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Aug 19, 2014

People who made me wiser


If we tell other people stories we usually tell stories of our drug using participants. But today we decided to share a story of our medical volunteer Pavel. For me this story was really moving - sometimes we just take the greatness of our team members for granted and we dont notice how we change as we do our work - how we change our attitude, how we become wiser and kinder, how we grow together. Sometimes people are sceptical about our work - even the medical professionals. They think that drug users should only be listened to when they come to a clinic - while they rarely do, for obvious reasons - people are too scared, to stigmatised, to untrustful. They dont often face support and understanding in the medical institutions, especially in Russia they dont. Pavels story shows how he learnt the importance of going out to the street and meeting people where they are. How this experience contributed to his personal and professional growth. We are really lucky to have such a great friend and colleague working with us and we are happy and proud to share his story with you. Maybe you can also pass it on to your friends who are doctors, nurses and medical workers and they can learn something new from their colleague! Maybe they will also want to support our work with a small donation or a kind word of solidarity!

WIth love, Anya and ARF outreach team


People who made me wiser


I’ve heard about Andrey Rylkov Foundation for the first time in June, 2011. My ex-professor from Sechenov Moscow Medical Academy called me and said: “Pasha, I’ve met at a conference some people who worked with street drugs users and they invited me to join them during several outreaches. As a clinician I was interested and could not resist, but as a woman I am a bit scared. I know you will not leave me alone, you are too gentle and professional for that, aren’t you?”. The question have been asked in a right manner, so I had no chance to refuse.

At that time I have already graduated from medical college and academy with honorary diploma of advanced practice nurse, worked in forensic psychiatry hospital and as a flight nurse and was continuing my medical education on the II course of MD program. But professor’s call made me thinking of what do I actually know about street drugs users when they are outside of the hospital? What are their routine problems, how can they handle medical issues outside of medical facilities, how should I talk to them being without white coat and so forth. My medical schools taught me how to treat patients, but not how to deal with people from streets.

First outreach was anxious, but run smoothly and was full of discoveries. A huge group of people, living in the same city with me, but at the same time living in a parallel universe since being excluded from our society. People who live, make friends, find their love, brake up, get ill, due – on the street, sometimes work, sometimes steal to survive – back there on the street. Problems with police, healthcare, social care – all of that was absolutely new for me. Guys who are limited with medical care only because they have problems with documents. Foreigners from ex-USSR who are blocked out from medical services. Pregnant girls who cannot get medical care in hospital because of unavoidable abstinence caused by absence of officially banned substitution therapy – that was a shocking reality which I faced. Why I never saw it before? A parallel universe indeed.

ARF itself was a separate discovery. Clinicians, social workers, psychologists, journalists, car technicians, philologists, ex drug users, street drug users, students, - enthusiastic people of different education, income, social, religious and political viewpoints working and spending time on the street, supporting project participants in hospitals, prisons, abroad. No old-fashioned management, no hierarchy, absolute financial transparence.

I really enjoyed my new friends, lifestyle and helping projects participants and members. I did my best to share with ARF team and participants with medical, hygiene and social information and skills I could. But in fact I myself learned much more from my new friends both from the street and ARF. In order to get more of up-to-date skills and info I’ve applied on behalf of ARF and won in 2012 course of Integrated Treatment and Care of Injecting Drug Users at Open Medical Institute & Open Society Foundations (Salzburg, Austria).

Now I have also became a source of information for my medical colleagues who worked in hospitals, city ambulance service, outpatient clinics. Having my myths being broken, I became a myth breaker for others. Not only clinicians, even some members of my family were strictly against of that kind of my activity. I am glad that ARF taught me how to open one’s eyes on situation with drugs in Russia and make other people understand the problems.

Addiction is not a sentence, and good family and social well-being have lifetime warranty not for everyone. So many stories of people who are dead or who are still fighting for their live, health, families, children, beloved ones – they make me feel older and wiser.

Through Andrey Rylkov Foundation I received access to new epidemiological data, new guidelines and recommendations for treatment and monitoring for TB, HIV, HCV, HBV and other related infections. Thanks to ARF I have attended in 2013 INTEGRATED APPROACHES IN TREATMENT OF HIV AND RELATED CO-INFECTIONS (TB/HCV) seminar hosted by The European AIDS Treatment Group (EATG) in Saint-Petersburg.

Now I am at the VI course, MD is 1.5 years away. But life with Andrey Rylkov Foundation also helped me to find myself in Medicine – I would like to specialize myself in Infections Diseases after I get my MD diploma. ARF can do much more, and I hope that those who support ARF – our partners and donors – will keep doing that. This is a good karma.



Giving out syringes and warmth from heart to heart
Giving out syringes and warmth from heart to heart
Bringing health advise out to the street
Bringing health advise out to the street
Providing  health training to other team members
Providing health training to other team members
May 15, 2014

No place for needle litter

Anya and Vova
Anya and Vova

Dear friends,

Today we decided to share with you a report on a recent Subbotnik -  when ARF and our friends and participants drug users decided to help clean the city from the used needles and syringes. One of the greatest problems for our work is that there is no recycling system for used syringes - and we decided to look for the solutions to help clean the city.  This article was written by a friendly journalist who attended the Subbotnik. 


Activists of the Andrey Rylkov Foundation for Health and Social Justice and participants of the Harm Reduction Moscow project finished the last step of a used syringe collection campaign in several areas of Moscow. On Tuesday April 29 Maxim Malyshev, the campaign coordinator, brought the collected syringes to the Central Scientific Institute of Epidemiology of the Russian Federal Service for Consumer Surveillance to Protect Consumer Rights (Rospotrebnadzor) that promised to dispose of those syringes.

 The Foundation’s employees explained why they were collecting needles on Moscow streets and how difficult it was to get the authorities to assist in the disposal process. Saturday evening, employees of the Andrey Rylkov Foundation (ARF) gathered close to the subway station Maryino. They explained this choice thus: “This pharmacy sells Tropicamide freely. Drug users often inject the stuff here.” Tropicamide is the name of a brand of eyedrops; it is a pharmaceutical drug used by drug users. It must be sold on prescription, and pharmacies must document sales. At the appointed time an elderly man with a bundle came up to ARF’s employees. It was Sasha, a drug user and a long-time friend of the Foundation. “Here’s what I’ve collected - about 40 needles, not one less,” he said proudly, giving them his bundle. In response he got medicines, clean syringes, and condoms.

 “In principle, this is how a harm reduction program should work; those programs are banned in our country. In other countries drug users can freely exchange their syringes for new ones, which helps reduce risks – for example, HIV. Nevertheless, here this practice is prohibited,” said Timur Madatov, ARF’s lawyer. ARF’s campaign called Snowdrop was assisted by two volunteers – 38-year old Rita and a 32-year old man in sagging jeans and large sneakers; he introduced himself as Ilya the Streetcar. Both have been using drugs for several years. Ilya, whose parents live close to the subway station, showed us where there most of the syringes could be found. Used “thorns”, as Rita calls them, are scattered around apartment buildings, along pedestrian walkways, on the lawn. Asya, an employee of ARF, handed out rubber gloves. She had long metal tweezers and a 1.3 gallon water bottle used to store needles. Ilya took everyone to his building, saying hello to his neighbours on the way. ARF’s employees got to the 10th floor and went to the stairs where the cleaning operation was to take place. They saw used syringes everywhere: on the floor, hidden inside radiators and walls. “Rita, don’t you touch the needle,” Asya asked. She was watching the volunteer remove a syringe from a hole in the wall with her bare hands. Rita objected and continued. “But there are different types of hepatitis,” Asya insisted.

The activists kept finding used syringes virtually at every stairwell. On the second floor, a sign was spray-painted on the wall: “This place isn’t for junkies.” Timur Madatov, ARF’s lawyer, explains: “We wanted to begin disposing of syringes a few years ago. We called many offices and in each of them they told us we should contact another office. Then we realized that calling them was useless, and began sending out official requests. Some of those offices even took the time to answer our requests.” The Foundation sent one of the letters to Infectious Hospital No. 2 which refused to accept the collected syringes and suggested that ARF talk to the Moscow Health Department. The department was not willing to dispose of used syringes, specifying that medical waste should be disposed of “in a centralized fashion” by a special licensed organization. “According to the current sanitary regulations, used needles and syringes collected on the streets of Moscow during the campaign are not classified as medical waste,” the department responded. In its official response it emphasized that “the order of disposing of household garbage in Moscow is not within the Department’s mandate.” The Moscow Centre for Epidemiology suggested that ARF address “specialized organizations that recycle and remove medical waste,” but it did not specify which organizations those are. The Foundation also appealed to the Moscow Health Department’s Methodological Unit for Epidemiology, the Moscow AIDS Centre, and the Central Scientific Institute of Epidemiology. Finally, Rospotrebnadzor’s Central Scientific Institute of Epidemiology agreed to dispose of the needles collected on Moscow’s streets. It recommended that the activists pack the syringes in a heat-resistant plastic bag and a cardboard box. As the institute explained afterward, these measures were recommended in order to protect the Foundation’s employees.

ARF President Anya Sarang explained: “It’s crazy that we had to spend so much time to find an office that could dispose of the syringes. In civilized countries, this wouldn’t be a problem – there are needle exchange programs where drug users can pick up special containers and return the collected needles; this isn’t complicated. They come to harm reduction programs because they need syringes and communication.” According to her, in some countries such containers and disposal boxes are considered standard practice. “My friend saw these special containers for syringes in Australian Parliament. It’s strange that in Moscow it took us two years to find a way to get rid of the syringes in an organized fashion. I wouldn’t even mention what regular drug users have to go through,” Sarang said.

The Snowdrop campaign events took place close to several subway stations - in Maryino, Tekstilschiki, and Pervomayskaya. According to the participants, in some areas “there were not enough bottles to collect the needles.” Maxim Malyshev, the campaign organizer, said that Rospotrebnadzor’s Central Scientific Institute of Epidemiology promised to help with syringe disposal in the future. “Syringes are considered dangerous waste, and they can’t be thrown out with the garbage. However, getting HIV through those syringes is highly unlikely – the virus is not very tough, and it requires many conditions to penetrate our bodies. But getting hepatitis C is more likely; about 80 percent of drug users have it. It’s much tougher, and just a small amount of the virus is needed to get infected. But objectively, the aesthetical inconvenience of seeing used syringes is a bigger problem for people,“ Malyshev said. He was planning to continue collecting medical waste in the future. Malyshev said: “Since we have found a place where we can bring used syringes we can start collecting them regularly. But we need to find a place where we could store our inventory and where it will be convenient for our volunteers to come. Even regular residents can participate if they want; they only need to tell us where there are a lot of needles. And we can help depending on our abilities.”

Syringe carpet in Tekstilshiki park
Syringe carpet in Tekstilshiki park
ARF bag
ARF bag
Asya syringe mining
Asya syringe mining
Tekstilshiki treasures
Tekstilshiki treasures
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.


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