Harm Reduction for 3500 people in Moscow

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. 

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.

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.

Links:

• The ARF Receives the 2019 International Rolleston Award

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

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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.”