Kestutis Butkus: “The most important thing for me is not the decision of the Lithuanian court or the ECHR, but the fact that my case resulted in the passing of a law on the provision of OST in Lithuanian prisons. This is a real victory. Our common advocacy driving force.”

EHRA presents a series of conversations with people whose names and roles in harm reduction are well known in the region of Central and Eastern Europe and Central Asia, and beyond. They will share with us the most valuable – their experiences, thoughts, memories.

Kestutis Butkus is a well-known activist, one of the first from the community of people, who use drugs in Lithuania. 8 years ago, his right to health was violated by non-provision of opioid substitution treatment (OST) in prison (at that time, Lithuania remained one of the few EU countries where OST was inaccessible to people in prisons). Kestutis chose the path of struggle against the system and not because of, but rather in spite of, became one of the few (alas), who managed to influence the Law. Since 2018, opioid substitution therapy has been introduced in Lithuanian prisons, but we need to remember – this is only the beginning of a long way*

– What were the circumstances of your arrest in 2011?

– Eight years ago, police “apprehended” me by accident – they found a couple of grams of marijuana in the car. I had several outstanding fines at that time and the judge decided to sentence me to forty-five days in detention so that I would fully comprehend my crime. “Let him lie down and think,” she said. At the trial, I mentioned the methadone program, as I had been receiving substitution therapy for ten consecutive years, to which the judge’s reaction was: “This is outside our competence”.

– Wow. Did you agree with that ruling?

– I appealed, but my appeal was prepared by a person without a license (it used to be possible to do it that way) and then I was put on the wanted list. I didn’t know anything about it. Then one day I came to the migration services to collect my passport. First, they locked me in a room, then a convoy arrived and escorted me to prison. First to pre-trial detention, then to Lukiškės (a prison in Vilnius – comment by EHRA). During all that time no one really explained anything to me. I started writing letters – asking “what for”? There was no answer. Then I found out that those were the forty-five days of detention. It turned out nobody actually read my appeal, they didn’t even consider it. The court ruling came into force, which meant I had to be in prison.

On the first day of the detention, a doctor came to examine me, and I asked for methadone. The doctor, whose name was Mendelevich, said: “You’ll find it very hard – we don’t have a program here. I can only transfer you to the prison hospital, but everything is the same there, except that the ward is more spacious, and smoking is forbidden. You still won’t get methadone though, I can only prescribe “cockroaches”.

– What is it?

– We call light psychotropic substances “cockroaches”. They’re prescribed to everyone so that people can withstand imprisonment, but they have nothing to do with substitution therapy. I began to write appeals, requests, but there was no response.

– Do you remember the prison conditions well?

– Lukiškės is an old prison, it was built in the XIX century. At that time, it was considered one of the most modern in the Russian Empire (at that time most of Lithuania was under the Russian rule — comment by EHRA). These days however it falls short of the standards provided at similar institutions in the European Union. The cells are cramped, for four, there is a table, a washbasin and a toilet. Restriction of freedom is in itself a terrible thing, and those conditions make it simply indescribable. The first eight days were awful. I couldn’t sleep, I started suffering from claustrophobia, though I never had it before. I only managed to get through those moments because I could see a piece of the sky and some rooftops through the bars on the window. I was also lucky to have just one other inmate in my cell, not three (my neighbour was also from the community, by the way, but by that time he had gone through withdrawal).

– Did you spend your entire detention in Lukiškės?

– After eight days I was transferred to another prison – Provinishki (80 km from Vilnius – comment by EHRA). Once there I also immediately mentioned that I was on substitution therapy. The doctor’s answer was: “Don’t complain about your addiction. It’s dissoluteness, not illness.” I understood everything… I said: “I don’t need anything. Just prescribe me some aspirin to thin the blood” (I have a heart valve). They gave it to me, along with “cockroaches”. I was left in a one-person cell for fourteen days. All by myself, having bouts of insomnia…

– Did anyone know you were in prison without access to methadone? Were you allowed to have visitors?

– I was allowed to see a lawyer for the first time in Proviniski – my ex-wife contacted Emilis Subata (Dr. Emilis Subata, Director of the Vilnius Center for Addictive Disorders). He in turn contacted the “I Can Live” Coalition (Vilnius, Lithuania), as I was their member. They managed to hire legal protection for me. Then we thought that this incident could set the wheels in motion for the introduction of OST in Lithuanian prisons. At that time, civil society had been trying unsuccessfully for more than ten years to discuss the matter with the prison department of the Ministry of Justice.

– What measures did the solicitor take?

– He prepared a petition to the prison authorities demanding that they provide me with methadone and requesting a written reply. As a result, a psychiatrist came to see me … (Interestingly, it was only then that I learned that such a specialist was available in prison). He began to reason with me. I said: “Don’t talk, give me a letter.” It was exactly that that acted as a “catalyst” for the whole process. When I was released forty-five days later, the Coalition’s human rights lawyers read the prison’s reply and confirmed that it could be used to refer the case to court, and that we had a chance to overhaul the system. As for my condition… I couldn’t return to the substitution program for a year after my release. I thought I had dealt with withdrawal and that I was able to pull through but I was wrong. I often left the city to see my friends or went to the forest — I didn’t want my daughter (she was still a teenager then) to see what was happening to her dad.

– When did you manage to become stable?

– It was only after a year that I was able to return to the program. That’s when my “marathon” started. First, we went to the local court – they ruled against me. Then we went to the district court, then to the Appeals court – with the same result. Six years later we reached the Supreme Court.

What was the ruling?

– Same as before. That’s why we wrote to Strasbourg, to the European Court of Human Rights (ECHR). The court looked into our case, registered it with a number and accepted it for consideration. The ECHR works according to the following procedure: there are two Chambers. The first one determines whether all opportunities have been exhausted at the national level (in our case it was a yes). And if so, transfers the case to the second Chamber. As soon as that happened, the Lithuanian State literally “woke up” – representatives of the Ministry of Justice, the management of the two prisons I had been in, and the Ministry of Health. Six years on, the Ministry of Health suddenly “remembered” that they had a damage recovery commission, which was to be contacted no later than two weeks after an incident. Of course, I had not contacted the commission. I filed an appeal to the Supreme Court of Lithuania for a retrial based on that fact. It stalled the whole process.

– What was the reaction in Strasburg?

– The ECHR wrote to my lawyers asking what was going on. Lawyers reported that the Ministry of Health had taken the case to court. Upon learning that Strasbourg suspended the case pending clarification.

– Circles of Hell all round…

– Another year went by. In 2018, the Supreme Court acknowledged that I was the injured party. The damage caused to me was estimated… at three hundred euros, plus a bit more for the lawyers and redress – the court admitted I had been right. We appealed those three hundred euros – the court added another thousand on top and just over a thousand for my defence. However, after talking to my lawyers, I decided not to stop there and filed an appeal to Strasbourg over other violations – conditions of detention, standards of hygiene and size of the cell. In the West, such conditions constitute torture.

Last summer, Strasbourg accepted my case. Based on international case law, the lawyers requested thirty-five thousand euros in compensation. And I want to add – that is not a huge amount. There were similar cases in Poland and the UK, where the compensation was about a hundred thousand or more.

– If ECHR rules in your favour, who’s going to be liable for compensation?

– The state. To be more precise – the Justice Ministry. The most important thing for me however is not the decision of the Lithuanian court or the ECHR, but the fact that my case resulted in the passing of a law on the provision of OST in Lithuanian prisons. This is a real victory. Our common advocacy driving force.

– That is, from now on, if someone in need of methadone is put in jail, they’re going to get it there?

– In prison, remand prison, temporary detention facility – everywhere. The law applies to anyone detained for two or more days. There is a catch though. Only those who are officially enrolled on the OST program can receive methadone. We won’t leave it as it is though – the community is putting pressure on the prison department writing letters asking to amend the law and I hope we will be heard.

– Why do you think it took the prison department years to resolve the issue of access to life-saving treatment in prisons? Ruining hundreds of lives along the way – of those who didn’t dare to stand up to the system. Was it money?

– The prison department have a healthcare department within it. And the healthcare department thought that introducing OST in prisons was a very complicated and costly process. They argued that they needed millions to do it. I remember another argument of theirs – where would they keep methadone in prison, it requires special storage conditions! Where else if not in prison! What could be easier than designating a room and installing a methadone dispenser! Implementing the program did not require any significant funds. Who knows though, maybe the prison department just wanted to get some extra money from the Justice Ministry? They are like a state within a state, aren’t they – they report to it but at the same time are independent. They even have their own special internal system, ranks and epaulets.

– It’s like an iceberg then – you can see the reasons that are at the top, that’s 10 per cent, but there are more issues underwater which account for the remaining 90 per cent of barriers.

– I’ll give you another example. They opened the so-called rehabilitation centre for drug users at a prison in Alytus (town in Lithuania – comment by EHRA.) They constructed a building for it especially, furnished it with everything new. Guess who’s moved in there? The entire bunch of the prison’s top dogs, inmates who have nothing to do with the rehabilitation program. Furthermore, they were selling drugs from there for a few years. You think the prison authorities didn’t know that? After all, it’s no secret that drugs are available in prisons at crazy prices. How could such amounts of drugs filter their way into institutions without some help on the inside, from the staff? –

The introduction of the methadone program has slashed the numbers of paying “clientele”. Therefore, my answer about the reason for such a disastrous delay in the implementation of OST in prisons sounds simple – “not profitable.” And I’m happy that my case managed to break the deadlock.

* – According to the Report by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 2018: “…at Alytus, Marijampolė and Pravieniškės Prisons… Opioid substitution treatment was still not available in prisons visited. As in the past, methadone maintenance treatment was continued for persons in police custody but discontinued after their transfer to a prison. Further, there was still nothing on offer in terms of harm reduction, such as a syringe and needle exchange, distribution of condoms, etc.”


The future is intersectional

Author: Maria Plotko, Program Officer, EHRA

Over the last few months, two important conferences on drug policy and harm reduction took place in Europe: activists were sharing best practices and tools at the International Harm Reduction Conference in Porto, whereas researchers were presenting their findings at the  annual conference of the International Society for the Study of Drug Policy in Paris. The two conferences shared the topic but crucially did not form joint advocacy efforts. What drug policy movement needs now is to connect these two worlds. Here are my highlights from both conferences.

  • Porto

The latest Harm Reduction conference like probably always was the place where every person is not just tolerated but welcomed with a warm hug. Coming from Russia, where harm reduction is not really in the mainstream,  it felt like a huge opposition gathering. The topics I followed were drug policy, human rights and providing funding for harm reduction. 

As Nanna Gotfredsen from the Danish Street Lawyers said in her talk, by documenting the harm caused by repressive drug policies we can easily show what putting politics before people means. If only we could do the same with stigma and discrimination that these policies entail. People who use drugs are criminalized, stalked by the police, and at the same time have a hard time accessing legal aid almost everywhere in the world. There was a special session at the conference aimed at discussing the practices of paralawyers, or street lawyers, as a solution to this issue. Such programs of peer help to victims of human rights violations or violence  have been implemented in Denmark, Indonesia, and Russia, among others, and they were proven to be effective even in such severe circumstances as in the case of the Philippines.

In accordance with the slogan of the conference — “people before politics” — quite a lot was said about human rights. We, as a society, tend to blame individuals and trust the system to fix them, but it is in fact more fair to blame the system and the state, and give individuals the tools and autonomy to change it. Changing the existing drug policies is a political process, as well as citizen discussion, so  we need to use the existing mechanisms to push the governments further. For example, professor Rodrigo Uprimny who is also one of the members of the UN Committee on Economic, Social and Cultural rights spoke about the “Berlin wall” between Geneva as the home of human rights and Vienna as the host of the Commission on Narcotic Drugs. “We should build the bridge and make drug policy a human rights issue,” he said. The first step was done by the Chief Executives Board of the 31 UN agencies which, right before CND, adopted a common position on drug policy that endorsed decriminalisation of possession and use of drugs.

For people coming from countries with draconian drug policies, like myself, the Portugese officials said a lot of things like ”criminal justice is never good for issues related to drug use” (coming from a police representative) or everyone’s favourite quote from member of parliament Ricardo Baptista-Leite: ”harm reduction and love have one thing in common – they both should be unconditional”. To get to the world with a human-rights-based drug policy, we should encourage politicians to meet with people who use drugs, and, more generally, make people living at the margins of the community visible to the community and be helpful not only to people who use drugs but also to politicians and the police, ”allow them to take credit and praise them.”

  • Paris

A month later, another drug policy conference took place in Paris, this time bringing together scholars from all over the world. It was the 13th annual conference of the International Society for the Study of Drug Policy. For EHRA, this was the first time attending such a gathering.  Most of the speakers there were from the UK and the United States, some were representing Africa and Latin America. Our CEECA region was severely underrepresented at the conference, as I remember only two presentations covering Poland and the Baltic states (one of which was mine),  and one talk concerning a comparative analysis of drug policies in Germany and Azerbaijan. And whereas HR2019 was filled with people from the community, harm reduction practitioners and advocates, this conference was almost pure science. Due to the growing number of countries which have legalized cannabis for medical and/or recreational use, the number of presentations on various issues related to this vast topic was enough to spend three whole days listening only about it.

All the relevant arguments that we as advocates and harm reduction practitioners need were represented there: the efficiency of drug consumption rooms, the importance of decriminalization and depenalization, legalization of cannabis and sensible policing. There was an interesting presentation which concerned an analysis of all publications on decriminalization which revealed that prevalence of use is taken to be the dominant indicator of drug policy success. As a result, it seems that countries pass the laws for one reason, and then evaluate a totally different thing. At the end of each presentation, I was hoping to hear something about how that piece of research was used in policy making, and what was the reaction of the government, health professionals, or any other relevant stakeholders. However, strangely, most of the time presenters did not say a word about the next steps and policy implications that followed from their research, or how it was used in advocacy, or to what extent it was effective. Also, the presenters did not explain the reasons why they had decided to pursue this topic in the first place.

Due to “insufficient methodological tools to conduct community-based research,” community involvement in the research was presented as a new trend. The reasons why researchers «should» collaborate with peers listed on one of the slides were:

  • Utilitarian: increasingly, funders require it
  • Ethical: peers have the right to be involved in any publicly-funded research that may affect their health status or the services that they receive
  • Epistemological: peers have first-hand knowledge of the issues under consideration
  • Consequentialist: collaboration has the potential to improve the quality, relevance and impact of the research

At the opening of this conference Anne Souyris, the Deputy Mayor of Paris for Health, said: ”We always wait for dramatic health events to implement harm reduction. In order to be effective, drug policy should be flexible and adaptable. We should do it on the go, start small and then structure if necessary.” But even if the government is pro-active, the role of civil society is to keep the topic on the agenda, to work with the government, and make the law better. In Uruguay, before the legalization of cannabis, over 60% of people were against it at the beginning. The president administration initiated the reforms in order to fight against drug trafficking, not necessarily for the benefit of the people or in the name of human rights, and the lesson we learned is that the adopted legislation would have never been as we see it today if it wasn’t for the activists.

To conclude, the two conferences got me thinking that although they shared the messages and general conceptual frameworks, they did not share the audience. Stigma related to drugs is divisive even for people who use drugs, one can see the split between “bad drugs” and “good drugs”, for example,  socially acceptable upper-class party use contrasted with “those people in the street we have nothing to do with.” We see separate conferences for harm reduction, psychedelic, cannabis and ayahuasca users, cultivators, scientists and activists, doctors and police, palliative care and access to pain management.  Repressive drug policies affect the quality of life and safety of every person, and can be used as a way of controlling the population and implementing political repressions just the way we recently saw in Russia or like we see it happening every day in the Philippines. We have a common enemy — repressive drug policies. We need to join our forces, which means that we need an intersectional drug policy movement.

The future of harm reduction in the CEECA region: EHRA holds a meeting on strategic planning for 2020–2024

The opening of a two-days Strategic planning meeting for 2020–2024 took place in Vilnius today.

On 9-10 July 2019, the members of the EHRA Steering Committee, experts from the Central and Eastern Europe and Central Asia region (CEECA) as well as the key staff of the Secretariat are working together with the aim to analyze the advocacy results of the last two years and plan the future operational activities of the Association.

The strategic objectives for the EHRA’s development were created in 2017 by a team of the Secretariat and the Steering Committee and based on the experience of harm reduction advocacy approaches and analysis of the situation in the region (Strategic framework for 2018-2019). Today, the Steering Committee will analyze the results of the implementation of the Strategy, based on the results of the survey for the Association members.

“It is already clear that we need to “fix”, to restart harm reduction in the region, to choose the most effective approaches to communication and advocacy. I suppose, even through provocations, but to inform the officials about the importance of helping people, not punishing them. I do hope that during the meeting we will be able to come up with new and fresh answers to complex challenges,” – says Anna Dovbakh, Executive Director, EHRA.

The agenda of this meeting is to develop a theory of changes with the answers to the following questions: how do we want to see harm reduction in the CEECA countries in 5 years, and what do we need to achieve this future, considering many factors, such as:

– widespread distribution of new psychoactive substances and the drug scene changes;

– changes in the level of harm reduction funding and the sources of these funds in different countries of the region;

– changes in the quality of harm reduction services and access to services with the transition to the national funding;

– drug policies toughening in countries;

– сhanges in the civil society participation in decision-making processes at the national and local levels.

“For an organization that brings together more than 250 organizational and individual members in 7 CEECA subregions, it is important to develop strategic directions that will consider existing experience and introduce innovative approaches in advocacy; based on the enormous human and intellectual potential, to carry out work aimed at improving the quality of life for one and all at the national as well as at the regional level. It is important to go beyond the standard, not to be afraid to experiment and plan. After all, we are justly fighting for the fate of people, for the quality of their lives and a better future.” – Marina Chokheli, Chair of Steering Committee, EHRA.

“My expectations from the meeting in Vilnius relate to the importance of the role that EHRA plays today in drug policy reform in the EECA region. At the meeting, we need to decide our Strategy and course of the actions, so these changes in the existing punitive laws in most of our countries regarding people who use drugs could occur as soon as possible. The EHRA Strategy today is not a theory and the reasoning, as it could be, but it is our actions on which the life and health of specific people depend. There is a conditional “counter” in front of our eyes that shows how many people TODAY are arrested, how many TODAY have died from overdoses and lack of help, how many TODAY have become HIV-positive, etc.

This meeting is also important for EHRA too. It is important for us to hear each other life, to find common ground in the work of the Secretariat and the Steering Committee, to unite our efforts in order not to become the heroes of the fable “The Swan, the Pike and the Crab.” One team, one goal, actions in one direction – we cannot leave Vilnius without it.”- Alexander Levin, Steering Committee Co-Chair, EHRA.

Support. Don’t punish

What does SUPPORT mean to you? 

EHRA called everyone to be a part of international campaign Support. Don’t punish

Право каждого, Orenburg: 
#supportdontpunish #Правокаждого #АленаАсаева 
Campaign in Orenburg. Administration. Court. Parliament. Sun, positivity, unity, hope!


Support is … caring about different drug releated cases 
Support is … Community 
Support is … be honest
Support is …. going ahead together 
Support is ….Trust in justice
Support is …..when people understand you
Support is …. the LEGALIZE of cannabis! 
Support is FREEDOM

Association Harm Reduction Network and Ranar, Kyrgyzstan

The #EKHN Board joins the Support. Don’t punish movement. We focus on supporting harm reduction policies. For us, support is a team of promoting initiatives to respect the right to health and access to treatment for all who need it. #Supportdontpunish #Supportis. EKHN, Kazakhstan

Твой шанс

International support and development of OST in Belarus  – Твой шанс“, Belarus

Support is the improvement of psychoactive policies, which gives priority to public health and human rights, as well as to promoting drug policy reform and changing laws and policies that impede access to harm reduction activities. Kazakhstan. The photo exhibition “Orange Morning” as part of the #Supportdontpunish World Campaign

Support is to recognize the right of people to use the substances that they choose themselves and they will not be persecuted for this choice and subjected to repression. The slogan of the action in Kazakhstan is access to narcotic substances is a question of medicine. Kazakhstan. The photo exhibition “Orange Morning” as part of the World Campaign. #Supportdontpunish

Support is when each team member is unique and we have unity in the protection and care of each other. EHRA team

The impact of the Global Fund’s Eligibility Policy on the sustainability of the results of the last Global Fund HIV grant for Russia

Author: Ivan Varentsov, Sustainability and Transition Advisor, EHRA

The blog prepared on the basis of the presentation provided by the author on 29 April at the major session of the main program of the International Harm Reduction Conference, which was held in Porto from 28 April to 01 May, 2019

The situation with HIV in Russia is awful and here are some facts in support of this statement:

  • EECA is the only region in the world where the HIV epidemic continues to grow (UNAIDS, 2017)
  • Russia is home to 70% of people living with HIV in the region (UNAIDS, 2018)
  • The highest rates of newly diagnosed cases of HIV for 2017 were observed in the Russian Federation (71.1 per 100 000 population) (WHO 2018)
  • Russia and Ukraine contributed 75% of all cases in the WHO European Region and 92% of cases in the East (WHO 2018)
  • Results of the 2017 IBBS conducted in seven cities of Russia[1]:
    • 48,1 – 75,2% HIV prevalence among people who inject drugs (PWID),
    • 7,1 – 22,8% among men who have sex with men (MSM), and
    • 2,3-15.0% among sex workers (SW).
  • About 70% of all HIV cases in Russia are associated with the use of injecting drugs
  • More than 1 306 109HIV cases have been registered as of 1st November 2018 (Federal AIDS Center)
  • Coverage of PLWH by HIV treatment was about 42% in 2018[2]

To summarize: for many years there has been a concentrated epidemic among people who use drugs, sex workers and MSM in Russia with parenteral transmission being the predominant way of HIV spreading (42% of new cases in 2018). At the same time the government doesn’t support the implementation of prevention programs including harm reduction ones even at the minimum required scale.

Russia’s Global Fund eligibility context

Russia is an Upper-middle income country with high HIV disease burden, a member of G-20. It’s not on the Organization for Economic Co-operation and Development’s (OECD) Development Assistance Committee (DAC) List of Official Development Assistance (ODA) recipients. Normally this means that a country would not be eligible for any GF HIV funding. But there is a provision in the GF eligibility policy formerly known as “NGO rule”. According to this provision “Upper-middle income countries meeting the disease burden criteria but that are not on the OECD-DAC List of ODA recipients, may be eligible for an allocation for HIV/AIDS to directly finance non-governmental and civil society organizations, if there are demonstrated barriers to providing funding for interventions for key populations, as supported by the country’s epidemiology.  Eligibility for funding under this provision will be assessed by the Secretariat as part of the decision-making process for allocations”.

According to the 2019 Global Fund Eligibility List[3] Russia may get an allocation for HIV component for the next 3 years if the GF Secretariat decides that such barriers exist in country.

GF vs Russia Background

Since being established, the Global Fund has invested more than 250 million USD within Round 3, Round 4 and Round 5 to support HIV and TB response in Russia.  Actually, the only grant ever provided within the NGO rule was given to Russia in 2014 and it ended in summer 2018. What was important about that grant is that it was a $12 million project developed, coordinated and implemented by civil society and communities without any governmental involvement. It actually achieved very good results against set targets and was rated B1, with eight out of ten indicators rated A1.

The program consisted of three intertwined major components:

  • HIV prevention service delivery for PWID, SW and MSM (17 PWID programs, 5 MSM, 5 SW and 12 additional programs being co-financed)
  • Strengthening of community systems (establishment and support of 4 Community Forums to ensure the engagement of key populations in the meaningful dialogue with the government at all levels)
  • removing legal barriers (including 20 small grants)

Taking into account the relatively small funding available within this grant it’s, of course, impossible to say if this project had any impact on the HIV epidemic in Russia, and it would be really strange for someone to expect this. But it was of major importance for communities’ mobilization and strengthening of their systems. And of course, one should not forget about all those people who, thanks to the program, had access to HIV prevention services in more than 20 cities.

Eligibility crisis

The implementation of the last HIV program in Russia funded by GF ended in summer 2018. Everyone would probably agree that it would make sense for the donor to try and sustain the achieved results and level of services provided within the project until at least the end of 2019 when it becomes clear whether Russia is going to get a new allocation from GF or not.

Actually, there’s even a special provision in the GF eligibility policy allowing countries whose disease components within the existing grants become ineligible, to receive up to one allocation of Transition Funding to support priority transition needs following the change in eligibility. That’s unless the reason for the change in eligibility is due to the country obtaining High Income status or becoming an OECD-DAC member. But Russia was considered as ineligible to receive any transition funding from the Global Fund to sustain the achievements of the HIV project.

Here’s the reason: after being ranked as high-income country by World Bank for a couple of years, Russia was downgraded to an upper-middle income country in 2016. But for the purposes of the Global Fund’s 2017 Eligibility it was still considered high-income and therefore not eligible. That happened because of another provision of the Global Fund’s Eligibility policy according to which a component which becomes newly eligible may receive an allocation only after being ruled eligible for two consecutive eligibility determinations.

Just to repeat – the country was not high-income, but it was considered as high-income retrospectively and just because of that was denied funding to sustain the achieved results of the latest HIV program.

Some implications of the Global Fund Eligibility Policy for sustainability of services provided by NGOs

Talking about the impact the above-mentioned Global Fund eligibility bureaucracy had on access of KAPs to prevention services in the cities covered by the project: in April 2019, out of the 23 NGOs implementing 27 HIV prevention projects within the last GF program, 20 were approached by the author with a short questionnaire and 12 responded. The organizations were asked about how the termination of the support available within the GF project has affected accessibility, coverage and financial sustainability of the services.

Accessibility of services:

  • 4 organizations managed to maintain the services but had to decrease the number of outreach workers, outreach visits and amount of hand-out materials purchased.
  • 3 organization mentioned that they stopped providing needles and syringes as they couldn’t afford to buy them with the governmental funding
  • 2 organizations mentioned that they continue providing outreach services but on a voluntary basis and will probably stop soon
  • 2 organizations stopped provision of outreach services at all
  • 1 NGO completely stopped its activities (in 2010 it received the Red Ribbon Award)


  • All organizations mentioned the decrease in service coverage (between 0.2 and 18 times)


  • All organizations mentioned the decrease in funding available
  • Only 4 organizations managed to sustain the activities at a good level, all 4 due to the financial support from Elton John AIDS Foundation

Questions to GF and lessons to be learned

So, my big question to the Global Fund is – what was the point of abandoning everything that was achieved within the GF-funded 3-year project in 2018, when it’s highly likely that everything will have to be started from scratch in 2020? Isn’t it just a waste of money, time, efforts and lives of people affected by HIV?

I believe there is a lesson to be learned by the Global Fund: the Eligibility Policy’s requirement that a component meets eligibility criteria for two consecutive years should be changed if not abolished at all, as it’s inhumane and ineffective from an economic and epidemiological standpoint to wait for the second year to confirm if the country still has a ‘high’ disease burden or the same income status.

I do understand that now when Russia is considered a kind of global evil and that everyone is trying to impose sanctions on it, most donors have stopped the implementation of healthcare and other programs there. But donors should not mix up the country’s government and its people. People should come before politics and people who use drugs in Russia need your support as they don’t receive any from the government.

Taking into consideration all the factors about Russia such as its epidemiological situation with HIV, its geopolitical position, the migration flows in the region etc., – it should be clear that when planning a response to the HIV epidemic in EECA, the HIV situation in Russia must not be overlooked.

Failure to support the HIV response in Russia could jeopardize all efforts by donors and governments in neighboring countries to counteract the HIV epidemic there. One of the Global Fund’s major goals is to push for an end to the global HIV epidemic, and if it wants to achieve this goal in EECA it can’t neglect the HIV situation in Russia and avoid investing in it.




Special thanks to Jared Krauss/HRI and Steve Forrest/HRI for selected photos.

EHRA letter to support release of Andrey Yarovoy

Kobtseva Olga Anatolyevna

Representative of the Lugansk Republic in the humanitarian subgroup of the Tripartite Contact Group on the settlement of the conflict in the Donbass

Dear Olga Anatolyevna,

On behalf of the Eurasian Harm Reduction Association (EHRA) allow me to express our utmost concern about the fate, life and health of Andrei Mikhailovich Yarovoy, a citizen of Ukraine, date of birth 11/06/1967, who has been detained for 10 months in the territory of the Lugansk Republic.

Since 2009, Andrei has been a patient of opioid substitution therapy (buprenorphine). Andrei is a member of the Eurasian Harm Reduction Association (EHRA), the Eurasian Network of People who Use Drugs (ENPUD), the All-Ukrainian Association of People Who Use Drugs Volna, a human rights defender and a consultant to monitor the quality of services of the International Charitable Foundation “Alliance for Public Health”. Andrei worked in HIV / AIDS prevention programs that have been supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria since 2004. Andrei is a specialist in organizing HIV prevention and treatment programs for people who use drugs, who actively helped representatives of this group to access HIV treatment in Donbass since 2015, where programs supported by the Global Fund were implemented at that time.

On July 25, 2018, Andrei Yarovoy left Kiev for Lugansk as a consultant to the Alliance tfor Public Health o study the access of populations with a high risk of HIV infection to prevention services and life-saving treatment. On August 26, 2018, when Andrei crossed the checkpoint in the Krasnodonsky district, he was detained with 38 tablets of buprenorphine hydrochloride, a medicine used for opioid substitution therapy (OST), with a total weight of 0.152 mg. On the eve, Andrei legally received a 10-day supply of this drug (in total 0.16 g) for the treatment of his own chronic disease in a medical institution in Kiev. On August 27, 2018, Andrei was arrested, later convicted and sentenced to lengthy term with confiscation of property under Part 3 of Article 282 and Part 2 of Article 276 of the Criminal Code of the Lugansk Republic. At the moment, Andrei is being held in prison at 94420, p. Lininskoe, Sverdlovsk district, st. Profsoyuznaya, 16.

In November 2018, Professor Michel Kazatchkine, Special Adviser to the Joint United Nations Program on HIV / AIDS (UNAIDS) for Eastern Europe and Central Asia, published an explanation of the status of methadone and buprenorphine in the World Health Organization Model List of Essential Drugs for Basic Health and Treatment Systems most important diseases based on criteria of efficacy, safety and economic viability. These drugs are recommended by the World Health Organization for the treatment of opioid dependence as an opioid substitution treatment (OST). Opioid substitution therapy is one of the most studied medical practices for the treatment of addiction and the prevention of blood borne infections. It is endorsed by the World Health Organization (WHO), the Joint United Nations Program on AIDS (UNAIDS), the United Nations Office on Drugs and Crime (UNODC), medical professional organizations and researchers in the European Union and the United States and is widely used in most countries of Eastern Europe and Central Asia. The 1971 UN Convention on Psychotropic Substances provides for the possibility of transporting controlled drugs across borders for person’s own medical needs.

The humanitarian activity of Andrei Yarovoy is recognized by the world community. On April 28, 2019, during the grand opening of the 26th International Harm Reduction Conference in Porto (Portugal), Andrei Yarovoy was awarded the authoritative international aCarol and Travis Jenkins Award as a victim of human rights violations related to illegal imprisonment for storage of legally obtained medical drug. This award has been presented annually since 2005 to people who use drugs, who make an outstanding contribution to the potential harmful effects of substance use.

On behalf of the community of civil society organizations working and defending the rights of people who use drugs, activists and experts in the region of Eastern Europe and Central Asia, we ask you to consider the earliest possible release of Andrei Yarovoy and his return to his family, friends and his professional humanitarian work.

With respect and hope for a positive decision on the fate of Andrei Yarovoy,

Anna Dovbakh

Executive Director

Eurasian Harm Reduction Association

* The Eurasian Harm Reduction Association (EASA) is a non-profit public organization, registered on the initiative of harm reduction activists and organizations from Central and Eastern Europe and Central Asia (CEECA) in 2017 and uniting 251 organizational and individual members from 29 countries of the region. The EHRA’s mission is the creation in CEECA region of favorable environment for sustainable harm reduction programs and decent lives of people who use drugs.

EHRA and the Voice of the CEECA region at the HR19

Schedule of EHRA advocacy team and EHRA members during the International Harm Reduction Conference – #HR19 in Porto (Portugal):

29.04.19 Monday


Major 3: Money, Money, Money

Ivan Varentsov: The impact of the Global Fund’s Eligibility Policy on the sustainability of the results of the last Global Fund HIV grant for Russia.

Tetiana Deshko: Harm reduction programs sustainability at city levels: lessons from EECA.

Maria Plotko: Criminalization costs: the case of EECA region.

Day 1 of the International Harm Reduction Conference. Ivan Varentsov and Masha Plotko, EHRA at the major session “Money, Money, Money”. Ivan presents the impact of the Global Fund’s eligibility policy on the sustainability of the results of the last Global Fund HIV grant for Russia. And Masha shares the latest data by criminalization costs in the EECA region. #HR19, #EHRA, #CriminalizationCosts, #EECA, #Russia, #Sustainability, #GlobalFund

Posted by Eurasian Harm Reduction Association - EHRA on 2019 m. balandžio 29 d., pirmadienis

14:00 – 15:30

Concurrent 4: Reaching Communities Impacted by Conflict and Crisis

Svetlana Moroz: Access to Harm Reduction Services among Women who Use Drugs Living near the Armed Conflict Zone in Ukraine.

16:00 – 17:30

Concurrent 7: Assessing Risks and Providing Opportunities in Prison Settings

Kestutis Butkus: Lithuania – Substitution treatment is approved by law in the imprisonment places, 7 years of bringing a suit against Lithuanian institutions, 45 days of abstinence and tortures, and moral harm estimated 300 euros. Learned lessons and further steps.

30.04.19 Tuesday


Concurrent 13: Drug Checking: Past, Present and Future Innovations

Galyna Sergiienko: Drug checking service in Ukraine explores recreational drug scene.

16:00 – 17:30

Concurrent 16: Lost in Transition: Harm Reduction in Central and Eastern Europe

Yuliya Georgieva: Lost in Transition-Bulgaria struggling to ensure harm reduction activities after Global Fund withdraw.

Posted by Eurasian Harm Reduction Association - EHRA on 2019 m. balandžio 30 d., antradienis

Concurrent 18: ART Adherance

Kostyantyn Dumchev: Effective viral suppression despite delayed initiation of ART among HIV-positive PWID in Ukraine.

Denis Podopelov: Decreasing the level of discrimination against people who use drugs in need of antiretroviral therapy (ART) in Almetyevsk, Russia.

01.05.19 Wednesday

11:00 – 12:30

Major 9: Women’s Empowerment

Daria Matyushina-Ocheret: Advocacy for the Parental Rights of Women Who Use Drugs.

«Употребляешь наркотики - не смей рожать и воспитывать детей!» - это жестокое послание через систему социального обеспечения и здравоохранения посылает государства каждой женщине, употребляющей наркотики. Даша Матюшина, соратница и эксперт #EAСВ и советница #UNAIDS, обобщила для участников и участниц #HR19 основные результаты исследования нарушения репродуктивных прав женщин, употребляющих наркотики а Эстонии, Российской Федерации и в восточных областях Украины. Уязвимость женщин начинается с беременности, очень сильная сразу после родов, в момент развода. И даже вызов полиции в случае домашнего насилия в отношении женщины может привести к потере права опеки над своими детьми. Замкнутый круг, но активистки не сдаются, объединяясь в движение #наркофеминизм, давая надежду женщинам в странах.

Posted by Eurasian Harm Reduction Association - EHRA on 2019 m. gegužės 1 d., trečiadienis

Major 11: Community Power in Research and Advocacy

Chair: Olga Byelyayeva & Meaghan Thumath

Oxana Ibragimova: Advocacy by the community of people who use drugs of OST programs in Kazakhstan.

Aidana Fedosik: Research by community among sex workers in Orenburg, RF.

Posted by Eurasian Harm Reduction Association - EHRA on 2019 m. gegužės 1 d., trečiadienis

Concurrent 23: Innovative Harm Reduction Approaches

Alexey Kurmanaevskii/Alena Asaeva: Harm reduction via Darknet, or new approaches to harm reduction in the context of a new drug scene.

Vyacheslav Kushakov: Nightlife safety, sexual health and harm reduction programme for experimenting young people in Ukraine.

Dialogue Space


Olga Szubert​: 10 by 20: rolling out the campaign to redirect resources from drug control to harm reduction on national level

Personal View:

Eliza Kurcevic, Membership and Program Officer, EHRA“People Use Drugs. We Want To Know What Do We Use”

Ivan Varentsov, Sustainability and Transition Advisor, EHRA – “The impact of the Global Fund’s Eligibility Policy on the sustainability of the results of the last Global Fund HIV grant for Russia​”

Ganna Dovbakh, EHRA Executive Director – Porto aftertaste: populism, new allies and issue of quality

How much does it cost to criminalize people who use drugs?

Author: Anastasia Bezverkha

Original source of the article: Talking Drugs

The massive criminalization of people who use drugs in the EECA region instead of the declared support of public health and social security imposes a financial and social burden on States. On average, incarceration costs are 2-6 times higher than the expenditures for health and social services.

This is evidenced by the results of a study conducted by the Eurasian Harm Reduction Association (EHRA). The organization collected data on incarceration costs of people who use drugs from countries of the EECA region as well as data on money spent for harm reduction services.

The study showed that in almost all the countries of the EECA region harm reduction and other health services are extremely underfunded by the state and depend on international donors. Due to de facto criminalization of people who use drugs, these services are usually not a priority and therefore insufficiently funded from government budget.

The research also demonstrated that there are a lot of people in the EECA region imprisoned for drug related crimes. For instance, 29 % of all inmates in Georgia are convicted of such offences. Incommensurability of punishments for crimes related to drugs indicates a direction in which the country is developing in terms of democratization. In Lithuania the term of imprisonment imposed by the courts for the drug related offences, in cases when there is mostly no victim, but there is an adult who uses drugs himself/herself, is 8 years. At the same time, the average punishment for crimes against the person (rape or human trafficking) is about 6 years. 


Bulgaria, which is a relatively small country, spends 26 000 Euro annually for the detention of one person who uses drugs that is more than all other countries of the region except Slovenia. At the same time, there are no harm reduction programs in prisons (needle and syringe exchange points (NSP), opioid substitution therapy (OST) programs). According to the study, the Bulgarian government spends only 2 400 Euro per person per year for treatment and harm reduction programs. Thus, the cost of health care and social services is almost 11 times less than the cost of detention.


Russia is the country with the highest number of prisoners in EECA region. According to the Council of Europe Annual Penal Statistics SPACE I, there are 602 176 inmates in Russian prisons, 129 419 of them are convicted of drug related crimes. However, the country spends only 912 Euro/per inmate annually that means only 2.5 Euro/per inmate/per day. The estimate number of people who inject drugs (PWID) in Russia is around 1 million and 800 thousand persons. HIV prevalence among PWID is 25.6 %. Let’s remind: OST in Russia is prohibited by law.    


According to the National Statistics Committee as of 2017, there were approximately 7 475 inmates in Kyrgyzstan prisons, 526 of them were imprisoned for drug related crimes.

Speaking about treatment of persons with drug dependence in prisons, it should be mentioned, that there are 9 OST sites in prison settings in Kyrgyzstan as well as there is access to ART. As of January 1, 2017 there were 14 NSP exchange points in penitentiary system. The average amount spent per day for the detention of one inmate in Kyrgyzstan prisons is 2.99 Euro which adds up to 1 091.35 Euro per inmate annually. National OST and NSP programs for people who use drugs in Kyrgyzstan cost the state around 465.85 Euro per person per year.


There are 55 000 inmates in Ukrainian prisons, about 4 400 of them are convicted of drug related offences. In Ukraine harm reduction services such as NSP and OST are not available in prison settings. At the same time, the daily cost for the detention of one inmate in Ukrainian prisons is rather low – 2.6 Euro/per day/ per person – as well as in Russia. The estimate number of people who inject drugs in Ukraine is 350 000 persons. In case the person who uses injecting drugs needs standard package of harm reduction services such as OST, NSP and unemployment benefit, it will cost the state around 392 Euro/per person/per year. Thus, health and social services cost 5 times lower than incarceration.

Eliza Kurcevič, the research coordinator, told TalkingDrugs that budgetary funds are inappropriately allocated in the region under the existing drug policy. “In the majority of the countries of the EECA region situation is as follows: there are money for harm reduction services in all states, but they need to be reallocated within existing budgets. Significant savings in state budgets can be made if the countries refer people who use drugs to harm reduction services such as substitution therapy, employment assistance and support of their social adaptation instead of imprisonment”, – claims Ms. Kurcevič.

The cost of incarceration is calculated by multiplying 365 days (1 year) to the cost of maintenance of one prisoner/per day. This amount does not include the following expenses: police work, investigation of the case, court proceedings and lost taxes, which person cannot pay, because of the incarceration and following integration of a person into the society. If those expenditures were taken into account the cost of incarceration would be several times higher. Even a short term in prison means losses for a person such as losing opportunities for education, well-paid job, difficulties with custody of children and caring of them, and loss of a breadwinner for an entire family. Those losses caused by repressive drug policy are not yet taken into consideration in this study as well as the state cost to maintain special police units on drug related crimes, the work of judges, lawyers’ salaries, and other related expenditures.     

The study data has been collected by the efforts of the PWUD community, the EHRA partners and by organizations which provide harm reduction services in the countries of the EECA region.  

For more detailed information on the countries of the EECA region see the EHRA website at the link.