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Harm Reduction services for 3000 Moscow drug users

by The Andrey Rylkov Foundation
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Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users
Harm Reduction services for 3000 Moscow drug users

 COVID in Moscow. ARF grows new roots and branches. 

On March 30 Moscow went on lockdown. COVID pandemic has hit hard on the city as a whole, from education to businesses. Still, people who use drugs once again proved to be one of the most vulnerable and unprotected groups  - socially, economically, health and human rights wise. A couple of weeks into the pandemic a lot of our participants have found themselves in very dare circumstances  - many lost their random or more regular jobs and incomes while drug-related needs, costs and risks have steeply increased. People who are dependent on drugs, especially opiates, such as heroin and street methadone, were hit heavy. Medical methadone and buprenorphine are banned in Russia, other types of drug treatment include in-patient "detox" with the use of neuroleptics and antipsychotics in state drug treatment centres, but even these centres have started to shut their doors on people with drug problems since the medical facilities were getting converted into COVID-observatories. The first drug treatment departments to close were those for women. 

COVID immidiately magnified the harms of drug criminalization. Legal risks have soared. In Moscow most drug trade is made via messengers and dark-web: after completing payment, the user receives geo-coordinates of the newly aquired 'treasure' and has to pick it up in person -- e.g. dig it up in the woods, in a park, find magneted to a bench, a house entrance etc. It is impossible to get drugs by mail as mail is very unreliable and controlled by police. In addition to routine insecurities of going out to unknown places in order to pick up drugs and risking police abuse, extortion of money, arbitrary detentions and arrests, new threats emerged. Streets became empty while the number of cops out actually increased even more - they were assigned to check peoples lock-out permissions. The liability of being out without a permission was yet an additional risk. And of course, getting the virus was a risk in itself. Due to fast-paced economic crisis more people started to seek small jobs in drug business (eg “kladmen” - people who deliver ‘treasures’ to the hiding spots), which of course made them more vulnerable to police.  In response to the unfolding endangering environments, we had to step up our legal services and communicate legal advice and tips via social networks and individually. 

We were keen on organizing rapid monitoring of our participants' needs, problems and opinions on how our services could be adjusted. Our case managers had long phone/telegram talks with the regular clients, and in addition, we ran two open community surveys via Telegram. The first ran in the first week of the quarantine, and 400 people took part, the second -- a month later, included a little over 200 people. The first one focused on the new problems and challenges; the latter aimed to capture what resources people used to improve self-support and well-being. 

The main apparent problems were poverty-related insecurities and absence of economic safety nets. The response of the Russian government to the COVID problem was to announce two months of vacation, thus putting the burden of citizens support on business and employers, so most people were fired or not paid. In our survey, 58% of people reported that they did not have any money left, or a source of income or support. Among our participants, women sex workers had to bear additional risks - while most still risked their health and provided services during quarantine, but their revenues significantly dropped. 

Access to drugs was another major issue, 65% said they experienced a shortage in access and 45% reported increased pressure from the cops. Nevertheless, 37% decided to get drugs in the same way as they did before. Some people chose to stock up with larger quantities of drugs, which made them more vulnerable from the police perspective. But most couldn't afford stock ups, so they continued going out every day. Seven per cent of our respondents decided to go cold turkey and wait for the abstinence to wear off; others chose to decrease the volume and move to pharmacy drugs or alcohol. 

As a follow up with drugs insecurities and pressure of isolation, the mental health issues became of top concerns and absence of relevant services became more visible --  66% participants said that they experienced mental health problems: anxiety, loneliness, depression. Access to any support became more problematic - mental health support in Russia is mostly provided through the private sector, which makes it financially inaccessible for the majority of our participants. But even those who could afford some services now and then before the crisis, had to discontinue due to financial hardship. Many people who struggle with dependence chose NA groups as a  source of support but those also closed or moved online. We also had to shut down our tiny office where we usually provide space for community support initiatives: from family groups for people with drug dependency to chemsex support group to NA and clubs of interests. Besides, we used this space for legal/health/psychology consultations and our team meetings and supervision. Without the office, we had to move most of our support initiatives online or on hold. ARF volunteers started a new Telegram group chat focused on surviving quarantine and peer support/fun. We also brainstormed how we could extend our mental health services. We started a telephone/Telegram hotline, engaged with two additional psychologists who agreed to consult our clients regularly. We realized that it is vital to expand knowledge on tools of emotional support to the communities and asked our consulting psychologists to organize webinars.  

Globally COVID emphasized the urgency of response to domestic violence. ARF still doesnt have working algorithms to bring up the issue and respond to it. ARF case manager Yekaterina Selivanova is working on the case of a woman and her husband, who both have drug dependence, and he also has a mental health disorder. They have a seven-year-old kid. Periodically, the husband beats and insults his wife, including in front of their son, and this lasts for years. Because of this, she has to leave home, even during the quarantine. She has nowhere to go: she does not have her own living space, job. Women shelters in Moscow do not accept women with dependence. ARF has intensified collaboration with the Center "Sisters" that assists female victims of violence. Sisters will provide training for ARF team of outreach, lawyers and volunteers and help establish an algorithm of working with women who reported domestic or sexual or other abuse (eg by partners, public services or police). 

Besides responding to new emergencies, ARF had to change daily outreach and delivery scheme. We normally deliver daily services (5-6 days a week) and materials with the help of our mini-bus and foot outreach, for the new scheme of outreach delivery or prevention materials we had to rely on our participants themselves and this worked solid. In consultation with everyone, we came to the solution to distribute the materials via the networks of regular participants/ community volunteers. Moscow is very spread out, so we agreed with several community volunteers in different districts. Couple times a week we would provide them stocks of prevention materials and HIV self-tests to distribute it in their local networks through contactless arrangements. It worked very well, and while we reached out to fewer clients than usual, we are glad that our services continued to reach the most in need. In two months, we served almost 600 clients and received 27 reports of lives saved from a lethal overdose using our Naloxone. In addition to the satisfaction that we didn't have to interrupt services despite the new challenging environment, it was very inspiring to witness the miracle of community mobilization taking real dimensions. The community networks and systems of mutual help that we aspired to nurture and support through the years suddenly became very tangible and real. A lot of people offered help, and we managed to re-organize our work safely and smoothly. 

We also continued to provide case management as people’s needs did not decease, although many governmental institutions including hospitals and courts limited their work. Nevertheless, our priority was to ensure that people stay on ARVs and we brought some of our HIV positive  participants to the AIDS center. One person initiated ARV with our help during this time. Other importants requests included accompanying to hospitals, to drug clinic, to a police station, recovery of documents, provision of additional clothes and food. 

We also continued cooperation with mass media. We helped several journalists who worked on the stories about especially vulnerable groups to COVID, such as people who use drugs and sex workers. One of these stories, called “Thousands in methadone withdrawals. How Quarantine Affects Drug Users” published by Mediazona had gotten under the menacing look of the Head of the State Duma National Security Committee, deputy Piskarev. The deputy was outraged that in such difficult times, ARF provides services to such undeserving group as people who use drugs and blamed ARF for “drug propaganda” and serving the interests of the West, representing a threat to the national security. In several articles that followed the deputy’s outrage published by the Kremlin bot factory Riafan and some pro-government TV, the deputy informed that he had initiated a series of inspections into ARF activities by the prosecution and other executive bodies. 

The attack on ARF from the deputy and federal media led to a couple very unpleasant consequences - we had to limit access to our website which makes us very vulnerable to sanctions. According to the current law and the spirit of the many new legislative initiatives any harm reduction information or even depicting of a person who uses drugs, not as a menace to the society can be interpreted as drug propaganda. Besides, a major harm reduction donor expressed reservations regarding extending support due to unfavourable spotlight in the Kremlin media. In response to the deputy attacks, ARF cooperated with Amnesty International who linked us with groups providing technical assistance on improving our security protocols. Once again, we received a lot of inspiring solidarity! ARF work has been featured in several supportive publications such as this large feature of our COVID work on Meduza care and so many people reached out to us to express support! Once again we were happy to witness that overall public debate on drugs and drug policy has shifted from stigma and myths to understanding, humane and supportive perspective and deeper understanding of drug policy realities. To compensate for the web-site closure we have extended our social media work and started a new podcast on drugs and harm reduction. 

ARF continued to document challenges in access to health, cases of discrimination and human rights violations of people who use drugs. In addition to reporting to press, we have reported these problems to various state and international organs. In a letter to the  Moscow City Health Department  we indicated that refusal to provide drug treatment services puts individuals at risk of overdose deaths, infections and forces to criminal activities. We have wrote  similar letters to the Ministry of Health and to the Ministry of Internal Affairs and to the Government of the Russian Federation suggesting to develop a response to vulnerable groups during COVID. In addition ARF continued its human rights documenting work and included information about COVID response into its reports to the UN human rights bodies such as Committee on Elimination of All forms of discrimination against women and the UN Special Rapporteur on the promotion and protection of the right to freedom of opinion and expression. 

In conclusion. Covid has once again highlighted the severe vulnerabilities of our participants, most importantly absence of economic safety, absence of any meaningful support from the government structures in situation of economical crisis; absense of access to meaningful drug treatment and that drug services will be the first to be withdrawn in case of any next emergency such as COVID; absence of access and huge need for to mental health services combined with substance use/abuse counceling; lack of PWUD-friendly GBV services and lack of addressing GBV from harm reduction services providers such as ourselves. The COVID epidemic has once again proved that in the context of dictatorship and concervative ideologies in which we are operating the health authorities are not capable of protecting vulnerable citizens and its not in their interests. In such contexts, sustainability of health response should be built around investing in the communities and their resilient and lasting systems. The COVID crisis has highlighted the strengths and resourcefulness of our communities, including among people who use drugs regularly, recreationally but also with wider public that shares the ideals of humane and supportive drug policy. Covid challenged us to refresh services we already established and to look at the new challenges seeking for new responses. We are grateful to all our allies who inspired us with solidarity and strong commitment and to all of you who kept supporting our effort through the difficult times! 

On Wednesday 15th July the GlobalGiving will give us an opportunity to raise for our new needs and challenges by matching donations on their July Bonus Day. They offer generous matches on larger donations:  

a gift of $100-$499 will be matched at 15%

a gift of $500-$749 will be matched at 30%

a gift of $750-$1,000 will be matched at 50%. 

This is an opportunity for us to start building on the lessons of COVID and develop our new directions of work: mental health support system, GBV algorithm, alternative financing through investing in community initiatives (still in exploration), volunteers education. Any smaller gifts and especially recurring donations will be greatly appreciated - such donations help us to plan a little bit better. So please wait for July 15 if you can share a larger gift with us, or make a donation now via our GlobalGiving page.  

In solidarity, 

ARF team  



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In the reporting period the ARF continued the provision of the essential live-saving harm reduction services to people who inject drugs on the streets of Moscow including: provision of the sterile syringes and needles; provision of condoms as well as of different kinds of other supplies (water for injections, ointments, bandages, alcohol wipes, etc); access to HIV self or assisted testing and counselling; provision of consultations on other health related issues, such as overdose prevention, post-injection complications, HCV, TB, STIs and drug dependency; access to legal services for people who use drugs, to case management services as well as access to naloxone to prevent overdoses.

To give you a better insight into our work we would like to share with you the description of one case illustrating the case management work we do to initiate HIV positive participants of our harm reduction project onto treatment program:

Dmitry (name changed) for a long time came to our mobile outreach unit to receive handout materials. At one point, a staff member asked him if ever was tested for HIV and if he knew his HIV status. It turned out that Dmitry knows that he is HIV-positive, but he didn’t not know what to do next and was not very sure if he needs to do anything at all! After that, the outreach workers talked with Dmitry about what he knows about HIV and treatment, whether it is important for him to maintain health and why, what are his overall plans for his life, etc. As a result, in October 2019, in a conversation with an ARF outreach worker, Lena, Dmitry told her that he is ready to go to the AIDS Center, get registered and start receiving therapy. However, it turned out that there are certain barriers with regard to his access to the therapy – in particular a lack of Moscow registration. Lena helped Dmitry to get registered. While she was busy with that their supporting conversations continued. Every step made by Dmitry towards getting the therapy was noted as a small success on his way to the goal. At the end of December 2019, Dmitry independently reached the AIDS Center and passed his first tests. He was very glad that he had finally taken this step, and immediately shared with Lena his success. Now he is ready to go to the AIDS Center for the second time to get registered and start receiving therapy. Although this stage is not yet over, it is clear that Dmitry is already more active in his actions to preserve his health, and he is also more aware about the harm reduction measures in the context of drug use. He continues regularly coming to the bus, and also brings with him his friends who also need help.

And also we would like to share with you some statistics to show you the work we have done in Q4 2019 in numbers: 

During the 4th quarter of 2019 ARF through its Moscow HR project had served 847 participants (total number of contacts – 1381) and provided 54 863 clean syringes and 7 733 condoms. Our outreach workers have conducted 1585 consultations on different health related issues and made 234 HIV rapid tests (of them 25 positive). We continued distributing informational materials on health and legal issues. We provided 381 consultation on overdose and distributed 1 564 ampules of Naloxone - a medicine that prevents the overdose death. Reports on 167 lives being saved by Naloxone were received within the reporting period. Also, 66 HCV tests were conducted of which 20 came positive. During these months, as usual, the outreach work was conducted 5 – 6 days a week, in the evenings, by 12 outreach workers, with support of the mobile unit.

Additionally, within the reporting period 4 case managers took new 29 cases for support and 2 legal consultants provided 269 consultations on legal issues to project participants. 99 project participants received psychological support from the ARF psychologist during the reporting period. 

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In the third quarter of 2019 the Moscow HR project had served 767 clients (total number of contacts – 1225) and provided 51668 clean syringes and 6 753 condoms. Our outreach workers have conducted 966 consultations on different health related issues and made 131 HIV rapid tests (of them 14 positive). We distributed informational materials on health and legal issues and a newspaper for drug users. We provided 237 consultation on overdose and distributed 716 ampules of Naloxone - a medicine that prevents the overdose death. Reports on 125 lives being saved by Naloxone were received within the reporting period.

Also, within this period 4 case managers took new 21 cases for support and 3 legal consultants provided 109consultations on legal issues to project participants. The outreach work was conducted 5 days a week, in the evenings, by 11 outreach workers, with support of the mobile unit.

And we also would like to share with you one story of success illustrating our case management work within these three months period:

John (the name is changed) approached our Harm Reduction project 3 years ago. At first, he simply took clean syringes and consulted on how to treat a trophic ulcer on his leg. John came to the ARF mobile unit 2 or 3 times a week. At some point he began to stay longer to communicate with our outreach workers. It became clear that our support was important to him. In the process of communcationwe found out that John has a difficult family situation - he lives with his brothers, who abuse him and who are not trouble-free themselves. John sometimes did not want to return home. Also, John had constant problems with microloans.

As time passed, John started constantly participate in different activities of the foundation, such as Support Don't Punish campaign and collection of the used syringes in his neighbourhood for further utilization. He became involved into the discussions of the repressive Russian drug policy and participated in heated debates on how it should be changed.

John also started thinking about his drug dependency treatment. He has been using drugs for about 10 years, and actually didn‘t remember those times when he was not using. However, he was very tired of the consequences of drug use, the constant risk of criminal prosecution, post-injection complications. ARF staff had conversations with John on that topic during a year. John also appraoched us with a request for legal support with regard to his microloans (debts) and problems ge had with the credit agencies. Our case manager Lena went to court with John to deal with documents, and moderated his communication with a lawyer. In the past 4 months, Lena and John have been constantly in touch. John clearly has greatly increased his trust, as well as his motivation to change something in his life. Several times he tried to go to the drug treatment clinic in Moscow, but every time he couldn‘t undergo the treatment process till the end. Lena and other ARF colleagues talked with John about the possibility to undergo rehabilitation in another city. And recently, John called Lena and told her that he would like to go to another city for rehabilitation. An agreement was quickly achieved with a friendly rehabilitation project in another city of Russia, we bought John a train ticket and helped him to pack for the trip.

Now John is in rehabilitation center in the city of Almetyevsk, this is a first such kind of experience for him. And we hope that this experience will be positive. After a couple of months of rehabilitation, John plans to return to Moscow, start working again and live separately from his brothers. For our part, we are ready to provide him with any support he might need upon his return.

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Today we would like to provide you with a brief overview of the work of our harm reduction project in a second quarter of 2019.

Within this period the outreach work was conducted 5 days a week, as always in the evenings, by 10 outreach workers, with support of the mobile unit. During this 3 months period the Moscow HR project had served 941 clients (total number of contacts – 1450) and provided 45 411 clean syringes and 8 509 condoms (1900 of them purchased within this project as well). Our outreach workers have conducted 1415 consultations on different health related issues and made 162 HIV rapid tests (of them 16 positive). We distributed informational materials on health and legal issues and a newspaper for drug users. We provided 282 consultation on overdose and distributed 415 ampules of Naloxone - a medicine that prevents the overdose death. Reports on 96 lives being saved by Naloxone were received within the reporting period. Also, within the reporting period 5 case managers took new 13 cases for support and 3 legal consultants provided 87 consultations on legal issues to project participants.
And here is one story illustrating our case management work:
ARF started working with Vladislav in 2018. At the time he became the client of our case management services, Vlad was conditionally sentenced to 3.5 years under Article 228 part 1 and Article 228 part 2 of Russian criminal code and was scheduled for a court hearing. The Federal Penitentiary Service of Russia requested a change of probation period for a real imprisonment for him. ARF delegated the social worker, Slava Matyushkin, to support Vladislav at the court session as a public defender. Thanks to the work of the ARF lawyers, as well as to the work of the case management team, the court decided not to support the petition of the Federal Penitentiary Service and Vladislav remained free. Under the terms of his conditional release, he had to undergo treatment for drug addiction. By that time, Vladislav himself decided to undergo treatment and subsequently undergo a course of rehabilitation. Previously, he repeatedly underwent treatment in drug treatment clinics in Moscow and each time the results were unsuccessful. ARF team together with Vlad decided to seek help from our partners and colleagues from rehab centre in Almetyevsk so that Vladislav could undergo treatment and rehabilitation in the Republic of Tatarstan. Funds were collected to purchase a ticket, and in three days Vladislav has left for treatment. While he was in rehab center, some miscommunication between the Federal Penitentiary Service and the narcologist took place, because the information about Vlad’s treatment related processes was not transmitted in a timely manner. ARF case management team resolved the situation by transferring the information from the clinic to all interested parties. Within three months, Vladislav underwent treatment and rehabilitation, after that he returned to Moscow and continued working with ARF as a volunteer of the harm reduction program. Recently Vladislav was able to find a job, started to attend NA groups but still continues to volunteer with ARF.
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At a Harm Reduction International Conference 2019 in Porto, Portugal, the Harm Reduction International has awarded its International Rolleston Award to a Russian NGO Andrey Rylkov Foundation for Health and social Justice (ARF). The award honors the work and contribution to the field of harm reduction at the international level.

This International Rolleston Award was first presented at the ‘3rd International Conference on the Reduction of Drug Related Harm’ in Melbourne in 1992. At each International Harm Reduction Conference (every two years since 2011), it is given to an organisation, group or individual who has made an outstanding contribution to harm reduction from psychoactive substances at the international level. The award is named after Sir Humphrey Rolleston, President of the Royal College of Physicians who chaired the UK Departmental Committee on Morphine and Heroin Addiction.

Andrey Rylkov Foundation’s mission is to promote and develop humane drug policy based on tolerance, protection of health, dignity and human rights. The Foundation activities focus on advocacy for better access to health care, including HIV prevention and treatment for people who use drugs.  Currently, the HIV epidemic in Russia is one of the fastest growing in the world, and injecting drug users are most hit by the epidemic. The Russian government is internationally critiqued for its neglect of the epidemic and reluctance to introduce life-saving, evidence-based, low-cost prevention programs, such as needle and syringe programs and opiate substitution treatment which constitute, according to the World Health Organization, the core of HIV work among injecting drug users. In this context, ARF leads community effort in advocacy for effective HIV programming, and provides lifesaving HIV prevention services for drug users in Moscow.

“We are very proud to become the winner of the International Rolleston Award this year. This is a huge support and acknowledgement of the advocacy work we do in EECA region and Russia in particular to ensure the access of people who use drugs to the needed harm reduction services and to promote the humane drug policies“, says Lena Remneva, the ARF case manager who received the award on behalf of the organization.

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The Andrey Rylkov Foundation

Location: Moscow, Europe - Russia
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Twitter: @AndreyRylkov
Project Leader:
anya sarang
Moscow, Europe Russia
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