Mobile health services for 1000 Moscow drug users

Feb 18, 2014

Integrating legal aid into the core of our drug harm reduction services

Discussing the 2013, planning for 2014
Discussing the 2013, planning for 2014

We want to tell our supporters about a new component of our work – adding a legal aid component to our outreach work with Moscow drug users. Human rights and strategic litigation was at core of ARF work, but it mostly were strategic work with single cases from various cities aimed at changing the Russian legislation and make it more complicit with the International Law and supportive of humane drug policy. Outreach work in Moscow was not part of these activities. At some point of our human rights and litigation work we came to the conclusion that in most situation professional lawyers can do less than people themselves in order to represent their interests. Lawyers may be needed in order to fulfill some formal tasks, but drug users themselves can do a lot of work if they are aware of their rights and empowered to stand for them - with our assistance and with some legal oversight. Thus emerged a decision to grow our own street lawyers. The concept of our «Street Lawyers» project is to add on to our health harm reduction activities with the component of legal aid to our participants, but minimize involvement of professional lawyers but rather training outreach workers and project participants to gain understanding of legal issues and skills of legal representation. To achieve that we organize training for outreach workers to gain legal skills and to be able to help participants represent their interests in courts, public offices, hospitals etc. and also enable participants to defend their rights. Soon we realized that legal representation should be a core part of harm reduction activities – as important as health – as injustice, overincarceration, violations of human rights and human dignity are great harms of the War on drugs that ruin peoples lives, health, dignity and integrity.

We have received funding from the Levi Strauss Foundation for the advocacy work and used co-funding from our Crystal of Hope Award to fund prevention materials and launched the project on July 1, but a lot of preparation work was done before that. So from July 1st we have continued to carry out daily outreach visits to the streets of Moscow to meet with people who use drugs. We now have a team of 17 street workers consisting of 13 outreach workers, two case managers (one of them focuses specifically on women), one medical worker and one lawyer who select evenings of the week that are convenient for them and work in pairs. Also sometimes unpaid volunteers and journalists join the pairs. The visits last about 1-2 hours or as long as it takes to give out all the materials that the outreachers can carry in their backpacks.

Altogether, from July 1st to December 31st, 2013 we have had 938 contacts with drug users, of them 260 were contacts with women. We encountered 402 new project participants (135 women) and provided prevention materials (needles and syringes, condoms, alco-swaps, ointments, bandages, vitamins as well as Naloxone to prevent overdose deaths) carried out testing and counseling for HIV and hepatitis C on demand and provided short consultations on health and legal issues, as well as referral to medical and social services in Moscow. Some people asked for more specific assistance and our case managers worked to help them on their issues. As we started implementation of the legal aid component, our outreach consultations and case management started to concentrate more and more on legal issues encountered by the participants and utilize more and more legal tools and instruments.

We do have one professional and very enthusiastic lawyer Timur working with our team and one lawyer from a partner project who sometimes go to outreach and engage with participants out on the streets. Most commonly, we start with contact on the street during regular outreach then case management addressing participants’ medical issues and then legal issues emerge too. 

The project experienced problems in the first few months when people did not address to us with their legal problems as they were used to the idea that we mostly focus on health. We have printed and handed out special contact cards, but people were saying, "Well I'm taking [the card], but I don’t need it, I'm all right". However, after about three months we started to work on the real cases. Then another problem emerged – we would start to work with someone, and then something happened to them (police, jail, closed hospital) so that they could no longer sign the contract with ARF enabling us the power of attorney, and we could not act on their behalf. Because of this, we decided to develop an algorithm for working on all our cases: first, we interview the participant who needs help, then, with the help of a lawyer we analyze the interview/situation and decide which directions can be pursued, and we develop a case management plan. Then the person signs the power of attorney form and the case management agreement, we make copies of all available documents. However, in some situations this algorithm does not work, because new problems emerge suddenly (usually with police, detention or arrest) that were not discussed during the interview, so we need to be very flexible and change our tactics immediately, to react to the new circumstances. But having the contract and the power of attorney form greatly helps to represent participants’ interests later on.

Another problem is that project participants often ask for help at the last moment, for example just shortly before the court. In such cases, we do not have time to prepare sufficiently, motivate the participant, explain to him/her the potential risks, and tell them about special procedures. In such cases we depart from our algorithm and we conduct a brief interview only on the substance of the matter and there is no time to develop a detailed plan of social support, we act according to the situation.

It actually matters for judges if social workers are involved in the trial! Even in cases where we are not admitted into the process as public defenders, we actually manage to do a lot for the benefit of our participants. We enclose the case management plan to the case, write a statement to be read during the trial by a social worker. And during sentencing, some judges relied on some of those documents and paid attention to the presence of a social worker in the courtroom to soften the punishment. Note that the rate of acquittal sentences in Russia is estimated at 0,6% so the realistic goal at the first stage is to get a softer punishment.

We have faced several situations related to terminating parental rights to women accused on the 228 article (drugs) and developed a model of working with guardianship authorities. It involves an approach referred to as “family conferences”. Family conferences are one of the remediation technology tools, a technique for working with families. A family discusses the problem/issue and produces the most acceptable and workable plan for themselves. The role of the professionals is mostly facilitative - the family hears the opinion of experts but develops the plan themselves. It turned out that experts from guardianship authorities have basically no idea about the issue of dependency and approaches to working with drug-dependent people and they usually have very negative and judgmental attitude – disregarding the real situation in families and parents’ effort to maintain the family and care about the kids, the mere fact of their drug use serves as a ground to decide that they are not able to take care of the kids. Tragically, the guardianship authorities opinion is the most important ground for judges decisions on terminating parental rights in courts. In spite of what we can do, if the expert opinion of a guardianship authority is negative the court will decide in favor of terminating parental rights.

Similar situations emerge when we cooperate with penal system inspectors who oversee the probation. One of our participants has missed one visit to his inspector – he had to leave the city and informed the inspector beforehand in writing. However, the inspector issued a petition to punish our participant with a real prison sentence. Our social worker met with representatives of the inspection, described our work and our social support to the client, but to no effect. And the court only takes into account the opinion of an inspector when making its decision without considering other circumstances.

Another challenge is communicating with our participants’ parents. Many parents believe in lawyers and do not have much faith in public defenders. So they prefer to pay lawyers who are not really competent or efficient, and sometimes even obstruct our work. In such situations the project would benefit from having a person with the official status of attorney who could, if necessary, show them the documents (and also charge a lot of money and later give them to the poor!).

During the last month of 2013 we have realized our dream to make a Newspaper written by our participants and team members. Our first issue of the newspaper (called Slyapa I bayan), there were two articles on legal issues: on the rights of drug users and on the cons of the special order procedure, motivating people not to plea guilty without investigation and stand for Justice.


Our main partner on this project is Canadian HIV/AIDS Legal Network whose representative Mikhail Golichenko often consult us on most of the cases and oversees preparation of legal documents and provides advise on legal strategies within a particular case. Mikhail have organized several seminars for project outreach workers where we developed the strategy and algorithm, and received some basic knowledge and understanding on how to represent participants rights in various instances. Mikhail also led several seminars for legal specialists. In order to seek new partnerships, together with Canadian HIV/AIDS Legal Network we have organized a series of lectures for legal clinics in Moscow, as we had an idea to refer some cases to those legal clinics. But it doesn’t happen as we envisaged, as students in the legal clinics are not ready to take up real cases yet – so at the moment they help us to find answers for some legal questions - we prepare questions, and the legal clinics prepare the answers. This process does not go as fast as we would like it to but this is an emerging partnership. We have also had several meetings with the Public Interest Law Network who distributed our questions to a number of legal firms providing Pro Bono services in Russia. They have also answered some questions but we wish they could take several cases from us. Another legal partnership is with lawyers association Agora, who for example, took our case Margarita Charykova (see below) and greatly help, basically freed her out of prison and applied to the European Court on Human Rights on her behalf. We also partner with the project, which focuses on online legal aid on drug issues. Their lawyer Arseniy Levinson works as a volunteer with ARF goes to outreach and advises us on legal cases.

What did we learn from the project?

Timur, The project lawyer ”I have learned a lot about the legal problems of drug users and about the barriers they face when trying to realize their rights”.

Sonya, the project medical worker: ”I have learned a lot about the problematic access to medical help that drug users experience”.  I am proud of the fact that Naloxone that we give out saves lives

Lena, the case manager (focusing on women): ”Almost the entire legal sphere is novel to me. Before I knew only in broad terms that drug users face serious rights abuse, but now I understand the specifics, nuts and bolts”. 

Evgenii (social worker): Thanks to the project, I learned a lot about the Russian legislative system and Russian law enforcement. I became more confident when facing police, and several times I was able to suppress the abuse of my rights using the new knowledge. On multiple occasions, the police have decided to stop wasting their time harassing and intimidating me and my companions, to stop forcing me into giving testimonies, to stop illegally searching my car and going through my personal belongings.

What are we most proud of?

Timur, The project lawyer: “I am proud that some of the drug users are willing to assert their rights when given assistance. I am especially proud of our participant Ildar who didn't compromise his principles and did not agree to plea guilty and got out as a result. I am also proud that our case managers (who are not lawyers themselves) already participate in the court hearings to the full extent”.

Sonya, our medical worker: ” I am proud of the fact that Nalaxon that we give out saves lives”. 

Lena, the case manager (focusing on women): ”I am proud that I participate in this project”. 

Evgenii (social worker):I am proud of my colleagues who assist people who got into a difficult legal situation and bureaucratic trap. These situations worsen people’s lives and strengthen their addiction, making them defenseless against the corruption of courts, abusive cops and prisons. Our achievements are a drop in the sea, but even if we can achieve a little, alleviate people suffering even a little, reduce their prison sentence -- all of those things warm my heart and strengthen me. I believe that a localized struggle against the rotten system cultivates the positive dynamics, which will eventually overpower the omnipotence of the absurd and corrupt, and will increase my own and my friends independence and freedom.


Nov 15, 2013

The winter is coming... again!

Summertiiiime... and the outreach is easy!
Summertiiiime... and the outreach is easy!

Dear supporters!

Since summer we decided to put some of the exerpts from our daily outreach reports online and we have translated the September batch for our english-speaking supporters - you can find them below. September was a good month - we managed to establish a solid algorythm for our Street lawyers project, have two lawyers volunteering for us in moscow plus our regular support from the Canadian HIV/AIDS Legal Network. Now another two legal firms agreed (one international and one national) agreed to support some of ARF legal cases from moscow outreach pro bono, thanks to our cooperation with PILNET (Public Interest Law Network). We are now a bit overwhelmed with legal requests coming from our participants - its a completely new direction of our work, but already by now we dont understand how we tried to work on peoples health issues without considering their legal and human rights problems - they are inseparable and we now start to believe that legal protection should become a key part of any harm reduction work! September was rainy but still manageable in terms of the weather, but now the winter is coming and we will have to cut down our outreach significantly - we still approached our 60K target for buying a minibus only by 25%. So we do ask for you further support - please help to spread the word about our work among your colleagues and friends and ask them to support us and Moscow drug users too!! And now - some of the outreach reports from Moscow hot-spots! :)  


The Chronicles of HR-Moscow. September

30.08.2013 . Arseny , Lena G.

There was rain and autumn. There were not too many participants but enough. Lena has a hypothesis that in this area there is a pharmacy, which is open until 9pm and which sells cheaper stuff, and so before 9pm there are few people in this pharmacy. People know us, and are happy to see us. Did one HIV test for a girl. She was worried that the test will be positive, but her fears didn’t materialize. She once hinted about rehabilitation, but were couldn’t talk normally. Non-users also came up from a bookmaker’s office. They had questions about what we were doing. Surprisingly, they were friendly. At the end of the outreach we met K., gave him the remaining materials. He says there is some people at Textilshiki [another outreach spot]. But it must be verified.

03.09.2013. Lena G , Timur , Sonia 

Light rain. We came at about 8:10pm. We felt certain sparseness in the atmosphere. No one was waiting for us. Two girls came up. One was interested in rehabilitation. Gave her our card to call. Then there was another one, as she said, “one step from recovery.” She was interested in whether we can take her to work and all that. Talked to her heart to heart. She told us about her housing problems, that she had nowhere to live. Then came I., we gave him everything. By the way, I. requested Troxevasin, probably injectable, if I’m not mistaken. And then Roma N. He asked for detachable needles.

With Roma we had a very sincere and long conversation. It can be said that he made our evening. We gave alot of naloxone to the girls. They said that they needed it, because of the “goddamn overdosers”. Roma told us about a family we knew whose children were taken away. We said that we can help. He asked us to call, he will provide the contacts probably.

Then we moved on to the sex workers. Not a lot, frankly. Only one contacted us. She was standing there alone. Blond hair and big eyes, a limp. In short, we gave her everything, she received the secondary stuff. Went on. There were two more, but they didn’t need anything. Valya has hepatitis without HIV. Told them about the possibility of help with getting treatment. Maybe will call.

Oh yes, there was so few people there because the pharmacy wasn’t selling the tropicamid. That’s it.

09.09.2013. Timur , Lena G., Simeon, Yuri

This outreach was based on the wishes of the Swiss journalist Simon who wanted to mingle with some of the drug users, preferably with HR-Moscow participants. A few hours before we went there it was difficult to find someone who'd agree to be interviewed (and to gather them in one place), but in the end after all three people came to meet us and gave interviews. Simeon the reporter was accompanied by the photographer and translator Yuri.

After the interview with one participant, the foreigners took a taxi and we went to the Staryi Guy [another location]. There were a few less people than in those times when we went out there with Alexander. We had 7 contacts, plus a few people refused a contact. One couple wanted to return and get tested for HIV, but did not return. There were even two contacts with people we already met. We also had a chat with a woman who wasn’t a drug user, she was just interested. In truth, I used to not pay attention to contacts with “civilians”, but recently Arseny spoke to the effect that a right self-presentation for the casually interested can become an important element, and this seems to me a sensible argument. Maybe we should be giving these people some materials about drug policy?

We missed the alcohol wipes.

Foreigners interviewed Valya from Lublino (she came especially for this), and then another acquaintance, Ramsay (we once gave him materials for secondary distribution). He is interested in our work and is thinking about volunteering on outreach.

Timur led the foreigners to the subway , and we went with Valya to my place. Along the way, we decided to stop by the pharmacy next to Vykhino metro station - that is quite near my house; I’ve been wanting to check it out since 2-3 weeks. We arrived there at 11pm, and at that time there was a horde of druggies. Tropicamid is still on sale there. In a short period we made about 8 contacts, we gave out the remaining materials, all the brochures were taken. Did two tests for HIV and one for hepatitis C. There was a woman who knows about us and she said hi to Max – she’s a petite brunette, young enough, forgot her name. There was another woman Dasha, who had a legal request (she’s either doing correctional labor or is on probation, and she just needs a job). Due to her condition she couldn’t accurately formulate her request, but she took the card and even recorded my phone number in her notebook.

10.09.2013. Timur , Lena G , volunteer Oksana from the Silver Rose [sex workers union], Simon and Yura - journalists .

We left at around 8:10pm. We came on the spot and stayed there. A girl came up (there were two, but one went to the pharmacy, and the other came up to us). She was friendly. Took some insulin needles. Dusya was there with her crutches, she had received herprosthesis on a quota, but she can’t get to the testing site because she’s on crutches, and she can’t get a taxi. We gave her a number from the Silver Rose (from Oksana), who said she could help to organize transportation to the hospital but Dusya didnt want to take it, because it was "humiliating". Internal stigma is terrible.

Then there were two guys (one is lame, and the other one had tattoos on his arm). Very emotional guys. If you treat someone like a human being you’ll get the same in return. But at first they were tough, like those guys you’d be afraid to meet in a dark alley. One said that he’d call and write to a group on VKontakte. He wants to go to detox, he’s tired of drugs.

Then our journalists came up , and these guys agreed to talk about their life. They spent 20 minutes talking to the recorder, and then took some photos. Well, it's worth noting that these journalists were quite polite.

Then there were other guys, we gave them materials. [Our volunteer] B. also gave an interview. He talked at length about his drug use experience and philosophy. At 10:30 we hinted that it would be necessary to go to sex workers actually and we went to search for the girls. Here the journalists suggested using taxi services (at their expense). In the taxi was a Georgian guy, called Koba of which he was very proud [like Stalins party alias!]. And he wanted to tell the reporters about the other Koba [Stalin]. We explained to him that we need to take a ride through the sex workers spots. He said: "Aha, I know all the spots with girls, I’ll show you." And he did. We contacted five girls on two spots, gave away a lot of condoms and needles. They also took some back to an apartment for their colleagues. We gave them the Silver Rose [sex workers association] brochures. I told Koba about us. He understood. Says he is ready to give us a ride if we pay. Gave us his phone number.

Overall it was good and sincere.

17.09.2013 . Timur , Lena , Oksana , David

I 'll tell you a tale about how Lena , Timur , Oksana David did outreach! 

Darkness enveloped the neighborhood. Haze laughed in our faces. Only occasional drug users lit us up with the warmth of their hearts and the glitter of their eyes! We met P. (I think it was him because I’m not good with names and he has an ear tunnel). He’s great! We talked heart to heart. He talked about the problems his girlfriend has with her veins. Strange things are happening to them . Doctors say these are blood clots , but he is certain that it is something else. By the way , he also said that on the weekend he had saved a guy from overdose with our naloxone. So one more saved life!

There were cute girls there . They wanted 2cc and 5cc syringes (5ccs were in high demand) . One asked about Troxevasin , says it helps alot - even her veins appeared slightly .

Pasha [another participant] was there. Pasha was as always cheerful and full of energy (but without his usual bag). We gave him as much as we could. Gave him hugs in the spirit of the General Secretary.

By the way, we even had a request for 10ccs . This is just ... for the future.

There also was a girl (she always comes up, so pretty, dark-haired, petite). She says her children are being taken away .They don’t take away her [parental] rights but demand that she write a letter of attorney to give away the parental rights to her parents . We told her that we can help she said she'd call.

I should mention one amazing thing. A woman pulled up “on a silver horse” with an open side window. She asked me, why are you here all the time. I explained about HIV , hepatitis , tests, all of this .... She became interested . Lena joined here and gave her advice and our card. We said that we can help with all of this, and if necessary - to sue for access to medical treatment. In short , maybe she’ll call . Then there was a woman with a dog (large, called Red) . We gave many things to the woman and she also promised to call. We gave her naloxone . She said she uses it to help people who OD regularly.

Regarding the situation on the ground I’ll say the following: Tropicamid is not being sold anymore at this pharmacy and THERE AREN’T ENOUGH PEOPLE! They say there’s some in the underpass, but also alot of police, so not really a good spot.

Then we called Koba the taxi driver and drove through the sex workers spots. It felt good. We gave out a bunch of condoms (Oksana bought additional ones). We drove around the spots, for about 40 minutes. Lena and Oksana went out and contacted sex workers . We had a sincere, long talk with one of them.

Mini outreach 19.09.2013 . Lena G. , Eugene H.

Went with Eugene to our local pharmacy even later at eleven-thirty at night. We met an interesting woman Katya. She is HIV - positive for thirteen years, but the immune status is not bad, about 350 cells (she’s not on therapy yet) . She regularly goes for tests and is generally attentive to her health. She has a child of 10 years , and is regularly visited by the state social worker - Katya believes that the visits cause psychological harm to her child . However, she is confident in her abilities and believes that she will withdraw from the custody surveillance on her own. Her child is adversely affected ( perhaps this is not harassment, but special treatment ) at school – adults are spreading rumors about Katya that she "has AIDS". Katya expressed willingness to come to any seminars or training sessions, but only on weekends . We should probably already start a group of women with children.

Katya said that near this pharmacy cops are cruising all the time. A precinct is nearby. Kate raised the question : how do we protect the data of our participants , recorded in notebooks or phones, if we are detained? They can search through our things? There was one man , whom we have already met . Interestingly there also was an Afro- Russian .

Talked to the pharmacist: she leaned out the window and started asking us about what kind of vials we were giving out (it was the naloxone) . We explained to her , and in addition gave brochures about the ARF and about overdoses.

20.09.2013: Max and Arseny

We met with Maxim in 7:30pm at the subway and went to the spot. Rain and grayness drove already a low motivation to work practically to zero. The only thing that warmed us were thoughts and conversations about shawarma . We went to SG [spot] by bus, which went straight to the depot. We began to worry that we will get lost, but the locals surprised us in a positive way. By their conduct, they reminded us of our native inhabitants of [our hometown of] Tver. On the bus we had a real debate on where Max and I should get off and where to go. As a result, we found the right pharmacy .

We stood at the entrance to the 7th Continent Grocery , and prepared to communicate heart to heart with those who are still suffering . But almost immediately we had the feeling that everyone around us were strange and unreal. I kept my thoughts to myself so as not to look paranoid in the eyes of Maxim. Moreover, we indulged in nostalgia for psilocybes, and I thought I was just having the flash-backs. There were almost no participants and we hesitated to approach those who came to the pharmacy. The reason for that were passers-by. There were many. Men and women, young and old, dressed in sportswear and soviet-style, all were different. But, they stood in silence for a long time near the store, smoking, drinking coffee, talking occasionally . In general, we spent an hour not understanding anything, we got hungry and went to the grocery to buy food. I purchased a cake with condensed milk and a bottle of Orangina , paid before Maxim and stood waiting near the exit chewing the cake. And then I was approached by hunted participants, who whispered that we were surrounded by plainclothes cops, and disappeared. I told Max about my phantom, and we once again rushed to the street. And hell, all these passer-bys were real cops! They somehow relaxed in the evening, began to loudly discuss the news of the police department, to joke about drugs and other crap. ALL THE PEOPLE AROUND THE STORE WERE COPS!

Jul 16, 2013

Everyone deserves respect

Making a bag with necessary medical kit
Making a bag with necessary medical kit

I had no idea what an impact the outreach project can do for those who addicted to drugs. I was invited to see the work of outreach volunteers from inside. I met two very positive volunteers with backpackers full of syringes, medical swabs, creams, condoms and medication to prevent overdose. We based near the pharmacy and started waiting for drug-users. We set up bags for each person including medical kit and Andrey Rylkov Foundation brochure where every drug-user can find essential information about harm-reduction services. That day we've met about 15 drug-users, among them were two women. Some of drug-users knew ARF volunteers will be here waiting for them. Volunteers even knew some of drug-users. They talked like an old friends, asking each other how thing's going. Every person came up to us had got bag with medical kit and brochure. I met one woman who just found out that there is such organization like ARF who helps drug-users providing harm reduction services. She was amazed that somebody cares for her. She told us she would like to stop using drugs but she doesn't know how. Volunteers provided additional information to her about Andrey Rylkov Foundation, the rehabilitation centres, anonymous groups, anonymous consultations. Woman thanked us, she was touched by such care from strangers.She said she will call to ARF for help.

All I understood that day that everyone deserves being treated as a person with respect and dignity. I understood how syringes and friendly attitude can build trust and hope for a person, who due to circumstances has been brought  into drug addiction and become an outsider of life, neglected by government and community.

I found out how many disadvantage people addicted to drugs need common understanding and support.

That was an amazing experience for me.

Full bag with contact information of ARF on it
Full bag with contact information of ARF on it
ARF volunteer - future lawyer
ARF volunteer - future lawyer
ARF harm reduce brochure
ARF harm reduce brochure


May 28, 2013

ARF: bring more human rights to the streets!

Free Margarita Charykova! Action of support
Free Margarita Charykova! Action of support

During the reporting period from January to June 2013 consistent work of the project went on. Outreach activities were carried out all week long. Every week we developed schedule of outreach visits, where geographic locations were tied to days of the week, this had positive impact on stability of the project and gaining trust of project clients. Thanks to this outreach workers can regularly find out and monitor requests of participants and the project participants can benefit from a stability factor – an important element in the unstable world of people who use drugs that has positive influence on their behavior.

Also a lot of attention is being paid to researching changes in the drug scene. Outreach workers regularly ask project participants about occurring changes and occasionally conduct exploratory outreach visits to new unknown locations, information about these new locations provided by the project participants. This allows keeping track of drug scene changes, help project participants and take action to respond to the drug scene changes.

During the reporting period outreach workers distributed syringes, needles, alcohol swabs, pregnancy tests, condoms etc. HIV and hepatitis testing was offered. Thanks to keeping track of the changing drug scene and trustful relationships with project participants outreach workers can promptly respond to changing needs of project clients.

The project team consists of experienced and caring staff members involved in the street outreach activities.  Volunteers interested in drug policy and outreach social work with project participants often join the project team. Several volunteers joined the project team and the Foundation. This openness allows learning new things and passing on experience and knowledge. Also the project is open to working with journalists, photographers and researchers from medical and social fields; this allows attracting attention of the general public to the problems of people who use drugs.

An important source of support and resource for our project is support provided by people who use drugs at the outreach work locations. At every outreach location there are people from the community with whom we build trustful and friendly relations, who provide connection between the project and the community in the area. This helps us stay informed about all changes in locations where we work and enables us to respond promptly to changes while we continue working there.

One of the main achievements is the evolving legal support component and human rights support to people who use drugs. Priority direction for the development of this project component is project staff providing these services during outreach work and for outreach workers to become ‘street lawyers’. We have already achieved very positive results: a good example is the case of Margarita Charykova who was convicted by the Federal drug control service on drug charges and was mistreated in prison while having a severe health condition. With ARF support – facilitating legal aid through a partner NGO Agora and organizing public action and pressure, Margarita was released from prison. That clearly shows the potential of the outreach workers in providing legal support and advice on legal issues and community resources. Also it should be noted that the project provides ongoing consultations on legal issues during the outreach work and ongoing search for partner organizations that can provide legal support to the project participants and staff. Meetings were carried out with the network Pilnet and representatives of the web portal Hand Help; cooperation was established with a hub of legal clinics in Moscow and together with our partners from the Canadian HIV/AIDS Legal Network we have carried out a lecture for students from different universities involved into the work of legal clinics. We hope to have long term fruitful cooperation.

An interesting achievement was participation in the project Narcophobia in the alliance with the famous poet Delfinov that allowed attracting attention of many representatives of the modern art community and creative intelligentsia. A series of public lectures on the repressive drug policy attracted attention of the public and facilitated discussions around these issues.

Another important achievement was a series of seminars on access to free hepatitis C treatment in 3 cities of Russia (Tver, Moscow, Yekaterinburg). These seminars focused on limited accessibility of hepatitis C treatment and on the possibility of defending in the court the right for access to treatment. As a result of these seminars attention was attracted to proactive actions of the community of patients with hepatitis C and potential legal actions. The seminars were recorded and a video will be produced to provide brief guidance on defending one’s right to access to hepatitis C treatment. This video will provide opportunities for people who could not participate in the seminars to learn more about this.

The project maintained cooperation with other organizations working in other fields and providing services complementary to our activities and working in the same field and providing other services important to our project participants. Among examples of successful cooperation we should emphasize our cooperation with the Federal AIDS Center. Thanks to established contacts with medical specialists in the Federal AIDS Center people who do not have Moscow registration can receive ARV treatment. Another example is cooperation with the tuberculosis clinic 5, where several project participants received and currently receive treatment. We cooperate with the organization Yasen that helps with referrals of our participants to the inpatient narcological clinics and with provision of outpatient narcological treatment.  Catholic Mother Teresa sisters’ shelter became an important partner for our project; they provide lodging, rehabilitation and socialization for our participants.

As mentioned above, community education is implemented with the resources provided by the community itself. Seminars on overdose prevention and HIV prevention were conducted. Community support in the organization of the trainings and seminars is a valuable resource for the project. These trainings and seminars are organized not in the office, but in locations where local community representatives live and meet: we meet in coffee shops or in apartments of our friends from the community. All this creates warm and trustful relationship with our project participants.

We were successful in securing funds for our Street lawyers project from the Levi Strauss Foundation, and we still have the money to pay for needles and other prevention materials through our Crystal of Hope Award. And we are still in the process of fundraising for our Bus through the GlobalGiving site - so if you want to help and further support us - please tell your friends about our work and ask them to donate and support our cause!!


with kind regards, ARF team 


Feb 19, 2013

Harm Reduction - Moscow 2012 report

A team of experienced and passionate outreach workers works with street drug users since 2009. Outreach workers regularly distribute syringes, condoms, naloxone, alcohol swabs, needles, pregnancy tests, and other materials and test participants for HIV and hepatitis. Outreach workers actively distribute brochures on hepatitis, HIV, overdose, medical services in Moscow, etc. We continued cooperation with "Narcotics Anonymous", which provided us with community newspapers and business cards and support groups’ schedule. Project participants can use our telephone "hot line" service to learn about changes in our schedule, request necessary materials and testing for HIV and hepatitis and receive consultations. A medical consultant participated in the outreach work regularly and a surgeon sees our participants upon request.


We have established productive relations with the drug users community. Some of our participants enthusiastically share our values and beliefs and actively involve their friends and acquaintances in the project activities. They distribute prevention materials, syringes and carry out secondary outreach activities.


With the support from Eurasian Harm Reduction Network/European Commission we started to provide targeted services to women who use drugs. This helped strengthen the project’s social support component, which includes referring and accompanying women in various medical facilities, referring them to medical specialists for consultations, providing support and distributing personal hygiene and sanitary products.


Also during the reporting period the project had many contacts with the media. We worked with correspondents from Big City, Moskovsky Komsomolets, Independent, Guardian, internet portal Open Space, Philanthropist, Belgian National Radio, and the Moscow State University student radio. We are always pleased to work with the media that cover our work and contribute to our mission - to develop humane drug policy in Russia.


Project results in 2012:


The number of participants/of them woman – 657/178

The number of contacts/with woman – 1726/373

The number of new participants in 2012/woman – 377/82

Number of syringes/needles – 56484/4130

Number of condoms - 2258

The number of HIV tests/ of them positive - 43/3

Number of referrals / consultations on drug dependence -  50

Number of referrals / consultations on HIV testing/ treatment - 42

Number of referrals / consultations post-injection complications -  96

Number of given vials of naloxone - 282



Social support


We provide social support to our participants including telephone consultations for participants seeking drug treatment and medical care, information about medical facilities’ schedules, required documents and requirements for admission to treatment programs.


We accompany our participants to various medical facilities, when they undergo in-patient treatment we provide them with food and other necessities and visit them regularly. With support of our outreach worker several participants received detoxification and rehabilitation services. Other participants, including participants from other cities, received medical support in relevant medical facilities including very serious surgeries.


Our social worker and medical consultant participate in the outreach activities every week; our participants can ask questions and receive advice and support directly from them. The project’s medical consultant educates participants on wound care including wound redressing skills training.


A new activity we added in this reporting period is the support of a psychologist – a trained member of our team- who carries out brief consultations during outreach and provides in-depth consultations and motivational interviews with our participants and their families.


Networking with institutions that provide medical and social services


We have established working relations with the Moscow Drug Treatment Clinic # 19. Until November 2011 we referred our participants seeking detoxification and rehabilitation services to the clinic. Outreach workers provided support to the participants undergoing treatment, visited and supplied food for these participants during their stay in the clinic. Unfortunately, “pink stubs” for hospitalizing our participants from other cities were cancelled in November 2011. Consequently, we can no longer refer our participants from other cities for detoxification, rehabilitation or other medical services and they have no place where they can receive rehabilitation as in other cities it is unavailable.


Successful cooperation was also established with the TB clinic #11, where several participants were undergoing treatment. We provide psychological and material support (food parcels, second hand clothes) to our participants and maintain contact with medical specialists.


The project established co-operation with the following organizations/specialists:


regional STI clinic: outreach workers refer project participants for anonymous STI testing;

"Salvation Army" Surgeon who consults us and works with our participants;

Epidemiological Research Institute of the Rospotrebnadzor; we referred people to their “school of patients” for people with hepatitis C and distributed their materials.

human rights organization "Agora": their Moscow-based lawyer several times provided legal advice to our participants and organized a seminar “How to behave during police detention”.


Educational activities for the project participants and employees


In 2012, the project organized four training sessions. Two trainings were organized for the project staff. Psychologist Viktor Bogomolov provided a session on team building, developing and implementing a common vision. The second training on using narrative approaches in the street outreach work, communication with participants and motivating them for positive changes was very helpful for professional development.


The other two trainings were organized for project participants. Together with Ilnur Sharipov a lawyer from the organization “Agora” we discussed what our participants should do if they are being detained. We discussed various models of behavior and avoiding conflicts with law enforcement representatives. The other training was on HIV, ways of transmission, minimizing risks, and the importance of knowing test results.


The main challenges and steps taken to address them  


The main challenge in the work stems from the failure and unwillingness of healthcare services to work with drug dependent patients. Often, people who live on the street and use pharmacy drugs and homemade opiates have no chance to get medical care. Even if they have all the necessary identification papers, they still cannot get comprehensive care that would help solve their problems, such as injuries and post-injection complications. We try to help participants on a case by case basis – referring them to medical specialists who work with us for consultations.


Most of our participants cannot access medical services because they either do not have all necessary identification papers or came to Moscow from other cities. A system of “pink stubs” allowed us to refer these participants for detoxification, rehabilitation and other medical services. After the cancellation of these “pink stubs” in November 2012 we can no longer refer these participants to the Moscow medical facilities. We appealed this decision of the Moscow Health Department with support of volunteers - community defenders and pro-bono lawyers but so far there was no decision by the court.


A similar situation has been observed with pregnant participants of the project. They cannot receive drug treatment because due to pregnancy they cannot be admitted to drug treatment clinics (according to existing drug treatment standards, drug treatment is contraindicated for pregnant women as drugs used in drug treatment are toxic). Thus, pregnant women have no way of getting adequate medical assistance in connection with drug dependence. ARF is also involved in strategic litigation around lack of access to opioid substitution treatment for drug dependent women in Russia.


The project does not have an office or a room where people who use drugs and their friends could come to visit our outreach workers, receive information or meet for trainings and discussions, including discussions about our current repressive drug policies.


Changing weather conditions (seasonal factor) also create challenges for meeting new participants. We tried to collect money for the outreach bus but did not reach the goal by the winter of 2013 and this winter we experience the same problems.


Another challenge is changing drug scene. We solve this problem by organizing outreach to investigate new sites and learn about new sites from our participants.


Our participants have multiple legal problems which present a priority in their lives over their health and well-being. In 2012 we started to work with several lawyers groups such as pro-bono firm Second Opinion, the Canadian HIV/AIDS Legal Network, a legal clinic of the Russia Legal Academy, Legal Association Agora, web-resource Our outreach workers represented clients interests in courts and provided counceling and referral in cases where legal consultation is needed. We decided that in 2013 we will dedicate more attention to legal services and had a consultation with a group of Moscow lawyers in January 2013 on how to improve our cooperation.



The 2012 years activities were funded through the Crystal of Hope Award received by ARF for its outstanding contribution to HIV advocacy. 25% time of our case manager and some prevention materials was also funded through the Eurasian Harm Reduction Network/EC grant for developing services for women. We have also received some targeted donations for support of particular individuals, travel to Moscow etc. We started a campaign on Global Giving to fundraise for the bus, which was accompanied by a number of advocacy activities in Moscow. One of the brightest activities – an auction of contemporary art work in support of the fundraising organized by our friends from the Creative Bureau “How does it work” which sold several artwork to support our fundraising. However, we were not able to reach our goal to buy a minibus by winter of 2013.

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Project Leader

anya sarang

Moscow, Moscow Russia

Where is this project located?

Map of Mobile health services for 1000 Moscow drug users