Washington D.C., USA, 22-27 July 2012www.aids2012.org

Alternatives to NSEPs: community-based initiatives

Providing access to syringes in the politically hostile environment in Moscow,

Russia

Anya Sarang, Andrey Rylkov Foundation for Health and Social Justice

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Moscow * Population – 12 mln (official)10% of all Russia= population of Georgia x3; Moldova x 4; Estonia x 10; Switzerland x ~2, * Remains top 4 most expensive cities in the world shifting between 1-4 (highest cost of living) and Europe’s most expensive city• Most billionaires city (Forbes, 2011) • Ex-mayors wife is 3d richest woman/world

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Moscow background: epi

• Estimated drug users: 1.5 mln (chief narcologist of russia), 70-100K – IDUs

• 65% - opioids (heroin, street methadone, pharmacy opioids, poppy seeds preparations)

• 41.000 official HIV, 7 new registered infections per day (2011), epidemic growing

• BUT 25% IDUs don’t know their diagnosis • HIV prevalence growing: 2004 – 14%, 2011 – 18%. • Hep C incidence increased by 7.5 times in 98-2010• Hep C prevalence in IDUs – 69% (2011) • TB – 4700 new cases in 2010

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Background: politics

• Federal “government” opposes Harm reduction interventions: – Opioid substitution illegal– NSPs = thread to the national drug control strategy

• However, several NSP programs work in Russia, with support of GF and IHRD. – Grey legal zone– unsustainable

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Background: politics

• Resolution of the Moscow Department of Health prohibits realization of HR programs on the basis of municipal medical institution

• Several aggressive statements from ex-mayor• However, technically NSP is not illegal in moscow.

-- just nobody wants to mess with it! Myth of “HR illegality” inhibited development of services in the

city eg our application for funding from the Global Fund grant has

been refused on the basis that we don’t have established relations with the health authorities.

Washington D.C., USA, 22-27 July 2012www.aids2012.org

ARF, what do we do:

• Small grass-root NGO fighting for health and human rights of people who use drugs in Russia.

• mission is to promote and develop humane drug policy based on tolerance, protection of health, dignity and human rights.

• advocacy, human rights watchdog, service provision and capacity-building of affected communities and individuals.

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Community based outreach:

• Daily on-foot outreach – provision of syringes, condoms, HIV rapid tests, ointments, bandages, naloxone counseling and referral

• Drug users ‘spots’ • Medical specialist 1-2 times a week• Case management of clients • Legal counseling available on request• Training for drug users

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Numbers 2011

• Ovrerall clients – 774• Of them women – 312• Syringes and needles provided – 40 K• Condoms ~ 3K• HIV tests – 41• HIV Counseling / referral - 61• Counseling / referral to drug treatment etc - 60 • Most burning issue:

– post injection complications - 76

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Challenges

• No problems with police or municipal authority• No office or convenient storage of materials • Not possible to carry enough materials to one

outreach• No regular spaces for trainings • Seasonal challenges: one month of -40C and 4

month below -10C• Lack of services for IDUs or homeless people in the

city, including OST• Unsustainable funding

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Pluses:

• No office!! • No unnecessary conditions to our participants

including NO TORTURE BY CODING and etc !!! • No work ‘discipline’

- Horizontal self management- We love each other

• No overregulation or unnessasary bureaucracy– Flexible system of reporting = minimizes burn out

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Funding

• Intermittent funding, long periods of volunteer work

• Not included into the GF program • Application for the presidential funds declined • 2 years funded by UNODC • 2011-12 funding from Crystal of Hope Award• No perspective of funding in the near future

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Funding

• Mocro-donation campaign to buy a mobile unit

• www.en.rylkov-fond.org

• Successful in terms of awareness but not actual fundraising

Washington D.C., USA, 22-27 July 2012www.aids2012.org

The ‘government’ is going nuts

Censorship of Internet, ARF site illegally shut down, but soon it will be legal

Crack down on the NGOs (all NGOs who do some advocacy = Foreign Agents

Just say no to HIV prevention

Its illegal to protest all that