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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