Human rights violations of PWUD related with barriers to access treatment and other health services during Covid-19 in North Macedonia

Interview with Milka Spirovska, NGO “HOPS”, North Macedonia.

In 2021 “HOPS” implemented a small grant within “We Will Not End AIDS Without Harm Reduction” project framework.

Which human rights violations of people who use drugs you observed during Covid-19 times?

People who use drugs continuously face numerous violations of rights and discrimination. During the pandemic caused by Covid-19, in addition to the violation of their rights in the field of health care, people who use drugs also faced violation of their social rights, labor rights, family rights, protection from domestic violence, etc.

Regarding the violation of social protection rights, people who use drugs faced various problems: lack of information about the changes in rules, procedures that often occurred as a result of frequent changes in the epidemiological situation, inaccessibility to representatives from the competent institutions, slow decision making on their cases (people who use drugs have been waiting for months for institutions to respond to their requests for exercising the right to guaranteed minimum assistance, financial compensation for assistance and care from another person, education allowance etc.) The most serious identified problem is the rejection of their claims for social protection rights that they have been using for years.

They also faced violation of worker’s rights. People who use drugs, who have been employed face the loss of their jobs or the non – renewal of their expired contracts, and in particular the inability to earn for a living or those who were part of the informal economy.

Regarding the violation of family rights, they faced the deprivation of their minor children by the Centers for Social Work due to the fact that they are being treated for addiction with substitution therapy.

There were also cases of domestic violence in which the rights of people who use drugs were not protected by the competent institutions. The competent institutions did not act upon the reports with the explanation that there are private family matters, or initiate proceedings against them due to disturbance of public order and peace.

How you supported people whose rights were violated within this project (small grant)?

For more than 20 years, HOPS has been committed to promoting, respecting and protecting human rights and freedoms in order to improve the health and socio – economic status of marginalized communities, especially people who use drugs and sex workers, through equal access to services, community building, capacity building, research, analysis and advocacy. In its activities, it primarily implements its activities in order to improve the status of people who use drugs and sex workers, as well as all other marginalized groups in society.

This project has enabled us to help people who use drugs, including women who use drugs, to have better access to treatment and other health services by providing free legal aid. Through the reported case, the legal advisors identified cases of violations of rights in the field of health care and motivated the clients to report the cases to the competent institutions and bodies.

Two clients were motivated to report their cases. In both cases, the legal advisor for the clients prepared complaints to the Ombudsman. In other cases, clients were not sufficiently motivated to report their cases due to distrust of the system and institutions.

Through the online thematic discussion in which people from state institutions took part and the three videos that we made within this project, which contained personal stories of violations of rights in the field of health care of our clients, we saw the problems that are facing people who use drugs, and which problems were highlighted during the Covid-19 pandemic.

In some countries, Covid-19 created loads of challenges not only for people who use drugs, but also for the civil society organizations/ service providers. Could you please tell us, what new challenges did you face because of Covid-19?

The Covid-19 pandemic was a challenge for both our clients and our organization. Adhering to the measures and recommendations of the Government and the Protocol for organizing the work of HOPS in an emergency caused by Covid-19, HOPS reorganized the work in a way that the employees had been working from home. The exception was the field workers who performed field activities. Тhey were constantly at the front and provided our clients with the necessary equipment, but they were protected with appropriate equipment (protective gloves and masks, disinfectants), in order to protect their health and the health of our clients. The clients were contacted by phone and were continuously informed about the measures, recommendations and conclusions of the Government, and in emergencies where they needed help from our employees, they received the appropriate services.

One of your activities was a launch of awareness raising campaign for improving health rights of PWUD by promoting the 3 short videos with people stories. How the public and stakeholders reacted to this campaign?

We faced a challenge in motivating clients to tell their stories. It is very difficult to motivate clients who have faced violations of rights to speak publicly about their problems and it is even more difficult to report cases to the competent institutions, due to, as I mentioned above, their distrust of the system and institutions. However, videos were promoted on the HOPS website, social media Facebook and Instagram and YouTube and we had the uploaded videos viewed. We believe that we have reached the public and we have successfully reached the goal of the planned activity.

Webinar on police response to GBV toward women using drugs

On December 16, 2021 EHRA hosted webinar for law enforcement representatives  on police response to domestic/ intimate partner violence among women who use drugs. The aim of the webinar was to build capacity and knowledge about effective police approaches in provision of help and protection to women using drugs in case of domestic and intimate partner violence. The webinar was attended by police representatives from Ukraine, Belarus, Moldova, Romania, Kazakhstan, Lithuania, Belgium, Russian Federation, Serbia, Estonia.

HIG bby Plotko cover
Help impossible to ignore: basic needs and barriers in access to health and social care services and shelters in case of violence for women using drugs in the EECA region, by Maria Plotko
Police services provision, part of a multi-sectoral response to GBV. Standard Operating Procedures
Building bridges cover
Building bridges between survivor and provider, by Ionela Horga
Policing domestic violence. Belgian approach
Department of Human Rights. National Police of Ukraine

CLIENT-CENTERED APPROACH AND BELONGING TO THE COMMUNITY ARE THE QUALITIES THAT HELP OVERCOME CHALLENGES DURING COVID-19

Interview with Maksim Malyshev, “Andrey Rylkov Foundation” (ARF), Russia.

In 2021 “Andrey Rylkov Foundation” implemented a small grant within “We Will Not End AIDS Without Harm Reduction” project framework.

What violations of the rights of people who use drugs related to the Covid-19 situation have you registered during the pandemic?

During the pandemic we noticed a decrease in the availability of treatment for people who use drugs, which constitutes a violation of the right to health. In particular, we have documented the fact that a test for Covid-19 was added to the usual list of tests that are required for admission to drug addiction treatment programs in hospital setting.

For many people who use drugs it becomes an overwhelming task to do this test free of charge at the expense of compulsory health insurance (OMC), since they do not always hold an OMC policy nor are registered with a local clinic. Commercial tests at [private] laboratories are an additional financial burden, too great for a person who uses drugs.

Such a problem was identified, for example, at the hospital of the National Scientific Center for Narcology of the Serbsky State Scientific Center of Moscow.

How did the small grant help you assist the people whose rights were violated?

ARF provided several types of assistance within the framework of the grant:

– targeted assistance and social support services for people who use drugs in the context of ensuring the rights to free medical care in various fields. Such assistance included social support, provision of legal support, dialogue and mediation with government agencies responsible for provision of healthcare services;

– broader assistance for the community of people who use drugs included government advocacy to reduce barriers to accessing health services in the setting of the coronavirus pandemic. These activities incorporated launching complaints and appeals to various organizations, and even a lawsuit against one public health service provider. We can also here mention creation and dissemination of templates for appeals to remove barriers to accessing health services due to the pandemic, which have emerged before people who use drugs;

– and finally, people who use drugs were provided with information assistance in the form of actualization of the problems caused by coronavirus infection, as well as provision of access to information about the infection itself and its effect on psychoactive substances and antiretroviral therapy drugs. Also, an important informational focus was put on development of a pamphlet regarding vital importance and possibilities of vaccination for people who use drugs.

Covid-19 has created new challenges not only for people who use drugs, but also for civil society organizations working with the community. Please tell us about the new challenges you have faced.

The most important challenges for us were:

– restructuring of work and partial refocus from offline work towards remote services. It proved to be difficult both for us and our clients as well;

– difficulties caused by changes how medical institutions and other authorities themselves worked [during the pandemic]: quarantines, lockdowns, increased secrecy under the pretext of a pandemic;

– safety of our clients in the context of Covid-19 infections was also an important topic, and we had to correlate every action with the risk of infection of our clients;

– and at the end of the day, another important challenge was ensuring safety of our staff in the context of Covid-19.

What would help you overcome the difficulties / challenges that have arisen in a more successful, more effective manner?

First of all, we were helped by our client-centeredness and by being part of the community we work with. These qualities allowed us to always side with people who use drugs and to effectively overcome the difficulties.

Strengthening this vector could be helped by ensuring our greater resilience, both in financial and psychological sense.

 

5h European Harm Reduction Conference, 2021

 

Eurasian Harm Reduction Association is proud of being an active partner of the conference and invites to the sessions where our organization members will make presentations or be the organizer of the session.

The whole programme of the conference You may find here 

10th of November

Plenary opening session S1

Quo vadis: the development of drug policy and harm reduction embedded
into the broader development of societies in Europe

 

Keynote speech:
Alexis Goosdeel, EMCDDA

 

Moderated discussion – Ricardo Bapiste Leite, Global Parlamentarians Network Unite
Panellists discuss drug policy developments in the European region

 

Panellists:
European Commission, DG Justice, tbc
Senator Lynn Ruane, Ireland, Global Parliamentarian Network Unite
Jindrich Vobrovil, Institute of Rational Addiction Policies (IRAP)
Iga Kender-Jeziorska, Civil Society Forum on Drugs
Mat Southwell, EuroNPUD

Thomas Kattau, Council of Europe, Pompidou Group
Mariam Jashi, Member of Parliament, Georgia
Massimo Barra, Rome Consensus (Red Cross)
Ganna Dovbakh, Eurasian Harm Reduction Association (EHRA)
Milutin Milosevic, Drug Policy Network South East Europe (DPNSEE)

Leverage the power of data to advocate for drug policy reform:
the Global Drug Policy Index, Matthew Wall, Head of the Department of Politics, Philosophy and International Relations, Swansea University

 

NOTE:

For those, who cannot attend the conference in person, we offer free live streaming of selected sessions.

https://www.harmreductionconference.eu/index.php/live-stream-register/

11th of November

Major Session 1 - Drug policy: decriminalisation – the next logical step for Europe?

 

Organiser: International Drug Policy Consortium (IDPC)

Chair: Eliza Kurcevič (EHRA)

 

The criminalisation of people who use drugs (PWUD) compounds drug-related harms and worsens health and welfare outcomes worldwide. However, a growing number of jurisdictions have decriminalised the possession of some or all drugs for personal use, including many pioneering examples from Europe.

When done in line with the evidence and partnership with PWUD, decriminalisation has the potential to improve public health and human rights dramatically. However, when sub-optimal models are created or models prejudice some drugs over others, this potential can be missed, and new problems can emerge.

Decriminalisation policies have always been permitted within international drug conventions. There has also been increased acknowledgement and promotion of this approach in recent years – most recently from a common position for the entire UN system.

In this session, the International Drug Policy Consortium (IDPC) invites you to explore the arguments for decriminalisation and some of the complex and challenging questions which remain. Europe can become a global champion for effective, ‘gold standard’ decriminalisation approaches – just as it was for harm reduction adoption decades ago.

 

Speakers:
Marie Nougier (IDPC)
Rui Miguel Coimbra Morais (CASO Drug Users Union)
Zaved Mahmood (OHCHR)
Tore Sørensen (Norwegian Ministry of Care and Health Services)

 

NOTE:

For those, who cannot attend the conference in person, we offer free live streaming of selected sessions.

https://www.harmreductionconference.eu/index.php/live-stream-register/

Parallel Session 3 – Girls power in HR2: women leadership to ensure access to Harm Reduction

 

Organiser: Re Generation, Eurasian Harm Reduction Association (EHRA), Metzineres, ENPUD

Chair: Irena Molnar, RE Generation

 

Women who use drugs are still frequently overlooked in their access to broad harm reduction meaning health and social care despite the complex harms, stigmatisation and structural violence they face. A substantial increase in gender-sensitive services is necessary to appropriately address their needs . Women who use drugs are often caught up in a vicious cycle of gender-based violence and drug use where the stress and trauma of violence perpetuate the women’s drug use, and the actions and behaviours associated with drug use expose them to heightened risk of violence  which grows tremendously due to COVID-19 restrictions, lack of job and lockdown. The reproductive and health rights, protection of standards of living and parental rights of WWUD are violated .

In response to discrimination, right violation and injustice activists from all over the Europe build the Narcofeminist movement. Narcofeminists support the ideology of FEMINISM, intersectional feminism in particular, which focuses on the intersection of different female identities and tries to look at how women and others, including trans and gender non-conforming people with different experiences face discrimination.

Womxn- lead harm reduction organisations are developing gender sensitive and gender transformative services, all over the broad Europe manage to improve access to health, legal protection and social care services for women who use drugs in case of violence – directly via improving a service of their own or building partnerships and providing capacity building for service providers.

Objective of the session is to promote womxn-lead harm reduction and activism and to provide interactive platform for experience sharing about:
·       Barriers for women to access harm reduction and ways to overcome it in different subregions of the Europe
·       Ways to counteract gender based violence toward women using drugs in the context of COVID-19
·       Gender sensitive women-lead harm reduction approaches
·       Narcofeminism and womxn activistm – building movement and finding allies among human rights and feminist movements

During the panel artist from the Metzineres team will be doing a graffiti or editing the animated movie, with the new ideas that could come from the panel

 

Speakers:

 ·       Why women-led initiatives and services are needed and How do they work? Aura Roig, Metzineres
·       Help impossible to ignore: basis needs and barriers in access to health and social care services and shelters in case of violence for women using drugs in the EECA region, EHRA
·       Sexism Free Night – project involving nightlife promotes, NGOs and academia – promoting safer and more egalitarian nightlife enviroments for all, Irena Molnar, RE Generation
·       Self-care and saftey protocols, supervision and mutual support for Narcofeminist leaders: mental health during Covid-19, Olga Belyaeva, ENPUD with participation from Alla Bessonova
·       Overcoming stigmatisation of women using drugs in media and social care programmes in Ukraine, Halyna Kornienko, All-Ukrainian union of women using drugs VONA

Mothers who use drugs: stigmatised and parenting, Alexandra Gurinova, Deutsche Aids Hilfe

Panel discussion

Parallel Session 4 – Monitoring and quality standards for harm reduction

 

OrganiserC-EHRN

Chair: Dagmar Hedrich, consulent
Katrin Schiffer, C-EHRN

 

Importance of civil society monitoring and Quality Standards for policymaking and advocacy

 

Quality Standards (QS) are crucial to improving harm reduction services’ quality and bridging the gap between science and practice. However, the extent and ways in which QS for harm reduction are known, implemented in daily practices, and monitored, varies substantially.
This session aims to introduce the different quality standards available for Harm Reduction in Europe and discuss the state or art of its implementation and monitoring, focusing on a civil society perspective. Some of the questions that we aim to debate are what types of QS are needed and valuable for the Harm Reduction field and how can we strengthen its monitoring and implementation in Europe.

 

Speakers:
Wouter Vanderplasschen (Gent University)
Dijana Jerkovic (Gent University, FENIQS)
Ganna Dovbakh (EHRA)
Matej Kosir (UTRIP)
Rafaela Rigoni (C-EHRN)
Peter Sarosi (CSFD)

Parallel Session 8 – NPS and mental health: humbug or an alarming situation?

 

Organiser: Eurasian Harm Reduction Association (EHRA)
Chair: Ganna Dovbakh, EHRA

NPS and mental health issues: humbug or an alarming situation? The EECA example.

In recent years, the growing use of new psychoactive substances has exacerbated the threats to the health of people who use drugs. These threats include overdoses, more risky drug use practices (such as frequent injections, sharing drug use equipment, etc.), the spread of HIV and other infectious diseases, and mental health issues.

Research conducted with people who use new psychoactive substances in 8 Eastern Europe and Central Asia region countries showed that one of the most common consequences among people who use new psychoactive substances is mental health issues. These include paranoia, aggression, psychosis, panic attacks, parasuicide and other mental health issues. The research respondents stated that mental health issues were rarely a case while using ‘traditional’ drugs. However, it has become an alarming issue in the last few years, especially with the use of synthetic cannabinoids and synthetic cathinones.

Even though sometimes mental health issues can occur due to drug use, it does not mean that this is the only and primary factor that can cause mental health issues.

This session aims to exchange views and discuss how to accurately respond to mental health issues among people who use new psychoactive substances without harmful consequences to the community, in the context of the current social, political, and economic situation in countries of Eastern Europe and Central Asia.

The objectives are:

  • to present findings of the studies on new psychoactive substance use in Eastern Europe and Central Asia region, focusing on mental health issues;
  • to present views and insights of practitioners working with people who use new psychoactive substances and mental health;
  • to discuss the possible interconnection between drug use and mental health issues;
  • to discuss whether some of the mental health interventions should be included in the harm reduction package; and
  • to propose public health responses and interventions for people who use new psychoactive substances.

Speakers:

  • Introduction, Ganna Dovbakh, EHRA
  • Basic Needs and Barriers in Access to HIV Related Medical and Social Services for People Who Use NPS/Stimulants in Moldova and Ukraine: focus on mental health, Zhannat Kosmukhamedova, (UNODC)
  • Use of NPS in EECA region: threat to public health or temporary trend? Eliza Kurcevic, EHRA
  • Statement on people who use drugs and mental health, Mauro Guarinieri, INPUD
  • Possible public health responses and interventions for people who use NPS. Do we need to include mental health within harm reduction package? Antons Mozalevskis, WHO Europe

Panel discussion on possible harm reduction and public health response to mental health issues among people using drugs, specifically among those who use NPS

Parallel Session 10 – Objects or subjects? Youth in drug policy and harm reduction services

 

Organiser: YODA
Chair: 
Iga Jeziorska, YODA

Objects or subjects? Youth in drug policy and harm reduction services

 
‘A Better Tomorrow for the Worlds’ Youth’ was the title of the 2016 United Nations General Assembly Special Session on drug policy.
Was it just a slogan?

Protecting children and youth is often a crucial argument of policymakers to adopt and implement harsh drug regulations. However, on the other hand, young people are hardly involved in a meaningful way in the policymaking processes on local, national, and international levels. Even more importantly, in many countries, the youth is one of the key vulnerable populations with limited access to various services, especially harm reduction.

This session will address the controversies mentioned above in several European countries. The participants will discuss various dimensions of the youth access to harm reduction, from legal barriers and public policy to media narrative and public opinion. Focusing on the differences between Western and East-Central European political systems, economic development and culture, and engaging the audience in a discussion, we will try to find some answers regarding the determinants of youth access to harm reduction in various regions in Europe.

 

Speaker:

Eliza Kurcevič (EHRA)
Teodora Jovanovic (ReGeneration)
Beatrix Vas, (Youth RISE)

Major Session 7 - Monitoring and implementation of Quality Standards in Harm Reduction in CEECA

 

Organiser: Eurasian Harm Reduction Association (EHRA)
Chair: Masha Plotko, EHRA

 

Monitoring and implementation of Quality Standards in Harm Reduction – state of art, challenges and the way forward

During the transition from the Global Fund to state funding harm reduction (HR) due to harm reduction being accepted only as HIV prevention, medical and not social service, the governments tend to support only the medical part of the program. As a result, available packages and quality of harm reduction services while transitioning are decreasing even if services are supported. Indicators accessing the efficiency of HR programs in the CEECA region are usually numeric (for example, number of clients, number of people tested, number of syringes/condoms distributed) and lack qualitative data. Accessibility, client satisfaction with the program, and the influence on the client’s life (quality of life, reintegration into society) are not part of the evaluation.

Session objectives:

  • approaches and place of community-led monitoring in ensuring access to and quality of programs;
  • sufficient funding and calculation of the unit cost based on peoples‘ needs
  • basic quality criteria and comprehensiveness of packages of harm reduction services

 

Pre-recorded presentations for the session:

We suggest all session participants to watch video presentations in advance to have a live discussion during the session.

  • Harm reduction during transition: changes in packages, unit costs and quality of services (Maria Plotko, EHRA)
  • Challenges of transitioning – Is Ukraine could be considered as a good example for the region? (Evgenia Kuvshinova, Ukraine) – Balkan countries: how harm reduction transited to state funding and what needs to be done next? (Irena Molnar, Serbia)
  • Community led monitoring in EECA and lessons learned (Vitalij Rabinchuk, Moldova)
  • Harm reduction where Global Fund has never been (Magdalena Bartnik, Poland)
  • Flexible harm reduction (Machteld Busz, Netherlands)
  • Role of clients and civil society in harm reduction development (Marine Gaubert, France)

Facilitated discussion with panellists 

Question 1: What is the ultimate goal of harm reduction based on quality standards (QS), IDUIT and other international recommendations: HIV or HCV response? Health and wellbeing of people using drugs? Human rights protection? Social justice?

Question 2: Who defines the actual available package of harm reduction services, and what does it depend on?

  • National standards and unit costs or quality standards
  • Needs
  • Available resources
  • Our niche or partnership with other services
  • Capacities of staff
  • What could harm reductionists do to make a package of services comprehensive?

Question 3: Role of community and civil society in monitoring and advocating for the quality of harm reduction services?

Panellists:

Machteld Busz, Netherlands
Irena Molnar, Serbia
Vitalij Rabinchuk, Moldova
Magdalena Bartnik, Poland
Marine Gaubert, France

The results of the stakeholder meeting “How to make effective and efficient online and remote HIV prevention, treatment and care services for key populations”

COVID-19 has had an unprecedented impact on HIV prevention, treatment and support programmes for key populations in the countries of Central, Eastern Europe and Central Asia (CEECA). It has brought with it not only devastating threats, but also new opportunities for innovation and change.  One such innovation has been the introduction of online or remote service delivery.

On 7 September 2021, the Eurasian Regional Consortium  held an online discussion. More than 30 practitioners and experts from NGOs that provide HIV-related health and social services to key populations in Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Lithuania, Moldova, Russia, Tajikistan and Ukraine together with representatives of technical agencies and specialists from state and municipal health services examined current challenges and priorities for promoting sustainable and quality digital and remote HIV services for key populations in CEECA.

The main objective of the meeting was to create a platform for discussion at regional level, involving practitioners and experts to examine key technical and expert support needs and identify next steps in promoting sustainable and quality digital and remote services for key populations in the countries of the region.

The research team consisting of Anna Tokar, Maria Samko and Marina Kornilova presented the methodology and results of the mapping of existing digital and remote HIV services for key populations in CEECA. A compendium describing best practices based on the mapping study was also shown. The presentation described key barriers, key needs and recommendations for promotion of services.

The results of the study once again confirmed that the transition from the traditional way of delivering services to an online format creates a number of new challenges and needs for both service providers and funders, such as public services and donor organisations. These needs include requirement for additional technical and financial resources, specialist staff skills, data recording, cybersecurity, protection of sensitive data and quality control.

ONLINE CARE: Mapping digital and remote medical and social services for key populations in relation to HIV in the region of Central and Eastern Europe and Central Asia.

The first part focuses on mapping existing practices of online and remote services, identifying the challenges and needs of service providers to effectively implement them

Best practices in the provision of digital and remote medical and social HIV services for key populations in the region of Central and Eastern Europe and Central Asia.

The second part describes the methodology of the most common services currently provided in the countries of the CEECA region.

Practical experiences of remote and online services were presented by organisations from Moldova, Russia and Ukraine. In their presentations, speakers paid special attention to how the process of service delivery was organised, what challenges they faced and how they overcame them, what results have already been achieved.

Nikolay Unguryan presented experience of ‘Humanitarian Action’ web-based outreach in the context of harm reduction and HIV prevention for people who use drugs in Saint-Petersburg, Russia.

Andrey Chernyshev presented experience of ALLIANCE.GLOBAL of rolling out remote services such as community-based HIV, STIs and viral hepatitis testing and counselling, HIV self-testing, provision of pre-exposure prophylaxis (PrEP) and national awareness campaigns in COVID-19 context in Ukraine.

Ruslan Poverga presented the Positive Initiative’s experience on distribution of prevention materials to key groups through pharmacies and vending machines, and approaches of registering online services in the national database: “RID” in Moldova. 

The participants discussed the existing critical issues regarding the provision of online services in their respective countries and developed a list of key priorities for the next steps to be taken by the key stakeholders for successful promotion and development of quality digital and remote services in the following thematic areas:

Technical solutions and management systems

Limited technical resources, including the availability of modern PCs and tablets, constant access to high-speed mobile internet, were identified as priority issues that hampered the development of online services. Participants felt that investment in hardware should be focused on developing modern web interfaces, mobile applications and software that would facilitate the interaction between service provider and client, adviser workstations should be equipped to help ensure the privacy of both client and adviser, online service record keeping systems and client uniqueness should be automated and synchronised with other service providers, and client confidentiality should be ensured.

The need to address cyber-security issues (including the issue of security of personal data of clients and employees) was raised as a separate issue.

Among the priority issues that need to be addressed at both national and regional levels, participants mentioned the need to develop guidelines and standards for the provision of digital and remote services, which would be based on the existing evidence base, as well as standards and recommendations of key international organizations.

In the context of accounting, planning and cyber security of online services, experts participating in the meeting pointed out that most countries already have databases in which the personal data of online service customers are already stored and recorded on servers, but the problem is that these databases are not compatible with each other or are outdated, making it impossible to share or synchronise them. One technical solution would be to update and interoperate these databases, which would solve the issue of storing personal data on secure servers, record unique clients, plan services more correctly and avoid the need to create new costly databases. Where such databases do not exist in a country, the experience of other countries should be used and regional networks and initiatives could help by documenting evidence-based approaches, best practices, and sharing experiences between countries in this area.

Other priorities for technical solutions and management systems included costing of services, taking into account different approaches and needs of different key groups, as well as a flexible combination of offline and online services.

Monitoring and evaluation

Virtually all organisations record the provision of digital and remote services to some degree, but the lack of a single, generally accepted vision of what a digital and/or remote service is, where and when it begins/stops, including what components it comprises, leads to problems with customer record-keeping.

The lack of a common definition and understanding of a digital/remote service, as well as standards for its provision and a transparent and reliable system for recording digital services, makes it impossible to carry out meaningful quality control and to assess the effectiveness of digital services. For the most part, the quality of digital service delivery is assessed by customer feedback.

Participants highlighted the need to monitor online services separately from other consultations that are conducted offline, including on clients contacts and message recording. One challenging issue where investment and technical assistance is needed is in setting up costly online counselling systems in multiple languages (both national, English, French for migrants).

HIV services need to be integrated into the existing health counselling systems.

At the regional level there is need to develop recommendations or best practices on how to keep records management of digital and remote services and number of clients reached by such services. A client management system for online services should be an important priority for donor organisations and should be discussed openly with all stakeholders.

The role of regional networks and initiatives should be to document and promote best practices in logging and tracking of online services (e.g. terminal and online services tracking, use of online payment terminals, other innovative approaches), as well as to organize exchange of experiences between countries and technical assistance.

Capacity building, supervision and support for social workers providing online services.

The following key priority issues were voiced at the meeting:

  • Lack of skills among staff;
  • Difficulties in adapting staff to the online format;
  • Difficulties with balancing work online and leisure, and, as a consequence, professional burnout;

The following needs were identified as priorities:

  • New staff for organisations (e.g. IT specialist, website administrator, application administrator, chat/forum moderator, content manager/copywriter);
  • new knowledge and skills in computer literacy, working with web-based communication platforms, social networks and messengers, knowledge and use of their functionality in work, online counselling, burnout prevention, cyberbullying prevention and data security
  • skills in developing and implementing procedures and policies to ensure the protection of personal data and confidentiality of both client and service provider when delivering online services.

Results of the EHRA General and Regional meetings to elect new Steering Committee members

During May 24 – June 6, 2021 Eurasian Harm Reduction Association (EHRA) conducted online General and Regional members’ meetings in Russia and South-Eastern Europe. Quorum for the General and Regional meetings to elect new Steering Committee members needed no less than one third of the members for General meeting and no less than one third of the members from the particular region.

GENERAL MEETING. EHRA has 316 organizational and individual members, who were eligible to vote. From 316 members – 132 participated in the General meeting. It means, that quorum was met, because 41,77% of members participated in it.

The results of approval of EHRA financial report for 2020 year:

  • 123 members confirmed EHRA financial report for 2020;
  • 9 members abstained;
  • 0 members did not confirm.

EHRA financial report for 2020 year is approved.

REGIONAL MEETINGS

RUSSIA. In total the region has 46 official EHRA members, who were eligible to vote. From those 46 members – 26 participated in the meeting and cast the vote for their candidate, which means, that quorum was met, because 56,52% of members from the region participated in the elections of the SC member.

The results of voting:

  • Aleksey Lakhov – 8 votes (30,8% of all valid votes)
  • Aydana Fedosik – 7 votes (26,9% of all valid votes)
  • Natalya Sidorenko – 7 votes (26,9% of all valid votes)
  • Aleksey Korolkov – 4 votes (15,4% of all valid votes)

Aleksey Lakhov is elected for 3 years term as EHRA Steering Committee member to represent Russia region.

SOUTH-EASTERN EUROPE. In total the region has 26 official EHRA members, who were eligible to vote. From those 26 members – 10 participated in the meeting and cast the vote for their candidate, which means, that quorum was met, because 38,46% of members from the region participated in the elections of the SC member.

The results of voting:

  • 10 participants voted for candidate Denis Dedajic (100% of all valid votes)

Denis Dedajic is elected for 3 years term as EHRA Steering Committee member to represent South-Eastern Europe region.

Give a helping hand, not handcuffs: Social decriminalization campaign in Lithuania

This year “Young Wave” has focused small grant activities on the development of the social campaign. Why have you chosen such kind of activity?  Could you please tell us what your campaign is about?

Even though it was a small grant, for us it was a big project! In Lithuania, we knew that the Parliament is due to discuss drug decriminalization amendments this year. As the only NGO in the country focused on drug harm reduction for young people, we decided that it is our responsibility to start raising awareness and understanding on how drug criminalization disproportionately affects young peoples’ lives. Over the past 3 years, alarming indicators have shown that drug policy in Lithuania is focused only on criminalization of people who use drugs and those, who possess small amounts of drugs without intent to distribute. For example, possession of drugs in small quantities without intent to distribute accounted for 77% of all drug related crimes committed in 2019. 63 % of offenders were under the age of 29. Each year, about 750 people are serving sentences in prisons, which cost Lithuania around 10,5 million Euro per year. These are just a few indicators, that prompted us to create a social campaign on the harms of drug criminalization. The campaign is called “Give a helping hand, not handcuffs” (in Lithuanian – “Ištiesk ranką, ne antrankius”).  

Why this campaign was developed, what were the expectations, main expected results/changes?

This campaign was developed in recognition of the fact that the political process to achieve drug decriminalization would be very contested, and our opposition would mobilize in the media and social networks. We realized that we also need to strengthen our message so that politicians feel that young people and society at large are concerned about the harms of drug criminalization. If we don’t take action, who will? The expectation was that our campaign would get featured publicly  in the media, social networks, and at least will offer a counterpoint to the narratives of the political right wing in our country. Obviously, the main expected change would be for the drug decriminalization law to pass the vote in the Parliament, but we still have some time before the vote. If it doesn’t pass, at least we would have mobilized the community and got it ready for the next response. During the campaign we have found new allies and new stakeholders for us to grow and be more impactful in the future.

What were the main activities in your campaign?

The main activity of the campaign was the launch of three posters placement on 50 advertising spaces in the country’s capital over two weeks. These posters presented stories from people that have suffered harm from the drug criminalization laws. For example – the man who was sentenced 25 times, but received access to opioid substitution treatment instead of going back to prison for the 26th time. It all happened with the support of a police officer, who listened to the person and understood that incarceration was not a solution. Police officer helped the man to receive referral to the opioid substitution treatment. In another example, we had an image of a young woman who spent her 23rd birthday in a correctional facility just because she was caught with marijuana joint during the party. Once these posters were released, we had to write press releases and engage with various media for interviews and discussions, as well as foster involvement in the campaign through social media.

What was the public reaction to the campaign?

We actually had a lot of engagement with the public. Our Facebook social media posts had over 200,000 organic reach and around 30,000 engagements. Our campaign was covered in all major news channels and portals in the country. We had an overwhelming support from various public figures, but also the public. Especially notable were people who were sharing their personal stories of harm they have experienced from judicial and police systems. One story in particular stands out where a 16-year old girl was forced to strip naked and squat after 0.3 g of cannabis was found in a car by the police and she admitted that it was hers. She ended up spending 7,000 Euro on legal bills and had no money to attend university. Another notable story was where a person was arrested for possession of cannabis only to be bailed out by her parents (it was kind of blackmail from the police). She then described the following months of stigmatization due to the investigation which caused suicidal thoughts.  Many of these stories really highlighted the importance of who we are. There was also a large wave of negative interactions with our detractors as it’s a very controversial topic in the eyes of the public. Such comments would basically say that drug users are degenerates and they got what deserved. A lot of people seem to believe that drug use is a crime on a par with a murder and calls into question a person’s moral character. Other more consistent interactions focused on why there is a need for decriminalization when we should be focusing on people using less substances. These talking points were not unexpected and we hoped to facilitate dialogue between the two sides. The more people are talking about it, the more the Parliament feels that their decision has weight.

Some well-known public figures ultimately formed more concrete responses to our position based on moral representation and demonstration of virtue such as opposition leader Ramūnas Karbauskis and media figure Rūta Janutienė, to which we responded in dedicated social media and blog posts deconstructing their positions and correcting misinformation.

What challenges did you face? What was the hardest one? Were there any unexpected issues?

I would say the biggest challenge we faced was the management of negative online interactions in social media. The non-trivial amount of these interactions was potentially hate speech, and we took necessary precautions in order to moderate a safe and tolerant online space for dialogue. Other challenges we faced were communicating with various interest groups regarding our messaging – the journalist ethics commission and the Lithuanian youth telephone helpline in order to assure that our messaging is respectful, legal but powerful. It was also difficult to find people to share their stories and faces for the campaign, because of the overwhelming drug-related stigma associated with drug use, which this campaign tries to mitigate.

Opponents of drug decriminalization were always using confusing language in their communication. For example, they have always publicly stated that drug decriminalization is the same as drug legalization. And sometimes they even deliberately “legalization” rather than “decriminalization”, although they knew the difference between these two words. This tactic was used to confuse public and spread more misinformation so that this law does not pass in the Parliament.

The law project is already in the Parliament and soon will be discussed in the main committee. What are your thoughts about it? Will the law pass or not? Why?

It’s hard to say. Of course, the Parliament heard our message and our cases, however the opposition also took similar steps. Some of the main discussion topics are that the law should stay punitive, and that small fines can’t be imposed, as they don’t prevent drug use. Another argument was that instead of decriminalization we should offer people rehabilitation and/or treatment in order to avoid being charged with a criminal offense, however existing criminal offences would make them ineligible for this waiver. What is more, if a person would not agree to undergo a course of treatment, she/he would be punished with the criminal liability. So, this “alternative” seems more like a compulsory treatment in case of avoiding criminal liability. Some parliamentarians believe in the distinction between ‘soft’ and ‘hard’ drugs and believe that marijuana decriminalization is more acceptable, but ‘harder’ substances should remain criminalized.

The debates seem to be very heated, and we hoped to facilitate evidence-based discussion, however the rhetoric used by our detractors still contains mostly misinformation and moralization. Ultimately, I believe we have a real chance, but it seems likely that the opposition will be able to somehow change the law so that we don’t get everything outlined in the initial law proposal. But we welcome every step in the right direction at this point.

What are the main lessons learnt? If you start the campaign tomorrow with the experience you already have, what would you do differently?

I think thanks to the campaign we have much more confidence in ourselves. Initially we were afraid that we would struggle to get recognition and support, however there was no shortage of that. In fact, it was probably the most successful project in terms of public engagement we have ever made. I think we would focus more on the messaging and spreading out powerful stories based on concrete examples from legal cases, so that we can point to certain procedures that caused harm, which would make our common cause more convincing. We will definitely consider doing it again in the future, subject to funding.

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:

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  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