Benchmarking sustainability of the HIV response in the context of transition from donor funding
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:
- Compliance, Integrity and Antifraud policy
- Conflict of Interest policy
- Non-discrimination, Anti-Harassment Policy and Complaint Procedure
- 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.
We are looking for the consultants to conduct the assessment of the fulfillment of HIV related sustainability commitments given by the national governments in the context of country transition from the Global Fund’s support to national funding in the following countries: Bosnia and Herzegovina, Georgia, Montenegro, North Macedonia and Serbia
Being a partner of the Alliance for Public Health, the All-Ukrainian Network of PLWH 100% Life and other regional and national partners in the implementation of the Global Fund funded regional HIV project “Sustainability of services for key populations in Eastern Europe and Central Asia”, the Eurasian Harm Reduction Association (EHRA) is aimed at the improving the financial sustainability and allocative efficiency of HIV programs in EECA countries.
To contribute to this objective, EHRA is planning to conduct the assessment of the fulfillment of HIV related sustainability commitments given by the governments of 5 EECA countries in the context of their transition from the Global Fund‘s support to national funding. It is expected that based on the results of such assessment the key civil society regional and national partners working in those selected countries, will be able to adjust their advocacy efforts and actions to improve the financial sustainability and allocative efficiency of HIV national programs.
For that purposes in 2020 EHRA has developed a methodology and tools to conduct such assessment on a periodic basis.
- A Methodological Guide «Benchmarking Sustainability of the HIV Response in the Context of Transition from Donor Funding»
- Transition Monitoring Tool (TMT)
EHRA is looking for 5 national consultants (1 per each country) to help with conducting such assessments in Bosnia and Herzegovina, Georgia, Montenegro, North Macedonia, and Serbia.
In Bosnia and Herzegovina and North Macedonia, the assessments will be conducted retrospectively, taking into account that the implementation of the last Global Fund HIV grants ended in these countries in 2016 and late 2017 respectively.
Key tasks to be conducted by the consultants
The consultants are expected to conduct in each of 5 countries the national assessment process in accordance with the Assessment Guide “Benchmarking Sustainability of the HIV Response in the Context of Transition from Donor Funding” to be provided by EHRA. The assessment process should include the next stages:
- Scoping: Identify and collect a set of strategic and programmatic documents, including national laws and regulations relevant to the transition process through desk review and interviews with key stakeholders.
- Conduct a review of those documents with the purpose to identify the government’s commitments with regards to transition; formulate and group commitments per the guidance provided by EHRA. The consultant should also identify where public/government’s commitments are deficient to properly address transition challenges or to be monitored.
- Coordinate and work with the national reference group to be composed of community representatives and national experts and engage them in (i) selecting priority commitments for the monitoring; (ii) define formulation of commitments if those are not sufficiently elaborated in public documents; and (iii) elaborate additional commitments if considered absolutely necessary for transition process monitoring.
- Collect data through desk research and/or key informant interviews aimed to measure progress for the selected set of commitments.
- Input selected indicators into the Transition Monitoring Tool to calculate the score; and,
- Write an analytical report to summarize the findings.
A Sample Outline of the National Report is provided in Annex 5 to the Assessment Guide. The report should include contextual sections, findings, and conclusions for each of the assessed commitments as well as general conclusions and recommendations for key national stakeholders.
1.A. Repository and mapping of documents relevant to the transition process (placeholders) and containing the government’s obligations with regards to transition (intentional or officially approved).
1.B. Repository of commitments, which the country (relevant public/governmental agencies) has committed to implement in support of transition of HIV response.
- Filled in Transition Monitoring Tool.
- Analytical Report on the results of the assessment of the fulfillment of HIV related sustainability commitments given by the national government in the context of the country transition from the Global Fund’s support to national funding.
The language of the resulted documents should be English.
The total contract cost for the work of one consultant under this ToR should not exceed 3,000 USD (including all taxes).
How to apply
The individual consultants are invited to submit their CV and the Letter of Interest by e-mail referenced under title “Consultant to conduct the assessment of transition related commitments in [name of the country you are interested to conduct the assessment in]” to email@example.com by COB 22 of January 2021 24:00 EET.
Looking back over the past year, the Eurasian Harm Reduction Association has found that several words have become solidly integrated into everyday use.
We have learnt a lot this year and we have a lot to look forward to in the New Year, 2021. You can call us eternal optimists, but we believe that we will make it through the difficulties, safe and strong! May we all have a strong spirit and new achievements!
This year we really want to greet everyone personally and wish something unique and unusual. We have hidden our wishes in a gift, and it takes only one click to receive it!
Could you please share, why you decided to focus on drug consumption rooms as harm reduction service in Croatia?
Drug consumption rooms were included as a possibility or one of the measures in the National guidelines on harm reduction. So, we thought that now was a great moment to work and develop more detailed information on it, because governmental bodies are planning a review of the guidelines. And it would be great if drug consumption rooms are better explained in the guidelines.
During the project, you conducted a needs assessment among PWUD in Croatia. Could you please share the main results from this assessment? How people are reacting to the suggestion to start opening DCRs in Croatia?
We collected responses from 120 people who use drugs from 5 cities. Most of them are in favour of safe injecting rooms. During needs assessment, 80% of them answered that DCRs are needed. What is more, they would like additional services to be provided in DCRs, such as: opportunity to get a coffee or soup. Also, it would be useful to have an access to psychosocial counselling. The only issue, that might occur with opening the site is the local neighbourhood and its residents, who wouldn’t be happy about DCR.
Another activity which was implemented by you – development of the policy paper on safe consumption rooms. Could you please share what this policy paper includes and for whom it’s developed?
This policy paper provides answers if DCRs should be opened in Croatia and what are the main obstacles. It includes a theoretical basis about injection rooms, data on injection rooms in Europe, analysis of legislation, and recommendations for further work. It will be used for the development of new Guidelines on harm reduction in Croatia. The policy paper will be presented to representatives of national and local authorities to raise the issue of DCRs opening.
Are there any legal barriers to open DCRs in Croatia? If yes, could you briefly share what they are, and are there any possibilities to overcome it.
According to the existing criminal legislation in the Republic of Croatia, it is not possible to implement a harm reduction program that includes the establishment and operation of drug injection. Criminal Code, Article 191 criminalizes venues that enable consumers to use drugs. We were working together with a lawyer in producing the analysis and came to conclusion that there are two options: 1) an Ireland model- they made a lex specialis on DCR in 2017 or 2) change the Criminal code (Article No. 191)- where the questionable issue in providing the venue for injecting is raised. In that specific article all types of assisting in injecting drugs are mentioned and some would argue that even existing needle and exchange programs are illegal, there has been a national consensus since 1996 that giving new equipment to users wouldn’t be seen as assisting in drug use. There are adjusting national documents such as strategy on drug abuse and HIV prevention that mention harm reduction in a positive manner. But the issue of “venue” remains problematic.
What do you think should be the next steps in starting/ promoting safe consumption rooms in Croatia? And what should be civil society’s role in all this?
We need to continue to lobby and raise awareness on the positive aspects of the DCRs. NGOs that implement harm reduction programs are very important in raising awareness and educating other stakeholders.
We have updated the website www.smanjenje-stete.com as well as our main website www.udruga-let.hr and will continue to promote the need for DCRs. Policy paper and leaflets will be available for raising awareness and I will be speaking at the national conference and presenting the work we have done with support from the Robert Carr Foundation and EHRA.
We have now access to international documents provided by our international speaker at the conference and desk review we did.As each developmental project it might take time to open a DCR but at least we have a good starting point:
- Users are eager and would like this kind of service
- Analysis was provided and will be included in the National guidelines on harm reduction
- Capacities of FLIGHT and BENEFIT organizations have been developed and
- We are talking and promoting harm reduction and its efficiency.
In the challenging year of 2020, when we all have to keep social distance, mutual support and jointly, coordinated actions are significant to ensure that people who use drugs in the CEECA region have access to medical, legal, and social help. This unity of EHRA leadership was mostly felt on November 19-20 during the Association’s Steering Committee and Advisory Board’s annual meeting. The on-line meeting was attended by 10 of the 13 members of the Steering Committee and EHRA Advisory Board members John-Peter Kools and Rick Lines. The session was led by Marina Chokheli, chair of the Steering Committee from Georgia.
On the first day, the Steering Committee and the Association Secretariat discussed the program activities’ results and planned the main events and products for the year 2021. When harm reduction funding and effectiveness is under serious threat in most countries of the region, an honest conversation about what works and what doesn’t in regional advocacy is very important. On behalf of organisations and activists in Southeast Europe, the co-chair of the Steering Committee from Bulgaria, Yulia Georgieva, initiated the creation of a specific EHRA workgroup to respond effectively to harm reduction closures and more systematically organise regional support for the national efforts of activists and community leaders for harm reduction funding.
It has become a good tradition to plan in detail approaches to mitigate organisational, political, and reputational risks in the Association’s work by the Steering Committee. Discussed steps to minimise the following risks that have the most significant impact on the implementation of the Association’s 2021 strategy:
– The COVID-19 crisis: COVID-19 crises: rapid changes in advocacy priorities, cooperation with state, access to services.
– Changes in state policy in CEECA countries, military conflicts between nations, revolutions within the region’s countries.
– Prohibition of EHRA members’ activities in CEECA countries, including a ban on disseminating information in the Russian language due to the implementation of “drug propaganda” laws.
– Significant decrease in the number of organisations/activists working in the field of drug policy at the national level, due to lack of support or repression.
– Closure of harm reduction programs in CEECA countries.
During the meeting, the Steering Committee discussed and made several important decisions for the work of the Association:
– To support further editing of the EHRA Code of Ethics, which will regulate the relationships and compliance with the key policies for all EHRA members and partners. The finalised Code in two languages will be published on the website, included in the admission procedure for new members and the EHRA contracts.
– To organise elections of the new Steering Committee members by regional meetings and community in January, May and October, following the current Steering Committee members’ mandate in 2021.
– Make the practice of virtual regional gatherings of the EHRA a regular practice, to be held at least once every six months.The next EHRA regional members calls will be organised in February 2021.
Starting November 1, 2020 Andrey Rylkov Foundation for Health and Social Justice (ARF) will be able to continue its harm reduction services in Moscow through the Positive Action Harm Reduction HIV Challenge award by ViiV Healthcare.
While funding for HIV prevention work in key populations became almost impossible to secure either through international or domestic sources, we are happy that we will be able to continue our work. ARF received the Positive Action Challenge Grand Award in the amount of 75 000 GBP in June 2020. The decision to award ARF was announced at a Virtual AIDS-2020 Conference the same month. Positive Action Challenges seek to find innovative solutions to a particular issue or challenge. The Harm Reduction Challenge sought innovative ideas for community or peer-led initiatives or programmes that provide comprehensive, innovative and accessible harm reduction services at the community level for people who inject drugs.
„Winners of the Positive Action Harm Reduction Challenge enact community or peer-led approaches to non-stigmatising, inclusive and comprehensive harm reduction and HIV care. Approaches like these help to meaninfully engage and involve people who inject drugs and help to address the rising HIV epidemic in the community,“ said Jennifer Carpenter, ViiV Healthcare Positive Action Breakthrough Manager.
The award will help ARF cover core harm reduction services to people who inject drugs on the streets of Moscow and keep exploring ways to improve key populations access to HIV prevention and treatment by placing more focus on mental health support, with a specific objectives to:
- continue ARF daily outreach work on the streets of Moscow providing comprehensive services on HIV, HCV, overdose prevention, human rights redress, legal aid and mental health support;
- ensure the accessibility of PWID to case management on the issues of health and rights;
- expand the access of HIV-positive people to ARV treatment by improving mental health support systems;
- develop and pilot the monitoring and evaluation system that would integrate the health and human rights indicators.
The Andrey Rylkov Foundation is a grass-roots organization based in Moscow working since 2009. Our mission is to promote and develop humane drug policy based on tolerance, protection of health, dignity and human rights. In advancing its mission, ARF engages in 5 key strategies:
- direct service provision on the streets, including health and legal aid;
- advocacy and public campaigns;
- human rights monitoring and documentation;
- strategic litigation;
- PWUD community systems strengthening
While the award will help to cover essential services and staff, ARF donor funding for harm reduction has decreased by 40% in 2021. We are compensating with the ever growing contribution of our amazing volunteers network and through crowdfunding. We therefore use this opportunity to thank once again our volunteers and supporters for providing key support to our activities which becomes even more essential in these challenging times.
Harm reduction at music festivals – it is not a new practice for Europe. However, here, in CEECA region, we are just making first steps towards implementation of such practices in condition of criminalization of drug possession and distribution. This year at one of the small festivals in Lithuania, our team joined the initiative and now we are ready to share a few impressions. “Say know” instead of “say no” to drugs was our motto during the YAGA festival, which took place on August 6-10 in Lithuania.
The participants of the festival, regardless of whether they use psychoactive substances or not, were very interested in any information on how to protect themselves and others in different situations related to the consumption and different sexual practices. What do we need to know to reduce the risk or harm from substance use?
– You need to know what you use. With legal substances, the quality of the product has been tested and licensed by the government. In the case of illegal substances, you can not trust what drug dealers say. Drug testing is a key approach to harm reduction. It would be ideal to analyze the content of different substances in a drug, but so far only a couple of countries in Europe have offered such testing . In the context of the festival, it is possible to carry out reagent tests, when a person can test by himself or herself whether the substance declared by the seller is in a tablet or powder, some tests also make it possible to determine the purity of the substance. After taking several tests, a person will be able to find out if there are any other substances in the tablets.
– You need to know the health risks and consequences of using psychoactive substances in different ways and know remember reduction measures to prevent the risks. EHRA team at the exhibition of harm reduction tools showed visitors what items can help to reduce the health risks of smoking, oral, injected, or rectal use.
– You need to know how to prevent overdose or how to make human life safer in the event of an overdose. And while the use of naloxone is recommended for opioid drugs, there are no such simple overdose prevention methods for stimulants.
What is important is that the team has agreed in advance with the festival organizers, local authorities, the police, and medical services on all harm reduction activities. Any talk about drugs, peer counseling, or a seminar on drugs initially frightens the organizers, as if the conversation itself was propaganda for use. In Lithuania, the Be safe lab project has been running for several years now at the most popular music festivals, in cooperation with the Drug, Tobacco, and alcohol control department and the Coalition “I can live”. Thanks to this project, festival participants have access to information about the harm caused by different substances, especially if they are mixed, and have an opportunity to receive professional medical (psychological and drug treatment) assistance in case of problems. Such partnership facilitated our activity at the festival.
Information about the safe combination of drugs, harm reduction measures for different ways of use, reducing the risk of overdose, and assistance with the unpleasant consequences of drug use (what is called a bad trip, when psychosis, paranoid conditions, etc.) – these topics mostly were in demand among festival participants. It was important that professional help and support in case of problems related to the use of this drug was available 24 hours a day, 7 days a week right at the festival. Our partners from Demetra during the festival provided the opportunity for those wishing to be tested for HIV, as well as free consultations on safe sex and receive condoms and lubricants.
One of popular spots in the festival camp was EHRA’s equipment exhibition “HARM REDUCTION TOOLS”. The wooden stand demonstrated different examples of the tools used to reduce harm was placed with short explanation – for what drug is it used and what health harm it could prevent. Different drug use equipment like smoking kits, snorting kits, booty bumping, tools for oral administration of drugs, injecting equipment, reagents for the drug checking were presented.
In total, around 15-20 different tools from traditional needles and syringes, condoms and lubricants to overdose preventing medication such as nasal naloxone, other tools of safety such as tests for drug checking and gelatine capsules. During several hours per day one of the EHRA volunteers guided festival participants on what was presented on the stand as well as provided with additional explanation on harm reduction approaches and tools used all around the globe and in Lithuania.
Also this year EHRA team organized a seminar “Sex, Drugs and Harm Reduction” to tell festival visitors more about harm reduction, safe use of psychoactive substances and about protection in “chemsex”.
The last but, not least initiative was the distribution of reagent tests for those who wanted to check psychoactive substances. This action was important in term of local approach to the harm reduction as in Lithuania on-site drug checking is not allowed (criminalized).
Harm reduction during music festivals and events, introduction of harm reduction tools for non-injection use into harm reduction programs, integration of substance testing in CEECA countries – all these tasks are faced by EHRA in advocacy. Based on the practical experience of consulting during the festival, the team will act more effectively in future activities.
In accordance with the Decree No.18 of the President of Belarus “children are subject to state protection and placement in state care in the event it is established that their parents do not properly fulfill their obligations for the children’s upbringing and support, and therefore such children are deemed to be in a socially dangerous situation (SOP)”.