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.
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
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
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 hand-help.ru. 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.
Dear friends, (just a couple words for russian spearkers: druzja esli hotite otchet po russki, ya ego skoro poveshu na sait!!) we would like to give you a short update on some of important directions of ARF work.
Anya and ARF team.
Dear all!! While we are still in the process of collecting the money for the bus (so far, 1/6th of the sum has been raised and we thank you all once again for your generous donations!!), our outreach on-foot work goes on! Today we would like to share with you our report for the last 10 month of our work with drug users in Moscow. One of our main achievements is of course a great team and volunteers and our great participants, who actively share our passion to harm reduction and several people to whom we were able to help and support!!
outreach Moscow team.
In the period between 1 September 2011 and 31 June 2012, outreach work was done systematically. Outreach happens during the working week. Each working week has an outreach schedule where geographic locations are tied to week days, which positively affects the project’s stability and the clients’ attitude to it. Outreach workers have had an opportunity to identify and conduct monitoring of the clients’ needs, and the clients have obtained a factor of stability – as we think this is an important element in the changing world of drug users which positively affects their behavior. The reporting period was marked by exploring several new sites for further outreach work, and by work with new target groups: users of homemade opiates (from poppy seeds) and heroin users.
During the whole project clients have been regularly tested for HIV and hepatitis B and C. Also on several occasions pregnancy tests were distributed. Every time outreach workers visit the sites, they have information materials on the following topics: hepatitis, HIV, overdoses, HR-Moscow, business cards, etc. that they are actively distributing. Also this year we began our collaboration with the Narcotics Anonymous community that has provided the NA-Moscow newsletter and business cards with a schedule of drug user support groups. The project hotline worked consistently, this allowed the clients to learn about changes to our schedule, request necessary materials and testing for HIV and hepatitis.
Our team is an experienced core group that is passionate about outreach work and harm reduction. New team members are also joining that enables us to transfer our experience to newcomers and to obtain new knowledge from them.
During the reporting period we had fruitful cooperation with various media. Journalists from France, Spain, Holland, UK and Russia told their audiences about our clients, about us and our work. Those were excellent and truthful stories about our work, and we took an active part in their creation.
Speaking of numbers, in the period of 1 September 2011 to June 2012 they were as follows:
Number of clients/of them women — 305/94
Overall number of contacts/women — 1295/302
Number of first-time contacts/women — 305/94
Syringes distributed — 36844
Needles distributed — 1552
Alcohol swabs distributed — 22670
Condoms distributed — 1618
Number of HIV tests — 36
Including positive test results — 3
Number of referrals/consultations for drug dependency — 30
Number of referrals/consultations on testing/treatment of HIV — 23
Number of referrals/consultations on post-injection complications — 29
During the whole project we provided our clients with case management services. These services included phone consultations for those in need of drug treatment and medical assistance, explaining the schedule of medical facilities, entry requirements and necessary paperwork.
As necessary, personal assistance to accompany clients to various hospitals, provision of food and other necessary things, as well as personal visits were arranged. With help from our social worker, a few clients underwent detox and rehabilitation. Other clients, including those from out of town, were helped at relevant medical facilities.
Also our social worker and medical consultant do weekly outreach, which allows the clients to voice their problems and ask for help the social worker and medical consultant directly. That also facilitates the know-how of our project – systematic education of our clients in bandaging and wound care during outreach work.
And the most important and difficult endeavor during this period was management of two pregnant clients. The whole project provided all kinds of assistance and support, arranged counseling by specialists, purchased medical drugs and, if necessary, food. Currently we continue to support them after birth, providing small material assistance.
BUILDING COLLABORATION WITH FACILITIES THAT OFFER MEDICAL AND SOCIAL SERVICES
We built collaboration with Narcological Hospital No. 19. In particular, we reached an agreement with chief physician that a paper indicating the stage of HIV is not necessary for hospitalization to the HIV ward. Basically, this agreement removed one more barrier for access to drug treatment for our clients. It is also necessary to mention our close partnership with the head of the HIV ward at Hospital No. 19.
We held successful negotiations with head for social work at the rehabilitation ward of Narcological Hospital No. 17 regarding collaboration and rehabilitation of drug users. We built collaboration with Sechenov Medical Academy. We turn to the Academy for advice, and we have conducted two lectures on the “Heart to Heart” method with the Academy’s students where we spoke about harm reduction and why we are doing it.
We also established collaboration with one of the district STI clinics regarding anonymous STI testing for our clients. We continue working with a Salvation Army surgeon who is an ARF volunteer. Upon earlier agreement we contacted him for advice and referred our clients who needed surgical assistance, upon earlier agreement.
We also partnered with Crossroads, a center for psychological assistance to children and adolescents. In that framework we accepted the center’s staff as outreach volunteers. During our outreach work we distributed invitations to the Patients’ School for chronic hepatitis C organized by the Institute for Epidemiology.
The project also partnered with the human rights organization Agora. For example, Agora’s lawyer based in Moscow provided several legal consultations to our clients.
DEVELOPING VOLUNTEER NETWORK
In the course of the project the outreach team not only became closer but also got new members from a volunteer pool. We should specifically mention our medical consultant. Not only he began working with us and sharing our views, but he has also involved volunteers from the medical environment.
We organized productive work with the drug user community. There is a circle of clients with whom we built friendly and informal communication. Those clients enthusiastically share our views and convictions, involve their friends in the project, perform secondary exchange of syringes and other materials; they have supported the production of a few media reports, articles and interviews.
EDUCATION FOR PROJECT CLIENTS AND STAFF
In spite of the absence of project funds for training, project staff did a series of training events for drug users on a voluntary basis. First of all, there are two seminars on the history of drug policy and drug user activism.
Also, training was held on opiate overdoses, with subsequent provision of naloxone and a practical training on first aid for overdoses. Also, training on HIV was organized (transmission, testing, treatment, prevention) on request from a group of drug users, after which testing was provided to all those who wanted it.
A seminar with elements of training was organized for project staff on the issue of HIV and hepatitis testing for street clients. At the seminar we reviewed the aspects of pre and post-testing counseling, and performed several practical tests.
KEY CHALLENGES AND STEPS TAKEN TO ADDRESS THEM
The main challenge in this work comes from the unavailability of substitution therapy, as well as from healthcare facilities’ lack of preparedness and motivation for working with drug dependent patients. People who live on the streets and use prescription drugs and homemade opiates have no chances to receive medical assistance. Even if they have the necessary papers, they still cannot receive comprehensive aid to have their problems addressed – such as wounds and post-injection complications plus drug dependency. We cannot do anything in this situation and are trying to help our clients individually by referring them to our familiar doctors for consultations where we try to address their problems.
Those clients who are drug dependent pregnant women have a similar situation. They cannot get treatment for drug dependency because due to their pregnancy they are not accepted at drug treatment centers (existing Russian standards for drug treatment assistance are contraindicated for pregnant women, the drugs are toxic and tetragenic). Therefore, there are not any possibilities for pregnant women to receive adequate assistance for drug dependency.
The lack of space to store and distribute materials is also a challenge. Outreach workers have to obtain large quantities of syringes for storage, and that is uncomfortable in terms of transportation and the need to have an agreement with the team member who stores those materials at home.
As mentioned above, the lack of knowledge of pre- and post-test counseling is an issue for new team members. That is why training on counseling was organized for the project team, and more experienced team members shared their experience of counseling related to HIV and hepatitis testing and practiced testing.
Weather changes (the seasonal factor) also results in challenges related to searching for clients. For example, in winter of 2012 temperatures fell to -40 during one month, and street outreach was limited to 30 minutes – 1 hour. Currently we are collecting money to purchase a mobile outreach van through a micro-donations campaign on the website GlobalGiving: http://www.globalgiving.org/projects/moscow-health-for-1000-drug-users/ The outreach van would allow us to provide more quality services during winter, bring more materials, offer first aid and arrange HIV testing and counseling in a more relaxed environment.
Throughout the project we received co-funding: private donations to purchase prevention materials, condoms, antibacterial ointments, and naloxone. We have begun implementation of a project to offer services to IDU women. The project is implemented jointly with the Eurasian harm reduction network, with financial support from the European Commission. Its implementation has allowed to pay for the work of a case manager and to purchase additional materials. This co-funding and donations allow us to save some money from the requested budget, therefore we are asking AIDS Life to continue the project (without additional funding) next year.
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Combined with other sources of funding, this project raised enough money to fund the outlined activities and is no longer accepting donations.
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