Educational podcasts to support work of paralegals are on air

To support the work of paralegals and guide them through algorithm of basic legal support provision to key populations in access to HIV services, EHRA jointly with HIV Legal Network have developed a series of podcasts. The key topics of podcasts: HIV cascade and human rights, instruments of paralegals, 7 steps in paralegals’ work, and peculiarities of work with different key populations groups.

The podcasts are available at EHRA educational platform in section of educational materials for paralegals in Russian (for access please register).

The podcasts were produced by EHRA within the project “Overcoming legal barriers for key populations – on the way to 90-90-90” funded by the Elton John AIDS Foundation. The project is aimed at improvement of the effectiveness of HIV continuum of care by overcoming legal barriers for the most vulnerable key populations in selected cities of Georgia, Kazakhstan and Moldova.

 

HERE you can find other EHRA’s educational materials on  protection of human rights and learn about our work n this field.

EXTENDED: Call for Consultancy to analyze the changes in the harm reduction packages and unit costs during transition from international to domestic funding in Ukraine, Moldova, North Macedonia and Kyrgyzstan

The Eurasian Harm Reduction Association is seeking a short-term national consultancy in Ukraine, Moldova, North Macedonia and Kyrgyzstan to analyze the changes in the harm reduction packages and unit costs during transition from international to domestic funding.

Background Information

Despite commitment by governments to continue HIV prevention among key groups, transition has significantly weakened community systems and interrupted services. Available packages and quality of harm reduction services are decreasing even if services are supported. Lack of political support for harm reduction, not only as an HIV prevention measure but as a social service, is one of the main obstacles to sustainable and sufficient funding for quality programmes.[1]

Since harm reduction (HR) programs have been first introduced in the countries the package of provided services changed and varies from country to country. Ukraine, Moldova, North Macedonia and Kyrgyzstan recently started funding the HR services from domestic resources through social-contracting and public procurement.

EHRA is looking for national consultants in Ukraine, Moldova, North Macedonia and Kyrgyzstan to analyze the changes in the harm reduction packages and unit costs during transition from international to government funding.

Objectives of the consultancy:

  • Analyze changes in unit cost per client, list/package of services since HR services were introduced in the country using secondary data (applications to the Global Fund to Fight AIDS, Tuberculosis and Malaria, budgets or target setting in national documents, national AIDS response strategies, standards/packages of services and/or national unit costs calculations, state procurement tenders and contracts with service providers);
  • Describe the rationale behind the changes in the package and/or unit costs (interviews with 2-3 key national informants involved in decision-making process)
  • Analyze the impact of occurred changes in unit costs and package of HR services on services provision, quality of provided services and client satisfaction with them ( interviews with services providers and community representatives/clients from different cities of the country).

Steps of the consultancy:

  1. Secondary data analysis
  2. Development of questionnaires in consultation with EHRA and national consultants from other 3 countries
  3. Interviews with key informants (the list of informants should be approved by EHRA)
  • 2-3 with national stakeholders involved indecision-making process regarding unit costs, standards and packages of services
  • 5 with harm reduction services providers from different cities of the country
  • 10 with clients of opioid substitution and needle and syringe programs
  1. Prepare draft analytical report based on the collected data
  2. Finalize the report based on EHRA’s feedback

Expected results of the consultancy:

  • Analytical report in Russian or English (up to 30 pages) on how the transition process affects harm reduction packages, unit costs and quality of provided services.
  • Suggested recommendations for donors and governments based on the analyzed data and interviews with key informants
  • Translation of the report into the national language

Proposed timeline: All tasks should be completed by May 31, 2021.

This call for proposals is organized within the  “Thinking outside the box: overcoming challenges in community advocacy for sustainable and high-quality HIV services” project of the Eurasian Regional Consortium financed by the Robert Carr civil society Networks Fund (RCF).

The Eurasian Regional Consortium joins the efforts of Eurasian Coalition on Health, Rights, Gender and Sexual Diversity (ECOM), Eurasian Women’s AIDS Network (EWNA) and Eurasian Harm Reduction Association (EHRA) to effectively address the lack of financial sustainability in prevention, treatment, care and support programs for the key populations vulnerable in terms of their rights violation and the risk of HIV.

Selection criteria:

The submitted applications will be evaluated by the selection committee of the Eurasian Harm Reduction Association. The following criteria will be used to evaluate the bids (the maximum possible number of points is 100):

  • Knowledge and understanding of GF funding and national procurement procedures (25 points)
  • Clear understanding of situation with harm reduction funding in the country (25 points)
  • Relevant work experience (analytical reports) (20 points)
  • Established connections with service providers (15 points)
  • Experience in monitoring and evaluation (10 points)
  • Fluent Russian or English (5 points)

EHRA will consider for the contract only applicants that scored at least 80 points out of 100.

This announcement shall not be construed as a contract or a commitment of any kind. This request for proposals in no way obligates EHRA to award a contract, nor does it commit EHRA to pay any cost incurred in the preparation and submission of the proposals.

Terms of payment and other conditions same as a final timeline will be indicated in the agreement which EHRA will sign with the winner.

How to apply

Applicants must submit the following documents to maria@harmreductioneurasia.org, the subject of the letter is “Call UC”,the deadline for submission is before 24:00 EET on March 24, 2021:

  1. CV
  2. Letter of interest with suggested consultancy fee (USD) and number of working days (8 hours/day)
  3. List of potential respondents from organizations providing harm reduction services

[1] https://www.hri.global/files/2020/10/26/Global_State_HRI_2020_2_2_Eurasia_FA_WEB.pdf

Drug policy and harm reduction in Southeast and Central Europe

Have there been any significant developments in the region of Central and Southeast Europe since 2018? Any scale-back or scale-up of harm reduction services? 

There are some improvements in some countries, for example, in Serbia, Montenegro and Macedonia. Although governments still allocate very small budgets for harm reduction, at least they are becoming more open, willing to cooperate with the civil society and end this terrible situation after the Global Fund funding ended and other programs collapsed.

There is a new outreach program in Belgrade. The Bosnian government seems to be open to give funding for harm reduction; some money was allocated in Montenegro. The financing in Bulgaria that was stopped due to some bureaucratic problem related to the funding criteria introduced by the government has been resolved to a certain extent now, and the needle exchange program operates again in Sofia, and a new drop-in centre was also opened, which was later closed down.

There is still a shortage of opiate substitution medications in Romania, and the Ministry of Health is very inactive to solve this. Thankfully, there are still available programs even amid the coronavirus pandemic. Organization Carusel has made some significant improvements and recently opened a new shelter.

No real improvements happened in Hungary, apart from a new mobile outreach program in Budapest, called HepaGo, which reaches those areas where needle exchange programs were shut down in 2014. The only problem is that it is financed with international money, which makes it fragile; it’s not sustainable without money from the state. Injecting drug use in Budapest is decreasing, probably because people are switching to smoking synthetic cannabinoids.

More and more people use new psychoactive substances in other Eastern and Central European countries: some of them as the main drug, and some in combination with other substances. I think it is a very significant change for care systems because most of them were primarily constructed to get opiate users into substitution programs. But how do you deal with the treatment of new substances’ users? I’ve heard that rehab programs don’t work for them as well as with opiate users. We probably need to explore these short-term interventions for these users, who are sometimes much younger than heroin users. People still need help, but they need some different approaches.

You said that some governments had become more open to harm reduction. What has changed to make them do that? 

I think the fact that they sit down at the negotiating table is already a good sign. In Belgrade, we presented a study about the clients of a closed needle and syringe program, and the feedback from the government was very positive, they are now more friendly to the civil society and speak with them more actively. They still can’t offer much, but at least they have some budget for harm reduction programs. In most cases, I think this change happens because of the pressure and advocacy by the civil society. But these bureaucratic machines are very slow. After years of advocacy, it gets to the stage when the implementation of programs is in the hands of decision-makers. A few years ago, we formed the Drug Policy Network South East Europe, and it took us two more years until ministries started implementing real measures. 

Are these measures mainly related to the “old harm reduction”, or do they also involve new services, like drug checking or drug consumption rooms? 

Some organisations in Eastern and Central Europe started doing drug checking in nightlife settings and during festivals. In Western Europe, however, liquid chromatography machines are now used in festivals. I think many organisations in our region could also afford them. The real barriers are not financial. Money could be collected through fundraising or crowdsourcing campaigns. There are a lot of wealthy middle-class people going to these festivals. It’s not a big deal to raise the money. I think that the real problems are legal barriers and police practices.

Are these the same barriers for introducing new harm reduction approaches in general? To open drug consumption rooms or change service packages in harm reduction settings? 

In an environment where you don’t even have resources to operate traditional harm reduction services, like needle and syringe programs or opiate substitution, you don’t have funding for anything else. It requires stable, sustainable funding from the government to run these programs. It’s not something you can just start and see what happens. The second issue is the attitude of governments. They don’t want to risk this kind of public controversy. Even in the progressive Czech Republic, conflicts arise with residents who oppose needle and syringe programs. It’s a kind of political risk for leaders in our societies with a lot of conservative-minded people to introduce an innovative program.

You said that because people don’t inject so much, they need different harm reduction. What do you think prevents the existing services from changing their packages?

They are changing. At least in Hungary, they are changing. For example, if there is less demand for needles, they will distribute some other things. At the moment, these are COVID-specific things, like masks, gloves, disinfectants. There is also a demand for social help. Many people are still living with Hepatitis C, and they need help to get into treatment. That’s why we called our new project HepaGo. People who injected drugs before didn’t have access to treatment. This is what this project helps to achieve in collaboration with hepatology doctors.

Psychologists’ help is essential in the case of new psychoactive substances because of psychosis, aggressive behaviour associated with them. Also, most of these people live on the street, and they face a lot of social issues. We should realise that harm reduction is not only about HIV and hepatitis C, but it’s about different kinds of help to people who live on the margins. They need other types of support as well, like helping them to find housing and normalise their social relationships.

You said that some new networks had been formed in the Southern subregion. What kind of networks?

I had in mind the Drug Policy Network South East Europe. They organise conferences for regional harm reduction actors, provide help on the country level, publish reports. It would be useful if people from this and other networks, like the Eurasian Harm Reduction Association, could visit countries to sit down with local politicians, bureaucrats, researchers and civil society. This would provide local NGOs with an opportunity to talk to governments and set agendas. Such a model would be useful in the future after the pandemic is over.

What is the civil society’s role, and what do they advocate for in different countries? 

Budget is still the main issue. It’s a year to year survival for programs, which limits the scope of advocacy because you have to fight for the very resources that enable you to operate. You don’t really have the capacity, energy and staff to fight for other things. The funding for harm reduction in the region is unstable. That is also one of the reasons we don’t have enough innovations or don’t open drug consumption rooms or implement naloxone programs. Governments primarily aim at banning substances and don’t care about providing support to drug users. And I see a lot of uncertainty among service providers in light of these changes in the drug market. The readily available harm reduction models that used to work are not enough.

Who funds the services? Are there governments or other international donors besides the Global Fund that do this in the region?

Most of the funding comes from national or local governments. I don’t know any significant international financing of services coming to the region right now. I know organisations that have conducted successful fundraising or crowdsourcing campaigns. The new drop-in centre in Sofia was opened with the fundraised money. I also know organisations in Hungary that work with marginalised Roma people, not only drug users, who have led some successful crowdsourcing campaigns. It is not a lot of money, not enough to run organisations, especially if they provide lifesaving, public health and social services that the government should fund. Crowdsourcing opportunities won’t substitute the stability of government funding.

Do any organizations advocate for the decriminalization of drug possession, drug use or the human rights of people who use drugs?

There are not that many. There was a decriminalization campaign in Lithuania in 2017, but I don’t remember any others. You need to have liberal or socialist governments to have a successful campaign in this area. I don’t see any countries now where anybody could say that there is at least a 50 per cent chance to lead a successful advocacy campaign in the fields you mention.

But it doesn’t mean you shouldn’t do it.

You are right; it doesn’t. It doesn’t mean that you should not deal with criminal justice and criminalisation of people, because these are critical issues. I see efforts being made to add alternatives to incarceration systems. In Poland, for example, they are talking about more alternatives and also how to link the criminal justice system to the treatment system.

Would you agree that most organisations in the region primarily work on the provision of services and funding, but not drug policy and advocacy? 

I think some organisations do advocacy on top of providing services, and some don’t even understand why advocacy is crucial in the first place. What they do is not always advocacy—they try to make some behind-the-scenes pacts with governments. Only very few organisations, maybe one third, are brave enough to organise campaigns like Support don’t Punish on the 26 of June. Even when they do, it’s sometimes very weak. In general, advocacy is very weak in the region. Only very few organisations do real advocacy; and mostly on funding and services. They don’t want to take the risk of being political to talk about criminalisation. Harm reduction services are much easier for people to swallow than decriminalisation. It’s not easy for many in the government to understand that these people need help; they should not be punished in the first place. We don’t see much of this attitude in the region.

You said that organisations must be brave to do advocacy. What kind of consequences could they face? Will they lose funding if they speak about decriminalisation, or is there more to it?

That’s the main fear. Most of these organisations are very much dependent on government funding, and they are afraid to lose it. I wouldn’t say that this fear is unfounded in the environment of very scarce resources. Governments tend to support organisations that they find more manageable and conforming to their expectations. That’s why there is a need for bravery to speak up for decriminalisation. You can be labelled a “political civil society”, which in some countries like mine, are called “Soros agents” [the Hungarian-born American billionaire philanthropist George Soros finances many liberal and progressive causes] or be accused of wanting to legalise drugs. I think many service providers want to avoid being labelled as a radical organisation.

But harm reduction is mentioned in policy documents and is featured in national health packages.

Many national drug strategies do mention harm reduction. Some countries mention surprisingly progressive things, for example, in some Balkan countries. I’ve heard that some national drug strategies there have been copy-pasted from EU documents. But it doesn’t mean, of course, that these documents are implemented, despite all these references, existing mechanisms for funding or alternatives to incarceration. They are simply not used. Or if they are, not on the full scale. It is not a priority for governments.

But why do they have all these policies but don’t implement them? 

I think it’s a kind of nature of policymaking: it’s much easier to adopt guidelines and recommendations than implement them. Governments can claim success by issuing a new rule or strategy, tick the box of having a national drug strategy in the form of a comprehensive, balanced document. They can tell the media and people, “We are working on a drug policy, we have a strategy”. But they are not so eager when it comes to allocating resources for their implementation. Monitoring and evaluation are also missing in most countries. In Hungary, four organisations working in rehabilitation, treatment, prevention and harm reduction, united in the Civil Society Forum on Drugs. We did an independent civil society evaluation of the implementation of our national drug strategy and produced a report based on focus group research and interviews with service providers. But governments don’t make any efforts to evaluate their policies.  

Could you identify any good advocacy efforts in the subregion? Also, what do you think works when you speak to governments? 

What works very much depends on the attitude of each particular government. For example, Poland has a very conservative government, but at least they have the National Drug Agency, which kind of counterbalances these conservative tendencies, and they can maintain support for harm reduction programs and civil society. The conferences on drug policies that the Polish Drug Policy Network organised in the previous years in different cities was a beneficial civil society initiative to show that drug policy is not only about national governments. Some issues could be solved on the local level. They also trained a lot of municipal authorities and professionals.

Super conservative governments now rule in many countries, but there are liberal city mayors. When the national government is inaccessible, we can go to city authorities. We have been doing this in Hungary, and a lot has been achieved in local governments. Some of them now support harm reduction. One thing we have learned in the past two or three years is that we should focus more on local policies. Harm reduction was born as a grassroots initiative in European cities: Frankfurt, Zürich and others. It has always been a local thing. Possibly, it won’t work in all the Balkan countries, but it does in Hungary and Slovakia. Bratislava has a new city mayor, and Iveta Chovancova, a former member of the Eurasian Harm Reduction Association’s Steering Committee, now works for the city administration and helps promote harm reduction programs from the inside. The next harm reduction conference will be held in Prague, and I see the city also supports this conference.

Could you talk more about the Roma population and drug use in the region. I understand it’s a big problem.

I wrote an article about this some time ago that sums up the scope for this issue. There are large Roma populations in Slovakia, Czech Republic, Hungary, Romania, Serbia and Bulgaria. In Hungary, for example, seven percent of the population is Roma. Most of them are likely unemployed and don’t have access to essential services, suffer from segregation in schools and places they live in.

The situation is similar in other countries with large Roma populations. Even though drug policies claim to be colour-blind, but there is racial profiling in the region. When we speak about this, we usually think about the US and Afro Americans and Latino Americans, but we don’t talk about what is happening in our region. We don’t talk about the trauma of people who have a much greater chance to be arrested for drug use and be imprisoned. You can see in many cities across the region that nine out of ten people in needle exchange centres are Roma. We don’t have enough studies and research about this, but Roma constitute a big part of the poor. Sometimes existing programs don’t reach out to these communities because they operate in city centres, while these people live in segregated areas. And if you don’t have culturally appropriate outreach programs to bring help to their part of the city, you don’t even see them. They become completely invisible. I think we need to work more on this. If we researched how much Hep C or HIV affect these populations, we would indeed find that they are disproportionately affected.

What about other groups, like women or young people or men who have sex with men? Are there any specific services for these groups in the region?

I see very few services targeting these populations. The only needle and syringe program for women in Hungary was closed in 2014. The research on women done last year by Zsuzsa Kaló in Hungary found that the country’s treatment system is not friendly to women and don’t always meet their needs, especially if children are involved. Women don’t have a place to leave their children when they go to services. There is also the problem of domestic violence. If their partners are also drug users, women don’t always want to go to the same service. Women are pretty much dependent on their partner for assistance and getting drugs.

Most specific services target sex-workers. They sometimes overlap, of course. Only one program in Hungary provides shelter and services explicitly for pregnant women who use drugs. It’s similar in other countries, I think. The only exception could be migrants and refugees, which is a massive issue in Balkans now. I’ve heard about programs that go to refugee camps for HIV and Hep C testing or reach out to drug users.

What about young people who use drugs? Do any programs address their needs? 

In my experience, most such organisations are set up and operated by young people who are party drug users. Therefore, all their services are linked to the party scene. I don’t see the same for marginalised injecting drug users. Youth organisations are mostly for psychedelic drug users. I have always admired this organisation in Belorussia Legalize Belarus. In a country like Belarus, it’s impressive. These idealistic young people do good things, but they are not harm reduction service providers.

Let’s talk about some specific services, like the opioid agonist treatment (OAT). Are there any problems with take-home dosages, mandatory drug checks? 

In most countries, maybe except the Czech Republic and Slovenia, the main issue has always been accessing services. But with the shrinking number of opiate users in some countries as Hungary, the situation is changing. Still, regulations are very restrictive. Many people are pushed to detox or are not able to access the type of therapy they prefer, e.g., they are forced to take Suboxone when they want methadone or buprenorphine. Sometimes these decisions are not based on the needs of clients but are dictated by agreements between pharmaceutical companies and service providers. Many clients in Hungary were not happy when services switched from pills to liquid methadone.

OAT programs sometimes feel like very rigid systems that are more serving the people who are providing the service rather than those who receive it. Because of these restrictions, some people opt to get a prescription from doctors to buy the therapy they want in pharmacies. But there are not many of them; only those who can afford this. Most still get their treatment from state- or NGO-run programs. I think that the COVID-19 pandemic can change this rigidness, help break down these barriers. We hear that the rules are changing in many countries now, and people are allowed take-home dosages for more extended periods of time.

Is there any difference in terms of quality of services or clients between NGO- and state-run substitution clinics?

Most state-run clinics I have visited in the region are in hospitals. They are approachable for those who live in cities. With NGOs, it’s a mixed picture, but they are less prevalent. For example, in Hungary, I think only one or two NGOs do that. In most other countries, especially in the Balkans, it is still very much doctors in white coats in hospitals.

Do clients prefer NGO-run sites?

I never asked clients this specific question but think that they would much rather go to a drop-in centre rather than to a clinical, sterile, bureaucratic setting that is not user friendly and has this kind of authoritarian atmosphere. A lot of people are queuing in these hospitals, and there are conflicts. The black market for methadone is a considerable problem in many countries. Dealing happens near these large hospitals. We had a lot of reports about people robbed by some violent gangs after leaving a hospital, who take their methadone. I think it is safer and more friendly to have decentralised OAT centres. It would also be great if general practitioners or psychiatrist could prescribe methadone to be obtained in pharmacies.

Why do you think it’s so hard to scale up these services? 

Again, I think it’s more an ideological rather than a financial barrier. Many governments say that there is not enough money. I don’t think it’s the issue. When governments start to prioritise, they always find the money. But these issues are not something that politicians can gain political capital with; they are not popular. They cannot sell it as a political product. It’s similar to renovating prisons. They can say that money is spent to build new jails to put more people into them, but not that the new jails are more humane for inmates.

Why do you think it’s so politicised? We’re speaking about health issues. 

Because drug use is a moral issue, many don’t perceive it as a public health issue like diabetes. Most people still condemn drug use, stigmatise it. I don’t think this attitude would much change if drugs were legalised. This label would remain because people perceive that it is drug users’ fault: You are morally inferior if you use drugs, and you don’t deserve to receive this funding because you are less than me. I am a normal person, pay my taxes, but you don’t. Why do you deserve more? Why shouldn’t we give the money to kindergartens? Alcoholism is perceived as part of our culture, but drugs are viewed as something alien.

What about barriers to services and their quality? 

As I have mentioned, restrictive rules primarily prevent people from being admitted to programmes. Also, people are often prescribed very low doses. And we know that insufficient quantities don’t work. We have been trying to change this in Hungary for a long time without real success. Some responsive doctors prescribe sufficient doses, but most of them are very conservative, with the abstinence-minded mentality, who push people to reduce their dose. Another issue is limited slots for substitution treatment. Of course, it’s different in each country. In Hungary, if hospitals admit more people, they must cover these expenses from their budget, they do not receive this normative fund from the state budget. That’s why there are waiting lists. People must undergo one or two unsuccessful attempts to quit, and only then they are admitted into programs. But it depends on doctors—their attitudes remain the most significant barrier.

What about polydrug use? If you’re a polydrug user, can you enter the program?

It also depends on the doctor. Some programs require urine tests, and you can be kicked out if you use other substances. A good professional with a normal mindset would not kick out someone just because he or she smoked marijuana. It depends on the professionalism and humanity of doctors.

What about the quality of services? How comprehensive are they? 

Most hospitals conduct motivational interviews for people who want to quit and have ties to rehabilitation centres. OAT programs are often accused of being “pill meals.” But it’s not true. Most programs are making serious efforts. I have never seen an OAT that kicks you out because you refuse to go to group meetings or counselling. If clients don’t need this type of personal interaction and just want to pick up their medicine, they can go to a substitution clinic without having interactions with any other services for years. But if you want, there are possibilities.

Are there groups of OAT clients who advocate for the improvement of the quality and coverage of services?

This area is very underdeveloped, and there are very few groups like that. This is one of the critical problems in our region that service providers don’t make much efforts to encourage community involvement. Mostly because it would need additional financial, time and energy investments. You need to have resources and capacities to do this. Advocacy organisations can’t do this alone. But if you are a service provider, I think it could be done with the training of peer leaders. Some young people organisations are working in the field of psychedelics or cannabis, but not with marginalised communities.

Governments don’t adequately implement monitoring mechanisms. The Czech Republic has some kind of quality accreditation for drug prevention programs, but not for harm reduction. I don’t see any significant efforts to monitor and evaluate these programs.

Why do you think there are no working monitoring mechanisms? It would make sense because the governments fund them. 

Countries have different protocols. But again, it requires money to implement them. The first thing governments should recognise is that it’s also their responsibility to ensure that these programs operate according to quality standards. Professional guidelines in Hungary foresee that each harm reduction program needs to employ at least two half-time workers and a professional worker. There are standards for the professional education of these people. But it is not enough to pay their salaries from the funds the government provides to these programs. It’s a contradiction: the professional guidelines say that you need to have this and that, but there are no resources. When governments don’t provide sufficient budgets for these services, they will not pay attention to the quality evaluation because they know that it is impossible to achieve the standards with existing resources. Harm reduction programs are happy if they can produce base salaries for the staff and for the safe disposal of needles, which requires a lot of money. They don’t have money for extra services, like psychologists or gynaecologists. It’s a resource issue.

Can you talk more about the new psychoactive substances and amphetamine-type stimulants?

The primary stimulant in our regions is still amphetamine. But the new psychoactive stimulants are also coming, especially in Poland, Hungary, Romania. In Slovakia and the Czech Republic, pervitin (methamphetamine) prevails. In Hungary, most injecting drug users use cathinone-type new stimulants. The trend of synthetic cannabinoid use can be seen in many countries: in prisons, among homeless or Roma people. Most marginalised groups massively turn to synthetic cannabinoids because they are cheap, readily available, and they just knock you out: you don’t feel the pain and suffering of everyday life. It’s an “ideal” drug for the poor. These new synthetic stimulants and cannabinoids are dealt with separately, not in one group.

And what about overdose prevention and access to naloxone? 

In most countries, naloxone cannot be taken home or distributed because of the protocols allowing only a professional doctor to administer it. It’s only available in emergency units, and nasal naloxone is missing entirely. I don’t see any real efforts to introduce naloxone, maybe only in the Baltics, in Estonia, not in other countries. When we had the heroin crises about ten years ago, service providers advocated for naloxone, but not anymore. I don’t think that it is a part of any advocacy efforts.

What is happening with drug use and harm reduction in prisons? Is there any new research about these issues? 

The prison issue is still a white spot in most countries. No OATs exist in Hungarian prisons. But even in the countries where they do, access to them is very low. Needle exchange is absent entirely. Most prisons don’t address drug issues at all, sometimes provide some counselling, Narcotics Anonymous or something like that. Prisoners increasingly use new psychoactive substances because it’s much easier to smuggle them in and it is much more difficult to test them. Prisoners were banned from receiving postcards in Hungarian prisons because there were many instances when they were soaked in drugs. Letters to prisoners are now xeroxed. Sending tobacco is also not allowed because cigarettes were often infused with cannabinoids. I think that synthetic cannabinoid issue is the biggest problem in prisons where the use of new psychoactive substances is widespread among the population. The rate of people incarcerated because of drug use in our region is not very high, but laws are very restrictive, sentences are disproportionately severe, and alternatives to incarceration are underdeveloped and underused, even if they exist in laws.

Is there a problem with legal help for people who use drugs and interact with law enforcement? 

In some countries, such as Poland, this is a problem of training law enforcement. The legal framework for alternatives exists, but judges and prosecutors don’t use it. I know that the Polish Drug Policy Network has made efforts to train judges and prosecutors. In Hungary, the law allows people to opt for six months in an outpatient program in the case of small amounts. About 90 per cent of people who are sent to this program are occasional cannabis users who don’t need any treatment. Even if one of these alternatives exists, there are no real filters in place, like in Portugal, when only problematic cases are referred to treatment. There is no need to treat those who don’t need this.

My last question is about hepatitis C, HIV and TB treatments. What are the major problems?

After the HIV outbreak in Romania, we didn’t see more outbreaks in the region. Testing and counselling are still very low, especially in some countries like Hungary. Even if people are tested positive, how to ensure that they go to treatment? With the new hepatitis C treatment, there is some money from the big pharmaceutical companies, which is a positive thing. In Slovakia, they gave some money for harm reduction organisations to help drug users to get into hepatitis C treatment. It also later happened in Hungary. The biggest problem is in those countries where there is no harm reduction, or its coverage is limited, like Hungary or the Balkans, where it is hard to get treatment for these people. I wonder how many people, who were infected with Hep C five or six years ago, will develop cirrhosis or even die needlessly when they could otherwise be saved? This is devastating to see.

Grants: Community-led research on client satisfaction with OST services

EHRA invites community-led groups interested in conducting the study on client satisfaction with opioid maintenance treatment based on EHRA’s methodology and in cooperation with professional researchers to submit their project proposals.

Community-led monitoring has a critical role in identifying and effectively addressing issues and bottlenecks in reaching, connecting and retaining people along the prevention and treatment continuums and improving the quality of care. Information gathered within the monitoring can be leveraged by users/communities to help understand, explain, justify and specify within their advocacy the changes that have to be made. The proposed methodology will help assess the quality of services, clients’ perception of OST program and their quality of life.

Two successful candidates will receive 8500 USD on research related activities. Selected candidates will:

  • Work closely with researchers on methodology adaptation to the country context
  • Recruit interviewers and study participants
  • Participate in data analysis and development of the report and recommendations
  • Present the research to the relevant stakeholders

Implementation period:

  • March 1, 2021 – November 30, 2021

This call for proposals is organized within the  “Thinking outside the box: overcoming challenges in community advocacy for sustainable and high-quality HIV services” project of the Eurasian Regional Consortium financed by the Robert Carr civil society Networks Fund (RCF).

The Eurasian Regional Consortium joins the efforts of Eurasian Coalition on Health, Rights, Gender and Sexual Diversity (ECOM), Eurasian Women’s AIDS Network (EWNA) and Eurasian Harm Reduction Association (EHRA) to effectively address the lack of financial sustainability in prevention, treatment, care and support programs for the key populations vulnerable in terms of their rights violation and the risk of HIV.

Eligibility criteria:

  • Officially registered community-based organization working in drug policy and harm reduction
  • Initiative group working in drug policy and harm reduction that has financial agent registered in one of the project countries
  • Civil society organization working closely and in the interests of the community of people who use drugs

Selection criteria:

The submitted applications will be evaluated by the selection committee of the Eurasian Harm Reduction Association. The following criteria will be used to evaluate the bids (the maximum possible number of points is 100):

  • Problem statement and understanding the situation with opioid maintenance treatment in country / city (50 points)
  • Experience in community-led research or monitoring (40 points)
  • The group/organization is delegated by, accountable to and/or led by the community of people who use drugs (10 points)

How to apply

Applicants must submit the following documents to maria@harmreductioneurasia.org, the subject of the letter is “Call CLM”, the deadline for submission is before 24:00 EET on February 26, 2021:

  1. Application form
  2. Organizational registration document
  3. Memorandum of cooperation (in case of working through financial agent)

EHRA is looking for a consultant to update „Criminalization Costs“ data

The Eurasian Harm Reduction Association (EHRA) as a part of the three years project of the International Harm Reduction Consortium “We Will Not End AIDS Without Harm Reduction” is looking for a consultant to collect and update information on „Criminalization costs“ in 27 countries[1] in CEECA region.

Tasks of the consultant and expected results:

·        To identify list of national focal points in 27 countries, who will support consultant in finding data needed for the update of the „Criminalization costs“.

·        To do a desk review in international and national reports and interviews to receive needed data in each country (with references) on the following indicators:

                           I.          The costs of incarceration:

1.      Number of prisoners

2.      Number of prisoners for drug law offences

3.      Average sentence for drug law offences

4.      HIV prevalence in prisons

5.      OST in prisons (YES/NO)

6.      ART in prisons (YES/NO)

7.      NSP in prisons (YES/NO)

8.      The costs of incarceration (per prisoner/ per year)

                          II.          The costs of health and social services:

1.      Number of PWID in the country

2.      HIV prevalence among PWID

3.      NSP price (per client/ per year)

4.      OST price (per client/ per year)

5.      Unemployment benefit (minimum) (per year or per month)

·        To write short summaries about each country, based on the collected data and prepare it for EHRA website. Example of the summary can be seen here.

Proposed timeline:

All tasks should be completed in the period from 8th March till 30th May, 2021.

Evaluation criteria

The submitted applications will be evaluated by the selection committee of the Eurasian Harm Reduction Association

A two-stage procedure will be utilized in evaluating the proposals:

·        evaluation of the previous experience (portfolio) via technical criteria – 80% in total evaluation

·        comparison of the costs (best value for money) – 20% in total evaluation.

Cost evaluation is only undertaken for technical submissions that score a minimum 70 points out of a maximum of 100 as a requirement to pass the technical evaluation. A proposal which fails to achieve the minimum technical threshold will not be considered further.

To assess submitted applications, the following technical criteria will be used (80%):

·        Experience in carrying out desk researches (data collection) in the harm reduction and drug policy field, develepment of technical reports and documentation on drug use issues (40 points)

·        Wide range of contacts on regional level to identify list of national focal points to collect information (40 points)

·        Literate written English and/or Russian (20 points)

Cost proposal (20%):

EHRA will allocate same importance to the provided portfolio and recorded experience as to the cost of the services. The cost proposal will be evaluated in terms of best value-for money to EHRA in EUR, price and other factors considered.

Condition

This announcement and its attachments shall not be construed as a contract or a commitment of any kind. This request for proposals in no way obligates EHRA to award a contract, nor does it commit EHRA to pay any cost incurred in the preparation and submission of the proposals.

Terms of payment and other conditions same as a final timeline will be indicated in the agreement which EHRA will sign with the winner.

How to apply

The candidates are invited to submit their:

·        CV

·        Letter of interest with the suggested consultancy fee for all work and

·        Suggested national focal points list

by e-mail referenced under title “Criminalization costs consultant” to Eliza Kurcevic at eliza@harmreductioneurasia.org by 23rd February 2021, 24:00 EET.

Results will be announced by 1st March 2021. Each candidate will be contacted individually.

Any questions regarding the participation should be sent to eliza@harmreductioneurasia.org


[1] Countries: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czechia, Estonia, Georgia, Hungary, Kazakhstan, Kosovo, Kyrgyzstan, Latvia, Lithuania, Moldova, Montenegro, North Macedonia, Poland, Romania, Russia, Serbia, Slovakia, Slovenia, Tajikistan, Ukraine.

TENDER: PROVISION OF GRAPHIC DESIGN AND LAYOUT

EXTENDED! Deadline for submission: March 7, 2021

EHRA is looking for companies, design studios or graphic designing freelancers to develop graphic design layouts and other presentation materials such as brochures, posters, reports, analytical materials, books, briefs and design infographics and illustrations. Most of the EHRA publications are digital, published in Russian and English for different audiences, include text material, tables, illustrative material.

Set of works on development of graphic design layouts and presentation materials consists of:

– development of design concepts, taking into account the requirements of corporate identity (brand book), which includes in particular: the presentation of the plot and stylistic series, options of text material layout, the interaction of text and illustration material, finalizing the approved concept based on the EHRA’s comments;

– preparation of original layouts and digital page making, which includes: graphic design, layout of pages within the approved concept, creation/purchase of rights to illustrative / photo materials, corresponding to the approved concept, preparation of the necessary illustrative material, creation of pictograms, creation of infographics, proof-reading, preparation of digital or printing files.

EHRA’s publications examples here à https://harmreductioneurasia.org/library/

Working conditions:

Distance work using own facilities: computer, stable access to the Internet.

Consultancy agreement without social insurance for one year starting from March 2021.

Requirements for companies:

  • Working experience (at least 1-year, good business reputation in this sector of activity, as well as the necessary manpower and technical resources to fulfill obligations under the contract).
  • A strong portfolio of graphic designing project and layouts;

Requirements for freelancers:

  • At least 1+ year of experience as a graphic designer;
  • A strong portfolio of graphics projects; reports layout in particular;
  • Professional user of design software like Photoshop, Sketch, Adobe Illustrator, Adobe InDesign;
  • Good taste;
  • Proven understanding of current visual and social trends reflected in portfolio;
  • Ability to meet deadlines in a high pressure environment;
  • Intermediate or higher level of English and Russian;
  • Good organizational skills, strong attention to detail, strive for perfection.

 Interested participants should provide:

  • Cover letter with described previous work experience in arbitrary form;
  • Updated CV outlining specific relevant experience and skills (for freelancers only);
  • portfolio of works
  • price offer (in EUR) for the following graphic design categories:
  1. Design report layout: A4 format, development of at least 2 variants of cover page, typical text pages, illustration pages, half-title. Creation of the grid, design and layout of 40 pages, drawing of illustrations, purchase of illustrative- and photo-materials with transfer of rights to the EHRA. Finalization (including proofreading in English or Russian) of the concept according to the EHRA’s comments. Use this publication as reference to estimate number of illustrations – https://harmreductioneurasia.org/wp-content/uploads/2020/09/2020_8_20_EHRA_NPS-Report_Georgia_EN-1.pdf
  2. Design poster: A0 format, development of at least 2 variants of grid, design, and layout, rendering of illustrations, purchase of illustrative material and photo materials with transfer of rights to the EHRA. Finalization of the concept according to the EHRA’s comments.
  3. Design infographic (per one).

NB! If you don’t have a relevant experience in some of the above mention categories, please, skip it and don’t put any cost of that category in the form.

 

Special conditions

Participants should ensure the cost of the work specified in the application for a period of no less than 14 months from the date of the tender.

Based on the results of the tender, the winners will be invited to sign 2-year long contracts. Further work will be carried out according to EHRA request, which will specify the time frame and other specific terms.

Submission of documents for participation in the tender does not impose on EHRA obligations to conclude a contract.

Documents should be sent to:  Igor Gordon igor@harmreductioneurasia.org

Deadline for submission: March 7, 2021

Eurasian Harm Reduction Association Code of Ethics

The Eurasian Harm Reduction Association (EHRA) Code of Ethics (the Code) is a set of fundamental principles, standards and policies to govern decisions and behaviour at EHRA. The Code clarifies an organization’s mission, values and principles, linking them with defined standards of professional conduct, as well as gives specific guidance for handling issues like compliance, integrity, anti-fraud, non-discrimination, anti-harassment policy and Conflict of interest.

The Code is intended primarily for EHRA’s employees and members, and together with the EHRA Code of Conduct the Code is a main guide and reference for employees and governing bodies to support day-to-day decision making. The Code also serves as statement of organizational values internally for EHRA members, as well as for partners with whom EHRA has contractual and partnership relations. The Code shows EHRA commitments for external stakeholders such as advocacy allies, potential EHRA donors, UN agencies, other national and international organizations.

EHRA requires governing bodies, members and employees to observe high standards of business and personal ethics in the conduct of their duties and responsibilities. As employees and representatives of the EHRA, we must practice honesty and integrity in fulfilling our responsibilities and comply with all applicable laws and regulations.

The Code is made up of 4 policies:

  1. Compliance, Integrity and Antifraud policy
  2. Conflict of Interest policy
  3. Non-discrimination, Anti-Harassment Policy and Complaint Procedure
  4. Whistleblowing policy

The Code was formulated and adopted by EHRA Steering Committee and included input from EHRA members.  The Code should be revised depending on needs, but not less than once in 5 years. All revisions and amendments should be approved by the Steering Committee. 

FULL TEXT OF THE EHRA CODE OF ETHICS

 

Vacancy announcement: Communications and Public Relations Officer (call open until February 26, 2021)

EXPECTED START DATE: ASAP

JOB TYPE: permanent, full time

JOB LOCATION: Vilnius, Lithuania

COMPENSATION:  Minimum gross salary is 1700 euro and up depending on qualifications and experience

OVERALL RESPONSIBILITY

  • Oversee and implement the organization’s communication.
  • Employ effective communications to support EHRA’s mission delivery and increase the effectiveness of EHRA’s advocacy and technical support.
  • Lead the implementation of a comprehensive communication plan to support EHRA’s strategic objectives, program delivery, branding and organizational development.
  • Coordinate EHRA’s key messaging/communications products and communications channels (website, listserv, social media etc.).
  • Develop and maintain relations with media to ensure EHRA’s presence in media and coverage of key harm reduction and human rights issues.

QUALIFICATIONS FOR POSITION

  • Degree in Communications, Marketing or or a related field.
  • Experience of media content development (written article, video product, PR products);
  • Experience and skills in organizing regional or national media/public awareness or issue-based campaign through different media.
  • Strong verbal and written communication skills including media relations, briefings, meeting facilitation and presentations.
  • Working experience in a similar position in international environment.
  • English and Russian language speaking and writing skills.
  • Ability to multitask.
  • Flexibility, adaptability and a commitment to work within an international team.
  • Excellent computer skills, PowerPoint (video production and editing is an asset).
  • Understanding of the non-profit/NGO world.
  • Tolerance and comfort working with diverse communities (people who use drugs, sex workers, men who have sex with men, etc.).

Interested candidates should provide:

  • updated CV outlining specific relevant experience and two references.
  • at least three examples of work in communications, PR or marketing OR job portfolio.
  • a short cover letter indicating suitability for the position.

Documents should be sent to: igor@harmreductioneurasia.org until February 26, 2021.

Download full job description HERE

Interviews will be done on a rolling basis.

Only shortlisted applicants will be contacted.

 

EXTENDED: Tender for consultancy to conduct mapping of budget advocacy effort and impact in EECA region for the past 3 years

the new deadline for submission is before 24:00 EET on February, 17, 2021

Within the regional analysis and dialogue “Taking stock of budget advocacy efforts to date in EECA region”, the Eurasian Harm Reduction Association (EHRA) announces an open call for a consultant to conduct the mapping of budget advocacy activities and its impact on sustainability and funding of HIV services for key populations, for the past 3years in Eastern Europe and Central Asia region.

Objectives of the consultancy

The objective of the consultancy is to map budget advocacy effort and projects funded by different international donors and its impact on sustainability and funding of HIV services for key populations, for the past 3 years in 8 EECA countries (Bulgaria, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Montenegro, Northern Macedonia, Ukraine).

The mapping will include:

  • analysis of scope, funding and geography of budget advocacy projects implemented in the region;
  • defining roles of different civil society organisations, community groups, patients’ organisations, transperancy and open budget partners, parliament members and other officials;
  • identifying different components of budget advocacy implemented in countries;
  • documenting results that have been achieved, how they were measured and how they were compared to the initially set goals and targets;
  • analysis of what budget advocacy interventions have been most successful in leading to the documented outcomes;
  • analysis of factors such as specific advocacy approaches, partnerships, processes of health reforms or introduction of e-governance, transparent procurement, etc., which led to results in budget advocacy and ensured transition of HIV response services for key populations to domestic funding.

Focus of the mapping should be made on the efforts and projects dedicated to advocacy for sustainable funding of specific HIV prevention, testing and treatment services for such key affected populations as people using drugs, sex workers, men having sex with men, trans* people, people living with HIV and inmates.

The outcome dimensions of the projects and effort need to be taken into account while mapping:

  • budget related outcomes: specific budget approved, released or allocated;
  • outcomes for health finance systems, mechanisms of procurement and funding of services;
  • impact on capacity of CSOs in budget negotiation skills, shifting focus on the budget advocacy.

For the regional analysis the data from already published national reports and project reports could be used. The recently published report on the results of budget advocacy in Kyrgyzstan in the period from 2016-2019 could be a good example of such documents.

Tasks of the consultant:

  1. To develop the outline of the mapping and questioner for semi structured interviews with informants. EHRA will provide list of the key informants which could be extended by the consultant.
  2. To collect and analyze available publications and other secondary data.
  3. To conduct up to 20 interviews with key informants.
  4. To draft the mapping report which includes 8 country case studies and regional overview.
  5. To present report for discussion during the expert group meeting in April 2021.
  6. To finalize the report based on expert group recommendations.

Expected results of the consultancy:

  • Report on mapping of budget advocacy efforts and analysis of outcomes in EECA region in the past 3 years. Report should include 8 country case studies/mapping results analysis and regional overview;
  • Suggested recommendations for donors on priorities for investments in budget advocacy of services for key populations in EECA based on mapping and new economic and public health challenges impacting budget advocacy efforts in EECA region.

Knowledge of spoken Russian and English for conduction of interviews with budget advocacy projects implementors across the region is essential. The mapping developed within the consultancy can be submitted to EHRA in Russian or English (per consultant’s preference).

Find more information about project, objectives, timeline and evaluation criteria HERE

How to apply

Applicants must submit their CV, application (letter of interest) and relevant materials with experience proof in free form to anna@harmreductioneurasia.org, the subject of the letter is “EECA budget advocacy mapping”, the deadline for submission is before 24:00 EET on February, 17, 2021. The CV and application should clearly reflect the competency of the candidate necessary to complete this task, as well as include the proposed number of working days for each stage, cost and timing of their implementation and confirmation of fluency in Russian and English to implement the task.

Harm reduction service delivery to people who use drugs during a public health emergency

Harm reduction service delivery to people who use drugs during a public health emergency: Examples from the COVID-19 pandemic in selected countries

Virtually every country of the world has been faced with the COVID-19 pandemic. As learning developed as to how to combat transmission of the virus, countries increasingly resorted to national ‘lockdowns’ during the first wave of the pandemic from around March to June 2020. After coming out of the first wave of COVID-19, countries have used local, regional and national ‘lockdowns’ to once again prevent further transmission during the second wave and similar approaches are expected in the future in the event of further waves of the pandemic hitting countries until every country can vaccinate a high proportion of their population. For those people who are highly drug dependent, with a resulting compromised immune system, COVID-19 presents a serious threat to life regardless of age. Governments, non-governmental (NGOs) and communitybased organisations (CBOs) working to support people who use drugs, and other vulnerable and marginalised people in society, have had to react rapidly to the massive increase in COVID-19 transmission across countries and continents. The ten case studies presented here provide a snapshot of the responses of specific organisations and communities who work with people who use drugs and some other marginalised groups around the world, including Afghanistan, Australia, the Czech Republic, Kenya, Poland, Russia, Spain, Switzerland, Ukraine and the United Kingdom.