Future development and analysis of the past: EHRA holds the first Steering Committee meeting

On 13-14 February, the Eurasian Harm Reduction Association (EHRA) holds an annual meeting of the Steering Committee in Vilnius (Lithuania). This meeting has a particular importance, since it is the first one in the history of the organization.

What’s more, a great significance of this meeting is the new membership of the Steering Committee – according to the results of the regional online meeting in January 2018, the new representatives are elected in the Baltic countries (Jurgita Poškevičiūtė), Belarus-Ukraine-Moldova (Vitalii Lavryk), Central Asia (Oxana Ibragimova), Central Europe (David Pešek), South-Eastern Europe (Yuliya Georgieva) regions.

“I’m honored to be elected. For me this is an opportunity to engage in regional processes more actively. Especially concerning the issues of harm reduction and drug policy in those European countries who are EU member states and formally considered high income Northern countries (such as Lithuania and other Baltic states) but whose HIV epidemiological situation and a pitifully poor access to health and social services for people who use drugs is much more similar to the Eastern Europe and Central Asia,” says Jurgita Poškevičiūtė, Director of Administration  “I Can Live Coalition” (Vilnius, Lithuania) and the new elected member of the Steering Committee representing Baltic countries region.

The two-day meeting is based on the analysis and results of the Association’s work in 2017 (financial and program reporting), further perspective of organization’s activity, discussions of the management processes and operational management of the EHRA’s Secretariat. As a result, the Committee extended the powers of Leonid Vlasenko as Chairman and Nino Tsereteli as co-chair until August 2018. In 2018, there will be re-elections of several more members of the Steering Committee, including from the community of people who use drugs. The terms of reference for the Treasurer was approved as well as the Regulations of the Advisory Board – two new governance bodies for organization. The Treasurer will monitor the financial health of the Association, and the Advisory Board, composed of high-level international experts, will help to advance the Association’s interests and objectives at the regional and international levels. Jurgita Poškevičiūtė was chosen as The Treasurer of the Steering Committee, and as for the members of the Advisory Board, they will have to be invited from all over the world.

There are lots of plans for EHRA in 2018 – participation in international conferences and various committees and groups. But the main thing now is the work on a multi-country application to the Global Fund in consortium with other regional communities networks and participation in the call for proposals.

Kazakhstan Risks Losing Opioid Maintenance Therapy Programs

The outcomes of the assessment of the opioid maintenance treatment (OMT) programs, initiated by the Government of the Republic of Kazakhstan in 2017, may lead to the complete halt of these programs in the country. Multiple violations of human rights were recorded during the assessment, it was conducted in breach of international bioethical standards. Based on that, the Eurasian Harm Reduction Association (EHRA) and Canadian HIV/AIDS Legal Network appealed to United Nations Committee on Economic, Social and Cultural Rights (CESCR) urging the Government of Kazakhstan to provide information on their plans to increase the availability of OMT as well as ensure the respect and protection of human rights of drug-dependent individuals and people living with HIV.

In 2017, only 2,69% of all injecting drug users on the outpatient register in Kazakhstan were receiving OMT, contrary to WHO’s recommendations of at least 20% coverage. OMT programs, initiated in Kazakhstan in 2008, under the recommendations from various international organisations, have not received unanimous support from politicians, law enforcement, and healthcare institutions. In June 2017, the Ministry of the Interior, backed by seven members of the parliament, requested immediate termination of OMT in Kazakhstan. The Prime Minister’s Office soon ordered an evaluation of the OMT programs, which was started at the end of September by the establishment of the Inter-Sectoral Working Group composed of 17 members. On 30 October 2017, the Working Group produced a Resolution with the conclusions that OMT is effective in Kazakhstan and it should be continued with some improvements regarding the accessibility and the quality of services.

However, some members of the Working Group were not satisfied with the positive recommendations and initiated an alternative research. With the help of the police, the new research was conducted without a proper methodology and gravely violating the rights of the OMT patients: a number of interviewed OMT patients were misinformed about the true aims of the research and were threatened or coerced into giving their statements, and they had to give urine for drug testing without the signing of consent forms.

At the end of December, the group provided its findings in a “Special Opinion”, the main conclusion of which was that OMT is not effective and should be terminated, asserting countries that have completely terminated OMT programs. Subsequently, the Ministry of the Interior issued information about the establishment of a new commission for additional assessment of the effectiveness of OMT with the participation of the National Security Committee and Foreign Intelligence Service. As a result, as of January 2018, the admission of new patients in the centers for methadone maintenance therapy was stopped.

“Despite the fact that OMT programs have proven to be one of the best means to decrease the spread of HIV, the Kazakh Government has taken a worrying step, which may have irreversible negative consequences for the livelihood of the country’s population. Primarily, it affects the OMT patients who are seeking alternatives to illicit drug use,” says Dasha Matyushina-Ocheret, EHRA’s Policy Reform Advisor. “The situation is particularly grave, since the Global Fund, which is the main financial donor for harm reduction programs in Kazakhstan, may stop the funding at the end of this year. Therefore, the decision was taken to present a parallel report on the access of people who inject drugs to drug dependence treatment in Kazakhstan to the CESCR as one of the means to help the people in need to continue receiving life-saving opioid substitution therapy.”

This is the second parallel submission by EHRA and Canadian HIV/AIDS Legal Network for the 62nd Pre-Sessional Working Group of the CESCR, which will take place in Geneva, on 3-6 April 2018. Last week, together with the Estonian organisation of people who use psychoactive substances LUNEST, they also tabled a report on the situation of women who use drugs in Estonia.

For more information, please read the Briefing Paper on the Access of People who Inject Drugs to Drug Dependence Treatment in Kazakhstan.

Regional Dialogue for the development of a new regional program and a multicountry application to the Global Fund is announced

Dear colleagues, 
The Regional Communities Networks Consortium uniting Eurasian Coalition on Male Health (ECOM), Eurasian Harm Reduction Association (EHRA), Eurasian Women’s Network on AIDS (EWNA), Sex Workers’ Rights Advocacy Network (SWAN), Eurasian Network of People Who Use Drugs (ENPUD) is announcing the Regional Dialogue for the development of a new regional program and a multicountry application to the Global Fund, aimed at strengthening sustainable national funding for HIV prevention and treatment programs, especially among key populations in EECA countries.
The regional program will be designed to strengthen efforts to improve the effectiveness of planning and monitoring system of programs, to reduce the prices of drugs for HIV, TB and hepatitis treatment and prevention, and strengthen community systems for key populations and people living with HIV.
The scope of the program of the Regional Communities Networks Consortium can include any of the EECA countries, except for the Balkan countries, that meet the Global Fund’s eligibility criteria and requirements for multi-country grants.
The Regional Dialogue is held from January 30 to February 23 in the form of an online survey, to which all interested organizations, groups and individuals are invited.
You can preview the online survey form by link. Please do not use this form to send your answears and comments, please fill out an online survey.
Please note that the survey contains questions that require response, and questions where answer is not necessary.

New members of the EHRA’s Steering Committee are elected

During the 15-29 January, 2018 Eurasian Harm Reduction Association (EHRA) conducted online Regional Meetings of it’s members to elect new Steering Committee representatives in the Baltic States, Belarus-Ukraine-Moldova, Central Asia, Central Europe, South-Eastern Europe regions. Quorum for the Regional meeting to elect new member needed no less than a half of the members from region and the new Steering Committee member became the person, who got the majority of the votes from voted members. So, how it was:

  1. Central Asia. In total the region has 42 official EHRA members, who were eligible to vote. From those 42 members – 31 participated in the meeting and cast the vote for their candidate, which means, that quorum was met, because 73,81% of members from the region participated in the elections of the SC member. In total 42 people participated in the meeting, but 11 votes were counted as not valid, because these persons were not eligible to vote (not official individual or organizational member of EHRA; don’t have an authorization from the leader of the organization). The results of voting:

– Oxana Ibragimova – 23 votes (74,20% of all valid votes)

– Sagyngali Yelkeyev – 4 votes (12,90% of all valid votes)

– Indira Kazieva – 4 votes (12,90% of all valid votes)

Oxana Ibragimova is elected for 3 years term as EHRA Steering Committee member representing the Central Asia region.

  1. Ukraine-Moldova-Belarus. In total the region has 60 official EHRA members, who were eligible to vote. From those 60 members – 33 participated in the meeting and cast the vote for their candidate, which means, that quorum was met, because 55,00% of members from the region participated in the elections of the SC member. In total 33 people participated in the meeting, 0 votes were counted as not valid. The results of voting:

– Vitalii Lavryk – 16 votes (48,49 % of all valid votes)

– Ala Iatco – 7 votes (21,21% of all valid votes)

– Liudmila Trukhan – 10 votes (30,30 % of all valid votes)

Vitalii Lavryk is elected for 3 years term as EHRA Steering Committee member representing the region of UKkraine-Moldova-Belarus.

  1. Baltics region. In total the region has 19 official EHRA members, who were eligible to vote. From those 19 members – 12 participated in the meeting and cast the vote for their candidate, which means, that quorum was met, because 63,16 % of members from the region participated in the elections of the SC member. In total 12 people participated in the meeting, 0 votes were counted as not valid. The results of voting:

– Jurgita Poškevičiūtė – 8 votes (66,67% of all valid votes)

– Elena Antonova – 4 votes (33,33% of all valid votes)

Jurgita Poškevičiūtė is elected for 3 years term as EHRA Steering Committee member representing Baltic countries region.


  1. South-Eastern Europe. In total the region has 21 official EHRA members, who were eligible to vote. From those 21 members – 15 participated in the meeting and cast the vote for their candidate, which means, that quorum was met, because 71,43 % of members from the region participated in the elections of the SC member. In total 26 people participated in the meeting, 11 votes were counted as not valid (not official individual or organizational member of EHRA; don’t have an authorization from the leader of the organization). The results of voting:

– Denis Dedajic – 4 votes (26,67% of all valid votes)

– Samir Ibisevic – 3 votes (20,00% of all valid votes)

– Eroll Shporta – 2 votes (13,33% of all valid votes)

– Yuliya Georgieva – 6 votes (40% of all valid votes)

Yuliya Georgieva is elected for 3 years term as EHRA Steering Committee member representing the South-Eastern Europe region.

  1. Central Europe. In total the region has 11 official EHRA members, who were eligible to vote. From those 11 members – 8 participated in the meeting and cast the vote for their candidate, which means, that quorum was met, because 72,73 % of members from the region participated in the elections of the SC member. In total 9 people participated in the meeting, 1 vote was counted as not valid (not official individual or organizational member of EHRA; don’t have an authorization from the leader of the organization). The results of voting:

– Janko Belin – 1 vote (12,5% of all valid votes)

– David Pešek – 7 votes (87,5% of all valid votes)

David Pešek is elected for 3 years term as EHRA Steering Committee member representing the South-Eastern Europe region.


Congratulations to the new elected Steering Committee members!

Human Rights Violations Of Women Who Use Drugs In Estonia Submitted To United Nations

Canadian HIV/AIDS Legal Network, the Estonian organization LUNEST and the Eurasian Harm Reduction Association (EHRA) submitted a report regarding the situation with the enjoyment of social rights among women who use drugs and/or living with HIV in Estonia to the UN Committee on Economic, Social and Cultural Rights (CESCR). The report was compiled based on a number of human rights violations in Estonia, identified during a research study conducted by a team of non-governmental organizations in 2017.

The aim of this submission is to request the Estonian Government to address the issues of health, parental, child protection and labor rights violations incurred by women who use drugs.

An opportunity to voice concerns

Established in 1985, CESCR is a UN human rights body consisting of 18 independent experts that monitor implementation of the International Covenant on Economic, Social and Cultural Rights by its States parties, which are obliged to submit regular reports to the Committee on how the rights are being implemented in their countries. The Committee’s rules allow for international, regional, and national organisations and human rights institutions to submit parallel reports with questions for governments in advance of the dialogue with the states.

“The submission of such reports is a unique opportunity for non-governmental organisations to directly participate in the monitoring of human rights violations in their countries and bring these violations to the attention of UN bodies. We hope that based on our report on women who use drugs in Estonia, CESCR will include these issues into the list of questions for the Estonian Government,” Mikhail Golichenko of Canadian HIV/AIDS Legal Network explains the importance of the submission. “If we succeed and our concerns are included, the Estonian State representatives will be expected to submit replies and explanations to them. Thus, the voices of people who use drugs will be heard and, hopefully, the violations of their rights will be addressed and solved.”

Pre-sessional Working Group Session, during which CESCR will present the Estonian Government with the list of questions will take place in Geneva, on 3-6 April this year. The final report from Estonia will be presented to the Committee at a later stage.

Why Estonia?

Despite rather good overall human rights record in Estonia, people who use drugs still experience discrimination and stigmatisation from a number of state institutions, such as the police, child protection, and public health services. According to the European Drug Report 2017, Estonia has the highest number of mortalities from overdose in Europe (103 deaths per million) and one of the highest number of HIV prevalece attributed to injecting drug use (41.9 cases per million).

“The report to the CESCR means that Estonia, which has shown good progress in terms of providing access to HIV prevention and treatment, if compared to its neighbouring states, still has a long way to go to eliminate systematic violations of human rights against its most vulnerable population groups. What we have learned during our research of women who use drugs last year was unexpected and shocking. The recorded numbers of the misuse of power, arbitrary detentions and deprivation of parental rights is a worrying sign that even such countries as Estonia, which has been long considered as one of the most-developed post-Soviet countries, violate the rights of people who use drugs” Dasha Matyushina-Ocheret, Policy Reform Advisor at EHRA states the reasons behind the report. “We truly hope, that through an open dialogue and cooperation with local and international non-governmental ogranisations, the Estonian authorities will ensure that the rights of vulnerable groups, such as women who use drugs, are respected and protected.”

Draft briefing paper, which served as a basis for the parallel report to CESCR, was conducted in Tallinn, the capital of Estonia, and Northeastern Ida-Virumaa county, were 38 in-depth interviews with women who use drugs were taken and later analysed. Apart from violations of parental rights, non-protection against gender-based violence, labor, health and child rights violations, the study has also found that the respondents lack access to legal and social support services, there are insufficient gender-sensitive services for women who use drugs, including quality opioid substitution treatment and rehabilitation. The study was conducted by Canadian HIV/AIDS Legal Network, the Eurasian Harm Reduction Association and the Estonian organisation LUNEST.

Invitation to participate in the tender for the selection of photographers. Deadline extended.

Eurasian Harm Reduction Association (further EHRA) announces a tender for the selection of photographers for a long-term cooperation with EHRA in Lithuania.

Based on the results of the tender, EHRA will select several photographers, with whom EHRA will conclude long-term contracts.

More information about the Association and specifics of the work you can find on our website http://harmreductioneurasia.org

Type and subject of the tender:

As part of its work, EHRA requires quality, professional photos to fill the site’s content, groups in social networks, to use it in promotional materials (presentations, stands, guides, methodologies, articles, blogs, interviews, project implementation reports to partners and donors).

As a result of the tender, photographers with the highest amount of points will be chosen. Description of work:

– photography (conferences, meetings, round tables, trainings, seminars, etc.; portrait and group photo sessions of the EHRA team); photo processing.

Requirements to participants of the tender/evaluation criteria:

Essential requirement for the participants:

– place of residence – Lithuania;

– knowledge of Russian or English languages (Intermediate level B1 – minimum);

– work experience as a professional photographer at least 3 years;

– tolerance to vulnerable groups of people.

General requirements:

To assess the tender applications, the following criteria will be used (maximum amount of points for each criterion):

Participants must submit:

  1. CV in a free format, which should include:
  • previous work experience as a professional photographer;
  • indication of the cost of services: photography/ photo processing in EURO (1 hour/1 photo).

2 A link to the portfolio of your work (At least 10 examples).

3 Copies of diplomas and certificates.

ATTENTION! If these documents are not provided in full, such application in not considered for evaluation.

Application deadline – 1 p.m., February 05, 2018, Vilnius local time. Please send your documents to Yuliia Holub at julia@harmreductioneurasia.org

Special conditions:

Upon the completion of the tender procedures, EHRA will sign long-term contracts with the selected number of winners on a fixed cost of services per unit basis in EURO (one hour of photography and photo processing of one photo). Further work will be carried out based on the needs of EHRA and according to the timeline and other conditions, which will be decided upon in each individual case.

The submission of documents for participation in the tender does not impose on EHRA any additional obligation to conclude a contract.

Deadline Extended: AIDS 2018 Abstract Support




Amsterdam Youth Force, Eurasian Harm Reduction Association (EHRA) and AFEW International invite applicants from Eastern Europe and Central Asia region (EECA) to submit drafts abstracts for XXII International AIDS Conference 2018 in Amsterdam (AIDS2018) to board panel of experts for review. The deadline is extended until 25th January 2018.

We would like to invite Eastern European and Central Asian (EECA) researchers, clinicians, scientists, community activists and young people to submit their abstracts to our EECA AIDS2018 Abstract Support team. Boosting the representation of academics in this region is important as this is the only region in the world where the epidemic is still growing. To increase the chances to present their work at the conference for researchers, clinicians, community activists and young people from EECA who may have less experience in writing scientific abstracts in English, we will be facilitating scientific and English language assistance. We will link you to a researcher or a professional in your field which can provide you with scientific feedback on how to improve the quality of your abstract. To specifically support young researchers and community activists, we also offer a feedback session via Skype to discuss the suggested changes to your work.

If this sounds like something you could benefit from, please read further about the eligibility criteria and review process.

Eligibility Criteria

You can submit your abstract to aids2018@afew.nl for a professional review if you are:

  • A (young) researcher, scientists, clinician, community activist or representative of community based organization or NGO; and
  • Planning to submit an abstract to 22nd International AIDS Conference 2018 in Amsterdam, 23-27 July 2018 (AIDS2018); and
  • Working in one of the following countries: Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan;

The review process:

  • We will be accepting submissions from the 1st of December 2017 until the 25th of January 2018 in both English and Russian languages. The feedback to the submitted draft abstracts will be provided in one round. The panelists will provide in-depth feedback on the initial content, as well as suggestions for improvement.
  • If you want to receive language support – translation into English or English editing, you have to submit our abstract before 21st Limited translation and editing services will occur between the 22 January and 2 February 2018.

For the abstract submissions written in English, you will receive feedback on the scientific quality of work, and the limited number of abstracts will get assistance with English editing.

After you have finalized your abstract based on the received feedback, you can send it to us again with the email title «Need language assistance».

  • Due to the limited capacity of the panelists, in total up to 110 abstracts will be able to receive feedback. Therefore, the rule “first come – first served” will apply. First 110 abstracts submitted from eligible applicants will be forwarded to a relevant panelist based on his/her expertise and academical background, for feedback and in some cases for personal communication.

Please send your abstract in Word format, include a brief letter of motivation, which scientific track you will be submitting to and details about yourself including your age if you would like to apply as a young researcher or community activist.

Below you will find links to materials on how to write conference abstracts, available in English and Russian.

Requirement to abstracts:

  • The abstract should be written in accordance with the official requirements of the AIDS Conference.
  • The draft abstract should be written in Russian or English.
  • The content of the abstract should be in line with one of the conference scientific tracks. The scientific track must be specified under the heading of the abstract.
  • There is a maximum of two abstracts per applicant.
  • Those applicants who want to receive language support either the translation into Russian, or editing of the English abstract, will have to submit a short motivation letter to explain why they need such support.


AFEW International, EHRA and Amsterdam Youth Force form a Steering Committee and the secretariat of the EECA Abstract support project. Only people designated to serve within Steering Committee and the secretariat and the reviewers assigned to each abstract will have access to the abstract submissions as well as the contact details of the applicants. We will not release any information on who has received assistance for their submissions at any point unless we have consent to do so.

Useful resources

  1. Abstract writing module available in Russian and English

An Abstract writing module is developed in collaboration with the International AIDS Society (IAS) – the organizer of the AIDS conferences, and written by editors of the Journal of the International AIDS Society, an open-access platform for essential and innovative HIV/AIDS research. It is available for everybody in English and translated into Russian by AFEW International.

  1. Online training on abstract writing

AFEW International has conducted a training on community based participatory research and abstract writing. This training was steamed live and records as well as hand outs and presentations are available in Russian here:

Abstract writing: structure, review criteria, submission tips

Good abstract title

On the road to AIDS2018: practical guide

Presentations and handouts (downloadable, please scroll down)

If you want to receive English presentations and handouts, please refer to the email address below.

  1. Tips and trick on how to write a good abstract.

AIDS2018: Preparing for registration and submitting abstracts. An Article was written by a young researchers Anna Tokar, in Russian is available here, and in English here

You can follow us on http://www.afew.org/aids2018eeca/ and https://www.facebook.com/AFEWInternational/ for all the updates on the available recourses and opportunities.

Harm Reduction Beyond Numbers

Author: Péter Sárosi, Drugreporter

How cultural attitudes, the political environment, and donor expectations shape harm reduction – and how they can divert it from its original mission as a movement.

We have been producing movies about drug policies since 2007. Through all these years, we have been traveling a lot across the world, visiting harm reduction sites and interviewing hundreds of harm reduction activists, professionals, and decision makers in various countries.

It is easy to make premature judgments about harm reduction in a country. I always have my own preconception about it before actually traveling there, based on articles and reports I have read. Most of the time, I have to admit that the reality is much more complex than my expectations. My experience tells me that sometimes countries labelled as retrograde in terms of drug policy and harm reduction can amaze you with vivid, vibrant local harm reduction scenes. And countries praised for their progressive drug policies can equally disappoint you with their rigid, medicalised systems.

Sometimes you learn the most cutting edge lessons about harm reduction and human rights among the people living in disadvantaged countries. A mistake often made is that the experience of these people is underestimated, and only success stories are highlighted and celebrated by reports from international organisations. Exchanging experiences and knowledge among decision makers and harm reduction professionals working in similar, difficult environments is often as useful as presenting best practices from Western countries. Lack of measurable success in changing policies is not necessarily a sign of the failure of advocacy efforts.

Harm reduction is of the people, for the people, and by the people. Assessing scientific data about trends of infections or access to services is necessary when measuring the social impact of harm reduction as a set of interventions. But statistical data in itself is far from sufficient to have a real insight into how harm reduction works as a movement, how is it embedded into the local political and cultural context, and how it affects the lives of individuals and communities.

We can identify some main factors shaping and framing harm reduction. These structural factors are actually not so different from those shaping the individual drug experience. Since the 1960s it has been a commonly accepted wisdom that the drug experience depends on three factors: set (the mindset of the drug user), setting (the physical and social environment), and dose (of the substance used). Similarly, three factors can largely determine harm reduction in a country:

1) Cultural environment – Social attitudes to drug use, historical development of the drug treatment system, education and attitudes of public health and social professionals, the influence of abstinence-culture, and the role of religion and church.

2) Political environment – State of democracy, freedom of association & power of civil society, type of government, the state of development of the welfare state, drug laws, law enforcement practices, public health regulations, and the external influence of neighbouring countries.

3) Funding environment – Who is funding harm reduction, what is the framework of the funding, what are the donors’ expectations about supported activities, how the money is distributed.

Western European cities are the best propagated examples of how we can reverse drug related death and disease by investing in harm reduction. Services are well funded by the government, well connected, and coordinated to municipal health, social and criminal justice systems. The political and cultural environment is tolerant or supportive. However, city leaders often embraced harm reduction from a cosmetic point of view: to get rid of street nuisance and bad press coverage. In developed countries high-tech, well-funded services often work without real mobilisation and involvement from drug user communities. The best services are sometimes not only the well funded services – but those operated by NGOs investing a lot of time and energy into advocacy, community mobilising, and peer involvement.

Harm reduction has been mainstreamed in much of Western Europe. It is business as usual, operated by technocrats or public health officials paid by the government, working according to official standards. If you attend a harm reduction conference in Europe you will meet social workers, public health pundits, and law enforcement officials discussing research findings, grant systems, and professional protocols. The contrast is stark if you attend a harm reduction conference in the US, where harm reduction is still an underground movement challenging the status quo of the mainstream abstinence culture and tough-on-drugs policies. Funding is unstable, whilst federal funding for needle exchange was banned until recently. You will see way more rebels and punks at these events who discuss social justice and structural racism. While harm reduction is – sometimes grudgingly – accepted by even social conservatives in Western Europe, it is more like a Leftish guerrilla movement in the US, driven by drug user activists and radical social workers. The opiate overdose epidemic has been recently helping harm reduction become part of the mainstream – at a terrible cost in human lives and suffering.

In most Eastern European and Asian countries you often see broken down hospitals, burnt out and underpaid health professionals, and understaffed and under-equipped services. HIV infection and overdose death rates can be rampant. Criminal laws are repressive. Drug users are often coerced into so-called treatment programs. In this hostile environment, harm reduction could only lay down roots with the help of international donors, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Its positive impact is tremendous in reducing new infections and scaling up HIV treatment and prevention among the so-called key populations. Without the support of the Global Fund, these communities would have no voice and no future.

However, harm reduction dependent mostly on international donors is like a plant nurtured indoors by artificial light, with no deep roots in the cultural and political soil of the hosting society. Whilst the funding environment is favourable it may flourish. But as soon as it is deprived from international support and is exposed to the harsh outdoor environment, its fragility will be revealed. This happened when the Global Fund changed its funding policy after the financial crisis and many countries lost their eligibility. This resulted in the sudden collapse of many community-based harm reduction services and the further marginalisation of injecting drug users. Many people died as a consequence. Service providers tend to follow the flow of the money. Many abandoned harm reduction services and chose a different survival strategy. It soon appeared that by only focusing on funding services without investment into public education and community advocacy, international donors could not make harm reduction sustainable.

Donors do not only fund and shape harm reduction – they can also distort it.

For example, they often put harm reduction in the framework of HIV prevention and thus into the realm of public health interventions. National donors often subordinate harm reduction to treatment and prevention. These reductionist interpretations of harm reduction as a set of public health interventions are devoid of many other important dimensions of psychoactive substance use. For example, the social dimensions of poverty, exclusion, institutional racism and segregation, homelessness, and unemployment. Or the legal-political dimension of repressive criminal laws that are pushing substances and people who use them underground. To address these systemic factors harm reduction must go beyond public health interventions and mobilise marginalised communities against repressive and exclusive government policies and laws. Criminal justice reform must be an essential part of harm reduction – but it has not been on the agenda of many harm reduction organisations.

Second, putting harm reduction into the context of HIV prevention reduces its focus to only injecting drug use. While injecting drug users are far more marginalised than any other groups of drug users, harm reduction as a philosophy and practice must go beyond injecting use and transform the way we perceive drug use in general. It should include pragmatic and compassionate programs to reduce the harm of recreational drug use as well, for example in a party setting – even if it has nothing to do with HIV prevention directly. The vast majority of drug users are non-injecting recreational drug users, reaching them is not only important to avoid accidents, but can do a lot to promote the acceptance of harm reduction as a guiding principle among the general population. In countries where harm reduction is dependent on Global Fund, programs supporting party-going young people are underfunded and scarce. When streets were swamped with new psychoactive drugs, and new patterns of drug use and distribution started to trend among young people, programs designed to serve opiate injectors could not cope with these problems.

Third, big donors shape their grantees in their own image. It is very easy for NGOs competing for limited resources to lose sight of their mission and to follow the expectations of the donors in order to secure funding. But donor expectations about ideas, supported activities, regions and groups do not shape how NGOs and community groups work alone. To apply for grants, to manage grants, and to report to the donors requires huge investment in time and human resources. The bureaucratic processes required by donors change the perception of time, staff, services – and in the end, the mission of the organisation. Many grantees realise that for the donor it is not the real social impact that matters but organisational stability in managing and reporting grants. Community activists often transform into technocrats who lose the connection to the communities they serve. When activists speak a language full of jargon and acronyms only the selected few understand, their arguments do not appeal to the general public or to hostile neighbourhoods.

National and international donors must learn the lesson and invest more into community organising, public education, and advocacy to change social attitudes and policies about people who use drugs. Without transforming the set and setting, that is, the cultural and the political environment, harm reduction is vulnerable and cannot adapt to new challenges. Where harm reduction is not well embedded into and accepted by society, and not well connected to the community, sudden changes in the political environment can lead to collapsing services even in countries where national funding for services is available, as exemplified by my own country, Hungary.

Rigid rules by international donors about governance and co-funding favour big organisations based in wealthy countries over community activists living and working in repressive environments. These rigid rules do not guarantee the social impact of grants. Investment into people rather than just organisations, services, and projects can do. Sometimes the best ideas and initiatives come from grassroots activists and community groups without well established governance structures. Instead of requiring grantees to transform into grant processing companies, obsessed with Western-type management methods completely alien from community activists working on the ground, new flexible rules and modes of funding should be developed. Forging synergies among social movements is also important – they cannot win in isolation. They can learn a lot from each other about innovative advocacy methods to mainstream their messages. Only together they can fight austerity measures, rising right-wing populism, and the new authoritarian crackdown on civil society. In the end, the success of harm reduction as a movement depends on the larger context of social justice movements, the state of democracy, and the existence of a strong civil society.

Source: Drugreporter

Healthcare for people who use drugs in Europe

Author: Yuliia Holub

Today and tomorrow, EHRA representatives work actively as the members of core group of EU HIV/AIDS, Hepatitis and Tuberculosis Civil Society Forum (CSF) in Luxembourg and during the plenary meeting.

CSF (on European level) is a providing platform for mutual learning and strategic thinking to improve policies and their implementation by stimulating the exchange of knowledge and knowhow between CSF members and the European Commission. What’s more, it helps in strengthening the advocacy for the rights of the key communities living or affected by these infections by addressing short-comings in the response to the epidemics, sharing knowledge and consensus building on standards to address critical and sensitive issues and contributing to European level policy and program development.

At the meeting, and in the work of the CSF for the next 6 months, for EHRA it is important to ensure effective joint advocacy for sustainable funding of harm reduction services in European countries, members of EU as well as candidates and neighbouring countries. In the situation when on EU level the general approach is “health is member state competence”, there are not enough opportunities for the regional advocacy exist. But we want to be sure, that we did everything to influence governments of European countries to make HIV, TB and hep C services available for people, who use drugs and other vulnerable groups.

Pilot OST Programs in Kazakhstan – How to Avoid Being Thrown Overboard

Author: Dasha Matyushina, Drug Policy and Human Rights Advisor, EHRA

In my almost twenty years of working in harm reduction I have visited many opioid substitution therapy sites in different countries. One of the first programs I was lucky to see was an OST site in New York. A likeable doctor was enthusiastically telling me about his patients – some of them were allowed to collect a two-week methadone supply because “they worked so hard and could not spare the time to come for therapy more often”. That very week I happened to visit another OST site in New York. I saw a huge queue to an armoured window where methadone was dispensed and a uniformed man with arms at the ready standing behind the queuing people. I just could not grasp the existence of two such absolutely different sites in one city.

Since then I have seen dozens of OST sites and talked to hundreds of their clients. The sites were more or less different but the talks I had all seemed an extension to my very first conversation with a girl client of a New York OST site from so long ago. I came from Russia, the country where OST was non-existent at the time, where people could only hope it would be available at some point, so it was really weird to hear people complaining – like, “I am a regular here but sick of this bloody methadone, no adequate care here, the drug quality is not as it used to be, the opening times suck and they don´t treat us as human beings here”…So I no longer idealized those programs and saw not only their value but also the restrictions they impose on people with opioid addictions.

On my way to Pavlodar I did not expect to see an exemplary OST site – I am aware of the challenges such programs face in Kazakhstan and how hard it was to open and keep sustaining OST sites there. I also know what a „pilot OST site“ really means: minimum clients, maximum rules.

Oxana from the Foundation “Ty ne odin” (“You are not Alone”) and I came to an opioid substitution therapy site at 9 o´clock in the morning.  There was a constant flow of people, some stopped to chat with me at the entrance, some passed by with a nod to an acquaintance and paid me no attention, some went away and came back with a coffee. There were too many names to remember. At some point there were only about ten of us left – men and women of different ages, some were with kids in buggies, some people were in wheelchairs themselves. They were talking about how much their lives had changed with the introduction of OST. They were sharing their problems – impossible to go visit people in other cities, hospitals still did not have methadone on stock and one had to come here by taxi practically from intensive care to get some. However, that conversation was different from everything I had heard from hundreds of other OST clients before.  These people were absolutely convinced of the necessity of this site, they were in dire need of it and ready to fight for it at all cost. They, the patients, were defending their doctors, explaining to me how vulnerable health care workers were in the face of all sorts of monitoring raids. They knew the OST program inside out – what funding sources covered which costs and which options they would have if the Global Fund withdrew the funding. They know everything because it is their program.

Pavlodar OST site is on the ground floor of the local narcology clinic and occupies a tiny room with a small anteroom with benches for clients to sit and chat. It´s a multi-storied building, the rest of it, as I am told, belongs to an in-patient facility for compulsory treatment. There are about seventy OST clients. Methadone doses are high – 70, 80, 100 mg and more. The same room is used for HIV and TB patients who come for ART and TB treatment. Almost all of the clients either work or study. Most of them have families.

The clients say that not a single program participant “gets extra high” – that would be a breach of the rules and several such slips result in exclusion from the program. The frequent checkups prove – the people on therapy have indeed stopped using street drugs. I must say it is very impressive – the hard proof that OST works towards full abstinence. But what happens to those clients who could not for one reason or another stop using drugs completely or resumed their consumption? If they are excluded from the OST program, do they have a chance to continue on ART or TB treatment? If OST did not succeed in helping them, does it mean they are simply thrown “overboard”, again?

The Pavlodar OST program as well as most other OST programs in EECA and in many other parts of the world is a high threshold program.  This means strict admission criteria – one should prove that other addiction therapies failed to work for them many times, bring official confirmation of being infected/non-infected by HIV, hepatitis etc. This means frequent and unannounced urine tests for presence of drugs – and if they prove positive the clients will either be forced to attend additional therapies aimed to stop their drug consumption altogether (this is what they do in the USA and Canada) or they are excluded from the program for “breaking the rules”.

Clients who „break the rules“ may be facing serious, overwhelming problems such as depression, home violence, a life crisis, bad social factors. Such people should have access to low threshold OST programs, so they can go on receiving methadone, ART and TB therapy. Such programs are increasingly popular in Canada, they put forward fewer demands „on admission“, there is no queuing and no waiting lists, more tolerance to relapses. Testing for drugs is done less frequently and the clients are informed beforehand. If the client is found using drugs, no reprisals follow. And such programs that do not aim to stop people from consuming drugs help saving lives, too – and to improve the quality of life as well. A recent Canadian study showed that despite the absence of sanctions in such low threshold programs one sees a steady decline in the usage of street opioids  and stimulants. The clients feel supported and see they can be accepted as they are today. Their social environment is gradually changing, bringing changes in their lives as well.

There are no low threshold programs in Kazakhstan to date. They may come. However, the number one priority at the moment is to keep what we already have, which means to get the state allocate funding to the existing high threshold programs. Otherwise hundreds of people and their families will be thrown overboard.