on chemsex . The topic of (problematic) chemsex was further elaborated in the presentations of Monty Moncrieff, Chief Executive of London Friend, a London charity working to promote the health and well-being of lesbian, gay, bisexual and trans (LGBT) people, and Daria Alexeeva, program director of AFEW International. Monty spoke about the London experience in harm reduction, while Daria presented materials of Nikolay Lyuchenkov, an infectious disease doctor and expert on sexual health issues from Russia, which were focused on trends and responses to chemsex in Russia and EECA region.

 

The third and final day of the conference was devoted to workshops on migration, rehabilitation and financial sustainability. Evgeniya Alekseeva, director of Public Health and Social Development Foundation “FOCUS-MEDIA”, presented analysis of NGOs funding situation in EECA region; Elena Zhirnova, manager of the project “Our Choice: Empowering Vulnerable Women in Kyrgyzstan” (AFEW-Kyrgyzstan) told about challenges and opportunities of social entrepreneurship in the country; and Fatima Yakupbayeva, co-founder of law firm “PRECEDENT” and publisher of the book “From Grant to Business Project”, shared auditing resources for launching a business model and recommendations on how to implement business ideas.

 

The session on migration started with a presentation by Rukhshona Kurbonova, coordinator of the Migrant Health Programs at International Organization for Migration in Tajikistan. She talked about labor migration in Central Asia, while Zulaika Esentaeva (IOM Kyrgyzstan) shared their experience on service-delivery by IOM Kyrgyzstan for vulnerable migrants.

The session on rehabilitation was devoted to building information campaigns. During the session, Marina Govorukhina, specialist on strategic communications and branding, author of the books “Communications in Public Organizations”, “Strategic Communications in Public Organizations”, demonstrated specific techniques of developing informational marketing campaigns for rehabilitation centers to the participants from Georgia, Kyrgyzstan and Ukraine.

Moreover, the School included a 2-day training for AFEW communication managers, during which participants focused on learning about storytelling and SMM in the context of NGOs.

 

 

Natalya Shumskaya, director of AFEW-Kyrgyzstan

I especially noted the session on new psychoactive substances. This topic is relevant for our country, as sexual ways of HIV transmission keep growing in Kyrgyzstan, and new psychoactive substance use impacts sexual behavior. For us it is a wonderful opportunity to take on the experience of those countries that have already faced similar problems, and elaborate effective strategies for preventative measures in our country.

The third day was remarkable due to the acute topic of sustainability of civil society organizations. We all see the tendency of decreasing donor support in our countries. That means that civil society should aim to ensure financial sustainability independently, and one of the opportunities is the development of social entrepreneurship. During this meeting we shared the experience of creating our own social enterprise – a beauty salon. I would like to especially point out the session by Fatima Yakupbayeva from the “Precedent” company. She gave us specific business-ideas, which could be developed by an NGO in order to earn money independently and further direct it to realization of our statutory goals.

The importance of this event is in sharing and exchange of experience. When the financial support for our organizations is not that high, it is important to avoid duplication of activities, and, on the other hand, to consolidate our efforts in order to realize our main strategic goals. For instance, the past regional meetings allowed us to bring good practices of working with youth at risk from Ukraine to our country. We are very grateful that we didn’t have to be the pioneers in this, but rather adapt and use their experience. Also, I think that the experience of Kyrgyzstan will be useful to some of our colleagues, and they will be able to apply it in their countries.

Monty Moncrieff MBE, Chief Executive of London Friend

It’s important for people working in the region on the same issues to have the opportunity to come together and share their knowledge and experience. It helps build the data on important topics, and enables participants to share what they’re seeing locally, as well as share tips on how to address new and emerging trends. It also helps build relationships, which spark ideas for new partnerships. Even though the internet gives us great opportunities to connect and work together online it’s difficult to get that richness of connection without bringing people together in person, and doing so for a number of days provides lots of opportunities for conversations outside the formal sessions.

We can always learn from one another, and hopefully by inviting people who have been working on issues for some time in other countries we can bring the benefit of that experience. We can share leaning about what’s worked and what hasn’t for us, and hopefully that can benefit people who are only starting to see these issues emerge locally.

Evgeniya Alekseeva, PHD in medical sciences, Director of Public Health and Social Development Foundation “FOCUS-MEDIA”

Meetings such as the Autumn School are important, because they bring together people from different countries and cities, create space for discussing acute issues and situations in our field, allow to form alliances, agree about partnerships, as well as have informal conversations and take a break from the daily routine.

At the Autumn School in Bishkek, I especially noted a very interesting session on chemsex, sessions on business projects for NGOs, and on migration. I will certainly use this knowledge further while writing proposals, developing new projects and creating new ideas.

Zarina Siyakova, program coordinator of the Tajik Network of Women Living with HIV

This meeting provided me with a great opportunity to learn more about what is happening in other countries in regards to promoting prevention and treatment of HIV. I especially noted the session on chemsex, as I hadn’t had a chance to encounter this issue before. I was particularly interested in the presentation by Monty Moncrieff, as well as the presentation of Nikolay Luchenkov from Russia on chemsex in EECA.

Also, I received answers to many questions on migration that I’m interested in, and most importantly, exchanged contacts with almost all the participants. It is well known that nowadays there is a very large stream of migrants from Tajikistan to Russia, and many of them lack information about services for migrants and d existing organizations in Russia. Now our organization will be able to refer our clients to these organizations, and we won’t lose them out of sight.

If you are interested in specific presentations of the Autumn School, please send your request to autumnschool@AFEW.nl.

EECA INTERACT is a step towards the development of unified community

Why is the Workshop EECA INTERACT so important for the EECA region?

Alexei Alexandrov, a member of the international committee of EECA INTERACT 2019, head of Minsk regional clinical centre “Psychiatry-narcology”.

EECA INTERACT can become a model for building regional and country interaction between young and experienced researchers, medical practitioners, employees of non-governmental organizations and members of community initiatives, as well as representatives of the government.

All these specialists are involved in solving the problems of HIV infection, tuberculosis and viral hepatitis, and also related problems of drug use, criminalization, prison health, stigma and human rights. The exchange of experience by specialists from EECA countries with similar situations on HIV, TB, Hep, drug use, the results of new studies and expert assessments will allow choosing the best solutions to change the situation and begin to really implement them.

For me, EECA INTERACT is not only a meeting with new colleagues and getting acquainted with the results of their work, discussing pressing issues, forming direct contacts to continue cooperation or a network of interaction. The seminar is a continuation of the efforts that we, experts of the EECA countries, are directing to respond to the HIV epidemic in the region, implementation of those innovations that have already been tested in the world and are evidence-based.

The workshop is a step towards the development of a unified scientific, expert and practical community of our countries, united by common tasks. Everyone can have their own vision of the situation, challenges and solutions, but only joint discussion and analysis will allow finding potential points of influence for success.

 

How would you rate the development of clinical and research networks in the EECA region today?

Sergii Dvoriak, a member of the international committee of EECA INTERACT 2019, M.D., D.Med.Sci, founder and senior scientist, UIPHP, professor at the department of social work, ALSRT.

In our region, a lot of problems are associated with the traditions and imperfections of medical education. For several years I conducted training seminars “Effective Treatment of Drug Dependence” in Salzburg (organized by the Open Society Foundation), where all participants, mainly doctors, were divided into 2 groups, the Russian-speaking from EECA and the English-speaking from Southeast Asia and Africa. People from EECA were educated in the “Soviet” system, the others – in the “Western”.

I noticed a very clear difference in the methods for solving clinical problems. People from EECA went into “philosophy” and the so-called pathogenetic way of thinking, and “Western” immediately appealed to existing protocols and standards, objective data, etc. I then realized that many of our specialists need to be retrained and they should focus on evidence-based methods, and not on general considerations and “clinical points of view.” For this, we need such meetings like EECA INTERACT, where these points can be emphasized. It is important also that decision-makers participate in such events.

In Ukraine over the past 10 years, significant progress has been made in the development of clinical and research links. To some extent, a solid research infrastructure has been created, several organizations were found which can not only participate in international collaborative projects but also independently carry out research and receive funding from donors such as National Institutes of Health, CDC, WHO etc. Unfortunately, national donors are still very sparingly involved in this process.

Ministry of Health also does not understand enough how important the systematic and continuous process of conducting scientific research is, and the importance of implementation projects is underestimated.

Officials believe that only mainly state institutions have the right to make scientific research. They expect global discoveries or creation of new vaccines, effective drugs, but they do not really understand that in the modern world only a limited number of countries and companies are able to take such steps. There are no such resources in EECA countries, but this does not mean that research is not needed. Doctors should be involved in scientific projects as much as possible, because this disciplines clinical thinking, makes it possible to get acquainted with the modern scientific context.

 

 

 

 

Monitoring of HIV-related stigma and discrimination

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

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

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

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

Facts abour EECA region

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

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

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

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

New collaboration of AFEW International

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

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

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

The project will:

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

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

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

The research team of the project consists of:

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

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

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

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

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

Sarah Larney, PhD (the UNSW team).

 

UNAIDS outlines progress on HIV, but decries funding cuts

The Joint United Nations Programme on HIV/AIDS (UNAIDS) released its latest report on the status of the HIV epidemic and the global response ahead of the 10th International AIDS Society Conference on HIV Science (IAS 2019), taking place this week in Mexico City.

The report highlights the impact community programmes have had in successfully expanding access to HIV treatment, supporting adherence and preventing new infections. However, it also shows that this progress is slowing and has been uneven, and that global funding for the HIV/AIDS response has fallen for the first time.

“We urgently need increased political leadership to end AIDS,” said UNAIDS interim executive director Gunilla Carlsson. “This starts with investing adequately and smartly and by looking at what’s making some countries so successful. Ending AIDS is possible if we focus on people, not diseases, create road maps for the people and locations being left behind, and take a human rights-based approach to reach people most affected by HIV.”

Some countries are meeting or exceeding the UNAIDS 90-90-90 targets – 90% of people living with HIV knowing their status, 90% of those diagnosed being on antiretroviral therapy and 90% of those on treatment having viral suppression by 2020 – while others are falling behind.

Global progress stood at 79% knowing their status, 78% on treatment and 86% with viral suppression in 2018. However, when looking at the proportion of all people living with HIV worldwide – not just the proportion of the previous subset – the figures are less impressive, with just 62% being on treatment and 53% having viral suppression.

But these figures mask some notable disparities. Nearly 90% of people in Western and Central Europe and North America know their HIV status and are on treatment, but only about 80% of those have an undetectable viral load. In Asia and Latin America, the proportions tested and on treatment are lower, but almost everyone on treatment has achieved viral suppression. Eastern Europe and Central Asia, the Middle East and North Africa, and Western and Central Africa are falling behind on all three measures.

Globally, new infections and AIDS-related deaths continue to decline, but less steeply than before. At the same time, the number of people on HIV treatment continues to rise and appears on track to meet the 2020 target. According to UNAIDS global estimates, in 2018:

  • 37.9 people worldwide were living with HIV;
  • 23.3 million (62%) had access to antiretroviral therapy;
  • 1.7 million newly acquired HIV;
  • 770,000 died from AIDS-related illnesses.

This represents a 16% drop in new infections since 2010, with most of the progress seen in Eastern and Southern Africa. But incidence has increased in some regions including Eastern Europe and Central Asia (up 29%), the Middle East and North Africa (up 10%) and Latin America (up 7%).

The report shows that members of key populations and their sexual partners now account for more than half (54%) of the 1.7 million people who newly acquired HIV in 2018. These groups include men who have sex with men, transgender people, sex workers, people who inject drugs and prisoners. In Eastern Europe and Central Asia and in the Middle East and North Africa, these populations are thought to account for 95% of new infections. Here too, the distribution of who bears the brunt of the epidemic varies widely by region.

Despite the availability of antiretrovirals that can prevent mother-to-child HIV transmission, just 82% of pregnant women have access to them, resulting in 160,000 new infections among children – well short of the target of less than 40,000.

Regarding HIV prevention, the report says that only around 300,000 people worldwide – including 130,000 in the US – are using pre-exposure prophylaxis (PrEP), although this is at best a rough estimate. Similarly, although people who inject drugs account for a high proportion of new HIV infections in some regions, many lack access to adequate harm reduction services.

Although it is harder to gauge progress in this area, the report notes that stigma, discrimination, criminalisation, harassment and violence remain problems for many people living with HIV.

 

Mariias Frolova: “The Most Important Thing is Working Together”

Author: Olya Kulyk, ICF “AIDS Foundation East-West” (AFEW-Ukraine)

Last year, AFEW-Ukraine gathered young activists of the project “Bridging the Gaps: Health and Rights for Key Populations” from four cities of Ukraine in a Summer Camp. One of the goals was to teach teenagers to design projects and prepare their own applications for funding. The projects created during the camp later were sent to AFEW-Ukraine’s competition of small grants.

18-year-old Mariias Frolova is a leader of the youth community centre “Compass” from the Community Organisation “Kharkiv charitable fund “Blago”. “Compass” is a centre for adolescents who use drugs. AFEW-Ukraine supports four of such centres in Ukraine. Mariias is telling about the projects of her team.

Mariias, please tell us why did you decide to create the projects for youth?

– I decided to develop projects for youth when I participated in the camp for project leaders of Bridging the Gaps project. After training, I thought that I could do something useful for myself or for other young people.

In “Compass” we often get together, play and discuss things. Our team got the idea of ​​watching films together and discussing them later. Initially, we wanted to choose educational films – about diseases, human rights and so on, so that we learn more. Then as a bonus, we added fiction films. We needed some extra equipment – a beamer, screen, and speakers.

AFEW-Ukraine supported the purchase of this equipment.

Our second project is called “QR code”. The project helps adolescents to learn more about their rights. One day our friend asked: “What would I do if I did not know about “Compass?” This made us think that not everyone knows about the centre and how cool it is, as this is the place for the adolescents to get help. We needed to inform adolescents that they can come to “Compass” while facing different situations in their lives. Now QR codes are popular. Through scanning them, you can get access to different information, so we decided to use them for informing youth about their rights and inviting them to the centre.

Who is the target audience for your projects and how do you inform about them?

– We locate our QR codes in schools and lyceums of Kharkiv. By scanning the QR code (there are six of them), adolescents are directed to the information about “Compass”, information about HIV, reproductive health, psychoactive substances and police. After reading the information, teenagers are offered to answer online questions on these topics. After passing the quest with six different topics and completing the task, participants receive an invitation to “Compass” and get a ticket to our cinema.

 Target group of the projects is youth of 14-19 years old, usually from not very rich families, often having limited access to leisure activities. Therefore, free movie screening is very attractive for them.

What are your achievements in projects implementations?

– Since October, we had 13 film screenings with 105 participants, followed by interesting in-depth discussions. 

Due to QR codes project, more people began to visit “Compass”. 64 people received invitations to come to the centre and the cinema. Some visitors to our cinema stay here for services… Since November last year, we received more than 260 answers to our online questionnaires.

QR codes and movie screening stimulate youth to learn more about HIV, drug use, reproductive health issues. Those who come to watch the movie, are also involved in discussions about safer behaviours. Social workers from the centre are invited for facilitating discussions and can immediately respond to any question or provide individual or group counselling if needed.

How did you benefit from creating and implementing projects?

– It was a great experience. After the projects I mentioned above, we developed a new one, submitted it to one big organization and won a grant that will allow us to have a gym in our centre.

I am confident that the most important thing is to work together. We can have different opinions, which can sometimes create problems, but instead of arguing we have to decide on everything together.

Research: ‘Virus Carriers’ and HIV Testing: Navigating Ukraine’s HIV Policies and Programming for Female Sex Workers

Background

There are an estimated 80,100 female sex workers (FSWs) in Ukraine, of whom 7% are living with HIV. Early HIV diagnosis continues to be a public health priority in Ukraine as only approximately 54% of people living with HIV are diagnosed nationwide. This study aims to analyse the content, context and discourse of HIV testing policies among female sex workers in Ukraine and how these policies are understood and implemented in practice.

Methods

To analyse past and current national policies, we searched the database of the Ukrainian Parliament and the Ministry of Health for relevant policy documents (e.g. legislation and orders). To analyse the day-to-day practice of those involved in the implementation of these HIV programmes, we conducted face-to-face semi-structured interviews with key stakeholders. All data were coded using deductive thematic analysis initially guided by the Policy Triangle, a framework which addresses policy content, the process of policy-making, the health policy context, actors involved in policy formulation and implementation.

Results

HIV testing policies are formed and implemented in the post-Soviet context through a vertical system of AIDS clinics, resulting in the separation of key affected populations from the rest of the health system. Successive testing policies have been strongly influenced by international donors and non-governmental organisations. Furthermore, a lack of government funding for HIV prevention created a gap that international donors and local non-governmental organisations covered to ensure the implementation of testing policies. Their role, however, had limited influence on the Ukrainian government to increase funding for prevention, including testing of FSWs. Since the early 1990s, when stigmatising and discriminatory forced/mandatory HIV testing was applied, these approaches were slowly replaced with voluntary testing, self-testing and assisted HIV testing, yet stigma was found to be a barrier among FSWs to access testing.

Conclusion

Poor governance and the fragmentation of the health system, ongoing health sector reforms, shrinking international funding, and persisting stigma towards people living with HIV and sex workers might impede the continuity and sustainability of HIV testing programmes. Local civil society may now have the opportunity to contribute to the development and further implementation of HIV testing policies in Ukraine.

Read the full version of the research here.

 

Most-at-Risk Adolescents Report Human Rights Violations in Ukraine

Ukraine has a high HIV prevalence with an estimated number of 240,000 people living with HIV in 2017. Most-at-risk adolescents (MARA) are among the most vulnerable groups of the HIV/AIDS epidemic in Ukraine. The estimated total number of MARA is 129,000 people (10-19 years old), of which 21,700 are people who inject drugs. There are yet no official statistics on the exact number of MARA, including underage people who use drugs. In Ukraine, MARA represent a very closed group. Lack of statistical data, stigma, discrimination and legal barriers make their access to HIV/Sexual Transmittable Infection (STI) services more complicated contributing to increased risks of HIV. Since 2012, AIDS Foundation East-West in Ukraine (AFEWUkraine) has an established system of services for young people who use drugs in the framework of the Bridging the Gaps programme. Social bureaus, rehabilitation centres and day-care centres in four cities are currently opened providing 21,290 services to 1,215 adolescents in Ukraine.

Experience shows that young people who use drugs are confronted with various types of violations of their rights, which are often not officially registered and publicly known. The fact that young people face stigma and discrimination forms a barrier for asking for help from health specialists. Adolescents are publicly humiliated by teachers, priests and even their parents because of the fact that they use drugs. There is also a lack of appropriate mechanisms for response and misunderstanding young drug users have about their own rights. In Chernivtsi, for instance, one of the problems is the lack of an effective mechanism for responding to suicide attempts among adolescents, especially if these attempts are related to the use of drugs. Therefore, young people who use drugs often do not report human rights violation or apply for protection. Social workers and psychologists do not feel they have relevant knowledge and tools to respond to violations.

Therefore, in 2016 AFEW-Ukraine created an instrument for monitoring human rights violations among young people who use drugs. This instrument was developed for any specialist providing help to young people who use drugs. It can be used by a wide range of organisations and specialists with some basic knowledge about human rights who worked with vulnerable children, adolescents and youth. Based on the outcomes of the monitor tool, the scale of the problem became apparent and advocacy actions on the national and local level can be adjusted. From 2017 onwards, in four Ukrainian cities – Chernivtsi, Kharkiv, Kropyvnytsky, Poltava – AFEW-Ukraine organised introductory trainings that helped specialists gain experience on how to use the tool.

“A social worker or any other professional working with people who live with HIV can defend their rights. This does not require special legal education. Specialists often do not understand that the problems faced by their clients is, in fact, the case of human rights violations that needs special attention,” says Anastasiya Shebardina, Senior Project Manager AFEW-Ukraine.

Over 100 specialists were trained on how to use the tool. Social workers, lawyers, teachers and psychologists of NGOs, representatives of the patrol police, the probation service, youth prevention services for children, social services, local departments of education and medical facilities from the referral network were among those specialists. They had the opportunity to analyse specific cases of violations of the rights of minors and in cooperation with trainers developed an action plan within each city. The tool consists of a questionnaire which is filled in on paper together with an adolescent. Based on the answers in the questionnaire, one can get an idea about the life of the adolescent. In the case of violation, adolescents are matched to a lawyer for legal assistance. An online form for registering human rights violations is filled out by social workers. This form allows to collect statistical data on the rights violations and, if necessary, a follow-up with counselling assistance. A wider range of participants who wished to learn more about the monitoring tool could do it during the educational webinar.

The tool demonstrates that documenting cases of human rights violations help service providers to recognize them and provide timely response better. The analysis of the documented cases allows to identify typical situations for each separate region or city and make advocacy actions more effective. NGOs have also established closer personal contacts with representatives of governmental agencies such as police and probation. Now they plan and implement joint activities. For more systematic future response, the instrument learns what need legal specialists and human rights organizations have to be involved in referral networks. In the long run, this instrument can become a national mechanism for civil society on improving service delivery and upholding human rights.

Pain Relief: Ukraine is on the Way to Legalizing Medical Marijuana

Authors: Yuliana Skibitskaya, Yana Kazmirenko, Ukraine

Ukraine may become the 14th European country to allow the use of medical cannabis. Activists are looking forward to the next move – drug policy liberalization.

Ukraine has taken the path of legalizing medical cannabis. In two months, a petition registered on the Ukrainian parliament’s website has collected 25,000 signatures, which makes it mandatory for MPs to review it. According to the petition’s authors, about two million Ukrainian citizens currently have no access to this effective therapy, which can help people with cancer, war veterans and patients in palliative care. Ulana Suprun, acting minister of health of Ukraine, also supports the legalization of medical marijuana. She says that the “rational” use of cannabis for medical purposes is legitimate. It is expected to be made available in pharmacies by prescription.

The draft law may be considered in May-June

The civil society movement for legalizing medical marijuana is led by the NGO 100% Life, the Ukrainian Association of Medical Cannabis, and 16 other civil society organizations.

On 20 March 2019, the relevant parliamentary committee considered the petition but failed to support it as there was no quorum at the session. MPs appealed to the Cabinet of Ministers with a suggestion to amend the current list of narcotic substances, which prohibits the use of cannabis in Ukraine for medical and research purposes. Cannabis would still be considered a narcotic drug but would be allowed for medical use.

“The Human Rights Committee supported the petition. Now MPs have a free hand, they can register a draft law based on the petition,” says one of the authors and leader of 100% Life, Dmitry Sherembey. “There is a group of MPs which supports us. We expect that in May-July the draft law may be registered and considered by the current parliament.” (In autumn Ukraine will hold parliamentary elections – note of editor).

Another author of the petition, Gennadiy Shabas, who heads the Ukrainian Association of Medical Cannabis, says the law should clearly define the rules of using cannabis for medical and research purposes in order to avoid any risks.

Medical marijuana may be used in HIV treatment

There have long been attempts to legalize medical marijuana in Ukraine, but significant progress was achieved only last year when the Ministry of Health openly supported civil society activists. For several years in a row, Cannabis Marches of Freedom have been held in Kyiv, with participants calling on the government to legalize cannabis.

Medical marijuana helps patients with cancer and Alzheimer’s disease, but can also be used for HIV therapy. Apart from the fact that medical cannabis relieves pain, scientists have discovered that people living with HIV who smoke marijuana have higher CD4 counts and lower viral load compared to patients who do not use this kind of therapy. Cannabinoids also help to tolerate opioids, which are often prescribed to AIDS patients. Marijuana prolongs the pain-alleviating effect, improves appetite and prevents tolerance and addiction to “hard” drugs.

Dmitry Sherembey explains that marijuana removes pain syndrome so that the body can direct its resources not at overcoming pain, but at fighting infection. Thus, cannabis not only makes life easier for patients, but it also improves their prognosis for fighting the disease, especially in the case of cancer.

“For instance, even if doctors gave a patient only three months, his prognosis may be improved by up to three years,” he says.

Legalization to reduce stigma

Velta Parkhomenko, the coordinator of the Ukrainian Union of People Who Use Drugs and manager of the NGO Eney Club, thinks that amending legal regulations on the use of medical cannabis is an important step for Ukraine in general, and especially for the community of people who use drugs.

“Legalization of medical cannabis will allow us to accelerate the process of humanizing drug policy. We are convinced that the fewer myths and stereotypes there are around psychoactive substances, the simpler it will be for us to talk about the problems of people who use drugs,” says Velta.

Another argument she offers is that legalizing medical marijuana will reduce stigma and discrimination and reaffirm the widely-recognised fact that drug dependence is not a crime but a chronic, recurring disease.

The activist hopes that the process will not stop with medical cannabis. The next logical steps should be to humanize drug policy, amend the table of maximum allowed quantities of narcotic drugs, and introduce changes in legislation.

Medical marijuana does not alter awareness and does not affect mental states

Medical marijuana is a medicine based on the active components contained in cannabis. The truth is that not all cannabinoids have a narcotic effect. That is why medical marijuana, as opposed to other types of marijuana, does not alter awareness or affect mental states. It may be administered in different ways, such as traditional smoking as well as pills, oils and other pharmaceutical forms.

Today, medical cannabis is mainly brought to Ukraine from neighbouring Poland, where it is sold in pharmacies. However, at present importing cannabinoid-containing medicines to Ukraine is equivalent to drug trafficking.