Health  Russia Project #18708

Harm Reduction services for 3000 Moscow drug users

by The Andrey Rylkov Foundation Vetted since 2012 Site Visit Verified
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

Dear friends, 

this time we would like to share with you the text about our organization and the work we do in Moscow which was published by VICE in December last year. The article also highlights the attitude of the government towards harm reduction and HIV prevention among people who use drugs in Russsia.  

Enjoy the reading!

ARF Team

------------

Last month, a Moscow court ordered the city’s only drug harm reduction NGO, the Andrey Rylkov Foundation (ARF), to pay 800,000 roubles (£9,575) for publishing what it called “drug propaganda”.

The ARF had upset Russia’s delicate sensibilities with an article providing safety advice about synthetic cathinones (AKA mephedrone, or “bath salts”), published in a drug users’ newsletter called Hats and Bayan. The ARF didn’t recommend readers take these drugs – only to be careful if they did, by starting with a small dose and using water, pills and vitamin C to mitigate some of the drug’s more disagreeable effects.

As a result of the fine, the ARF – a skeleton crew battling Russia’s alarming drug-related HIV epidemic – is now fighting for its life. Amnesty International described the fine as “suffocating”. If they can’t get the money together by Christmas, they’re finished – and this will have a direct impact on Moscow’s most at-risk citizens.

The ARF is the only organisation providing Moscow’s heroin-injecting population with clean needles, HIV prevention and harm reduction advice. Their philosophy is that if people aren’t going stop using drugs, they might as well make it safer for those drug users, by handing out clean needles, condoms and naloxone, a life-saving remedy that can reverse the effects of an overdose.

“If we go, there will be no harm reduction services available in the city,” says Anya Sarang, president and co-founder of the ARF. “The state-run organisations refuse to provide these services, as they contradict the National Drug Policy that explicitly opposes a harm reduction approach. Drug users are the main group affected by HIV, but there is no state or city budget allocations for HIV prevention in key populations in Russia.”

The survival of the ARF is crucial, because what’s happening in Russia is nothing short of a catastrophe. Since the fall of communism and the lifting of the Iron Curtain, Russia has become the single biggest heroin market in the world. The drug poured in from Afghanistan, distributed by gangs and crime syndicates linked to corrupt elites and the Russian military, and caused an HIV crisis as drug users shared needles.

And it’s getting worse: according to the UN AIDS programme, from 2010 to 2015 Russia accounted for over 80 percent of new HIV infections across Central Asia and Eastern Europe, while the number of new infections across the rest of Europe and North America fell in the same period. Eastern Europe accounts for a quarter of the world’s injecting drug users, and most of these are heroin users from Russia and Ukraine. Russia now has the fastest-growing HIV epidemic outside Africa. By 2017, there were some 1.16 million diagnosed cases in the country, but the real number could be far higher.

Worse, fentanyl is now increasing the dangers for Russia’s vast heroin-using population. “Last year the number of ODs sharply went up, possibly because of fentanyl,” says Sarang. “We can’t say for sure, because there’s no official data, but the number of times someone’s called and told us they’ve had to use naloxone has doubled. So more people are overdosing.”

Yet rather than trying to make the situation safer for drug users, the authorities are making things wildly more dangerous.

To understand modern Russia’s hardline, old school approach to drugs, you need to understand the 1990s. A defeated superpower on the brink of social, economic and demographic meltdown, Russia blamed the US (not entirely unfairly) on its woes. Out of that environment came Vladimir Putin, a resurgence of conservative nationalism and a drug war whose ferocity Ronald Reagan’s approach look like that of a whiny liberal.

Anything over two grams of hash, six grams of cannabis and a half-gram of heroin counts as a “significant amount” that could see you spending seven to 15 years in jail. The drug war has also allowed the rampantly corrupt police to terrorise drug users.

“We hear a lot about extortion, lawlessness, even torture of drug users – very, very scary stories,” says Sarang. “These people are living in a constant state of terror, afraid to go outside or to the pharmacy. We did a study last year and dozens of drug users told us how they were blackmailed by police. Although the consumption of drugs is decriminalised in theory, in practise the penalties are so severe a person could get ten years for a joint of marijuana. So naturally, they pay. It’s pure banditry.”

It’s not the first time Russia has turned on the ARF. In 2012, the Foundation ran afoul of the censorship laws when its site was shut down, again for “drug propaganda”, after posting an article discussing methadone, used in most countries in the West to ween people off heroin. To make matters worse, the Kremlin suspects that certain organisations might be fronts for subversive politics and “democracy promotion”. In 2016, the ARF was blacklisted as a “foreign agent“, a ruling that made it much more difficult to get the funding they need to help keep people alive.

It’s a stigmatising attitude that infests the rest of society – even those sworn to save people’s lives. According to the ARF, doctors have been known to openly scorn patients and sometimes refuse to treat them outright if they are known drug users or HIV+. One particularly heart-breaking story came from the Global Commission on Drug Policy’s 2017 report, involving an HIV+ mother barred from giving birth in a hospital and later stitched up by police and thrown in jail.

Russia’s approach to the so-called propaganda spread by the ARF mirrors its gay propaganda law, passed in 2013, ostensibly to protect children from the menace of “non-traditional sexual relationships”. It effectively banned discussing LGBT relationships in any positive way in the public sphere, inciting harassment and even murderous violence in the process. Epidemiologists have also blamed the law for shutting down awareness of Russia’s mushrooming HIV epidemic.

Russia has now taken the global drug warrior crown from America. Earlier this year, Russia blasted Canada’s move to free the weed. Moscow sees any steps toward drug liberalisation as caving into the permissive, depraved, godless, homosexual, drug-addled West. It has also consistently used its influence at the United Nations to push back against measures like harm reduction or greater access to methadone. Russia still follows a Soviet-era understanding of addiction that expects addicts to go cold turkey, so putting them on methadone is seen as just trading one noxious high for another.

“I thought that because I was a drug addict, this was my destiny. All I wanted was to die painlessly,” says Maxim Malyshev, a former dependent heroin user from Tver, a city north west of Moscow. Diagnosed with HIV in 1997, he spent 15 years being locked up and busting out of several rehab centres, before recovering from his addiction. Now an outreach worker for the ARF, he’s deeply worried about an organisation that not only helped him, but thousands of others.

“ARF is the only organisation in Moscow that does social work, harm reduction and HIV prevention among people who use drugsc,” Malyshev told me. “If we don’t raise this money the bailiffs will be forced to take it out of our account, and if this happens the work will simply stop and there’ll be no more nightly van with clean needles for users, no more testing on the streets, no more accompanied visits to the hospital and even no more heart-to-heart with drug users. Everything will be fucked.”

 

"Our shopping with Katya and her daughter Masha in advance to the Day of Knowledge went very well. I first saw Katya's daughter. Katya calls Masha a "bird" and is very sorry that they did not go to the zoo with us recently and did not participate in our other events. Masha is such a cheerful child. She really enjoed this shopping event. Masha will go to the first form this year and she is very excited about that. Most of the time, she was riding in a shopping cart, guarding purchases, and trying all the colors of the pens". This is how Vlada, on of the social workers of the Andrey Rylkov Foundation describes their joint trip to the store with one of the families in advance to 1st of September – the day when all children in Russia go to school after summer hollidays.

At the end of August 2018, we have traditionally supported parents and children we work with within our "Family Project" to help them to become prepared for school by September 1st. We help people from among the participants of our harm reduction project who has children of a school age to buy all those things necessary for school as most of them can not afford such expences themselves. Our social workers together with parents and their kids go to the shop and this becomes a part of the socialisation process as well. We help these parents financially, but often we can not pay for everything the family need, so in most cases our contribution is only a part of the required amount. During such joint shopping trips lot of interesting things happen: children and parents communicate, quarrel, make peace, laugh, experience, choose notebooks and briefcases together, etc. A social worker can help with the choice of something or, if there are several children, look after some children while others doing shopping. During these shopping visits, important discussions and conversations could take place. We try to make the most of this time to give a family the opportunity to spend time together and communicate outside their home reality.

The main objective of our Family Project is the creation of favorable conditions for warm, sincere and supportive intra-family relations between our drug-dependent participants and their children. Parents who use drugs (or who are in a state of remission) often face various difficulties: lack of sufficient money to provide the child with everything he\she needs, lack of strength and health in order to be a fairly good parent in their understanding, a prejudiced attitude from other people. We try to help parents to cope with these difficulties and build closer relationships with their children.

This year we managed to cover by our action 13 children from 9 families. We bought them a lot of useful things for the school including: pens, notebooks, rulers, erasers, pencil cases, atlases for geography, drawing books, drawing paper, compasses, folders, diary, notebooks, pens, bookshelfs, schoolbags, sneakers for physical culture, school uniforms.

Here is a feedback from some of our social workers who helped parents and children to make the necessary school purchases:

Olya: I really admire how those parents who use drugs whom we support take care of their children, with what warmth and tenderness they choose goods for them, how they consult with each other and make the decisions together. For me, participation in the project is always an opportunity to look at those families we patronate from a new angle, to live with them for several hours together. This does not mean that there are no disagreements inside these families. No, everything happens. But it is this participation with the families in their preparations for school that is always a little exciting and reverent, permeated with care and expectation of something new.

Lema: this year I saw that for some families such joint shopping trips could be tough, some parents and children it could be difficult to communicate with each other. And I understood that we are performing one more task: we give both children and parents some kind of alternative opportunity for communication with each other – in a respectful and calm manner. During these one and a half hours of joint shopping, we have the opportunity to talk gently with the child, calmly listen to the parent and help them to improve their communication with each other. And this is a very cool moment, when, as a result, the child and the parent understand that such way of communication with each other is possible.

Also, in order not to be unfounded, we asked our participants who benefited from our action to say a few words:

Nastya: "The most needed item for school which Alla wanted was the schoolbag. But it is often when you want one thing, but something else is available. And of course all the necessary stuff – notebooks, pens, as usual. This contribution to our preparation for school was very valuable. We have not seen each other for six months, so this event gave us the opportunity to do something together. We had a good time".

Maria: "We bought everything we needed to be prepared for school this year. Including a schoolbag, a pencil case. We bought everything we need, super! Thank you very much for the stationery, for other stuff, for everything".

Svetlana: "Of course I managed to buy useful things for school, this is very important. Particularly I‘m pleased with uniform, clothes and stationery".

 With each new meeting with the families of our participants, we understand how valuable is their warm communication, looks, smiles, sometimes resentments, and tears that end in reconciliation. We understand how we, social workers, should better organize space and conditions for such events so that children and their parents can better experience these bright moments. We have plannes to irganize the excursions to the museums and to visit some master classes, and also the New Year is coming which is one of the most magical holidays for children in Russia. With your support, we hope that we could be able to make the lives of those families of people who use drugs participating in our project a bit better.

ARF van in Moscow. MAX AVDEEV/THE NEW YORK TIMES
ARF van in Moscow. MAX AVDEEV/THE NEW YORK TIMES

As the World Cup is starting in Moscow and the city tries to present to the world as a modern capital of a well-off country, more attention is drawn to Russia's HIV crisis and the attempts of Non-governmental organizations such as our own to combat HIV among the most vulnerable groups (people who use drugs, sex workers, men who have sex with men) despite the government opposition to effective and evidence-based HIV services. Unfortunately, due to the conservative agenda of the Russian government, effective prevention is only possible with the hands of small grass-roots organizations such as ARF and our partners in several other cities. This PBS documentary discusses why Russia fails to take under control the epidemic and spotlights our work. We must express huge gratitude to our friends all over the world, those who support us through the GlobalGiving platform and thank you once again -- your donations help us maintain this important work and provide essential services to people who are most vulnerable and unprotected. 

Please have a look at the PBS Documentary and also a great article by Jon Cohen published in Science last week "Russian epidemic is getting worse, not better" which also features ARF efforts to sustain essential prevention services in Moscow.

Links:

Since 2009, we provide harm reduction services to people who use drugs in Moscow. The political and financial climate as well as the epidemiologic situation are not very supportive for our work – Russia still has one of the fastest growing HIV epidemics in the world with more than 1 million cases being registered and more then 50 000 HIV positive people living in Moscow. Officially registered number of people who use drugs living in Moscow is over 30 000 people. Unsafe injection of drugs is still the major cause of HIV transmission in Russia (more than 60% of all new cases), HIV epidemic is escalating in the country and its capital, but the government still denies the effectiveness of harm reduction measures and provides zero support to NGOs working on HIV prevention among key affected populations. Russian drug policy is still known as one of the most conservative and repressive among those around the world – it continues to declare a zero tolerance towards drug use inflaming the stigma and discrimination towards people who use drugs because of their drug dependence and primarily they are considered not as patients who need proper treatment and support but as criminals. It restricts the access for drug users to vitally important for them information on health issues and to the health services needed such as needle exchange programs and opioid substitution treatment.

Recently the Vice News filmed our work on HIV prevention among people who use drugs on the streets of Moscow. We would like to share this video with you as it also explains the political conditions we are working in as as well as the attitude of the officials to the problem of HIV epidemic in Russia.

“There is no political will to face the truth,” sais our outrech coordinatir Maksim Malyshev, in the video. “Instead of writing reports saying that we are working on it and that everything is going as planned, they need to admit that things are bad — really bad.”

Links:

HIV testing and counseling in our minivan
HIV testing and counseling in our minivan

Dear friends --

Before the end of 2017, I would like to thank you once again for your unceasing support of our work on providing essential services to people who use drugs in Moscow. I also wanted to briefly share with you some heartwarming results of our work in 2017.

Unfortunately, in 2017 the health crisis in Russia keeps aggravating - unlike in other countries of the world the HIV epidemic is on the rise, especially among people who use drugs. Hepatitis C treatment is not available to people in need, and around 9000 overdose deaths were officially registered last year. The government of Russia is very persistent in its opposition to effective, evidence-based and humane approaches, such as opioid treatment and harm reduction. Our organization and like-minded NGOs remain under constant attack of the authorities - which included us in the Foreign Agents registry, fined and punished for our work. Russian drug policy is still one of the most conservative and repressive in the world. But despite all that, we believe we must resist and to keep helping our community and friends, even in this oppressive political climate.

One of ARF's most important activities is the harm reduction project -- the only one in Moscow -- that provides services, support, and prevention materials to people who use drugs. Most of our participants are very poor and very marginalized people. Some of them are homeless, some are migrants, some are sex workers. Some don’t have any documents, many struggle to support themselves and their children and almost everyone faces legal problems. Our work helps people to improve their health, protect them from infections and overdose, but most importantly, we treat people with loving, dignity and respect that they deserve.

Here are some numbers: in 2017 we served around 3500 clients and provided 222.105 clean syringes and a little over 41.000 condoms. We carried out 1 138 counseling sessions on HIV and hepatitis and provided 324 HIV rapid tests, 26 of them turned out positive.
We distributed informational materials on health and legal issues and a newspaper for drug users. We provided 1233 individual consultation on overdose and 3573 ampules of Naloxone - a medicine that prevents the overdose death. We ask people to come back and tell us if there were able to save their friend's life with the help of Naloxone. In 2017 we received a record number of such reports -- 416 lives were saved with the help of Naloxone, and these are only those people that we know of for sure!

Besides working on the streets, we accompany our participants to health and social services, to drug treatment if opportunities arise. We help our project participants obtain the medical and social assistance they are entitled to. We also document cases of human rights violations and assist people who want to act and protect their rights. This year our participants have submitted 40 complaints to different government structures regarding violations of their rights. 207 participants received legal support, 82 participants received support in restoring their official documents. We have over 25 legal cases submitted to the European Court on Human Rights which aim to strategically challenge the repressive Russian legislation and practices.

Finally, we run a number of tiny sweet projects that help to make the lives of our participants a little bit happier. Among them: activities for children of people who use drugs - we take them to theaters and museums, organize parties where they can spend time with their parents, right now we are preparing for a New Year celebration. We also host several support groups, a cinema club, a women's club, and various social activities for our participants.

2018 is going to be a challenging year for us since we will not be getting the financial support of the Global Fund to Fight AIDS, tuberculosis, and malaria any longer, and no other major donors have emerged on the horizon so far. But we believe in our cause and will keep our little fight for the lives and health of our community and the humane drug policy in Russia. In this, we feel very much supported by our friends and like-minded people like yourselves, and we are very grateful for this support.

We wish you fun holiday adventures and a very very happy 2018!

With deep gratitude, on behalf of the team

Anya <3

Links:

 

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Organization Information

The Andrey Rylkov Foundation

Location: Moscow, Europe - Russia
Website:
Project Leader:
anya sarang
Moscow, Europe Russia
$28,816 raised of $55,000 goal
 
406 donations
$26,184 to go
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