AIDS 2018: Prison Corner and Harm Reduction Networking Zone Activities

More than 5 000 people, including famous actress Charlize Theron, visited the prison corner in Harm Reduction Networking Zone (HRNZ) located in the Global Village at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam. During five days, visitors could stop by, have a delicious cup of coffee made by former prisoners and participate in a programme with interactive debates, interviews, and presentations. Prisoners are usually a forgotten group since very few organisations pay attention to this vulnerable group of people. Taking into consideration that in many countries the issue of HIV/AIDS in prison is very sensitive and that the implementation of programs in prisons can hibernate or even fail, a pragmatic step-by-step guide for prison authorities and civil sector actors is now being developed by European Monitoring Centre for Drugs and Drug Addiction and European Centre for Disease Prevention and Control.

The executive director of AFEW International Anke van Dam stressed on the necessity of working in prisons in Eastern Europe and Central Asia (EECA). Health protection in prisons is a serious public health issue. Even though international law recognises the right of everyone, including people deprived of their liberty, in practice, many prisoners receive healthcare of a lower standard to the one available outside of the prison, if they receive treatment at all. In Eastern Europe and Central Asia, the unbearable circumstances and lack of coherency within the penal systems of the regions exists. AFEW recognizes the importance of people living within prisons receiving the same healthcare and life opportunities during and after their stay in prison. Together with prison authorities, AFEW is in constantly implementing prison health projects that seek collaboration with organisations working in prison. To introduce the region where AFEW is actively represented, Anke van Dam gave a book Invisible Lives: HIV on the Fringes of Society to Monica Beg, Chief of HIV/AIDS Section and Global Coordinator for HIV/AIDS at United Nations. Stories from the representatives of key populations from Tajikistan and Ukraine are depicted in the book.

AFEW expresses a big gratitude to our prison corner partners: The Council of Europe Pompidou Group, Asian Harm Reduction Network, International Corrections & Prison Association, Health Through Walls and UNODC.

Ukrainian success with the monitoring instrument

During the session about engaging young people who use drugs in Ukraine in the HIV and human rights response, AFEW-Ukraine presented the developments achieved during ‘Bridging the Gaps: Health and Rights for Key Populations’ and PITCH projects, supported by the Ministry of Foreign Affairs of the Netherlands.

AFEW-Ukraine’s manager Irina Nerubayeva presented the instrument for monitoring violations of human rights of adolescents using drugs in Ukraine, that has been used for a year among the partners in four regions of Ukraine. ‘Bridging the Gaps’ project partner – social worker from Kharkiv NGO Blago Alina Khokhlova – told about challenges and results of using the instrument and emphasized the importance of her organisation in developing effective advocacy programs in the city. Youth activist Daria Kopyevskayskaya from Kropyvnitsky (NGO Return to Life) emphasized the role that young people play in delivering information to their peers about rights.

Legal expert Vita Musatenko presented the most typical cases that were identified in the process of monitoring and advised what social workers can do to provide adequate response and help to a young person. Evgenia Kuvshinova from NGO Convictus told about her work with young people who use drugs in Kyiv at the Street Power Club where young clients receive a range of services, including testing for HIV, sexually transmitted diseases, hepatitis. There they also engage in educational activities and are trained as leaders.

From harm reduction programmes to methadone therapy

The session on HIV prevention, treatment, and care in the countries of the former Soviet Union allowed to learn about challenges and achievements of prison programmes from various countries of the former Soviet Union and receive information from government officials and NGOs. The head of the Medical Department of Kyrgyz Penitentiary Service Nazgul Soltobekova told about the system of HIV prevention and treatment in Kyrgyz prisons. She also shared the country’s successful experience in providing comprehensive services for people who use drugs in penitentiary facilities – from harm reduction programmes to methadone substitution therapy.

Konstantine Turashvili from the medical department of the Ministry of Corrections of Georgia told about HIV programmes in Georgian prisons and the country’s successes in hepatitis elimination programmes. Both speakers emphasized the importance of cooperation with community-based organisations that provide effective counseling services for inmates and help to ensure continuity of care of those released from detention facilities. This topic was further followed by Natalia Rudokvas from Kazakh NGO “Answer” who shared the experience of her NGO’s work with HIV positive inmates. Ikrom Ibragimov from AFEW-Tajikistan shared his experience of cooperation with the penitentiary system and told how NGO can build the capacity of prison staff in HIV, TB, and other related issues.

Being an expert in prison health, AFEW will continue advocating for HIV, TB and hepatitis C prevention and treatment programs for prisoners in EECA. We are promoting essential elements like harm reduction, including needle and syringe programmes, and opioid substitution therapy. Transitional client management that prepares prisoners for release and ensures linkage to follow-up after release is a valuable variant of client management that meets many of (ex)prisoners’ needs.

‘Bridging the Gaps’ through the eyes of teenagers

In 2011-2017, over eight thousand clients received 70,232 medical, psychological, social and legal services within ‘Bridging the Gaps: Health and Rights for Key Populations’ project in Ukraine. Halyna, Artem and Carl (names changed) were also clients of ‘Bridging the Gaps: Health and Rights for Key Populations’ project.

Resolving problems with the family

Halyna is 19 years old. She is a slim girl with beautiful eyes and a charming smile. Halyna was born in a small Ukrainian town bordering with Moldova. She has been living with a man she loves for a year. A month ago, they got married.

However, just two years ago, Halyna’s life was neither easy nor happy. Back then, she lived with her mother and stepfather and was a constant victim of abuse. Halyna’s stepfather did not want the girl to live with them, so was turning his wife against her own daughter. Halyna, who was still a minor, had to leave her home, find a job and make her own living. The girl started using drugs – first marijuana, then amphetamine, sometimes ecstasy or LSD. It lasted for a few months.

Once, when the girl told her mother everything. Talking about that period of her life, Halyna cannot hold her tears back.

“When I came back home, I was not quite adequate and had hysterics. Once, my stepfather called police and they took me away. They sent me to a juvenile shelter in Chernivtsi. I spent two months there. At first, it was difficult, and I wanted out of there as soon as possible, but when I went back home to my family, it was even worse. My stepfather abused me and made my mother do the same,” tells the girl.

The psychologist working in the shelter referred Halyna to the Dialogue Centre of Social and Psychological Support (New Family Foundation), implementing ‘Bridging the Gaps: Health and Rights for Key Populations’ project. Three times a week, Halyna attended counselling sessions with a psychologist and a social worker there. Besides, the girl, her mother and stepfather took part in family group conferences. The approach of family group conferences stipulates that a child may not be viewed separately from the family, so family members should be involved in solving child’s problems. Halyna says that it helped to maintain relations in her family for a while.

“Later, as my legal age was approaching, my mother and stepfather said that they did not want me to live with them. Our problems resumed, and I went back to drugs. After I turned 18, I had to move out,” tells the girl.

Despite the challenges, Halyna continued coming to the Centre for support and soon was able to quit drugs. She attended the Centre for about eight months. The girl says that for her, the Centre was a safe place and people working there helped her a lot. Halyna thinks that it is quite possible that if not for this support, she would still be using drugs.

Coming home for Mom’s birthday

Artem from Kropyvnytskyi is 22. He lives with his family – his parents, sister and grandmother. The young man says that he likes mountains, nature, rock-climbing and drugs.

When Artem was a teenager, he started taking alcohol, smoking cigarettes and then tried drugs for the first time. He confesses that he was not happy with his life and wanted to escape the reality, so he started “systematically” using drugs. Crystal meth, LSD, ecstasy and so on – he used everything except injecting drugs. It lasted for over four years.

Then his family intervened. Artem’s uncle suggested he should visit a psychologist from Lilia social bureau (NGO Return to Life). Psychologist’s counselling, awareness-raising classes, school of volunteers – all those things became part of the young man’s life.

However, just in several months he went back to drugs and had to start everything from scratch. Later, Artem spent three months in the rehabilitation centre run by the Return to Life NGO. He came back home last autumn, on his mother’s birthday.

“If it were not for this project and the social bureau, I would probably still be an active drug user. Maybe I would even end up in jail,” says Artem.

He became an active volunteer of the organization. Campaigns, workshops, summer school, working on his own project – all those things interest him and are an important part of his life. He has no desire to go back to drugs.

Drugs bring an illusion of the solution

Nineteen-year-old Carl is a second-year psychology student from the western region of Ukraine. He has parents and an older sister. Carl enjoys learning new things and likes history, especially military history. A year ago, he experienced some problems and his friends offered him a “way out” – together with them, he started using drugs.

“At first, I liked it, it felt exciting. Then I realized that drugs only bring me new problems. I grew addicted to drugs, could not communicate with people in a normal way, it interfered with my studies. When I understood that it all turns out to be a problem, I came to the Centre,” says Carl.

He heard about the Dialogue Centre a year and a half ago. Project workers regularly come to student dormitories and tell young people about HIV, drugs, safe sex, test them for HIV and hepatitis, distribute condoms.

“I lost many friends and acquaintances. Sometimes even my fellow students rejected me and called me a drug addict. I am a human, so when the society turns its back on me, it is very painful,” he recalls.

In the Centre, there was a psychologist who worked with Carl for six months. Embarrassed, Carl tells that he opened up during those counselling sessions and even cried. He says that the psychologist helped him to keep his life from going to pieces. Besides, in the Centre he could eat a meal and spend his leisure time.

“I know for sure what would happen to me if not for this Centre and this project. There was a friend of mine in the dormitory, who had a “point of no return”: he switched to hard injecting drugs, was kicked out of the dormitory and then – out of the university. It is quite probable that it would be the same with me,” says Carl.

The problems, which led the young man to drug use, are still there, but he realized that drugs do not resolve them, only bringing an illusion of solution. He is sure that every person should understand it.

About the project

‘Bridging the Gaps: Health and Rights for Key Populations’ is an international project, which was launched in Ukraine in 2011 and is aimed at protecting the human rights of drug users by changing social attitudes and government policies and improving the services they can access. The main activities are aimed at under-age drug users. Four partner organizations provide services to adolescents in four cities: Return to Life CF in Kropyvnytskyi, Public Health PRCF in Poltava, Blago CF in Kharkiv and New Family CF in Chernivtsi.

In Chernivtsi, there is a rehabilitation centre, while in other cities the services are provided through social bureaus and day care centres. The efforts are aimed at reducing the risks of drug use, re-establishing social connections and finding resources in the lives of adolescents to support them. The most important task for project workers is to make adolescents understand that in the centres they will be welcomed and will not be judged because of their drug habits.

‘Bridging the Gaps’ in Georgian Provinces

Gocha lives in a small town of Telavi

Author: Irma Kakhurashvili, Georgia

Gocha and Nikoloz are clients of ‘Bridging the Gaps: Health and Rights for Key Populations’ project in Georgia.

Art therapy works

Gocha lives in the hottest region of Georgia – Kakheti – in a small town of Telavi. He is a client of a Rehabilitation Centre in Gremi village. There he receives support to overcome his alcohol and substance use problems.

The Rehabilitation Centre for drug users run by Tanadgoma is the first and only stationary rehabilitation centre in the country offering free services to its clients. Since it was founded, over 25 clients received help free of charge there. In the Centre, clients can get social, psychological and health services. The Centre applies twelve-step recovery programme. Besides, it offers art therapy classes and even runs a ceramic workshop. The instructors working in the Centre were trained in a Ukraine-based rehab.

As many of his friends, Gocha used to smoke “harmless weed” since he was a schoolboy. Soon enough, he found himself among people who were eager to use other drugs as well. At first, he was curious to experiment with substances, but during the heroin boom in Georgia – when it could be purchased even in the Kakheti villages – the situation changed. If Gocha was lacking money to buy drugs, he had enough to get some alcohol. Gocha’s family knew about his problems. His parents told him that he would find himself in a trouble, but it did not help. After the government introduced stricter rules for drug dealers and users, Gocha switched to the homemade drugs.

He first came to the Tanadgoma Rehabilitation Centre two years ago. Gocha took part in the twelve-step recovery programme, attended counselling sessions and art therapy classes. Currently, the man is in remission, but sometimes he comes back to the Centre seeking services. He says that sometimes he drinks alcohol. Georgia is the motherland of wine, so it is hard to quit alcohol.

“I do not know what would happen to me if not for this project. Now working with clay and ceramics is the biggest joy for me. There is a radio set in the workshop and I can work all night long, listening to music. I have a lot of creative insights and the process of work is very important for me. When I draw sketches, I think of nothing else. My negative thoughts go away,” he tells.

Gocha does not know if he will be able to quit drugs and alcohol for good. There are no guarantees, but at least now he understands how to reduce the harm he does to his health. Gocha finds his support in knowing that if he goes home and has a relapse again, he can always come back to the Centre or contact harm reduction programmes.

Sometimes small tours are organized for the clients of the Centre. This region of Georgia is famous for its historical sights and beautiful nature.

“Sounds of the river calm me down. There I can think about my life. I spent 11 years behind the bars and I have many regrets… Now there are a lot of pharmacy drugs in Georgia, many people need psychosocial support… I do not understand why the government does not want to implement rehabilitation and employment programmes instead of the repressive drug policies. It does not want to be responsible for such people as me. So far, the Centre is the only place where someone cares about my mental health,” says Gocha.

He has two dreams: to equip the Rehabilitation Centre with exercise equipment for its clients to stay fit so that they are able to start a family.

“I want my empty house in Telavi to be full of child laughter and hope. I want to live a normal life,” says Gocha.

Drug use changed my life

Nikoloz is a former police officer

Nikoloz is 45 years old. He is a former police officer. His professional career ended up when he was arrested for drug use and sentenced to seven years of imprisonment. Before that day, he had no problems.

“I was 18 when my friend and I tried drugs for the first time. Little by little, I got used to drugs. My brother also did drugs, but I was afraid to tell him. I felt uncomfortable to talk about it with my family. Then I studied law, started working in police and that is when I got really “hooked.” I had powerful relatives, so I felt safe, but after eight years of active drug use I was locked up,” remembers Nikoloz.

Seven years in prison were a dreadful, lost period of his life. Then it was easy to get drugs in closed settings and Nikoloz used this opportunity. However, one case of severe overdose, when he almost died, made him rethink this situation. After he got back home, all his social connections were lost.

“Then I thought that it was enough, I had to stop. Even now, I hate drugs with all my heart. I fight them and fight myself. Last year I had a relapse. Therefore, I had to enrol into a substitution therapy programme and receive treatment in a clinic,” confesses Nikoloz.

He feels sorry because drugs changed his life but says that if years ago he had access to harm reduction programmes, he would definitely enrol in them. Back then, he knew little about reducing the risks of drug use.

“I had no strength or desire to quit drugs, but I would surely use them in a safer way, for example decreasing the frequency of injections. I would be able to control my life and health and would avoid overdose and hepatitis C. Drugs will always be there. Non-medical use of drugs is bad for everybody – the individual and the society – so protection of public health requires protection of drug users’ health. For that purpose, drug users should be integrated into the society and not isolated,” says Nikoloz.

In jail, Nikoloz got acquainted with people working for Tanadgoma, who offered different services to the inmates, in particular, psychological support, which was very important for him.

After Nikoloz was released, he went to a social bureau in Tbilisi. Tea Chakhrakia, working for Tanadgoma, helped him to re-issue his documents. Besides, people from Tanadgoma helped him to get a job with Akhali Gza NGO providing harm reduction services to people who use drugs. Since then, Nikoloz has been working as a social worker there. For him, his job is not only his responsibility, but also his real family, where he is loved and respected, and such love and respect are mutual.

Nikoloz is convinced that harm reduction services are more effective than incarceration. The best approach to resolve drug-related problems is to work with people who use drugs and not punish them.

“In our country, drug policy is based on some Utopian ideas because the government thinks that the drug use may be eradicated. In Georgia, criminal justice is the only method to solve the problems of injecting drug use. Drug use is treated as a criminal offence, though there is a strong evidence proving that repressive drug policies are ineffective and prevent access of people who use drugs to health services,” says Nikoloz.

Nikoloz is happy to share his experience with junior outreach workers. He works with clients, motivating them to get tested, helps them to prepare all the required documents, develops support plans, and tells people about safer drug use methods.

“I am really grateful to the project for the job that I have, which helps me feel that people need me. I received help one day, and now I can help others, sharing my experience with them. My clients are people who use drugs. Many of them use drugs only to overcome their withdrawal syndrome. They are the ones who really need support. I want them to understand what is waiting for them ahead,” he says.

Nikoloz says that with support of harm reduction experts many good things may be done for people who have already lost any hope. That is why it is important to implement the projects, which meet the specific needs of vulnerable populations.

“I am glad that in prison I met people who saw my potential and believed in me,” he says.

About the project

Bridging the Gaps: Health and Rights for Key Populations‘ is an international project implemented in 16 countries of the world to improve the health and protect the rights of vulnerable populations. In Georgia, the project was launched in September 2012. Its main goal is protecting human rights of drug users by changing social attitudes and government policies and improving the quality of services delivered and access to them.

In Georgia, the project is implemented by Bemoni Public Union and Tanadgoma Centre for Information and Counselling on Reproductive Health. Bemoni provides services in the social bureau based in Telavi (Kakheti), and Tanadgoma – in the social bureau based in Tbilisi. Besides, in 2015 Tanadgoma opened a Rehabilitation Centre for people who use drugs in the Gremi village, Kakheti.

In 2012-2017, over four thousand people who use drugs received 17,321 medical, psychological, social and legal services within the project.

AIDS Conference Brought me a Job in Tajikistan

Author: Nargis Hamrabaeva, Tajikistan

Fifty-year-old Zebo from a southern region of Tajikistan – Khatlon – is a former labour migrant. At the 22nd International AIDS Conference in Amsterdam (AIDS 2018), she had the courage to speak out about what she long kept in – her HIV-positive status. Zebo once again turned the attention of the international community to the fact that labour migrants are one of the populations most vulnerable to HIV.

We interviewed her in Amsterdam, right after she delivered a speech at one of the sessions dedicated to HIV in the context of labour migration.

– Zebo, why did you decide to go to Russia to earn money? Usually that is what men do.

– In 2004, after I divorced my husband, I was left alone with three small children – my elder siblings were 9 and 6 years old, and my smallest daughter was only 3 months old. I worked as a nurse at a local maternity clinic. My children grew up, with our expenses growing along the way, and my earnings were not enough to feed them all. My ex-husband had a new family and was not helping us. Many of my countrymen went abroad to earn money and support their families. I decided to do the same. That is how my children and I found our way to Saint Petersburg.

– Isn’t it difficult for a woman to be a labour migrant?

– It is very difficult. I was desperate and went to nowhere. For the first days, we slept at the railway station or in the street. Some strangers helped us, offering food or money. Once, a woman from Tajikistan, who worked in Saint Petersburg, saw us and was so kind to give shelter to my children and me. I started baking and selling pasties, earned some money. As time passed, more people were buying our pasties: I was baking and my elder daughter was selling them at the Sadovy street market. Luckily, we had many buyers. However, I had to work my fingers to the bone.

I tried to settle my personal life again as it was very hard for me to cope with all my troubles alone. I met a young man. In the beginning, everything was fine. Then I started noticing him doing some strange things. It turned out that he was a drug user. He injected drugs. I asked him to stop but it did not help. Then I decided to break up with him. Later I heard that he felt bad and his relatives took him back to his motherland. Since then, I have never heard from this man, but my HIV status always reminds me of him.

When did you first learn that you had HIV?

– In 2015, a year after I broke up with my partner. All of a sudden, I felt bad and had a fever. My relatives called an ambulance. In the hospital, they made some tests and I was diagnosed with HIV. In a month, I felt better and went back home, but six months later it happened again. I was dwindling, with my weight going down to 34 kilos. Doctors advised me to go back to my country and get treatment. Almost all my countrymen working in Saint Petersburg had to raise money to buy airline tickets for me and my children. They knew that I was severely ill but did not know the exact diagnosis. When I came home, my family knew I had HIV. They did not really welcome me back. My relatives turned their backs on me and asked me to leave our house. My mother said that I would infect everyone, told people not to eat from the same plate with me and not to shake hands with me. I remember her yelling: “Get out of the house, aidsy!” It hurt me to hear such words, especially from my own mother. Still there are kind people in this world, so a neighbour living opposite from my parent’s house offered me to stay with her. She gave me a small room in a little building. That is where I still live.

So you had to go back to square one again?

– Yes, I did. A woman I know told me about AFEW-Tajikistan office in Bokhtar. I went there and they received me well, helping with food and treatment. They also had a business workshop for the members of vulnerable populations and I was able to get a credit from a microfinance organization. I bought everything I needed to open a small sales outlet in the neighbourhood. Sometimes, when I need to go to the city, my daughter takes over my duties. Children always help and support me in everything I do. My son also assists street market vendors, bringing home 15 somoni a day (less than two US dollars – ed. note). After my speech at the Amsterdam conference, Director of AFEW-Tajikistan Ikrom Ibragimov offered me to work as a consultant in the Bokhtar office of the organization. Now I will receive a salary. I am so grateful to him and to all the members of his great team. With their support, my life is getting better.

Great! One more question about Amsterdam. What does participation in the AIDS conference mean to you?

– It is my first trip far abroad. It is also the first time I take part in such a conference. I listened to many speakers and was inspired by their stories. They were openly saying that they lived with HIV for 20-25 years, taking care of their health and living active and complete lives. It gave me strength and confidence. I was startled to learn that in many countries people living with HIV are not prosecuted and other people do not avoid them. In those several days of the conference, I received more sincere hugs and handshakes than I did since I learned about my diagnosis. Why is there such a strong stigma against people living with HIV in my country? Why do people still hold to stereotypes and are afraid of us? At one of the sessions of the Amsterdam conference, I heard a slogan: “Chase the virus, not people.” It is such a good point! 

AIDS 2018: Will Decriminalisation Resolve the Problem of HIV

Maybe one of the most important sessions at the recent 22nd International AIDS Conference AIDS 2018 held in Amsterdam was the session, which raised the question why we still fail in responding to the epidemic among people who inject drugs. Participants of the session were able to consider this problem from the different points of view: science, law enforcement and community of people who use drugs.

Methadone is good for police

For over 20 years, Professor Nick Crofts from the University of Melbourne has been working to engage police in HIV response. He considers that decriminalisation is an absolute necessity to resolve the problem.

“We fail responding to the epidemic because we have failed to enlist police as partners in the response to HIV,” he says. “Changing the situation, first of all, requires changing the role of police, which will, in turn, help bringing the marginalized communities back to the society.”

In Australia, Professor Crofts and his allies were able to convince the police that such harm reduction programmes as methadone therapy and syringe exchange may benefit police as well as the rest of the community.

“We still have not introduced harm reduction courses in police academies, have not adequately educated police and have not fostered the role of peer educators, which is important not only in the traditional environment of activists, but also in such specific group as future or current police officers. Police officers may listen only to other police officers,” says Nick Crofts with a smile.

HIV for culture change

It is essential to find police officers who support the idea of harm reduction and educate them so that they can then educate their colleagues in relevant agencies.

“Find at least one or two individuals who want to do something different! Find them and give them your support!” exclaims Professor Crofts.

HIV may be a starting point to change the culture of the police. For a start, we need to engage the police, hold joint workshops with people from civil society and police, foster gender diversity in the police (to recruit more female police officers) and, finally, include harm reduction into the programme of police academies.

However, the Professor points out that it may sound pie in the sky talking about police in some countries.

“A third of them understand harm reduction, a third can understand and another third will never understand. Our goal is to find those people who understand or can understand it and work with them until they outnumber those who will never understand harm reduction,” he says.

“Narcotic ration” for Russia

Dr. M-J Milloy, the epidemiologist from Vancouver, tells about an interesting case, which occurred in his city back in the 1990s. Back then, there was already a large needle and syringe exchange programme in Vancouver and methadone was available. The epidemic among people who use drugs had successfully been curbed, but suddenly there was an unexpected outbreak of new HIV cases. How could it happen in a city with a well-developed harm reduction programme? It was explained with the fact that people could not access the necessary services when they were incarcerated.

Epidemiologists found out that incarceration was one of the key factors increasing the risk of HIV acquisition and one in five new HIV cases in Vancouver was a result of incarceration.

At the same time, experts estimate that in Russia every hour ten people are infected with HIV, while tuberculosis is the main reason of mortality among those who live with HIV. Most of them are people who inject drugs. The country does not offer evidence-based treatment to people who use drugs, i.e. there is no methadone, which, according to a recent statement from the Russian Ministry of Foreign Affairs, is a “narcotic ration.”

AIDS 2018: Engaging Young People who use Drugs in the HIV and Human Rights Response in Ukraine


Ukraine presented its experience in engaging young people who use drugs in the HIV and human rights response during International AIDS Conference AIDS 2018 in Amsterdam. Organisations ACO “Convictus Ukraine”, ICF “AIDS Foundation East-West” (AFEW-Ukraine), CF “Return to Life” and CF “KCF “Blago” shared the results of their work.

Club for teenagers

The main purpose of the activity in the framework of the PITCH project is to prevent the spread of HIV and other dangerous diseases among vulnerable adolescents and to develop healthy lifestyle habits, the director of “Convictus Ukraine” Yevheniia Kuvshynova is saying.

In their work, “Convictus” team is actively using mobile clinic where they provide services for teenagers. A multidisciplinary team is operating on the basis of a mobile clinic. The mobile clinic helps them to bring the services to those who are not covered with prevention and treatment programs. There is also a school of leaders and a Street power youth club, where teenagers can spend their leisure time and receive help from psychologist or social workers, get information, medical services, testing, etc. Around 500 teenagers received services in the club.

Accepted the monitoring tool

Iryna Nerubaieva

The project manager of the ICF “AIDS Foundation East-West” (AFEW-Ukraine) Iryna Nerubaieva shared the results of the piloting of the tool for monitoring the violations of human rights of most-at-risk adolescents which was developed and implemented in the framework of the project Bridging the Gaps: Health and Rights for Key Populations. From January till December 2017 in four pilot cities, 792 interviews with adolescents and youth aged 14-21 were conducted. 430 adolescents were 14-18 years old. The number of cases of human rights violations registered in an online form was 92 of all surveyed. A young activist of the CF “Return to Life” Daria Kopyevska, a social worker of the CF “KCF “Blago”Alina Khokhlova and a lawyer and AFEW-Ukraine’s consultant Vita Musatenko also shared their experience.

“It is good to see that teenagers realized why they need this tool, and how social workers accepted it. Now they know how that it will help in their work,” Vita Musatenko is saying.

According to the latest estimates, the number of most-at-risk adolescents is 129 000, including 21 700 injection drug users. However, there is no official data on the exact number of most-at-risk adolescents, including underage drug users. In Ukraine, most-at-risk adolescents represent a very closed group, thus the lack of statistical data, stigma, discrimination and legal barriers make their access to HIV/STI services more complicated.


Awareness and Acceptability of PrEP Among Men Who Have Sex with Men in Kazakhstan

Oral pre-exposure prophylaxis (PrEP) is an antiretroviral method of HIV prevention recommended to men who have sex with men (MSM) at high risk of infection. In Kazakhstan, which has one of the fastest growing HIV epidemics globally, PrEP is not currently available. The aim of this study is to explore the possibilities for PrEP initiatives in Kazakhstan by investigating awareness and acceptability of this prevention method among MSM. This mixedmethods study employs an online survey and qualitative interviews to describe PrEP awareness and acceptability. Less than half (39.8%) of survey participants had heard of PrEP.

However, a majority (85.2%) of MSM would possibly or defi nitely use PrEP if it was available. Awareness of PrEP was positively associated with willingness to use PrEP. The main reason to be interested in PrEP was an increased feeling of protection, whereas barriers were related to the idea of taking daily medication and the potential for side effects. PrEP is an essential component of HIV combination prevention. Our findings suggest potential for PrEP programmes among MSM in Kazakhstan and possibly in other Central Asian nations, when taking into account burdens of taking PrEP as well as more structural health policy issues.

Read more of the study here.

AFEW International Receives Grant from the Elton John AIDS Foundation

Sir Elton John during International AIDS Conference in Amsterdam

Author: Olesya Kravchuk, AFEW International

AFEW International received the Emergency Support Fund Manager grant from the Elton John AIDS Foundation. This news was announced during the 22nd International AIDS Conference in Amsterdam. AFEW has got this grant together with AIDSfonds.

Within this ‘Emergency Support Fund Manager” grant, AFEW will use its long-lasting expertise and history in grant-making and support to strengthen the capacity of Community Based Organisations (CBOs) and Non-Governmental Organizations (NGOs) in Eastern Europe and Central Asia (EECA) to overcome emergencies and to become stronger organisations.

Louise van Deth, Director of AIDSfgonds

“We are very honoured to receive this grant that will last three years,” says the executive director of AFEW International Anke van Dam. “Access to the treatment in Eastern Europe and Central Asia is a crucial need, particularly for key populations most at risk and people living with HIV. Unfortunately, not more than 30% of people living with HIV have access to the treatment. Stock outs of anti-retroviral treatment (ART) do happen, and the Emergency Support Fund is a great means to avoid this.”

AFEW will disburse emergency grants to enable key populations CBOs and NGOs in Eastern Europe and Central Asia to survive emergency situations and to be prepared or avoid emergencies in the future. NGOs and CBOs often deal with emergency situations due to a restrictive legal environment for key populations at risk for HIV, stigma and discrimination of those groups and a limited space to operate as a CBO and NGO.

AFEW Network at AIDS 2018

AFEW Network at the 22nd International AIDS Conference AIDS 2018 in Amsterdam, the Netherlands, July 23-27, 2018

Date Status Event title and type Place
21/07 – 22/07 Pre-Conference Youth

Empowermentand Validation

Roeterseiland Campus: Roetersstraat 1012 WX, Amsterdam


Affiliated event Theatre play in the framework of the

Teenergizerproject “Voices of Youth from Eastern Europe and Central Asia at AIDS 2018”

CREA Cultureel Studentencentrum – Nieuwe Achtergracht 170, Amsterdam


Affiliated event Roundtable: A person-centred response to the epidemic, Journalist Fellowship training RAI, Elicium Centre D203


Affiliated event Opening of ATLAS 2018 exhibition: I will speak, I will speak! Beurs van Berlage

Damrak 243, 1012 ZJ Amsterdam

22/07 Pre-Conference Meeting 90-90-90 targets is not the end of AIDS; Joep Lange Institute;

Mayors of Kyiv and Almaty


08:30 – 10:00

Open for public Walking the walk: youth movements to fight

HIV epidemic in Eastern Europe and Central Asia

RAI, Global Village


Open for


Art and Social Change: a dialogue with artists and social and health professionals on how culture and social initiatives can strengthen each other. Guided tour along the artworks with AFEW Culture Initiative lead Jan van Esch and and Ambassador International Cultural Collaboration Arjen Uijterlinde RAI, Global Village

ActivEast community zone 515



Open for public Artists Displaced at AIDS 2018: guided tours of the series of installations by the Artists-in-Residence (AiRs) and the project curator RAI, Global Village

ActivEast community zone

24/07 Open for public Strength in Resilience: Learning from key population communities in EECA confronted with shrinking civil society space RAI, Global Village

ActivEast community zone 515



Open for public Meet, Greet and Brainstorm on

Harmreductionand the EU Parliamentary elections 2019

RAI stand COALITION PLUS (exhibition zone)


Open for public Meet & greet RAI, Global Village, booth 509 (Prison Corner)


& 14:30-15:00

Open for public Artists Displaced at AIDS 2018: guided tours of the series of installations by the Artists-in-Residence (AiRs) and the project curator RAI, Global Village

ActivEast community zone



Open for


Panel discussion: Protecting people who migrate in countries of origin, transit and destination RAI Forum


Open for public Prison Health a Logic Choice: Key Implementation Factors RAI AFEW Office,

Amtrium2nd floor, above the entrance to the Global village



Open for


Panel discussion: Providing health services in prisons: addressing inequities, preventing and treating HIV and TB RAI UNAIDS Office Space, meeting room 2


& 14:30-15:00

Open for public Artists Displaced at AIDS 2018: guided tours of the series of installations by the Artists-in-Residence (AiRs) and the project curator RAI, Global Village

ActivEast community zone



open AFEW Network‘s Experience in strengthening community monitoring and involvement in service delivery: From

grassrootto policy level

Global Village, Eastern Europe and Central Asian Networking zone
26/07 10.30-11.30 open for public Strength in resilience: learning from key population communities confronted with shrinking civil society space AIDS Fonds Networking zone


open for public Bridging the Gaps: Health and Rights of Key Populations and PITCH. Engaging young people who use drugs in Ukraine in the HIV and human rights response RAI, Global Village, booth 509 (Prison Corner)


& 14:30-15:00

Open for public Artists Displaced at AIDS 2018: guided tours of the series of installations by the Artists-in-Residence (AiRs) and the project curator RAI, Global Village

ActivEast community zone



open for public HIV prevention, treatment and care in prisons activities in Eastern Europe/former Soviet Union countries RAI, Global Village, booth 509 (Prison Corner)


open for public Press moment: “Don’t let the prisoners behind” RAI, Global Village, booth 509 (Prison Corner)

16:30 – 18:00

For AIDS2018 delegates Workshop Migration in Eastern Europe and Central Asia: access to health care for all? RAI, E105-108

21:00 – 24:00

Open event AFEW Disco “From EECA with Love” Tolhuistuin – IJpromenade 2, 1031 KT Amsterdam


Open for public Artists Displaced at AIDS 2018: guided tours of the series of installations by the Artists-in-Residence (AiRs) and the project curator RAI, Global Village

ActivEast community zone

                                                                               Activities throughout AIDS2018
Date Status Title Place
22/07 – 27/07 Open for public Dutch Approach Booth RAI, Global Village
22/07 – 27/07 Open for public EECA Region Networking zone RAI, Global Village, EECA networking zone

ActivEast community zone, 515

22/07 – 27/07 Open for public Harm Reduction, People Who Use Drugs and Prison Health Networking Zone RAI, Global Village
23/07 – 27/07 Open for public The Walking History Corridor: Visualising the Mythologies of HIV/AIDS, the Caucasus and Beyond RAI, 812

corridor that is linking the Global Village with the main Conference Space

23/07 – 27/07 Open for public Transparent Dining: An Evolving Museum of Life Experiences, Social Commentary and Culinary Gatherings by and for Women Affected by HIV/AIDS in the EECA Region RAI, outside of the Global Village
23/07 – 27/07 Open for public Putting on a different lens: sex work, harm reduction and medical research in the Netherlands viewed through an artistic Eastern European and Central Asian lens RAI, Global Village – 823, time TBD


Fight, Hide, Unite — Where and Why?


Authors: Magdalena Dabkowska, Janine Wildschut and Aicha Chaghouani  

In the region of Eastern Europe and Central Asia (EECA), as well as in some Central European countries such as Poland and Hungary, the space for civil society appears to be shrinking. This seems to be a global process, but the EECA region seems specifically affected with many countries following Russia’s example in restricting the legal environment for civil society organizations. Central Asia has one of the lowest rankings on civil and political freedoms of the world (just behind the Middle East and North Africa). The rankings in Eastern Europe are also declining. These developments stifle the involvement of civil society in the region, endangering the further development of civil society and the protection of human rights in many of these countries.

The shrinking of civil space has a wide range of consequences for different kinds of NGOs. When it comes to drug policy or HIV-focused organizations, however, its after-effects may be even more severe. In most places, fields such as HIV prevention or combating the stigmatization of drug use fall to civil society groups and organizations serving the needs of vulnerable communities and marginalized groups—not only people living with HIV or drug users, but also sex workers or members of the LGBTQ community. These groups already face an unfavorable situation, as they deal with difficult, unpopular issues, connected with stigma and lacking any kind of social prestige. This situation already requires extreme dedication on the part of those struggling to defend or empower vulnerable groups, so that any additional challenges or burdens for these NGOs may undermine—if not eradicate—the effects of entire fields, such as working with those infected with HIV. Even more disturbingly, the HIV epidemic continues to grow, as the region on the whole has failed to meet the Millennium Development Goal 6 on combating HIV.

In 2017 AFEW International, the Netherlands-based secretariat of AFEW, an EECA regional humanitarian network, conducted an assessment to examine the extent to which decreasing venues for civil society threaten the effectiveness of the response to HIV and related public health issues (i.e. what is the effect on harm reduction programs for people who use drugs).

The assessment focused on the consequences of the shrinking space for civil society in the EECA region for community networks of people who use drugs, as well as harm reduction and drug policy NGOs. The study also looked at the strategies civil society develops and chooses while its space for agency melts away. The coping strategies were gathered in three categories or types of reaction named in the title of the study’s outcome report. The report, just published in July 2018, is entitled “We Fight, We Hide or We Unite: Coping strategies amongst resilient harm reduction organizations and community networks in the context of shrinking space for civil society in Eastern Europe and Central Asia”.

For the purpose of the assessment, the shrinkage of civil society was defined as “a tendency of governments in the region to exercise more control over civil society”. Civil society was understood as “the entire range of organized groups or institutions that are independent from the state, voluntary, and at least to some extent self-generating and self-reliant.” These would include NGOs, independent media, think tanks, universities, social groups, and religious communities.

Methods chosen for the study included desk research covering international and regional studies and overviews, an online questionnaire taken from the “2016 state of civil society in Europe and Russia” study by the EU-Russia Civil Society Forum, 17 semi-structured expert interviews, and group discussions held after preliminary analyses of the findings had been performed. They were designed to interpret the assessment from different perspectives and to link the theoretical and factual information with its practical implementation.

At the initial stage of the assessment, nine countries were examined, out of which 6 were selected for further review. These included Kazakhstan, the Kyrgyz Republic, the Russian Federation, Tadzhikistan, Uzbekistan, and—outside of the EECA — Poland. „Poland represents an exception. It was added because of the current dynamics vis-à-vis civil society,” states the assessment report.


Desk research (i.e., showed that the region can be divided into three groups of countries, taking into account their political regimes and the state of civil society in them:

  • countries with a very challenging environment for civil society;
  • countries with a challenging, but stable situation;
  • countries rapidly shifting from the comfort zone to a challenging environment.

In all of this, there is a dissonance between how external monitoring mechanisms define situations in these countries and how they rank civil rights and the positive freedoms citizens enjoy, and how HIV, harm reduction, drug policy experts and activists in these countries perceive their own situation.

Surprising results

On the one hand, the study concludes that the situation in the first group of countries can be summarized as very challenging due to limited political rights and civil liberties; oppressive policies that threaten the work and existence of civil society organizations, especially the ones opposing the authorities or dealing with unpopular topics; restrictive laws on foreign funding and international collaboration (i.e. Foreign Agents Law and Law on Undesirable Organizations in the Russian Federation or Law on Public Associations in Tajikistan) etc. Interestingly, on the other hand, only the representatives of civil society from the Russian Federation confirm they can clearly feel the environment as being hard and often dangerous not only for their work, but also for their personal safety. “No one is safe. I’m in the opposition. Maybe I’m paranoid, but they create such a situation that everyone must be scared,” an NGO member from Russia explained. A different image arises in interviews with activists and NGO workers from other countries classified by the monitoring tools as having harsh and very challenging policies. The NGO representatives from Kazakhstan, the Kyrgyz Republic, Tadzhikistan, and Uzbekistan do not feel the high level of anxiety one would expect under the consolidated authoritarian regimes in these countries. Similarly, in the countries where the situation can be seen as challenging, but stable, there is no noticeable expectation or worry among civil society of serious new threats emerging on the horizon.

The reverse situation can be observed in Poland. Although a democratic country and an EU member, it has recently experienced a dynamic decrease of freedoms and human rights and open society standards. Thus, Polish NGOs active in the field of drug policy, harm reduction, HIV/AIDS tend to see the state as less and less favorable or safe for non-governmental organizations. “Since the situation in new and changing rapidly, Polish respondents appeared more anxious than their colleagues from countries where conditions are much more difficult. Moreover, Polish NGOs face an increasing need to reshape their strategies and tailor their activities to this new, unpredictable reality,” we read in the report from the assessment.

We can conclude that the way NGOs and communities perceive their situation (as threatening or safely stable) does not depend exclusively on the strictness of national policies, laws and regulations. It is the combination of legal provisions and the overall political climate AND the dynamics of the changes (for good or for bad) observed at these two levels that influence how civil society defines their situation.

Three ways of coping with the situation

The assessment also examined how organizations dealt with the space for their activities melting away. Each of the numerous and diverse coping strategies identified can be seen as a part of one of the three broader attitudes: “Fight” (openly oppose authorities and the system), “Hide” (keep silent to prevent problems), and “Unite” (actively seek collaboration with the authorities).

The Fight category is defined by the study as containing “protest against general laws and policies, against punishing organizations and smear campaigns, whilst simultaneously standing up for the rights of individuals who use drugs”. “The FIGHT strategy is often found in countries where the situation suddenly and swiftly deteriorates and in countries where the civil society space remains quite limited and strictly controlled by authorities. In countries characterized by strict control, the majority of CSOs HIDE their opinions, although a small group of powerful activists and CSOs take huge risks whilst vocalizing strong positions and acting upon them.” Some of them conduct strategic litigation, including cases against the government (as in the Russian Federation, for example), others provide legal advice for community members free of charge, or share basic legal knowledge through peer-to-peer training. When it comes to controversial topics (and most issues related to drug use and HIV are perceived as controversial), it is easier and safer to express ideas, opinions and criticism through regional channels. Therefore, a decision to work regionally may be yet another example of the Fight strategy.

Of course, open opposition to the authorities can place NGOs at even greater risk as it often creates more oppression. This is why—as it has already been mentioned—the majority of organizations decide to hide, that is to operate silently and not to attract the attention of the authorities. This means either not mentioning or advocating openly for activities out of line with the ideas of the authorities or even ceasing with such activities entirely. In order to safeguard still-feasible projects, to protect and sustain organizations and its staff, and finally to be able to apply for state funding, NGOs often decide to reframe or rename the work they do (i.e. instead of mentioning their work addressed to the MSM—men who have sex with men—community, they refer to it as to men’s health activities; or they avoid a term “harm reduction” by calling the work they provide “preventing HIV”).  Another example of the “hide” strategy is changing the formal structure of the organization (e.g. registering it as a commercial entity), so it becomes invisible for the regime’s radar (and in result it cannot be, e.g., listed as a foreign agent).

To save the work still permitted, some NGOs decide to “unite” with the authorities. They perceive such compromises as the only way to anyhow influence the direction taken in the country and they hope this strategy will secure them a future place in discussions no longer permissible at present. They do so, for example, by offering trainings on health and HIV for governmental people, by participating in roundtables and consultation processes open to civil society, by delivering health services to hard-to-reach communities, and so helping the authorities to reach their health targets. However, this guarantees neither the safety of the organization nor the favorable conditions for its work. During the assessment process a few stories were collected that warn against too much optimism in this regard. One of them was shared by the representative of a donor institution:

“There is one example of an organization. They positioned themselves as a partner to the government and I remember very clearly a moment of great optimism when the then Minister of Health of Russia addressed a regional HIV/AIDS conference in Moscow to say that the government would be adopting harm reduction programs. However, when the time came for the government to do that, the plan changed and the government announced that it would be promoting healthy lifestyles and not adopting NGO programming. So, generally speaking I have to say that those attempts by NGOs to calibrate the confrontation in my mind have not resulted in a greater commitment by or support from the government in the region. I think that’s an important lesson.

The study shares coping strategies exemplary for each of the three groups listed, the necessary conditions for applying them, and finally—their advantages and disadvantages. This form of a review thus might prove useful not only in its own field but other related areas. It provides NGOs with the possibility for checking where actually they position themselves, to see the pros and cons of the position they take, as well as to evaluate the outcomes and consequences of that choice. As simple as it may sound, such an evaluation often proves difficult on a daily basis, but also could be extremely useful, since in most cases the coping technique chosen is not necessarily an outcome of a complex process of planning and strategizing. It usually is an ad hoc reaction to rapid and/or unexpected changes, opportunities or—on the contrary—attacks.

International donors

The outcomes of this study/assessment could also be informative for international donors. The shrinking space for civil society would not be that dangerous if not accompanied by a worrying trend of international funding institutions stepping back from the region. Their retreat (at least partial) from the EECA has been caused by a number of factors, including re-prioritizing and shifting their focus to world’s poorest regions; becoming ‘unwanted’ on the territory of the Russian Federation, for example, or being hit by regulations that aim to limit external funds in order to tighten control over civil society. Whatever reasons are behind the donors’ decision to limit funding in the region, the reality is they contribute to the worrisome situation of a reduction in HIV-related work provided by civil society. This is a field that governments are unwilling to support, be it for moral or for political reasons. Therefore, the lack of stable international funding independent from the authorities has a number of unintended, though severe consequences. The assessment included a few interviews with national and international funding institutions, which shed some light on their current positions and what donors envision for the future. It seems that not only NGOs, but donors also are now developing ways to cope with the shrinking space for civil society. “Some donors are more open and flexible, whilst others need to adapt both internally and externally to the political climate to enable funding for those civil society organizations that continue to operate.” Their efforts are a step in the right direction, but far more is needed if drug policy, harm reduction, and HIV/AIDS CSOs in the region are to survive.


On the basis of the findings of the study, a number of recommendations can be formulated, some addressed to donors directly, i.e. a call to re-strategize and develop ways to still “support CSOs in EECA through flexible conditions, by providing funding through other channels, by working less on the forefront as a donor to keep CSOs safe, and by understanding in which countries CSOs are attempting to survive and where sustainability cannot currently serve as a goal”. Donors should immediately provide emergency funding before the implementation of new strategies. They should also consider community involvement as equally important and support it in different ways. To raise donor awareness and to advocate for attention and financial support for civil society in the region, international solidarity is essential. This is why regional networks and the exchange of knowledge and ideas are necessary (not only among activists, but—equally important—among donors). In the end, it is they who make up the international community that is often in position to engage in the dialogue with the authorities from the EECA countries.

A number of recommendations can also be listed for CSOs and communities, based on what they shared in the process of the assessment. One of the conclusions from the analysis of the material gathered is that the legal framework for CSOs and the daily realities they inhabit may be very different and that “the sense of being involved or under threat are heavily influenced by the combination of strictness and change”18. Understanding “the tension of this sensitive interaction may help CSOs react to changes and threats in a manner that is less ad hoc, allowing them to adopt strategies that are more cohesive and strategic.”

The importance of solidarity among CSOs needs to be stressed nowadays, when organizations often are forced to compete with one another for limited amounts of funding from a limited number of sources. Today, NGOs often also play against each other, often demonstrating little understanding for others, who choose coping strategies and approaches towards the authorities different from their own. Respect and cooperation are indispensable and irreplaceable if the whole movement in the region is to survive.

Last but not least, taking into account the current developments in Poland, Hungary, and a number of other Central European countries that are now—intentionally or not—following EECA regional trends, it is essential “to include these countries’ CSOs in discussions, dialogues and exchanges when we examine civil society’s coping strategies.”